TGIF

Friday 11/4 - There were only a handful of cases on the board today so we were expecting a slow Friday. Boy we're we wrong! The first surgery was a tonsillectomy secondary to persistent rheumatic fever (a complication of untreated strep throat). We also had a couple abscess debridements. But the big case was a young guy who came in with peritoneal signs (acute abdomen) from a stabbing that happened last night. He was very out of it and had rigidity, guarding, and diffuse tenderness. We got him back to the OR for an exploratory laparotomy and right after he was intubated, the patient coded on the table. 

The OR monitors are older and so they sometimes show an error in heart rate and O2 sat. So when the monitor started beeping and showing a flatline it wasn't too concerning bc normally the vital signs will pop back up in a minute or two. Around the same time the anesthesiologist was listening for breath sounds to indicate a good intubation but looked up concerned bc he didn't hear the heartbeat. That's when everyone stepped into action. Lots of Malagasy was being spoken but everyone remained calm. They started chest compressions, kept continuous breaths and pushed epi. I have no idea how much time passed but it felt like an eternity and I really thought we lost the patient. The staff started relaxing a little bit and we later found out it's bc the patient was back with us but with weak vitals that weren't registered on the monitor yet. Slowly the vitals came back to normal and the patient was starting to stabilize. It became a high risk surgery due to an unstable patient but once we opened him up we knew that continuing with the surgery was the right call. The stabbing had punctured the patients stomach and he had rice and other stomach contents floating free in his abdomen. The patient was very close to becoming septic so they cleaned out the free fluid and sewed up hole in his stomach. The surgery went smooth and we checked on the patient later that afternoon to find a very alert and oriented 20yo who was shocked to hear he almost died. 

Everyday the hospital takes a 2hr lunch break from 12-2p to go home, eat, and rejuvenate for the afternoon. We took advantage of the lunch break and headed into town to Antsena Kely ("small market"). This weekend we have two very exciting events we got invited to (stay tuned!) but needed proper attire. So off we went to go find Megan a dress and possibly shoes for me! 

We walked to the front gates and hailed 2 pus-pus to take us to the market. A pus-pus is like a chariot where you sit in cubby and a man (usually barefoot) lifts up the other side and starts running/pulling you towards your destination. Very strange concept at first but man was it fun! The men are so strong and can run so fast! The other type of transportation they have is a bike-pus which has a guy peddling a tricycle of sorts with you sitting behind. And to be honest, I think the running pus-pus actually get there faster! 

The afternoon was super quiet in the OR so the surgeons decided to practice knot tying with us and then Dali (nurse anesthetist) taught us blood replacement formulas. We had asked him about it a few days ago and he apparently went home to look up everything and came back in today to teach us! We are so fortunate to be surrounded by people who truly care about our education and want to help us learn! 

Right as we decided to head home for dinner, a young boy came in with a pleural effusion from falling(?) that needed a chest tube stat. We had been waiting on him to be NPO but his family kept feeding him water or soup. This means he couldn't be put under general anesthesia for the procedure and we could only use local lidocaine. It took a couple tries but Dr Harison got the tube into his lung and started draining blood. Before the boy left the OR, he had already drained 65cc and Dr Harison said he drained over 3L of fluid over the next day from his lung!! Poor boy could hardly breath before the chest tube!

Julie and Domoina cooked tacos for dinner to celebrate Domoina's moms birthday. It was a seasoning packet that scarlet brought from the US on her last trip and Domoina has been holding onto it for a special occasion!! Tacos have never tasted so good with all the fresh produce and meat!

As if today/this post isn't long enough, there is one more thing that must be mentioned! Midera promised to take us out on the town tonight and it just so happened one of this friends was throwing a Halloween party at a bar called Code Le 110. So even though I escaped Halloween in America, it still found me here and we celebrated big! We were given masks at the door and we walked into a fully decorated Halloween bash. The Norwegian girls met up with us a little later that night and we danced the night away! It was so much fun!! Oh and Midera introduced us to a local celebrity who is in town to perform a concert on Saturday. So if you ever hear about an artists named Rak Roots, just know that he's from Antsirabe Madagascar!