FULL FINAL DAY OF OPERATING AT BBH,
WITH THE CASES COMPLETE AND A FAREWELL DINNER WITH THE MEDICAL
STAFF IN OUR SENDOFF FROM BUKIDNON ON THE FIFTIETH ANNIVERSARY OF BBH
January 23, 2003
I had gone to bed with the intent to run this morning early, and had laid out the running gear, minimal as it may be. I woke up at one time with the idea that I should get out, but as yet heard no birdsong, which started up at about 4:30 AM. I got ready when I heard a loud sustained crash, like a big tree coming down, but the sound originated in the e front of the hospital roadway. I went out to see, sure enough, that a big tanker truck had tried to pull out and pass someone and the truck it was trying to pas must not have yielded. The front of the cab of the tanker was demolished, and it seems highly unlikely that anyone inside there could have come out intact.
I ran on around the crowd of onlookers and made my usual run to the Provincial Government agencies in the oval around Kaamulon Park in a fine mist of a rain, returning to shower in time to type these lines, before breakfast, then a call to line up with all the BBH staff to have our group posed portrait taken for what must be the thirtieth time.
THE FINAL OR CASES
AS PREDICTED, A RUSH OF ADD-ONS,
ON TOP OPF A “FULL BOARD” OF GOITERS
The morning staff meeting in the BBH requested a testimonial of sorts from each of us in “feedback” from the MMI team. I was most interested in John’s who said, after a number of jokes about how happy he was that God had spared Alison all the troubles of a stormy return trip to Mindanao, implying he had picked up all her inconveniencies several times over in his ride up from the Tboli area, he said what was most interesting to him is something Glenn had said yesterday that had inspired him. While we were driving out to the monastery, he had remarked about the US Stock Market had what it had done to him, when I had added “Yes, my net worth is 43% of what it was two years ago, and, you know, it does not make any difference (other than the fact that I know I can never retire as once anticipated!) since I am doing what I am supposed to do here on Mindanao where I am supposed to be.” He went on to add that when his wife asked him what he planned to do in returning to Mindanao, he had replied “To re-set my compass.”
We posed for a group picture with the staff and then when I got to the OR, we all had our picture taken in the OR with the OR staff. Then I turned to the posting board, and there were eight goiters posted---and they were just the elective cases! There was also a hysterectomy that Fred Casino wanted to do, so I set about doing rapid, swift, even slick thyroidectomies one after another. The patient was usually moving and extubated by Don, as efficient and competent as any anesthesiologist I have ever workted with here or there. Now came the add-ons. I had the honor of a 43 year-old man with a small bowel obstruction who had had a cancer of the cecum resected by right hemicolectomy in October. His best hope would be an adhesion, but it also could be from adhesions, which would be his best hope. While we prepared for it, Fred Casino had packed up his special kit of lip and palate instruments, a kit he has put together in his retirement for use on mission fields in the Philippines. He spoke to me just before I said goodbye to Jovi, who was returning to do here specialty exam over which she is scared. She is borrowing my books which I had brought to Ragon. to help her prepare, as I had Janette and Ragon before her.
Fred said to me “I was worried when they said they had a professor of surgery on this trip, since I had a different idea of what such a person would be like. You are like no other professor of surgery I have ever met!” He went on to explain that he was eager to see someone for a community hospital since they had to do good work swiftly since they were making money at medicine and doing a lot of work well is how they got rich. He had one professor in the Philippines who had talked a good game but could not start an operation with less than four hours and never could finish it. “And her you come along and make the fast community surgeons look like they are going in reverse, and are the ‘clown prince’ of the group besides!” he said admiringly.
Jovi had talked with me about Palowan, a long narrow island west of Mindanao which has a Baptist Hospital set up also by Dr. Nelson, the man who worked on bringing the BBH to almost a consultant specialty hospital, of 35 beds that can be pushed up to 50 beds and which has had dreams of expansion and updating in commemoration of its fiftieth anniversary this year. But the PBH (Palowan Baptist Hospital) is closed since there is no doctor. There is a Nurse Horton, who keeps that clinic running, but the well equipped little hospital of 16 beds. Jovi says she would like to go there but as a trained surgeon she might be wasted there where much of the activities include treating malaria and other tropical diseases, not much of which require surgical skills. But, it is described as remote, with monkeys swinging outside the windows of the hospital with a big population of needy patients and a long six hour drive over a road that is bad, most times of the year. It would be a good one to go to after my scouting trip to Leyte to LBH, to see what future swings through more than one of the four Baptist Hospitals might lead to in terms of support to the indigenous staff.
I talked with Alan, and we might do a Tboli/Leyte trip at the same time next year skipping BBH which is well staffed and stocked, and then do a second trip with just Don and Al and Alan and I to go to such a foreign mission as Cambodia (Kampuchea) with a return to Palowan. We will see.
And, now, to the bowel obstruction—I operated on him with Jennifer assisting—a real rejuvenation of her excitement, since she had been bored until the wonderful magic of the rapid and thorough thyroidectomy that had been the last case before lunch. Now she was going to be with me on this patient with dilated bowel and an unknown problem. I found no evidence of liver metastases. I found a very dilated bowel with a few adhesions anteriorly which were still fresh enough to have big bleeding vessels in them when I took them down. But, in the right gutter, there was a solidly stuck loop of bowel with a thick band in an internal hernia. I pulled it up and tore the bowel in an enterotomy. The devitalized bowel was broken, and I did a bowel resection. A two layer end to end bowel anastamosis was done with Jennifer doing the front half after I had done the back half. She was delirious with joy at doing what she had imagined herself doing when she came, and all the boredom she had professed earlier at not being busy enough had resolved.
Now, to add a few more: an elective C-section for a term pregnancy in a woman in whom Alan had done a myomectomy of the uterus was here and he felt uncomfortable having her labor on a scar, so did the Section for a squalling baby girl. Also still to come was a young man with a mid-shaft femoral fracture which we agreed would be ideal for fixing with an intramedullary rod. The problem was that there were no such pieces of hardware here in BBH, but the patent and family somehow got one and after the delay of the day in getting it delivered, the family was much more resourcefully taking advantage of the team’s last minute presence. So, some hardware is being inserted in a femur fracture as the last case of a busy day.
Now we will go out for a dinner with the medical staff, as we had last year. Every one of us had a choice and this is the final dinner with the group of the senior staff, which last year we had had on Valentine’s Day. So, I started the day in a fine misty rain, and now I will wander across to see if I can email you a final message before tomorrow morning’s early takeoff from Malaybalay by road, and then a farewell dinner to the team when Jennifer, Ragon and I board the boat for the crossing of the Philippine Sea to Cebu City for the first phase to later connect with the hovercraft to Leyte Clinic and Hospital at LBH.
FAREWELL DINNER WITH THE BBH MEDICAL STAFF
Last year it was the Valentine’s Day dinner we celebrated at the Lone Pine Hotel across the main street in Malaybalay from BBH adjacent to the Covac Internet Café from which I had just sent my departure messages from Malaybalay. This year, we are earlier, but we also took over the only large table in the hotel and told stories of the prior missions we had made, while eating sword fish grille. This may be the fanciest restaurant in town, but on the gold star ratings it comes up to about a fifth the way on Betty and Willie’s daily fare for us, breakfast lunch and dinner. WE talked of the final numbers (for the group---not including the later numbers I would be producing with Ragon at LBH) and I will list those on the report that will complete the Malaybalay phase of this Jan-C-series with the 8th chapter. Then we move on to Jan-D-series. Come on along, by road, sea, and then air, to make the long journey through the Philippines and all the way “home.”