Bones

My third day working independently here. Saturday is nominally a regular work day, although I’m told it’s usually very “light” in the operating room (or, “operating theatre” – OT, not OR – hey, after all this time, I’m back in the theatre!). Today, just a circumcision of 3-year-old with “paraphimosis” – his foreskin had gotten stuck behind the head of his penis and swollen up to the point that it was choking off the blood flow to the head. It can lead to gangrene and the loss of the penis head, but I think it was caught in time. And a 6-year-old with a broken thigh, whom we had to figure out a way to put into “traction,” the old-fashioned way of dealing with these things.

This encounter can stand in for what, for me, has been the biggest revelation so far: the miracle of modern orthopedic care. I’ve already had a lot of respect for it since, as some of you know, I had both my hips replaced last year (still not perfect, but much, much better than they were before the operation!). Also, I had a colleague in Egypt during my public health days whose husband was a pediatric orthopedic surgeon, and I’d gotten a little glimpse of how his work could save kids from neonatal conditions that would otherwise have left them crippled for life. We were sitting outside having some juice when a young man recognized him and came up with a face full of gratitude, thanking him for “setting him straight” (ortho-pedic = “straight child”) when he was young.

Something I hadn’t thought of before, though, was what it used to mean to have a broken bone. The kid we treated today had, I think, fallen out of a tree; he had the requisite x-ray (gotten at the one private clinic in town; the hospital has almost no film), which showed the two pieces of his thigh-bone overlapping by several inches (when you break a limb, your muscles shorten since they are no longer being held at full length by the bone and the bone pieces slide by one another). For it to heal properly, it has to be re-stretched, so the broken ends of the bone are somewhere near each other. These days, you just go into surgery, put a piece of metal in there, and that holds it in place till it heals. You can go home, move around on your legs the next day, live a normal life.

Here, however (and, thus, 80 years ago in the States, too), what you have to do is STRETCH the leg with weights until the ends of the bone are near each other, and then – wait. (You know the cartoons or old comedy routines where people are lying in a hospital bed with huge casts on their leg and a system of pullies and rigging over them? – like that.) Wait for 4 – 6 weeks, if you are an adult, a little less if you are a kid. Four to six weeks largely immobile in bed with a weight hanging off your leg. Does this or does this not sound like torture? Add to that that here, the bed you are waiting will be in a crowded, insufferably hot and humid hospital tent, redolent of all the effluvia of the human body, and you get an idea of what this poor kid now needs to do.

Happily, kids are amazingly self-repairing. If he were middle-aged, and we didn’t do it right, he would probably have a short, game leg for the rest of his life. With this guy, we probably don’t have to be perfect, because, in a way that reveals “the miracle of life” to be more than a cliché, his thigh will keep “trying” to return to its original length and position; it will “remodel” itself until, hopefully, it is as good as new.

Which is good, because we were far from perfect. After I sedated him (he was an excellent patient, he kept breathing!), my colleague adjusted the makeshift pulley device he had constructed by adding and removing – I’m not kidding – rocks from just outside the tent. In the end, we got the bone-ends not too far from each other (a half-inch of overlap, maybe? A little more?), and somewhat straighter than they had been with the previous traction setup. I still don’t see how he is possibly going to remain there for as long as he has to, having all his bodily functions tended to by his mother or another family member, and without going insane with boredom. But – well – we did what we could. (There is no pediatric orthopedist here, by the way – all of this was done by a general doctor, working out of an illustrated book on how to address surgical problems if you are in a place with no supplies and you aren’t a surgeon.)

I mean, no one likes to break a bone. But in the States – do we think of it as a PROBLEM? Isn’t it more kind of a right of passage of childhood; you get to stay home from school for a day or two, get lots of attention, everyone signs your cast – cool! The misery that it entailed at one time really hadn’t crossed my mind before this moment. Misery and disability: Despite kids’ amazing plasticity, they aren’t perfect. I noticed that a student who comes into my OT on certain days was limping and asked her if she’d hurt her leg; she said “no, my knee – problem since childhood.”

I often find myself thinking that medicine doesn’t really matter that much, is not that important; that it’s your soul that counts and is really “you,” all medicine does is give you a little more or less time to live with that soul, and, if we were all ascended masters, a little more or less time wouldn’t matter that much. Blah, blah. But working in places like this really calls me on that. I realize that it can unburden us.