Pretty Gross

It was a hectic one today. When we finally figured out which part of surgery to go to, we were immediately whisked to join rounds. Two doctors and a group of five German interns were all surrounding one patient; the interns moved aside and told us to have a closer look at what was going on. This man was a diabetic who was facing a possible leg amputation; his right lower leg was pretty much being eaten away by his own body. He had what is called diabetic mellitus, as well as osteomyelitus with gangrene. The muscles, ligaments and fat were all exposed; the skin had long since deteriorated and his body was now working on doing to same to everything that was now currently exposed. And, on top of his own cells attacking his body, everything that was now exposed, (the muscles, fat and ligaments) were becoming bacteria ridden, causing deterioration to accelerate. The head surgical doctor who led Miles and I to this great team also happened to be an expert, and this large group wanted his opinion on the amputation. The patient’s leg was really bad; they were torn whether to try applying this ointment and special bandaging to see if it would get any better, or if it was too far gone and needed to be removed. The final decision was to give the ointment and wrapping a try for a few days first; they wanted to help him save his leg, and he was so happy for this. They might even try debriding the area as well. Apparently leg amputations are a very common thing here, however, with around 12 amputation surgeries occurring daily. That is mind blowing to me! I think this can all be attributed to the lack of access to needed medication, such as insulin for some diabetics, as well as their culture—many people walk around with bare feet in South Africa; I am still surprised to see so many shoeless feet everywhere. And, bare feet are a huge no-no for diabetics. Almost all of the patients that I have seen in the hospital have horrendous feet, with black toe nails and sickly and infectious looking dark circles and dots covering the soles of them. The next patient we saw had cellulitis of her lower leg. It was very huge (almost like elephantitis) and very swollen, causing the skin to be very raised and deformed, as well as very red and tender. Cellulitis is pretty much when the cells of the skin become infected and swollen. This can even affect the muscles as well, causing increased swelling. I believe this was the case of the patient; her leg was extremely large. She apparently has had cellulitis of the same lower leg in 2006; she even had pockets that needed draining back then which left many scars. The next patient was quite disturbing to say the least. You might want to brace yourself before reading. She had a prolapsed hemorrhoid; it was the largest thing I have ever seen in my life. Miles described it, very accurately at that, but gross to think that it is a valid comparison, as a strawberry frosted donut with white sprinkles. It was HUGE. You can’t even imagine it without seeing it. There are four types of hemorrhoids, and this happened to be the type that comes out of the anus, as hers did. She apparently had trouble with this before, but was able to get it pushed back in. She had a baby about a week and half ago, and this caused it to pop back out. This is clearly a problem, as it causes A LOT of pain, and is in the way because of its excessive size. It is my understanding that she was taken to theatre soon after giving birth to get it put back in, but somehow it came out. So, yesterday, they were going to try another attempt at getting the hemorrhoid inside to increase comfort. It can be removed, and I’m absolutely not sure why they don’t just remove it now, because it needs to be removed eventually anyways; beats me. Anyhow, Miles and I observed the procedure, which happened right in her bed (nobody in the hospital has their own room, just mass rooms with probably 30-50 patient beds in them) with the curtains drawn! She was given a light anesthetic; it made her sleep, experience less pain, and ‘erases’ her memory of the event. But, during the procedure, she was still wincing in pain and trying to move the doctor’s hand, so she was unconscious yet semi conscious at the same time. It was pretty gruesome. It was never fully pushed back in, but still bandaged up and the procedure was considered ‘done’ by that particular doctor. That was the last round of our hospital day; kind of a bad ending, right??

The cars, and most particularly the big semi trucks here, have exhausts that blow out thick black smoke. The smell of it, mixed with all of the factories here that blow out the same smoke, makes me feel like I’m breathing in strong dangerous chemicals. I try to hold my breath in areas that are the worst because it scares me! Uncle Roy, our driver, has a mini-bus as they call them here; that is what all of the taxi driver’s use as well. His is a VW, but we would call it a van. He adores that thing like no other. Miles and I call it his beloved mini-bus. He inspects it all of the time, and opens the car doors for us so that we don’t wreck the doors by opening them ourselves. It’s the funniest thing ever. I have also wanted to catch a picture of pick-up trucks here; I have been unsuccessful thus far but will for sure get one by the time I leave. They are just regular looking trucks (the smaller ones), and the trucks are full of people at all times, every single time you see one. Sometimes with men off to work, sometimes with a whole family or two, or sometimes just children, but they are never empty. And you would be surprised how many people they can squeeze into the truck bed. I have seen what looked like 25! And some people even stand up in them which makes me feel extremely weary and nervous; I will never get used to some things here. I appreciate the amount of safety most abide by in the United States.