Day began in ICU with an interesting diagnosis: unconscious patient was obtunded due to neurosyphilis which was nowhere on our differential diagnosis! We got plenty of cases done in the OR. An excision of a skin cancer with grafting, an Achilles' tendon lengthening and then the case the ortho pods had been waiting all week to do: an intramedullary nailing of a femur. We were all set to start it at 8 when we discovered the patient was anaemic. No cross match and when we did no blood in the hospital! Nearly got the patient's brother to donate a unit but we diverted another patients blood and got the case underway after lunch.
After several days of hearty lunches we were given short rations today, not sure why, maybe they saw us on the roof last night!,
The IM nail took a while and we were going to start a plastics case when another 14 year old GSW to chest was transferred from another hospital! At least a litre in his chest drains. Became I tubed and had to be tubed. There followed much conversations with surgeons regarding possible surgery until a thoracic surgeon agreed to come in. Was told he would take an hour and we are still waiting! Bullet also managed to exit giving him a T12 paraplegia so his long term outlook is bleak.
Meanwhile we have reviewed Shauna's rash and have established a differential of secondary syphilis or leprosy. Could just be a reaction to DEET but that would be too obvious.
Meanwhile Dave Amirault and Marti LeBlanc headed to the medical school for some teaching. When Marti got back we did another unusual case: a 59 year old woman with a tumour of her hard palate the size of a lemon! Was surprisingly easy to intubation so the case was pleasingly uneventful. We left the OR to find a thunderstorm underway. Welcome relief from the muggy conditions today and quite spectacular.
We headed off to MINUSTAH for dinner and a few cold ones. Our fun was curtailed by 'problemes d'electricitie' but we left refreshed to convene on the roof. The poor kid with the GSW remains in ICU holding his own, no sign of the surgeon!
Tomorrow am we have a field trip to an orphanage which promises to be emotionally disturbing, but will be an insight into the problems Haiti still faces.
State of the art anaesthesia setup
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