Princess, your patient awaits.” Pieter took a deep bow, sweeping his arm toward the door of operating room number one. “And should her highness require any further assistance, I will be in the next room.”
“What’s going on in there?”
“Ruben is doing a tracheotomy.”
“Alone? Is he ready for that?”
“I think so. He’s done two with Margo. This one seems rather straightforward.”
Sarah’s patient had an umbilical hernia: an extreme “outie” belly button, everted and pooched out, like a little water balloon. It looked cute, but if not repaired, the bowel could become trapped in it. Worst case scenario, the little boy would die. A simple operation would prevent that from ever happening.
The surgery went smoothly, and Sarah was just beginning to close the wound, when someone opened the door. “Dr. Pieter say you come. STAT!”
She told the anesthetist to keep the child asleep. “I’ll be back as soon as I can.”
The room next door was in chaos, everyone was yelling and flailing about. Except Pieter, sitting at the head of the bed. He glanced at Sarah. “Chest tubes, please. Now.”
Ruben was paralyzed, eyes bulging.
She snapped on sterile gloves. “Which side?”
“Both.”
“Check. I’ll start on the right.”
She scrubbed the skin on the upper chest and threw some towels around the site, then probed to count the ribs.
Ruben looked over her shoulder as she popped the tube into the chest. “Is pneumothorax a complication of a tracheotomy?”
She snorted. “Hmmph. Ya think?”
Pieter cleared his throat loudly. His eyebrows knotted together above his face mask in disapproval. She should be teaching Ruben, not mocking him.
She sighed. “Let me show you how to secure this.” She put a heavy suture in the skin and wrapped it around the tube several times. “We call this a Roman sandal tie. If you pull on the tube, the stitch holds even tighter—kind of like Chinese handcuffs.”
Pieter gave a thumbs up. “O2 sat is better already.”
She told Ruben that he would be putting in the tube on the other side and grilled him, “What is a pneumothorax?”
“Air in the space around the lung.”
“And why is that bad?”
“Because the lung collapses.”
She tapped on the man’s chest. “We’ll place the tube up here, because air rises and collects above the lung.”
Ruben nodded and cut through the skin.
“Now feel with your finger to find the space between the ribs.”
Ruben poked the tube through the chest wall and tied it into place.
“Tell me why we would ever want to put a tube down here.” She pointed to a spot on the on the lower rib cage.
“If there was fluid in the chest—like blood or pus.”
“Right.” She patted him on the back. “Let’s go next door. You can close up the skin on my hernia case.”
SARAH HAD A cup of tea and mandazi waiting for Pieter in the lounge. “I was mean to Ruben. Thank you for reminding me to teach.”
“It’s understandable. His question irritated you.”
“They say there’s no such thing as a stupid question. But when you have the privilege of doing an operation, you have a responsibility to know the potential complications. Ruben wasn’t prepared.”
“But there are so few doctors here. And so much need. We are obliged to do our best with what we have to offer.”
“I guess being a coach to surgeons is part of the anesthesiologist’s job description?”
He chuckled. “Yes, and I must say it is very challenging.”
“What made you decide to go into anesthesia?”
“At first, I wanted to be a surgeon. I even took one year of surgery training.”
“And you changed because?”
“I learned that even if you do a great job, it’s no good if the patient does not wake up.”
“Good point. ‘The operation was a success, but the patient died.’ That’s an old cliché.”
“Exactly.”
“I guess if I weren’t here, you could have put the tubes in.”
“Not as nicely and quickly as you did. You’re a good surgeon. You’re efficient and you don’t waste motion. You decide quickly what needs to be done and take control of the situation.”
“Thanks.”
“By the way, Margo tells me I am invited to see a movie at your house tonight.”
“Yeah, we need someone to bring a pizza.”
“I am honored by such a gracious invitation.”
“Ameera heads to Arusha tomorrow to get ready for her wedding. So, it’s kind of like a bachelorette party. We’ll pretend that you’re one of the girls.”