Sunday, November 15, 2009

Project Hands Surgical

Another surgical mission with a team of Canadians from the group, Project Hands started yesterday with pre-op triage and evaluation.  What a looong day.  The patients have all been pre-screened, so it should be a quick in and out consultation just to verify that they do need surgery.  Unfortunately, it hasn't gone as smoothly as we would like.  The ginecological patients seem to be very demanding of the surgeon's time, and some of them have been labeled as surgery unnecessary.  Kind of defeats the purpose of the initial triage...

The hardest patient we had to turn away was a 47-year-old woman with stage four uterine cancer.  Unfortunately, PfS has decided that we cannot help cancer patients.  We simply do not have the resources to be able to pay for aggressive series of treatements, and sadly, neither do the patients.  It is a shame that this woman, Marta, made it all the way to San Juan thinking she was going to be operated on.  It wasn't until further testing was done on the woman that her terminal illness was known.  So we sat down with the woman after her consultation with the doctor and explained to her that an operation would not fix her problem.  I only listened in on the conversation while my co-worker did the talking.  I wanted to get an idea of what to say in the even that I should have to have this same conversation with a patient some day.  It was painful even as a spectator.  My co-worker told me that she avoided completely the word "cancer" because people freak out when they hear that word, and we don't have biopsy results to say that with 100% confidence.  After thorough explanation to the woman that she had an "illness" that needed very aggressive treatment and an operation would not cure it, she seemed to understand.  She asked how much the treatment cost and we explained that we couldn't really guesstimate a price but it involved a series of trips to Guatemala City, which is about 5 hours from her municipality by bus.  We told her that we can help set up an initial appointment for a biopsy, but from there they are on their own.  There is no doubt that they do not have the money for chemotherapy, so the most she will be able to do is go home and enjoy the rest of her life.  The woman's daughter seemed to understand the situation a little better, for she welled up with tears, but the woman kept her composure and simply nodded.  All she wanted was an operation to help with the pain when she urinated.  As it turns out, her illness was a lot more involved than she thought.

On a lighter note, I observed an abdominal hysterectomy today, which was most excellent.  I have yet to see a surgery that I don't enjoy.  I've been keeping pretty busy translating here and there and haven't gotten quite as much OR time, but tomorrow we have a full day of cases, so I expect to see a lot more.

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