I think I could feel the mask slipping down my face. I tried to wriggle my nose to keep it in place, but I may have been making it worse. With my hands resting against my chest, I tried not to move and touch anything, including the itchy patch of my head just above my right ear. The itching was the worst part. I had never had to just stand there, not scratching. But it was going to be well worth the uncomfortable minutes.
The Monday started out pretty normal for a day at Machame, except for the two other Cornell students, Jenny and Danielle, who had come to pay me and Brenna a visit. They were dying to see a birth, and had ventured to the labor and delivery ward around 10pm Sunday night, hoping to catch a woman in labor. Disappointed, they returned at 5am Monday morning, only to just miss a woman who had to undergo an unsuspected c-section. I had seen my share of births and stayed tucked under my blankets to avoid the chill of a Machame dawn.
After the morning devotions, the Patron of the hospital stood up to tell everyone about a woman in the ICU who had an extremely low hemoglobin count due to internal bleeding and would probably pass if she did not receive a blood transfusion. There was only 1 pint of blood in the blood bank that matched her blood type. Things didn’t look too good. Jenny, one of the other Cornell students, mustered up enough courage to donate blood for this poor woman. As O+, Jenny is a universal donor and the woman’s body should accept her blood. I thought about donating, but was unaware of my blood type and the thought of African needles, although I had seen them in their sealed packages, still frightened me.
The rest of us left to get Jenny some more sugar so she would be fine in the upcoming surgery that would start around 10am. We brought her some sugary, fried dough from the hospital canteen and then returned to the guest house to eat as well. Finishing up around 10 (things don’t normally start on time in
We were a little late for the first finger surgery, but our tardiness didn’t stop all of the staff from greeting us warmly. As I began to hover over the operating table, I could see Dr. Lyimo begin to put a wire through the proximal phalanx into its corresponding metacarpal bone. With the wire in place, the two fractured pieces of bone should fuse and the man should heal in a few weeks. I looked around during the surgery to make sure Jenny and Danielle weren’t feeling bad or on the verge of passing out, as Lauren had done the previous week. They were feeling fine and as Dr. Lyimo began to sew up the man’s hand, they began to ask Brenna about the time. As they could only stay at Machame until the early afternoon, they wanted to check in on labor and delivery one more time. Brenna agreed to be the martyr and walk them to ward and I stayed to watch the anesthesiologists try to bring the unconscious body back to life. I think they had over-sedated him because it took a very long time for the guy to breath on his own.
I decided to leave the operating theater and go and sit with the nurses outside. After joking about Brenna’s lack of rhythm, one of the nurses, Margaret, asked me why I had never scrubbed in and assisted in the surgeries. I responded that I had never scrubbed before and didn’t really know what to do. Instead of taking my response as an indicator that I was under-qualified to assist in surgery, she told me that she would ask Dr. Lyimo if I could assist. I didn’t think he would agree, but I hoped that he would while she walked over to talk to him. After a minute or two, he called to me and said it was fine if I assisted with the next surgery, the same case I remembered from the orthopedic clinic.
Finally it was time to scrub. Margaret and I walked to the two sinks and she began to describe the hand and arm washing technique. Fives minutes of washing elapsed and then I walked with my hands aloft into the theater. She then directed me to the sterile, metal container which contained my gown. Unrolling it, I timidly put my hands into the sleeves, trying to only touch the interior of the gown. Without any gloves on, the exterior of the gown was cleaner then my thoroughly washed hands. Margret then described how I had to hold the cuff of each sleeve with my thumb as I slipped my hand into the glove. My first attempt failed and the cuff slid down to my wrist, with the glove’s elastic base conforming around the cuff. I asked if I could try again but putting on another would contaminate my hands and it wasn’t worth starting over. I succeeded with my second attempt, with the cuff resting just below the base of my thumb. Then I was told to wait with my hands across my chest. Margret had to help set up all the utensils and it wasn’t yet time to don the second pair of gloves.
This is when things began itch. First it was a spot right above my right ear. Then it was a spot right under the mask, on my nose. Helpless, I stood waiting, twitching slightly so that my hands remained where they were but enough skin would move so that the itch would go away. I tried to direct the itch with my mind to at least move to my feet and legs, where I could shift my weight and scratch with my surgical boots or step on my own feet. Thinking back, this period of waiting seemed longer then the actual surgery itself. But after enough waiting, I was assisted into my second pair of gloves and the surgery began.
Making an ‘L’-shaped cut around the left index finger knuckle, Dr. Lyimo exposed the inner workings of the man’s hand. At this point, it was time for my first and major roll in the surgery. I was handed a small metal instrument that had very sharp, little teeth that were curved under and back toward the handle. Using this distorted fork-looking tool, I held open the skin while Dr. Lyimo worked. My left hand rested on that of the patients, holding everything steady. His skin was remarkably cold under my multi-gloved hands and it shocked me at first. I looked up to check the blood pressure, but I realized it was just the tourniquet halting the majority of blood, silently doing its job. After some quick flicks of his wrist, the surgeon had exposed the two separated ends of the tendon and began to suture them back together.
My next task was to flex the index finger so that Dr. Lyimo could see how his sutures were holding. With a satisfied little hop and a sigh, he took the patient’s hand and moved the finger back and forth, noting how the tendon moved. From my incredibly close viewpoint, I could see the small black markings of the sutures on the tendon move forward and aft along with the finger’s movement. His work under the skin was done and now it was time to sew up the dark outer covering.
Removing the tourniquet, the man’s flesh began to retain its red and pinkish hues. Observing that there were no capillaries to cauterize, Dr. Lyimo asked from another suture set and began to tie the skin back together. With every puncture of the skin a little bit of blood would ooze out, creating another job opportunity for me. Accepting gauze from Margaret, I dabbed at the cohesive liquid and allowed Dr. Lyimo to continue with his work. With the last suture in place, Dr. Lyimo tied off the strands, cut the lines, and asked the anesthesiologists to bring the man back. Allowing the medication to taking its time, the doctor began to take off his scrubs and hinted that I should do the same. Alas, my time in a surgical gown was over.
Although I did make another small mistake and took off a glove when I wasn’t really supposed to, I was able to help form the patient’s cast. Holding the limp hand in the air, Dr. Lyimo was able to use both of his hands to maneuver the Plaster of Paris bandages and create a smooth, white cast for the Tanzanian. Even though this part of the operation wasn’t quite as exhilarating, I still got a kick out of helping beyond my normal duties (tying gowns, wiping off aprons, getting gloves, etc).
I am not sure if I should have been assisting in an orthopedic surgery or not, as I have received no formal surgical training, but it was awesome actually scrubbing in and holding instruments while the doctor performed his magic. It is just beginning to dawn on me that this is my last week in this incredible country, and I may have reached a high point on that Monday afternoon in the orthopedic theater of Machame Hospital.
