Today is Sunday, August 20, 2017

A day in the clinic in the Philippines

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By GEORGE ROBERTSON, M.D.

Tuesday I got up early for snorkeling again and saw angelfish, jellyfish and more coral that was not covered in green moss. The water was clear and not too cold for comfort even in the early morning.

Divena, our hostess for the trip, had us a truck driver’s breakfast fixed at the church. The fresh fruit made for a delicious dessert after downing the scrambled eggs and pancakes. Pineapple was as sweet as I had eaten anywhere.

I had been dreading the morning ever since I saw the surgery patient the day before. Actually, Christie told me about her even before we arrived. She had a softball sized mass growing on the side of her face which, according to her, didn’t seem attached to anything. When I saw her at the clinic waiting in line, she looked hideous. Later I got to feel the lump that had her ear lobe and lower half of her ear growing out of it. Indeed it did feel free from the structures underneath until you got back to the angle of the jaw and then it couldn’t be separated from the parotid gland territory. I thought it might be a parotid tumor and dreaded having to dissect it out from the facial nerve, so much so that I almost didn’t do the procedure.

Todd, our group leader, talked with the locals and secured a spot in their operating room which did not have general anesthesia. When I explained to the patient that we could try her under local and that she might lose use of her mouth and eye muscles, she didn’t hesitate in wanting the surgery.

In the operating room we found an encapsulated lipoma that was very close to the marginal branch of the facial nerve but was easily removed.

Another case in a young woman with a benign breast mass turned out to be a trap for the surgeon that just didn’t go off. We took out a small fibroadenoma of the breast and afterward noticed white fluid coming up around the blood in the base of the wound. It was only then that I figured out that she was breast feeding. And another surprise was when she asked for medication for her goiter that I had not observed before. Then I took her pulse and found it to be 100 beats per minute signifying probable early thyrotoxicosis. I’m glad our Xylocaine with epinephrine didn’t put her into a thyroid storm.

The afternoon was a real circus with 32, count them, boys from 6 to 15 years old coming through our operating room for circumcisions which are not very often done at birth in the Philippines. I couldn’t believe that even the younger boys didn’t cry. The cases for me turned out to be a record 16.

We still had patients standing outside the theater when six o’clock in the afternoon rolled around and the vehicle came to take us back to the hotel. One fellow with a gigantic hydrocele was told to return in two days. They would be at another clinic, but I could probably start at the same little hospital operating room.

Editor’s Note: Robertson is a physician with Family Medical Associates, PC, in Lebanon.

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