Clinical Digest4

Clinical Digest: 11/3/10
Last Tuesday was a day I won’t forget so soon. That was the day when I, a career orthopod, did my first C-section! It was an awesome feeling, aweful too for sure, but uncomplicated in the end. I certainly have breached a barrier in my surgical abilities now. Such an achievement would hardly have been possible without the assistance of the great supervisor I had in the person of Dr Jobe Smith, American expat, having spent 8years in Norway and now here as a double-expat with the Norwegian charity Helse Bergen. Like him, everyday, I’m meeting people with a certain ‘je ne sais quoi’ to inspire me, be it their surgical skill, dedication to their specialty or their vision of development, in this bustling surgical department at Kamuzu in Lilongwe. Two other surgeons with Helse Bergen, whom I passingly alluded to before and who are currently keeping this overflowing orthopaedic department afloat are Drs Sven Young and Tor Nedrebo. Apart from their “affable personalities” I already mentioned, I believe the characteristic that does them greatest justice should be their passion. There doesn’t seem to be a ward round that’s too long (100+ patients at times), a clinic finishing too late (6.30pm) or a list too packed for them, as long as they have the reassurance that they’ve done all they can do to assist in this Malawian pandemonium during their time here. I’m enjoying working with them so much that it’s proving real hard to resist being drawn towards my Orthopaedic comfort zone, instead of widening my net to general surgery, obs&gynae and urology instead, as I’m meant to be doing.
Yes, as I found out on Thursday, urology will also form part of my repertoire in Ntcheu. It would indeed be extremely wasteful to refer such simple cases as phimoses and hydroceles to a central hospital, when I can learn the skills to treat them early by myself. So, with my new urological hat on, I had a go at doing a few circumcisions and was surprised how deceptively straightforward they can be. Most of them can be done under local anaesthetic or, as is often practised by “religious surgeons”, without any (aoow!). One of today’s cases ended up that way despite our care in administrating a meticulous nerve block to him. What a brave man! The tutor in this case was Dr Maher, an Egyptian expat, who impressed me at first as this most taciturn and self-composed surgeon in the morning handover meetings. Once in the operating theatre, it became obvious that he was no exception to the rule that all surgeons have a quirky (read macabre) sense of humour. He certainly knew how to relax his patients, by telling them that only 50% of the appendage had to be resected instead of the original 75% planned!! If there was one thing that seemed to work (in its own peculiar way), when the anaesthetic didn’t, then I’d have to say it was his kind of humour.
There is that quizzical aspect that I love about surgery. It is at once extremely serious (in the planning and execution of an operation), yet compulsively frivolous (in almost everything else- as evidenced by the countless innuendos related the passing of instruments- based on their shape or name!). It must be the way surgeons have had to evolve to preserve an overall balance.
My week was crowned on Thursday with yet another first: my first below knee amputation as the main surgeon. All those cases I assisted in suddenly disappeared from my memory bank and I was there trying to figure out how the book said to approach this operation and remember possible difficulties I might encounter. It was successful in the end, albeit slower than the clinical officer assisting me seemed used to (which he didn’t fail to indicate many a times!). This operation is very much a milestone for me and I feel much better equipped just for having this skill under my belt now. And what’s more, it’s potentially one of the most frequent life-saving operations I’ll be conducting in my time here. By that time, I hope I’ll have developed the speed my clinical officer would prefer ...