Yesterday morning I did rounds in the post-op ward. This was very different than what I am used to. Not that a hospital is an exciting place to be but this had a very different feel. Very gloomy and sad. The first patient we saw was a woman 8 days post-op total shoulder replacement. It was nice to finally see a patient early on that did not have a contracture. When I arrived, the woman was holding a cross, crying and rocking back and forth in her chair. She told me she just wanted to go home. She also asked me if she would ever be able to cook again. She said the nurse told her she would not be able to cook or garden again because her shoulder might dislocate. She was left there crying. I tried to comfort her and explained that she would use her arm again and explained the course of rehab to her and her therapist. I told her I would be at her house next month for dinner so she needed to get better haha. She laughed and said only if I brought lobster from Maine!
The next trauma case we saw was a young man that was in a car accident and glass severed his radial, median and ulnar nerves and radial and ulnar arteries. He had skin grafts from his stomach, nerve transplants from his femoral and peroneal nerves, and artery bypass surgery. He had this done 3 months ago and it was his first day of therapy. He had keloid scars about an inch in height and he did not have any range of motion or strength in his wrist. We were able to make great gains in his range of motion using a variety of different techniques including a homeade skin suction device (a syringe with a rubber plug that was shaved). This seemed to do the trick and drastically mobilized his skin! Not having all of my supplies has forced me to get creative, which is not necessarily a bad thing! I mentioned to the therapists that since he does not have sensation on a majority of his arm, he should not be given modalities which could burn him. They said it was too late, they had put him in the whirlpool and he suffered 2nd degree burns over his already traumatized arm. There were still some visible open wounds from this, but we were able to work around them. I was happy to hear one of the therapists say 'this is why we need to document.'
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| Supination before treatment |
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Supination after treatment
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| The suction device |
I was amazed to see how the patients get in and out of bed. They climb a set of four stairs to get into bed and use a trapeze to hoist themselves up. It is a big process for the nurses to get patients in and out of bed so I can see why many of the patients are in bed for such long periods of time.
Sorry to bore you, but I have rarely seen cases of such severe trauma so I am hoping you will also find it interesting! The next patient had steel fall on his legs while at work and broke his right tibia and left femur. He has been in bed for 3 weeks for his left femur and just had his right tibia operated on 3 days ago. This means he is looking at another 3-4 weeks in bed. He has many pressure sores, the biggest on his heel. When I arrived he had a massive headache. The nurse showed me his list of meds- he was taking very high doses of 10 pain meds simultaneously and said he has had a horrific headache for 3 weeks. This therapist did not seem very open to suggestions as far as taking pressure off of his bed sores and starting to work on strength and range of motion where concerned. I think if anything, the patient understood the importance of these issues and will hopefully take matters into his own hands.
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| The patient's right tibia post ORIF |
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| The patient's left femur post ORIF |
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The femur fracture before surgery
The evening concluded with a photography tour at the National Museum (from the 11 years of terrorist attacks). I cannot even begin to imagine what life must have been like for the Peruvian citizens during that time. Ana took me to a restaurant on Larcomar, overlooking the ocean which was wonderful.
Yesterday was my last day at Almenara and the students chipped in a bought me a bracelet. It is beautiful and the stones on it have great meaning. I was invited by one of the orthopedic surgeons to speak at the Peruvian National Arthroscopy meeting next June which is exciting! Off for one more adventure today before returning home on a red eye tonight! |
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| Ana and I |
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| Part of the crew at Almenara |
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| Sheri, a volunteer in internal medicine-at the Inca Market-she is great! |
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