Sunday, October 22, 2006

An Awesome Abscess-Amputation Filled Day

By Britt:

Woah, what a crazy, fun, awesome day I had! This morning we went to the Lifeline Haitian church, here in La Digue. I had a major Creole feat because I actually understood the entire sermon. Woot-woot. Later on we toured Jamie & Sharon around the village and went up to the dam. The water was calm enough, that we actually walked/climbed up and down the actual dam ... which was way fun. We have plans to go back later this week with mats so we can slide down it. Heck yes.

I had scheduled patients to start coming at 5. Our first one was Pastor Silanse. Lifeline supports his school and has a feeding station there; it is down the road a little ways. I need to ask his exact age, but I would guess he is in his late 60s or early 70s, which is a really long life by Haitian standards.

He has an abscess on his abdomen. It started about 15 days ago; but details are kind of difficult to get, especially clear ones ... so we are still kind of unclear on how exactly it started. Last week, we sent him to Cazale but it was the day that Lori was sick; but they were able to give him the necessary meds that I don't have here and also sent him to get a few tests done. Jamie taught me that often abscesses will form from the outside in. For example, if he had a splinter or a bug bite that got infected and wasn't treated and just continued festering ... into this. Jamie came prepared with scalpels and brought tons of gauze and suturing material. I am so thankful, as always, it was the perfect timing since I was running low on those things.

Last week when Pastor Silanse went to Cazale, the outside of the abscess was still crusty. So I had been putting silvadene on it to try to loosen up the crusty stuff so that it would be ready to be drained. Yesterday, when he came for a bandage change, it had already opened up and had been leaking a lot of pus. Most of the original crud had leaked out since yesterday. Today, the abscess started out like this:

Then, Jamie showed me how to cut away/open up some of the pockets of pus that still remain. That process looks a little something like this: (and yes, it was very deep)

After we made sure all the pockets of pus had been opened up, we washed it out with high water pressure (a garden hose to be exact; We call it medical improv). Then we cleaned it out with betadine and packed it with a 4x4 piece of gauze soaked in betadine. So, if you will, picture a hole large enough to shove a piece of wadded up gauze into it. Are you grossed out yet?

It was much worse yesterday when he came with it all leaking out (and it smells kinda) ... but today was just way too cool of a learning experience to be grossed out. Pastor Silanse is as tough as nails, we didn't numb the area because it would have taken way too much (more than we have) lidocaine. So he endured a garden hose and us poking around in there. I told him that I was so proud and that I was amazed how strong he was. He told me that he was strong 'paske mwen gen Jezi' : because I have Jesus. How awesome is that?

Onto the next patient. This is the finger, the one that I warned you about. So don't click this link if you don't want to see it again. And for that matter, don't scroll down. :)

This is Peirre; if you want a refresher of what happened, you can click the link to read the story. Anyway, the amputation job that the Haitian clinic did was less than excellent ... the distal tip of the bone was exposed. This creates a huge risk of infection entering the bone, which is 'tre grav': very serious.

It was decided that we needed to cut the bone down further so that none of it would be exposed. Also, by opening it all up, we could do a really good job of cleaning under the surface of the wound. This is the picture of me numbing it up. Jamie taught me how to do a digital block ... which is where you inject lidocaine into the place on your hand (the palm) where the natural crease is ... this is where the nerve bundle is located. By injecting into the nerve bundle, the lidocaine flows up into the finger, numbing the finger as well. I am told this is how hand surgeons do it in the states (even though in the picture it looks like I am torturing him.)

He was super tough for that part. I had to go down until the needle tip hit the bone, and then pull up a little bit ... that is where the nerves are. This was really painful for him because it wasn't like a quick shot, it was slow and pushing/pulling. But he was super tough and we did a successful digital block because he didn't feel a thing from then on out. Which is good, once you hear what we did next.

So the task at hand was to clip the bone down lower so that we could sew the soft tissue on top, covering it so that the bone was no longer exposed. Also, usually it will not even heal entirely/correctly if the bone is exposed. First we put a tourniquet around the base of the finger. Then we opened up/loosened the tissue around the bone, so that we had gotten down to the where the bone was visible/in access. That was by far the coolest part ... seeing the bone marrow. I wish we could take a picture of that; it was sweet!

You might ask, how does one cut a bone? With a wire cutter, of course. That was crazy. The whole time we were doing that (clipping the bone, one little snip at a time), I was just shocked at what I was actually doing/seeing. So ... we got the bone down to where it was far enough so that the soft tissue could be sewn up over it.

The next post shows a few more photos, including the finished product.