Finding Nemo and the Real Pain in the Neck

          Finding Nemo. A masterpiece if I may say so myself.      

I’ve realised this week that I need to start sleeping in the ICU to see the real action because all the crazy, exciting and scary things happen at night! On Friday morning I came in and met the patient we have now affectionately dubbed ‘The Fisherman’. He is a 25 year old who was out fishing on Thursday evening with friends and caught a wee fish. He put the live fish in his mouth between his teeth (God only knows why) but somehow took a big breath in and managed to inhale the fish into his lung. He started choking and his friends brought him to a village hospital, where they quickly identified he wasn’t able to breathe. That hospital didn’t have any pulse oximeters to measure the oxygen levels but he was going a bit blue, so they put a big needle in the neck to create a passage for air. Unfortunately that didn’t help much, and as said in my last post the vast majority of hospitals here don’t even have access to oxygen, so they sent him to Lacor hospital for further management. When he arrived he had oxygen saturations of 72%, and he was obviously pretty sick (as anyone with a live fish flapping around in his lung would be!). Ray and Francis took him straight to theatre, where it took two hours for the oromaxillofacial surgeon to remove the little fish piece by piece using a bronchoscope (lung camera) and a forceps. It was stuck headfirst between the right main bronchus and carina (see very detailed diagram attached). The next day when I saw him, he was talking to his friends, looking a bit worse-for-wear but thankfully (and rather miraculously) alive.

Francis (white coat) and the patient doing well two days post-op.

On Tuesday night a lady who had just had thyroid surgery earlier that day complained of pain in her neck, and the nurse Albert quickly realised she was bleeding. Bleeding like this can cause big problems in the neck as it can compress the airway and the vessels supplying the brain with blood. Her oxygen saturations dropped to only 70% and she quickly started slipping into unconsciousness. The fast acting nurse contacted the anaesthetist Francis and anaesthesiologist Ray who woke up the surgeon in the middle of the night to take the patient back to surgery straight away. There was a huge amount of swelling around the trachea (airway) but Francis managed to intubate, and after an hour of surgery stabilized the patient enough to put in a tracheostomy (semi-permanent airway in the neck which we will remove in a few days). I tottered in the next morning blissfully unaware of all this commotion overnight. I found her sitting up, breathing a bit of extra oxygen through the tracheostomy, but alive. Bleeding thyroids, although rare, are one of those situations that make anaesthetists and surgeons alike involuntarily shudder because they can go so horribly wrong and have a high mortality if rapid action is not taken. There is no doubt that Francis, Ray and the nurse Albert saved that lady’s life.

As you can probably deduce, I am massively impressed by the skills and knowledge of the people around me here, particularly Ray and Francis who have really welcomed me and have taught me so much. These are just two examples this week of lives saved at Lacor hospital where otherwise and elsewhere would have meant certain death for the patients. I feel like I am gaining so much more than I could possibly hope to give back to this place, between learning new skills, knowledge and experience and I am so happy to be here. Although I can take no credit for helping in these cases, it definitely makes the tough and sad cases easier knowing that Lacor Hospital and its skilled staff tipped the balance in favour of these two patients at least, and kept the greedy Grim Reaper at bay.

*More Good News*

Ray with a 24 year old who was in a road-traffic accident (* very common here - do not get me started on Ugandan drivers) : several broken ribs on the left and a collapsed right lung, successfully resuscitated and treated - discharged to the general surgical ward. 

45 year old man with air under the diaphragm from a perforated duodenal ulcer. This was repaired in surgery and he was discharged a few days later to the ward.

14 year old girl who fell from a mango tree three days before coming to hospital with shortness of breath and pain. XRay shows left haemothorax (blood in the lung space). She had a chest drain put in and was discharged to the surgical ward a few days later.