Saturday, November 8, 2014


She came in 2 ½ weeks postpartum. She must have come in Friday afternoon because by the time I saw her on Sunday, she already had an abdominal ultrasound that showed “ascites and her uterus was empty.”

I wasn’t overwhelmingly impressed with her state. She was neither fantastic, nor sick. She was a young Arabic girl who had delivered her first baby. Her baby was skinny as they had been giving him water, but nothing unusual. I gave them the spiel to not give water.

Something just didn’t quite feel right about her abdomen. I couldn’t really feel a small fundus, like I should. Her abdomen wasn’t really distended, but wasn’t really as soft as it should be either. She had no pain and was eating some. Apparently she had had pain the day before, but was getting better on oral antibiotics.

Something was just off, and I couldn’t tell what it was.

I told her not to eat the next morning, so that I would have the option of doing surgery if I wanted to. I hadn’t decided if I was going to do a D&C for possible retained membranes or a laparotomy for possible abscess.

She really had nothing special clinically to go by. It just wasn’t quite right. (Can I write that on my preoperative diagnosis?……not quite right?) Doctors call this a ‘gestalt,’ a gut feeling resulting from a combination of tiny parts of a patient’s being that seem fairly innocuous but add up to an ominous future.

The next morning, she didn’t look better, but no worse either. I repeated an ultrasound and found her uterus to be completely empty, but she had a 3cm cystic mass in her right lower quadrant.

We obviously don’t have a CT scan, although that would have made things much easier. Something just told me to open her.

So I did. And it’s a good thing.

Upon entry of the abdomen, liquidy pus came out, followed by liquidy poop.

Awesome. My favorite. I hate the smell of poop. I had just gotten over the pregnancy hormones and was actually feeling back to normal. I was actually feeling great. After the miscarriage, I got malaria for a couple of days, but then was feeling awesome! But I still hate the smell of rotting poop in an abdomen.

She was a mess inside. She must have been perforated several days. I don’t know how she looked so good clinically. The ascites seen on the ultrasound by Doudje several days before must have been diarrhea in the abdomen, or pus. Now, her intestines were all stuck together. While trying to gently separate some of the intestines we kept finding pockets of pus.

We managed to find 2 sites of intestinal perforations and repaired them. Even though they were less than a cm each, it’s never easy to repair inflamed tissue. Somehow we got a couple of layers of suture over the holes. We irrigated a ton, and put a couple of drains in. Then we began to close up her infected abdomen.

Upon suturing one of the drains, a used suture accidentally flung up into my unprotected eye.

Yuck. I closed up the fascia, put in interrupted sutures in her skin, then unscrubbed and washed my eye.

Let’s get an HIV test, just to be sure.

HIV test came back.



Did the suture really go in my eye? Or did it just touch the outside of my eye as I closed my eye. I wasn’t really sure. It was just dirty suture on my eye. It’s not like I got poked. It probably didn’t even touch the inside of my eyelid. Did it? I’m not sure.

Well, I know the HIV prophylaxis medicine is really nasty to take. I remember an attending in residency on those meds for a month and he looked awful by the end. It gives really bad diarrhea and just overall ickiness. I remember Ndilbe last year taking the meds here for a month. By week 3 ½ he looked terrible too.

But would I be mad at myself 10 years from now if I could have prevented HIV?

Yes, I should have been wearing protection!

Eye protection, that is! But it’s so HOT here that I can’t see with goggles on because they fog up instantly. I make a mental note to get some really nice, anti fog clear glasses or goggles next time I’m home.

But now, I didn’t really have a choice. I had to take HIV meds for a month. Olen would want me to. I will do it for Olen. Olen had been in America for 10 days and was now getting ready to go to the airport to come home.

I texted him and told him, and we both agreed for me to take the nasty meds.

So now I’ve been on nasty meds for 1 ½ weeks. I’m back to being nauseated again. It’s not quite as bad as pregnancy nausea and doesn’t come with the same fatigue. But it’s not fun. I now understand why people spit during hyperememsis gravidarum. They spit because even their spit tastes bad.

My spit tastes bad. Water tastes bad. Food tastes bad. I feel icky all of the time. But praise God that I have medicines that I can take. And it’s only 2 ½ more weeks to go!

Oh for 2 ½ weeks to pass quickly! Morning and night nasty effects of pills. I’ve got it easy though compared to the sick people here.

My patient is slow to recover. But she is recovering. Please pray for her continued recovery.

As a friendly reminder, we accept tax-deductible donations through Adventist Health International at Or there’s a donate link on our website that will take you there. You can pay by PayPal and shoot AHI an email to notify them you sent in a donation for us. Or you can send a check to “AHI - Bere, 11060 Anderson Street, Loma Linda, CA 92350” or call 909-558-4540 or fax 909-558-0242 or email You can even set up recurring donations. So many easy ways to give! AHI has a new standard of 100% of your donation will arrive here in Bere. They find all their overhead operating costs from other sources. Anyway, we’re very humbled by how God has chosen to use us and if you would like to be a part of it, please help with your prayers, finances if possible and volunteerism if you’re feeling called!

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