Scalpel's Edge

A surgeon's notes

A Thursday

It’s a while since I’ve blogged a day in my life.  This sort of post is pretty boring for my Nepali readers, but gives a unique perspective of the diversity of the cases we deal with here.  This was how my day ran last Thursday.  I was rostered to endoscopy and outpatients.

On the morning ward round, I helped review all the current inpatients on our unit, and we saw two new patients admitted overnight, both burns patients.  One was an 8 year old with a scald burn from spilled tea.  One was a 7 month old who precociously crawled into his household cooking fire and got burned on both feet and hands.

Endoscopy list (upper endoscopy only, no sedation)

  1. 56F with chronic gastric ulcer
  2. 50F with hiatus hernia – ?contributing to her epigastric pain
  3. 96M with duodenal ulcer – presented with haematemesis
  4. 32M with oesophageal varices – presented with haematemesis
  5. 18M with oesophageal varices – presented with haematemesis

Both the varies patients I referred to our colleague who does vatical banding.  Although a common pathology here, I have not learnt to do banding.

General surgical outpatients

My resident had seen some patients in clinic before I got there, but he saved some for me to review.  I’m mostly keeping the patient demographics secret to protect patient anonymity.

  • Plantar warts with one giant heel wart, present for 20 years – booked for surgery
  • Left breast cancer in premenopausal woman, biopsy negative – booked for mastectomy and axillary clearance
  • 2 Hydrocele – booked for free surgery under a current government funded hydrocele camp
  • 2 Minor skin lesion – referred to minor operating room for excision
  • 2 Review of postoperative wound – reassured
  • Haemorrhoids – booked for surgery
  • 4 Inguinal hernia – booked for surgery
  • Asymptomatic gallstones – reassured
  • Bilateral staghorn calculus with polycystic kidney disease and chronic renal impairment – referred to higher centre in Kathmandu for treatment
  • 3 Renal pelvis stone – referred for PCNL
  • Keloid ear piercing – good response to intralesional steroid injection, so another dose prescribed 
  • Chronic epididymo-orchitis – given long course of broad spectrum antibiotics
  • Uterine prolapse – booked for preoperative investigations
  • Urinary retention due to benign prostate disease – referred for TURP
  • Hydrocele and contralateral hernia – booked for surgery
  • Symptomatic cholelithiasis and polyp – booked for surgery
  • Chest wall pain – given symptomatic treatment
  • Lactating breast abscess – admitted
  • Previous patient with splenectomy for haemolytic disease popped in to say hello.  He has had a good outcome and has needed no further transfusions since surgery. 
  • Incisional hernia in appendicectomy scar – booked for surgery
  • Penile infection leading to penile auto-amputation, now presenting with chronic non-healing wound and incontinence (!) – admitted

I remember being completely overwhelmed in outpatients by the diversity of cases and my lack of knowledge, but I quickly learnt the basic management of many conditions.  I continue to be challenged by language in outpatients, but I can now pretty much understand and make myself understand.  I should also mention that the patients booked for surgery generally have their operation within 2-3 working days. 

One response to “A Thursday”

  1. Leonie Broadhurst says:

    Cris, I am constantly amazed by what you have to deal with over there and how you cope so well. God bless you and your family. Leonie

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