Alice in Horrorland

This week started out badly – we lost a patient (I’ll call her “Leila”), our first death since the project opened.  All the staff, patients and families have been dealing with their grief ever since.  Leila was very ill when she arrived from Iraq – in and out

This week started out badly – we lost a patient (I’ll call her “Leila”), our first death since the project opened.  All the staff, patients and families have been dealing with their grief ever since.  Leila was very ill when she arrived from Iraq – in and out of ICU and suffering from severe leg infections. 

I looked after her a few times, providing sedation so the surgeons and nurses performed dressing changes.  I was impressed by the compassion and skill of all the staff, taking care to minimize Leila’s pain.  Frail and cachectic, she eventually succumbed to overwhelming infections resistant to the newest (and most expensive) antibiotics modern medicine has to offer.  Her death has affected us all and provoked feelings of guilt and anger directed toward the government and armed forces responsible.

Some of the surgical procedures being performed here are truly amazing.  Facial trauma is common in our patients and requires prolonged, multi-step reconstruction (especially when the jaw is damaged by bomb blasts or gunshots).  The process begins with a complex assessment of bone and dental loss.  “Three dimensional” C.T. scans are   forwarded to a company in Europe which creates models of the skull and mandible the surgeons can use to plan the steps required.  An early step involves attaching a multihole plate to the remaining mandibular bone to act as a “skeleton” or framework for future bone attachment. 

The maxillofacial and plastic surgeons performed an 11+ hour free fibular flap to rebuild the mandible of a teenage boy last week. You can see from the radiology studies, he has lost about 9 cm of his right mandible with the accompanying teeth. Once the bone graft has healed, the plate will be removed and a dental prosthesis can be created for him.  

There are several children in the program in addition to the boy, above.  Burns to the face and hands are a common indication for plastic reconstruction. Contractures develop and if not treated immediately, loss of function and cosmetic distortion are dramatic. Facial burns and trauma make my job much more complicated (a fiberoptic bronchoscope is available and frequently necessary). Hand contractures involve both skin grafting AND digital manipulation and wiring, followed my months of physiotherapy to improve range of motion and practical function.  

My presentation on Pain Management was well received at “Journal Club” on Thursday – so well received that I have been requested to give another lecture NEXT week. I was also signed up for no less than three lectures for the operating room and ward nursing staff. I never pass up the opportunity to get up in front of an audience! Since this is my last week (and we already have 15 operations scheduled), I will have to be very efficient with my time – I can always sleep when I get home…  

I talked most of the team into joining me for dinner and a drink at the “Irish Pub” at a nearby hotel, which I can see from our apartment. None of us has been there before,so we weren’t even sure what they served as far as food (but hey, it’s a PUB, right??) Imagine my embarrassment when we walk in to find all they serve is alcohol! Even worse, as my two supervisors enter in front, the bartender looks at me and says in English, “Hi, welcome back!”  No, seriously, I’ve NEVER been in there before! Trust me! We pulled a U-turn and fortunately found a nearby Sushi restaurant a couple of the team had heard about and wanted to try. 

A few of us took advantage of the good weather last weekend to make a day-trip to the Dead Sea. Because it is landlocked, technically the Dead “Sea” is a salt-water lake. The only significant water entering it comes from the trickle of the Jordan River, but during the rainy season a lot of water rushes down the wadis into the Dead Sea too. Because of the ongoing drought, the Dead Sea is gradually drying up – the water level has dropped substantially over the years. Because the water continues to evaporate and the salt has nowhere to go, the concentration of sodium chloride (and many other elements and compounds) is over 30% (compared with the more usual 3% in ocean water. This is why the lake is really DEAD – nothing grows in it or near the shores. This is also why it is much more buoyant than fresh-water (or even usual sea-water). Swimming is really impossible – you don’t dare get water in your eyes or mouth (I dipped a finger in and touched it to my tongue as an experiment, and the area burned until I generated enough spit to dilute it). 

You cannot submerge enough body parts to really swim – anything but paddling around on your back causes your legs to flop about uselessly in the air.  Quite amusing, really! It was sunny and warm so there were lots of families at the beach resort we chose (which had the added advantage of fresh-water showers and two swimming pools). The “Lake” water was warm (probably 21 degrees or so) but the pools felt icy and refreshing after lounging about in the sun, eating ice cream. On a clear day, you can see the West Bank of Palestine on the other side, but it was hazy (either from smoke or sand & dust in the air).  

We concluded the afternoon with a short walk up one of the nearly-dry wadis, where several large plumbing pipes were laid to collect a few drops of the remaining run-off. It wasn’t as challenging a hike as the ones at Petra and happily, I have been keeping up with my exercises and long walks in Amman (mainly home from the hospital when the weather is good). My skipping rope has been ignored until recently, but with the deluge of rain we’ve seen the last few days I’ve been making more use of it. Just as long as the rapid heart-rate only occurs OUTSIDE the hospital!