An interesting week

So, the Prof was off last week with a bug. In the absence of the Zambian registrar as well, I was the only doctor in the surgical dept. While most of what we do is straightforward, we benefit hugely (every day) from Prof's experience with tricky decision making and complex surgery. It is a novel experience for a UK trainee to be in a position of not having support at least a phone call away! We were lucky to have only one big case that could not be deferred, but the decision making proved quite stressful.

Firstly, choosing who to operate on, who to approach for help if needs be (one of the gynaecologists has a lot of general experience) and what could wait for Prof was challenging. The one op I did that would be far beyond my sole responsibility in the UK was a laparotomy for an obstructing large bowel tumour. She had had bowel obstruction for a month, and was both very sick and rather difficult to operate on due to the degree of bowel dilatation. I was pretty pleased with the result (just a defunctioning stoma to allow her to get better before definitive surgery) but arrived the next day to discover the "bridge" (a piece of plastic holding the stoma in place) had been removed by either a nurse or a relative. So she has to go back to theatre to bring the stoma back out.

The only other close shave was a six year old with a depressed skull fracture, who looked like he would need a craniotomy (operation on the skull) to release the pressure. Having pestered the Prof (who was still not well) I was all lined up to take the patient to theatre with him. Then the patient woke up and all was avoided. The comment from a neurosurgical friend back home, who I had emailed about the case, was "what did the scan show? Is it an extradural haematoma?". Little does he know the nearest scanner is seven hours away, far too far to make a difference to someone with a head injury! We make our head injury decisions the old fashioned way.

Having talked up the stress of operating, in fact the hardest part of the week was organising the dept (me, two licentiates who are accustomed to working alone and several medical students). I had to plan the clinics, rounds, lists and day time calls. It all worked out until Friday when I was supposed to operate with the visiting orthopod (he comes once a month) and neither licentiate turned up to do their list. Anyway, the Prof returned this week, no major disasters apart from me getting sick at the weekend and missing my opportunity for some decent food (a cheeseburger) in Chipata.