JAN-C-8
THE DEPARTURE FROM BBH AT MALAYBALAY,
AND FAREWELL TO FRIENDS, INCLUDING THE TBOLI POST-OP PATIENTS,
AND PACKING UP FOR CAGAYAN DE ORO AND BEYOND
January 24, 2003
We have made a final round of our patients, and once again, to speak of miracles, there is NO serious complication among them. To be serious about our follow-up results, let us look at the numbers, and compare the results in outcome with what might be expected “under ideal circumstances”, such as the comparable outcome in a University Medical Center. Doing high volume surgery on big cases for advanced disease under improvised circumstances, one should expect a higher complication rate than the approximately 2% operative mortality, and about 15% morbidity, such as for goiters, about 5% for hoarseness, 8% for hypocalcemia, and about 2-4% for those who would require transfusion.
THE RESULTS
Here are our numbers:
93 major operations under general anesthesia, 22 minor operations under regional or local anesthesia, including many majors which might have required more extensive treatment elsewhere. There were in Malaybalay alone, 77 dental patients from whom165 teeth were pulled. In this group of patients there were: 0% operative mortality; and 0% serious complication of the kind listed. No hoarseness. One patient here at BBH who had a post-op calcium of 7.8 against their normal of 8.3 mg% who was not symptomatic in any way but was given some calcium for a day based on the laboratory numbers. There was one patient in Tboli who had the flap re-opened at the time of closure because of the recognition of some excess bleeding, but was not brought back to the OR, and no one experienced any excess bleeding from the drains placed, each of which were pulled the next day, generally just before the patients went home. The big goiter that I did solo had hypertension when she came to the OR, and she still had it post-op and required treatment for this unrelated antecedent medical condition. All told, we have benefited nearly everyone we touched, and without causing harm that could be avoided.
But, the image that still impresses me most is the memory of the one patient, whose name I will learn by text messaging and fill in later, back at Tboli. She came with her nephew who had a cleft lip and palate repaired, along with her very worried husband. She had an enormous goiter which was in her substernal extension and quite symptomatic. It would have been a very high risk to attempt to do anything surgical for her, and we would not have benefited her in submitting her to this high risk. We turned her down as inoperable because of the reconfirmed history of this mass having not been their only ten months before, and it had grown to the size of her head within that time—and that was only measuring the part we could see. This means that this is the very dangerous and untreatable from of anaplastic thyroid cancer—for which no therapy is available nor efficacious—either here in Tboli-land or in Washington DC. She came to the celebration and grateful farewell program at Tboli’s TECH on the night before our final operating day---why? To rejoice with those who had had the operation she had so desperately sought! She stood in the front row of the program and sang along, as best she could, with a life expectancy measured in perhaps four weeks, grateful that her friends and neighbors had experienced a successful treatment denied to her! Compare this patient response to the expectations and demands of North American overserviced “medical consumers!”
MAKING OUR FINAL ROUNDS AT BBH
We looked over the patients we had operated as recently as yesterday and found them doing well—even the distended and tachycardic patient who had the small bowel obstruction and a bowel resection and end-to-end bowel primary anastamosis with a fair amount of foul spillage in his peritoneum. The Tboli patients are all being loaded into the ambulance sent up by Waning to collect them—the Captain having completed his final stage of his mouth reconstruction for the gunshot wound of the face, and Lilia having completed the next to last reconstruction of her “gnoma” in adding tissue to her face between her nose and mouth. Then, there is Josephine Tano, who has a forehead flap graft from which a nose is being constructed for her, without a clue how the vomer strut will be supported in the next phase of her reconstruction. We will continue to keep watching her, and waiting for inspiration as we go along, with some limited approach to each stage of her reconstruction in order to completely rebuild a mid-face where none was present when we first met this young and remarkable girl, now changing into a young lady, who has not become a recluse because of her deformity, but is outgoing and helpful in the community.
Now, we depart for the road trip to Cagayan de Oro, where we will go to the same “Beach Resort” where we were for a few hours last year in the downpour that somewhat dampened our holiday overnight, which was short enough with a 4:00 AM departure for a flight that never left until much later in the day when the airport re-opened, closed by the same heavy rainstorm that lasted 24 hours last year at our attempts at departure. The rest of the group will stay overnight and then leave for Manila on the same schedule we would have had then had it come about. But, Ragon, Jennifer and I, by pre-arrangement, will catch the sea-going boat that will carry us overnight to Cebu City, where we catch the high-performance fast hydrofoil that will carry us across Leyte Gulf to begin our final phase of our Philippine Mission. Stay tuned!