The queen insists on quiet

Today's title is because I was feeling a little diva-ish, and threw around a little subtle sarcastic attitude, which I'm sure was almost completely lost on my audience....

It was an interesting day, and I’m not sure why. I think, perhaps, I forgot where I was and slipped back into New York mode. I was mildly irritated by almost everything today and let myself get frustrated in the operating room. To start my day, I was informed that I would not be assisting with the one interesting case of the day. It was done in one of those oh-so-sly-can’t-say-no kind of ways. In an effort to get more cases done, wouldn’t I like to have my own room and do solo cases today? Of course, I agreed. Anything I could do to help the patients get the procedures they needed.

His little plan backfired, though, when he cancelled the patient he had asked me to do. They were scrambling to determine which case to start next, and the intern was nowhere to be found, so I ended up assisting in the interesting pediatric case, after all. Hah! (An anorectoplasty, if you're interested) While we were working in there, he asked them to bring me a case from the ward that needed an urgent amputation. He hadn’t answered his phone, he hadn’t received a message, there were no smoke signals in the sky, he just happened to be keeping this lovely (and might I say smelly) wet gangrene case as a surprise treat. I left about thirty minutes later to check the status of the case, and the patient was still in the pre-op area. I calmly explained, yet once again, that I was doing the case, no, there was no need to wait for the surgeon to finish. He was going to continue his elective cases while I did this one in another room. (Left hand meet right hand, aarrghh).

Finally, the patient was taken to theatre. Knowing I had AFAT (Anesthesia F-around time, another global constant) to deal with, I changed clothes quickly to run to the canteen for a mandazi to have with tea. Got back, changed, had tea, and the patient still hadn’t gotten her spinal anaesthetic yet! I went and sat in the room to hurry things along, and still it took another 30 minutes. So, then I scrubbed. I was left alone with a student anaesthetist and a student scrub nurse. Despite the fact that he had been puttering around with instruments for half an hour, he wasn’t ready for me to prep. There was no chlorhexidine, there was no betadine, there were no sponge sticks. The patient hadn’t been hooked up to cautery, there was no cautery instrument, he didn’t have scalpels on the tray. I think that might have been the first time I let go of any of the anger that was building when I said, “You know, this would only take 20 minutes if anyone would actually let me get started.”

Finally got the case done. Not only was it my first without a power saw, apparently their amputation saw has been in need to sharpening for months. My right upper arm is a little sore. ;-)

Then, Dr. Slick (I felt very used by this attending today, might have been part of the overall mood) pulls this one. “Let’s get this last case started, I’ll harvest the skin graft, you can prepare the graft sites.” Fantastic. No worries. Until he shaved off some skin and said, “Ok, just get that tacked on. Have a great night, see you later.”

Now, in the US, this might not seem like such a big deal. You slap the skin on, grab a skin stapler and secure the thing. Five minutes tops. Maybe six, if you’re worried about being hyperperfect and trimming edges. (Who me?) Well, you guessed it, no such thing as skin stapling in Kisumu. Every place that would have required a two-second staple, now required a much more time and labor intensive 4-0 chromic stitch. Cut to an hour later, and I was finally done securing graft to six separate recipient sites. Add to that an intern that I had to keep reminding to cut my suture, and an anaesthetist who pretended not to hear me when I asked to have the table raised higher but kept bugging me to finish because he was out of ketamine (it was well within the patient’s safety to switch to halothane, but that requires manual ventilation by the anaesthetist).

So, yes, perhaps not a stellar day, but I am doing my best to wash away the bitterness and start anew tomorrow. And a sincere apology to my non-medical friends who probably really don’t want to hear me whine about stuff like this. But, hey, you can always go back to yesterday and look at the zebras again… ;-)

Oh, and just for giggles. There's a snack product here called "the Big Stix", essentially Kenya's answer to Chee-tos. But the subtitle is the best. "Knobbly stiks of corn"...