The night started out calm. We had just finished a case of surgical toileting that didn’t last an hour. I got excited because I was finally going to be able to catch some sleep. I asked the surgical resident to let me do the next operation before we call it a night. At this point, if you told me that that night was going to be my longest, I would never have believed you.
I went to the ward and prepared the patient. He was a man in his forties. A lovely human being, to say the least. He had a genuine laughter with a deafening crescendo in the early phases, brief plateau phase and a sudden stop. He had smoked loads and loads of cigarettes. His hands and lips were pitch dark from the many years of smoking. We were going to cut his leg that had since become so painful after losing its blood supply. It was going to be my first amputation. I was anxious.
The operation started shortly after 11 pm. We projected that we would be done by midnight. My hands were steady and sterile. After years of hard work I was finally having this moment. My mother would have been proud of me had she got an opportunity to get into our theatre that night. I am my mother’s son. I took my space and spoke gently as we were doing the WHO timeout before the operation.
“Any critical or non-routine steps? “ the circulating nurse asked in a lovely voice
“Anticipated blood loss?”
I made a fish mouth incision on the thigh and dissected out the powerful quadriceps, tying the major bleeders and coagulating the smaller ones. The noise from the monitors and the sound of diathermy in action was occasionally interrupted by a few stories among the nurses. Sooner or later, we got to the femoral artery and vein and their large branches. We dissected and tied them.
A few minutes later, we got to the femur. I held the saw and started cutting the bone. All of a sudden our theatre became a work shop. I often wondered how someone would choose this carpentry specialty of medicine. Orthopedics would never give me joy for sure. The bone was becoming unusually hard. The saw was getting blunt in the process. The patient was under spinal anesthesia, so he was able to talk.
He said, “Daktari hiyo mguu niliwekewa chuma 2010.”
I almost collapsed. All this while I had been struggling to cut a bone that had been reinforced with stainless steel. Worst of all, no one in the entire team had picked up that history of previous surgery. That is the moment I knew we were on the brink of tragedy. It was 1 am. The ambient temperature was well below 10 degrees Celsius. I was freezing. We threw in the towel and decided to ask for senior help. The consultant on call that night did not pick up his phone. My heart was racing. We called another one who managed to pick up and come to our rescue. We sat still and waited. The great wait of my life. The operation had prolonged so the risk of complications was rising with every minute of further delay.
We expected that he would shout at us. He did not. He scrubbed up quickly and joined our mess. The implant was removed to our great relief. We finished up the operation a few minutes past four. That night was not easy folks. Luckily for the patient, he never complicated. We discharged him on the third post-operative day.