Friday, January 7, 2011

#13 Poop

Where does your poop go?  For most people back home it goes in a toilet.  If you have had surgery on your intestines, maybe it goes into a liquid tight bag attached to your abdomen.  But for most people it doesn’t come out of a hole in your abdomen and run down your belly.  
I run into Olen in between OR cases yesterday, “Do you remember this patient’s name?”
“Someone wrote for her to come back and see you in a week when she was discharged.”  
People here carry around their little “carnet” (car-NAY) with medical information and recent drugs prescribed in it.  It is very small, but it is the best way of keeping their medical information.  There’s no other medical charting that’s permanent.  Only one sheet from the OR for the surgical ward, and one sheet for the medical patients that has their medicines prescribed, test results, and 1 set of vitals per day.  It keeps things pretty simple I suppose.  
I went to see her in the office.  Oh, I remember her face.  And her husband’s.  She was one of my first cases here.  James and I did surgery on her before he left.  
We had taken her back for a pelvic mass and abdominal pain.  When we opened her up, the organs in her pelvis were like cement.  They were all stuck together.  Best case scenario would have been endometriosis, but I think it was cancer.  Of course we have NO pathology here, so I guess we’ll never really know.  Her left ovary was semi large and fluid filled (about 5cm I would say).  
Where is the GYN oncologist when I need her/him?  I tried to dissect down and get the large blood vessel going to the ovaries so I could take them out.  The anatomy was all wrong and distorted.  Everything was stuck.  After some time, I aborted my plan to take out the ovaries/uterus.  
This (probably GYN cancer and) had spread to the colon and the distal colon was like cement also.  None of the colon was that flexible.  We decided to at least help her to be able to poop and made a loop colostomy.  We brought the colon to the skin, made a hole in it, and sutured it to the surface.  It was somewhat dilated, so it wasn’t exactly easy.  There was lots and lots of feces.  I remembered why I don’t like bowel surgery.  
I was so thankful James was there.  He found a colostomy bag, but there were no devices left to fix it to the skin.  They usually come together, but all we had left were bags.  So, James gets inventive and tries the expensive dermabond that was donated(think superglue that’s been sterilized and costs $60 tube instead of 60 cents).  
The dermabond works for a couple days.  We try taping the bag to her skin.  No luck.  The poop continues to leak.  
It’s hard enough to hear that you have a terrible disease in your pelvis, let alone not be able to stay clean.  
Oh, and did I mention that postoperatively the patients usually only get oral motrin and tylenol?  On very rare occassions do we give the pentazocine (an IV medication for pain, an opiate agonist-antagonist, that’s right, like giving heroin and putting you into heroin withdrawals at the same time).
Postoperatively, I am thankful her colostomy is working and is healthy and pink.  She ended up going home after a little over a week.  At first she didn’t want to go home yet and was nervous of the poop going everywhere (understandably).  I told her I would try to find her some supplies.  We wrote to the next volunteer coming, Jessica, and I think she has somehow managed to bring some ostomy (poop bag) equipment.  
Back in the office with the same girl and her husband, I examine the abdomen.  The hole in the colon on the abdomen is nice and pink.  It looks good.  She says it works.  I explain to her that I’m sorry I don’t have the supplies yet.  They live far away, but her husband has a mobile number.  We write it down and hopefully will be able to call them back soon to say we have a bag for her colon.  
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