First Day Back

It was my first day back to work in the Urgent Care Clinic. I actually didn't see my first patient until 1100, but then it started to get a bit busy- smashed hand from door slam, hypoglycemia, severe nausea and vomiting turning out to be pregnancy, known miscarriage with heavy bleeding, abd pain from constipation - you know, the usual. I felt very slow getting any work done. It will definitely take some time to get back into the swing of things, but I'm sure I'll get there eventually. Thank goodness I have tomorrow off.

So many stories still to tell from Afghanistan. I think I mentioned earlier a brief visit from Afghanistan's president, Hamid Kharzai. I'm hoping I'll be able to post a small video. I also wanted to mention my two Afghan mandibular reconstruction patients. Both of these men were had their lower jaw blown out by gunshot injuries. They arrived maybe a week or two apart. I take very little credit for the care of these men as it really was our wonderful ENT doc who did some amazing, but rather unsuccessful surgeries on both of them. They both originally had a piece of their hip bone removed and grafted to reconstruct their lower jaw and then a free flap from their abdomen placed over the bone. Sadly neither of these took very likely to the poor nutrition of the Afghan population. The first one, who I would refer to as the nice one, as the other was a bit high maintence and stubborn, had a second jaw reconstruction done with a bone graft from his fibula (lower leg bone) complete with skin flap. It looked good at first, but it just didn't take either. I think the ENT doc was seriously considering somehow getting some leeches which are apparently fairly common place in these types of surgeries in the States. I just have to commend my dear surgical colleague here though because the hip graft surgeries each took between 7-8 hours in the operating room. The fibular flap was upwards of 14-15 hours. CRAZY! But he still did it. It was very frustrating, however, to see these men spend so much time with their jaws wired shut and when finally removed still unable to eat for fear of infection from any oral contamination. Hence both these gentleman were on tubes feeds for weeks. Nothing by mouth except moistened sponges on a stick to keep their mouth moist. My dear nice Afghan male appeared to become rather depressed and he was eventually transferred to a FOB (forward on base) who happened to have a highly specialized ENT physician trained in jaw flaps. He didn't return before I left, but I do hope all is well. The other gentleman appeared to resign himself to a long stay at the hospital and became much less stubborn.

I might have to tell the crazy bomb maker story next.