Dan, Heather, Jeremiah, Emma, Claire, Levi, Josie, Jane and Ethan

Saturday, June 16, 2018

The Final Countdown (Ten Years in Waiting)


This week, I finalized the twelve surgical cases which were selected for my American Board of Orthopaedic Surgery (ABOS) part-2 oral certification exam, scheduled for July 24, 2018 at 6:30am at the Palmer House in downtown Chicago.  It all felt rather anti-climatic as I clicked the “submit” button around midnight on Thursday, after literally a 10 year process of waiting, trusting, and praying for the board to change it’s decades-old policy to allow me (and others) to “collect” cases while working overseas in missions settings (see When God’s Voice Thunders inMiraculous Ways).  Now, it all comes down to a three hour, grueling oral examination in which I will describe and defend these 12 cases, which were selected from a list of 120 that I did during a six-month period from April to September 2017.  In many ways, those six months were the most difficult of my career as an orthopaedic surgeon, as I felt continually pushed to the edge of my limitations, and had to manage complications which might not have occurred otherwise in a location without resource limitations.  The “strange and bizarre” cases at Kijabe, which differ so greatly from the “bread and butter” cases in the states, I’m sure, will raise a few eyebrows during my exam. 

After 10 years practicing in rural Kenya, it almost feels as if the “strange and bizarre” has become my new “bread and butter.”  Just last week, I did a hemipelvectomy (amputation of the entire hindquarter, including part of the pelvis) on a sweet, 45-year-old lady with dediffentiated chrondrosarcoma of the hip, a case way out of my comfort zone (sorry, no pics on this one).  Working late into the night, tying off large pulsing arteries deep in the pelvis in this HIV+ patient, her blood soaked through my cloth gown down to my skin.  I fearfully wondered if I would now have to take the one-month course of PEP (post-exposure prophylaxis) required after exposure to HIV+ blood.  Thankfully, after consultation with the PEP specialist at Kijabe, that answer was “no,” as these medications are known (by personal experience from another exposure in which a general surgery resident decided to stick my finger with a needle) to cause you to feel as if you’ve gotten the flu after being thoroughly beaten with a lead pipe.   

While I don’t have a hemipelvectomy on my list of 12, I still have some other challenging cases to defend, such as the patient who required an above knee amputation after her total knee replacement became infected with e. Coli, likely obtained at the local hospital she went to for “therapy” after discharge.   Her daughters later explained the conditions at this local hospital were entirely “unsanitary” and her wound left uncovered for days on end.  By the time she returned to Kijabe, her knee was draining copious pus, and she had developed a necrotizing-type fasciitis, which could not be controlled despite strong antibiotics and multiple trips to theatre.  Because I work in a resource-poor setting, other non-conventional techniques will need to be gingerly explained to the examiners, for instance, why I used a shorter plate here, or why I used a SIGN nail there.    Thankfully, though, all patients, whether complicated or not, did remarkably, even miraculously, well.

In the end, it is clear that God is sovereignly orchestrating all these events, from beginning to end, including the exact cases that were selected.  I’m praying this examination will be a testimony to many that God is at work around the world to bring glory to His name through orthopaedic medical missions.  Your fervent prayers are also appreciated during the final prep all the way up to the time of the actual exam.  Pray not only that I pass, but also that God would be glorified through the process, and that He would raise up others to follow a similar path so that PAACS orthopaedics can continue to expand (more on that later!).

Thanks for your ongoing prayers and support!



7 comments:

Craig Galat said...

As always you amaze me. We will be praying for you as you prepare and take your boards.

David Jomo said...

Super proud. God is good. All the best in your defense.

david Kironyo said...

Wishing you the very best Dr Galat.Praying for you

Unknown said...

Wish you the very best. Success

Justin Woods said...

As I prepare for my part 1 boards, I will be praying for you Dan. To God be the glory!

Emilio Fernandez said...

Hello how are you?
My name is Emilio, I am a Spanish boy and I live in a town near Madrid. I am a person very interested in knowing things related to the culture, the way of life of the inhabitants of our planet, the fauna, the flora and the landscapes of all the countries of the world etc., in summary, I am a person who enjoys traveling , learning and respecting the diversity of people from all over the world.

I love to travel and know all the aspects mentioned in person, but unfortunately, since this is very expensive and my purchasing power is quite small, I came up with a way to travel with imagination to all corners of our planet. A few years ago I started a collection of stamps since this activity allows me to know in an original way some aspects such as fauna, flora, characters, monuments, etc. of all countries. As unfortunately, every day it is more difficult to get stamps, some time ago I started another collection in which my goal would be to get at least one letter from each country and territory with postal autonomy in the world. This modest objective is feasible to achieve in most countries, but unfortunately it is impossible to achieve in other different territories for several reasons, either because they are countries at war, either because they are countries with extreme poverty, they are territories with small population or because any reason, their postal system is not working properly.

For all this I would like to ask you a small favor:

Would you be so kind as to send me a letter by traditional mail from Kenya? I understand perfectly that you think your blog is not the right place to ask this, and even, it is very probably that you will ignore my letter, but I would like to draw your attention about the difficulty that I have in receiving a letter from that country, besides, I do not know anyone or where to write in Kenya in order to increase my collection. A letter for me is like a small souvenir, it's as if I had visited that country with my imagination and at the same time, the arrival of the letters from a country is a sign of peace and normality and an original way of promoting a country in the world. My postal address is as follows:

Emilio Fernandez Esteban
Calle Valencia, 39
28903 Getafe (Madrid)
Spain

I would also like to invite you to visit my blog: http://cartasenmibuzon.blogspot.com there, if you wish you can take a look at my collection and in this way understand in a more graphic way why I make this request.

Finally, I would like to thank you for the attention given to this letter, and whether you can help me or not, I send my sincere wishes for peace, health and happiness for you, your family and all your loved ones.

Sincerely

Emilio Fernandez

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