By Sarah Woodrow, MD
Cooper Neurological Institute
This is part seven in a series of updates from Dr. Woodrow’s mission to Ethiopia. View additional posts from her on the Inside Cooper blog by clicking here to view all posts tagged “Ethiopia.”
The frustration has set in. That’s how I know I am feeling better. Last week between the jet lag, the cold and some mild but constant GI symptoms I was quite relieved just to get through the day. This week, I want to work. That’s why I am here, afterall. But it is a constant struggle. Monday it takes the anesthetist 3 hours to get our patient ready so that we can start our case. It is a 15 month-old boy with a bad brain tumor. We operate for 7 hours straight. I am still not sure if it is fatigue or common sense talking when I decide then that given the location of the tumor, the amount of bleeding that has occurred, our limited equipment and the likely diagnosis better to quit while I am ahead rather than risk causing further harm. At the end of the case the anesthetists tells the resident that he will never again agree to do a neurosurgical case – it took us too long. I refrain from telling him that I had planned for a 10 hour case given the situation and that the 3 hour delay in start did not help the situation. I was not impressed.
Tuesday and Wednesday all of the neurosurgical faculty and residents are off at a course. That left me to run the OPD (outpatient department/clinic) all by myself. Normally there are about 40 patients to see in a morning. The clinic nurse is my translator. Fortunately I have done this clinic before, and I know both the system and the nurse well. The clinic is like a walking textbook of neurosurgery. About half of the patients are pediatric. I find these patients both the most interesting but also the most devastating to deal with. Almost all of them are surgical candidates. Most have various congenital malformations of the central nervous system. Several have hydrocephalus (a build up of cerebral spinal fluid in the head). This results in them having heads that are at least twice the size of normal and that look eerily alien-like. This can occur for a number of different reasons including infection, tumors and in association with congenital disorders.
All of them deserve to be admitted immediately and operated on yesterday. None of them can be. Even if I could convince the pediatricians to admit them, it would take us weeks to operate on all of them. So, they get placed on the “urgent admission” list. The nurses tell me they will be admitted in about a week. I know this is being way too optimistic.
Meanwhile the adult patient I see who went blind 2 months ago due to a large but benign brain tumor gets slated for a “regular” admission. The family is relieved that the doctor is recommending admission to try and fix the problem. They assume that she is getting better care because I am white. They do not realize that there is 6-month waiting list to get into a neurosurgery bed in the hospital. Nor do they realize that I will no longer be here by then.
Even under ideal circumstances this is a difficult case. I keep my fingers crossed that one of the other FIENS volunteers will be here when she is finally admitted. I am relieved when Dr. Abat pops his head in about 1230. He came over during the lunch session and has been seeing patients to offset my load. I make the nurses giggle as I do a little happy dance when they announce that I have completed the patient list.