Wednesdays are “clinic day” for the orthopedic department, the one day of the week where surgeries are not routinely scheduled and patients arrive from all over this small part of the world to have their orthopedic issues evaluated. I liken clinic day to Forrest Gump’s proverbial “box of chocolates”…you never know what you’re gonna get. Could it be a draining fistula?...A two month old fracture-dislocation?...An open fracture that’s been festering for the past five days?”
Last Wednesday was extra-special. The “box of chocolates” motif also applies to orthopedic admissions from Casualty (the Emergency Department) from the night before. As of yet, there is no set protocol for the residents to follow regarding orthopedic trauma patients (which I remedied today), specifically regarding when Dr. Galat should be paged. I had hoped, in vain, to do a surgery or two before clinic in order to catch up on the back-log of cases, but when I arrived in the orthopedic ward at 6:30am, I was greeted by three new patients with the most incredible montage of trauma: (1) a female with a cervical spine fracture, a “unilateral jumped facet,” and lumbar spine fractures, (2) a 17 year old boy with a midshaft femur fracture, and (3) a poor young lady with bilateral tibia fractures, one side open (where the bone breaks through the skin), and an open elbow fracture (that thankfully at least had been washed in the operating room the night before). For those without ortho training, let’s just say these are all bad things.
I took a deep breath, cancelled our pre-clinic surgeries, and excused myself to run home for a quick refresher course on the proper treatment of “jumped facets.” This involved screwing tongs into the patient’s skull and using 20 pounds of traction to realign the spine the way God intended. Speaking of which, I (again) was praying the entire time, as I have never seen or done this myself. Thankfully, God intervened yet again, and x-rays after the patient was in traction for 30 minutes revealed perfect alignment of the spine.
Plans were made to operate on the young lady with the open fractures after clinic (I estimated at least 5 hours for the case). But it became apparent that this would not happen after I saw the massive crowds of people already lining up to be seen in the ortho clinic. Solomon (a Kenyan superstar physical therapist/functioning non-operative orthopedist) and I saw close to 90 patients and wrapped up our day at 8pm. By this time, the operating theater day staff was long-gone, having to walk home (sometimes miles) before it gets dark. The “on-call” staff is only available for “true emergencies,” such as perforated colons, not open fractures that have already been washed out. Truthfully, I was somewhat relieved because I was exhausted. I went home and collapsed into bed. The following day, I fixed all her fractures (and another one I found while she was in surgery), fixed the boys femur fracture, and did a few other cases.
Please continue to pray for our family and for our patients here. Because of the sheer volume of trauma cases, the back-log continues to grow. So far, I have 8 cases scheduled for Monday, and the weekend is still young. And, if you are an orthopedic surgeon with an interest in trauma and desire for some excitement, you are welcome to visit! Thank you for all your prayers and support.
Hi Dan, Aunt Ruth sent me a link to your blog. I read it every so often and have sent it on to my parents. My dad's brother is a plastic surgeon so I asked them to pass it on to him. I'm really enjoying the glimpses of your life in Kenya and the way God has opened doors for you and Heather to do his work.
Lisa (Hunyadi) MacKay
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