Thursday, March 15, 2012

#100 Responsible #3

Responsible 3 (Follow-up to blogs Responsible 1 and Responsible 2)

If you read our blogs you may remember a woman named Josephine. I’ve known her for over a year. All of the hospital staff knows her. She lives in Bere now. You can read her story on the previous blogs.

A year ago we were just happy to have her alive. Then finally she was strong enough to punch me in the arm. I told her she could go home whenever she could punch my arm. Now she’s quite strong! Ouch.

She developed a small little chronic wound on her abdominal incision that has been getting packed for a long time.

Also, the vaginal fistula.

She’s smelled like urine for a year now. She can’t even drink water or it will run right down her leg. She can’t be with her husband, though that might not be so bad since I’ve only seen him helping her at the hospital twice. Still, she suffers from the stench of urine.

It is time to end this.

Or is it? We’ve been quite busy in the operating room this past month. James and Franklin were here last week and had been helping us a lot in the OR. Today we have already done several surgeries. It is already 3pm. Fistula repairs take a long time. They are never easy. Excuses. Excuses. Excuses. Trust me. I could find a million excuses because these are not always easy, especially at the end of the day.

But I know her. She belongs to me now. My heart melts. She hasn’t eaten anything all day. I had promised her already we would try to stop the stench of urine today. She is excited and nervous. I am just plain tired.

So we decide to go for it. I tell my dad that he had to be the energy on this case because I was tired.

We both scrub. We just did another fistula repair last week. She was still dry. So our hopes are up.

It was a big 4cm vesico-vaginal fistula located in the anterior-posterior vagina. Part of it is scarred off to the right, way back in the corner. They like to do that to be difficult!

It sounds simple to do. Just cut some tissue off between the vagina and bladder. Sew the bladder shut. Put some layers over it. Then sew the vagina shut.

Our commentary is as follows:

Wow, this is going to be hard. Okay, we can do this. Oh that’s great, we are doing well.

One hour later:

Oh I can’t see. Olen could you come hold the light behind us, this head lamp is killing my head. I think we finally have the bladder freed up from the vaginal wall.

Two hours later:

Oh, every time I find the right place to stitch, I lose my place. If I only had a small angle needle. Oh, I’m tired. Let’s switch places.

Wow, this is hard to hold for a long time. Let’s take a little break.

Okay, now I can see again. I thought we had that corner well stitched already. Why is it still leaking? We did not come here to do this over again later! Another break. Lets think.

Three hours later:

Okay, that’s where it is leaking. Where did that hole come from? I thought we had that spot well sutured. It’s so hard to see. Maybe this would have been easier abdominally? Oh good, that is the key stitch in the corner. More stitches to put more layers over the once leaking spot.

Four hours later:

Maybe we should modify our closure? If we take this posterior vaginal tissue, it will cover it all nicely. Just rip some vaginal epithelium off so it heals well. Wonderful, that worked well. It’s not leaking. Urine is coming from the foley only! Yay! God is Good! Wow, that was a hard case!

I know most people would never want to hear their surgeons’ commentary, especially if it was a hard case.

For the first time in a year Josephine is not leaking urine out of her vagina. Please pray that her postoperative recovery will go well!

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