Gap Medics part 2: surgery placement

On my third day of surgery, we arrived late to a Caesarean section, so the doctor showed us the patient’s ovaries and fallopian tubes.

Afterwards we saw an excision of 2 masses on the back due to blockages of sebaceous glands. The skin over the back was sterilised and 2 eye-shaped chunks of skin was cut out with a scalpel. Masses were taken out and the skin was sutured up. During this process, the skin was burnt to prevent infection and further bleeding (which may result in a clot). A tube was stuck through between the two eye-shaped excisions and blood was drained during the suturing. There were also another 2 small prophylactic excisions made.

We then saw a leiomyoma removal (fibroids due to the myometrium, the muscle layer of the uterus) followed up with an appendectomy. The whole frontal area was sterilised, the skin above the uterus was cut sagittally, however the woman had lots of fat so the procedure was more difficult. Ligaments were cut; fallopian tubes, ovaries and the cervix were cut out along with the uterus; things were tied off from suturing. The appendectomy was performed straight after and the appendix appeared quite long with lots of fat hanging off it.

We also got to see a full Caesarean section, where the skin over the uterus was sterilised, a horizontal incision was made over the uterus and many layers were cut horizontally (up to the uterus). The baby was delivered head first and began crying.; the baby’s mouth was cleared and the baby was wrapped like a burrito. The uterus and the other layers were then stitched up and during the suturing there was lots of blood. The skin overlying the uterus was stitched up with orange stitching, which was very fine and looked very clean – as though there was no Caesarean section in the first place! It was a girl.

I came in late during a mass excision of the breast, only to see the suturing. The mass was the size of a marble and the patient was awake.

The last thing we saw for the day was a burnt foot. The patient had poured hot water on their left foot a week ago. The patient had diabetes and hypertension, which affected the healing of the foot. While he was awake, iodine was applied, some tissue was cut, hydrogen peroxide cleaned the wound and the foot was wrapped. Process also known as debridement.

It was my birthday that night so I had a little too much to drink, which made me miss out on half a day of my fourth day in surgery. Yes that is correct, I had a hangover – how responsible of me. Apparently I didn’t miss out on much. What I did see however was a unexpected Caesarean section. Epidural anaesthesia was applied at the cauda equina so everything below this point became numb. Catherter was inserted into the urethra. Betadine surgical scrub was applied over the abdomen and covered/wiped with a cloth; betadine solution was applied over abdomen and covered. During this Caesarean section, there was less blood than the previous one. It was a boy.

Last surgery we saw for the week was a discectomy of an intervertebral disc between spinal segments L4 and L5. A catheter was inserted in the penis of the sleeping patient. Patient was rolled over into prone position and iodine was applied over the back. The back was cut and wedged open. Because the patient had abnormal hypertrophy of the facet joints, the surgeon pulled chunks out of the lamina to make the intervertebral disc extrusion accessible, i.e. to make space. At this point (L4-L5), the CNS exists as the cauda equina, so the nerve roots could be separated, and part of the intervertebral disc putting pressure against the cauda equina could be removed. Afterwards the back was then stitched up. During this surgery, the surgeon was so nice to us. Although we couldn’t see much of the surgery, it felt as though he felt bad about it, so he explained everything very clearly and even let us stand right behind him so we could look over his shoulder.

On the King’s birthday, we visited an orphanage. It was wonderful feeling of having all these boys swarm you, grab you by the arm and connect with you. We bought them some snacks, played around in the grass and before saying goodbye. Goodness it was so hard to depart from them – it felt like I was the mother chicken and all my little chicks were exhibiting parental imprinting! I’m trying to think of a gift that everyone can use… my friend already got them a nice soccer ball – perhaps a frisbee? I’m looking forward to seeing them again. Some orphans and I:

IMG_2808

 

On Saturday, we visited Chiang Rai and the Golden Triangle. Along the way we stopped off at a hot spring and we boiled some eggs. There was a unique temple in Chiang Rai, called the white temple – as the name suggests, everything is white on the outside. On the inside, the paintings were very modern – there were figures of minions from despicable me,  superman, twin towers on fire, etc. (we weren’t allowed to take pictures inside). Because the temple was built 19 years ago, they were still painting the inside of the temple! Nearby, there was a golden toilet – coloured so because apparently that was the colour of urine and faeces mixed together. We then left the White Temple for the Long Neck tribe. The people from the Long Neck tribe living in Thailand are originally from a country inside Myanmar (Burma) and always fight against the burmese government. Because Myanmar is adjacent to Thailand, the Thai government cannot grant Thai citizenship to the Long Neck tribes, as they would be politically supporting the Long Neck people, and going against the Burmese government. As  consequence, the Long Neck tribes are not allowed outside of their houses because they don’t have Thai visas. Because they wear about 5kg of rings around their neck, they appear to have long necks because their shoulders actually drop! I asked our tour guide about the paint on their face, so explained that it was a cosmetic (like foundation) derived from a tree and got a very beautiful Long Neck girl to paint my cheeks with it. Afterwards, we went on a boat trip around the Golden Triangle – named so because gold was worth equal in weight to opium and lots of opium was traded on a no-man’s land run by mafia in the middle of the three countries Thailand, Myanmar and Laos. We crossed the river into Laos and there I tried a shot of a Cobra in sticky rice whiskey followed by another shot of a Tiger Penis in sticky rice whiskey. When we got back to Thailand, we visited the scorpion mountain before taking a 3-4 hour drive back to our house.

 

On Sunday, we went to Baan Chang Elephant Park – it was awesome! We fed the elephants, we washed the elephants, we learnt how to command the elephants for movement and we scrubbed the elephants. Pictures paint a thousand words, so here’s my thesis:

 

Cheers,
J

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