Script and Scalpel

For those expecting the usual excellent writing on this blog please be advised that this edition is written by the “other” doctor. Just consider me a much less talented guest blogger.

I’m usually not one for writing. Writing requires too much thought and too much time. I’m not sure which is more difficult for me, taking the time to think or just sitting down to write. Neither comes naturally to me. That being said, I wanted to share some of my experiences these first few weeks at Kudjip Nazarene Hospital.

It seems a bit surreal to be back where I grew up, with many familiar faces but also with many things that are so different.  Stepping into my role as the junior surgeon at Kudjip has been an exciting new challenge for me.  It is also a very humbling one. Daily I’m reminded of how much I don’t know and how much I have to learn.  Many things I thought I knew I’m having to re-learn in a Papua New Guinea appropriate manner.  How to diagnose and treat a surgical problem here in PNG is in some ways quite different from what I’ve been used to. For example, a lady in her mid-thirties came in with right upper abdominal pain. She had been having this pain for almost a week and it wasn’t getting any better. Her white blood cell count was elevated and she had a mass on the right side that could be felt on exam. In the USA she’d probably have gotten an ultrasound read by a radiologist and most likely a CAT scan. In her age group the most likely  diagnosis in the USA would be gallbladder disease. The lady had had an ultrasound done by Dr. Erin (one of the family docs here) and she had gotten a second opinion from Dr. Bill. They weren’t sure what it was but thought it might be a liver abscess.  So I saw her, did another ultrasound to see what they were talking about, and saw what looked like an abscess or a mass at the lower border of her liver (although it didn’t look quite right) and promptly called in my senior partner…Dad.  With her concerning exam, elevated WBC and fever we decided to do what any self respecting surgeon would do, get a CAT scan and consults from infectious disease and interventional radiology.  Just kidding! Here the old surgical maxim of “when in doubt cut it out” is sometimes true, not trite.  The next day we took her to surgery for exploration and found a perforated retro-cecal appendix that had formed an abscess walled off by the liver edge, gallbladder, duodenum, transverse colon and omentum.

I am finding out very quickly that common pathology looks quite different when it presents late.  I’m learning that my ultrasound skills need some work and that the lack of diagnostic tools is achallenge, but a challenge that is not without intellectual reward.  I’ve also found that operating here has already given me a breadth and scope that makes being a surgeon so much fun.

Just for fun I’ll list a selection from the plethora of pathology I saw during my first two weeks. Two patients with thoracic stab wounds, one of which needed to go to the OT (operating theatre, yes we prefer the British naming and spelling over here.  It’s quite a step up in class compared to the operating room.) to control bleeding from an intercostal artery.We also saw two colon cancers, five appendectomies of varying sorts (three perforated, one gangrenous and one acute), two sequestrectomies for osteomyelitis (bone infection), trans-anal excision of a rectal tumor, two submandibular gland masses, three pediatric neck abscesses, two modified radical mastectomies, one facial stab wound that came in pumping blood from the temporal artery, a couple of cesarean sections, several hysterectomies, a re-implantation of a ureter with a bladder flap for a uretero-vaginal fistula, two hand incision and drainage procedures, a few upper endoscopies, several rigid sigmoidoscopies, a machete chop-chop to the scalp with an underlying fracture, a machete chop to the upper extremity with a humeral fracture, a C3-C4 cervical spine subluxation, several inguinal hernias, a hydrocele, several lymph node biopsies for suspected lymphoma…and I think I might even be missing a few!  As one can see, if you are looking for variety in your surgical practice, Papua New Guinea is the place to be.

In closing I’ll share one more story. As is often the case in medicine, “you just can’t make this stuff up.”  A couple weeks ago on a Saturday, I was called to the ER to evaluate a stab wound.
Two boys had been “playing” with knives and that play had turned into a fight. The patient, an eight year old boy, had been stabbed in the back by his cousin when he had tried to steal his cousin’s knife. He had a decent sized hemothorax (blood in the chest cavity) and as I began telling him that he would need a tube in his chest to drain the blood I asked him his name. My first stab wound patient in practice was an eight year old boy named….. wait for it…. Zoro 🙂 Yep, I laughed out loud.

Fortunately for him, he did well and did not need major surgery. He has since gone home and I’m looking forward to seeing him in follow-up clinic next week. I’ve already instructed him that there is to be no sword play, at least not until he sees me for his follow up visit!

I am incredibly grateful to the Lord for bringing our family to Kudjip.  It is quickly becoming home for all of us.  Please continue to keep us in your prayers as we live, learn and serve in this new/old incredible place.