Thursday, a better day

The lady is anesthetized, lying on her stomach. You can see her  head at the top of the picture.

I was tired and stiff in the knees when I got up but I spent a pleasant half hour sitting on the patio, enjoying the breeze and checking my email. We had a complimentary buffet courtesy of the hotel. The sticky rice with mango was good. At work it took a bit longer than usual to get under way. Our first case was the lady with the neck mass. It was necrotic and smelled bad. She wasn't bad to intubate and the cautery was working! We lost about 120 ml of blood during the dissection, not bad at all.

The mass came off easily with no extension below the fascia.

My second case was a 71 year old lady with calcified masses on both hips. They were almost symmetrical, the left being larger. Turns out they were probably TB of the ischium. That's two cases of pelvic tuberculosis in two days. Must be common here.

Dr. Lotuaco swung a flap from the inter-scapular area to allow a skin closure without tension.

Case #3 was a five year- old girl with bilateral popliteal cysts. I worked with Dr. Enescio, a general surgeon and Rotarian from here. We did this case with the patient prone, but by then turning and positioning people was old hat.
Case #4 was a hernia repair under spinal. The man had what looked like a foot of small bowel in the hernia sack, so he will feel better from this. My spinal didn't work so I put him to sleep. This vaporizer can be very frustrating at times, when you want to put out a lot of anesthetic and it won't cooperate!

Not a varsity anesthesia machine. Leak of 4 l/min @ 30 cm H20 pressure.  Vaporizer output non-linear,  seemed low overall. But then, it is an isoflurane vaporizer filled with halothane. 

I was on the last van out and returned to find a Rotary send off underway. Ideally they would make their speeches and present each other with trinkets and certificates first, waiting for everyone to arrive before they eat. This is not the Rotary way. Fortunately their was plenty of food left and the barbecued chicken tasted great.

Speaking of food: Thursday one of the nurses gave me some dried, fried squid that was very chewy but had an interesting, garlicky flavor. At lunch I had some skate wing that was marinated and tasted okay