I’m a stranger in the strangest of lands

Despite my valiant efforts at wiping away yesterday’s bitterness and starting anew, the events of today chipped away at my sunny, if artificial, brightness before tea time. When tackling an elective list of twelve cases, it’s probably best to start the first operation before 10 am, no?

I’m still not convinced I’ve even figured out what the hold-up was. But, I profess only a mild indignation at the late beginning, as I was not looking forward to the orthopaedics festival that was planned. I mean no disrespect to my friends who have chosen this career, but there’s a reason I didn’t choose it. The last two weeks have been enough ortho to sate my lust for power tools for quite some time.

Again, despite having conversations about allowing me to run a second room with the non-ortho cases, none of the anesthetists felt the need to communicate with the rest of the staff and no one would go get my patients from the wards! Without the strength to fight another uphill battle, I took it all in stride, read a little bit, sipped my tea, nibbled my mandazi. Fortunately after about an hour, there was a very complex cancer surgery being done by the maxillofacial surgeon, and so I quietly strolled into his theatre and watched him for a while.

Finally, I was deemed worthy of a patient, and they brought her from the ward. I went to the surgeon’s room to tell them I would be starting soon and was promised the assistance of the intern as soon as they were done with the hardware portion of the case they were doing.

My case? A woman with suspected pancreas cancer with an obstructed biliary system and elevated bilirubin. My task? A cholecystojejunostomy (connecting a loop of small intestine to the gallbladder to relieve the obstruction). Don’t ask me if I’ve ever done one before. I’d have to lie. My preference was to do a more complicated reconstruction, but I was told “just bring up a loop, two-layer closure, okay?” So, I think I stepped up to the plate and used my surgical reasoning to do the job correctly. It might have been easier had I not been flummoxed by two things: (a) the intern never showed up and (2) my assistant was a student scrub nurse who had never scrubbed before. Did I mention I also wasn’t allowed to have cautery because of the complex cancer case I had been watching so faithfully earlier?

Finally finished with that around 5:45, when I am told that there is an elective patient that’s been waiting all day, can’t I just do a quick breast mass excision? Well, sure, except there are lesions in both breasts, and they are the size of a small pea and difficult to feel. Add to that, no one apparently heard the surgeon tell me that, because 45 minutes later, the anaesthetists are preparing to leave when I look at them with no small amount of incredulity. They forgot. Forgot. FOR...GOT! Perhaps I starting acting a little childish at this point, muttering under my breath and dully beating my head against the wall... The woman probably won't even notice that I did teeny tiny incisions near her nipples so that the scars won't be noticeable. P-a-i-n-f-u-l.

My little tuk-tuk didn’t drop me off at the guest house until 8:30pm, and I decided to go to a restaurant nearby because I’m craving steak. I’m calmly sipping my beer when the waitress returns to inform me… out of steak.

So ends another day of frustration. I’m so disenchanted with the OR right now, I hope for a few good days to end on a strong note.

Plans still aren’t definite for the weekend (my last one in Kenya!), so I’m not sure what I’m doing. I thought I did, but things change as they usually do.

Oh, and in case you’re wondering what it is I’ve been eating for lunch at the hospital… Ugali is a form of white corn meal cooked to something thicker than grits consistency. If Bobby Flay were here, he’d cut it into rectangles, grill it, and call it Kenyan polenta. The cabbage is cabbage, and the fish is smoked tilapia from Lake Victoria.