Freestylie

It is particularly hot at the moment in Muheza which, I must say, is particularly draining. Today was interesting surgically with the first case of the day something again I’ve never seen before. It was an older chap who supposedly had particularly large bilateral hydroceles (balloons of fluid around the testes). However, on opening his scrotum, we were confronted with lashings of pus from the first side. A careful and sequential drainage and debridement of dead tissue ensued and despite my initial hopes that we might preserve the testis, it was gone. So a formal orchidectomy was performed. The cord was divided through a second incision in the groin as on exploration the nastiness had tracked up towards the inguinal canal. I wanted to be sure that it hadn’t in fact tracked down from within the abdomen. Thankfully not. My fears of some bizarre intrabdominal abscess / cancer driving this process were fortunately not to be realised. All very odd though. I did not touch the other side, and we left things open in the hope that the now apparently healthy remaining tissue might heal. We will inspect again in due course.

The next two cases of the day were to try me, both inguinal hernia repairs. The first was a recurrent hernia following previous suture repair. These are always tricky as whatever technique has been used has invariably completely destroyed the ‘normal’ anatomy making dissection difficult and creation of a suitable space for the mesh challenging. However, it went really well and I was feeling very pleased with how things had gone. And then we opened the mesh. The first inkling that something was up was when we opened the ‘green’ wrap to find not an envelope, but a folded and taped piece of paper. Ok. Not in itself a problem. On the one hand creative / resourceful. On the other it was not what I had demonstrated, and I had provided an ample supply of envelopes. Hmmm. (you may also recall my comments yesterday about the anxieties associated with handing over this final piece of the process). But the real trouble was when I opened this paper to find a somewhat undersized piece of mesh. To say it was tiny is only overexaggerating a little. Grrrr. At this I was annoyed. I ‘gently’ enquired about why this was the case, given that I had provided clear instructions, a demonstration and even a template for cutting the mesh. I am pleased to say that outwardly I remained completely calm, smiling and constructive (explaining and demonstrating why this was a problem) whilst inwardly being distinctly peeved – freestyling on the first one!?! Really? The response of course was all smiles and with much laughter and banter from within theatre (the head of CSSD got a good ribbing – all in Swahili of course, but I followed most and had the rest translated). He wanted to save the envelopes for some reason and had lost the template so ‘made it up’ (I think using an envelope). Somehow (by using the diagonal of the piece), I managed to make it work acceptably (if it was too small I would have used another) and the end result was absolutely fine. So another colourful step on our journey.

The final case was another large hernia and with complete loss of domain of the back wall of the inguinal canal. What this means is that an already tired me, had to sweat my way through an operation that would normal be ‘quick and easy’. Head down, plod through. Be creative. Reconstruct the ‘normal’ anatomy as much as possible. And the end result. Well very pleasing actually. The mesh? Well it was as it should have been – it was one I had prepared previously.

Oh, and happy commercial love day!