Gunshots to the face

Apparently one of the more popular Christmas gifts in Cape Town this year was a gunshot to the face.  We took care of 5 patients with gunshot wounds to the face over the past 3 days.  The most remarkable thing is that they all did really well!  The picture above was the result of a through and through gunshot wound during a robbery.  The entry wound was subtle, and is highlighted by the red circle.  The exit wound was more substantial and blew out part of his right cheek.  He had 2 molars knocked out in the process, but was able to talk and eat today without difficulty.  The story he told me made an impression:

He is the owner of a small store in one of the townships.  A thief came in with a gun and demanded all of his money.  He asked not to be hurt and opened the money box.  At that point, the thief shot him from 3 feet away.  Thinking the owner was dead on the floor, the thief sat in his chair and started counting the money.  The owner took advantage of this opportunity and grabbed the machete that he had hidden behind his counter.  He was able to muster one strong blow to the thief's right shoulder, almost disarticulating his shoulder, which made the thief "scream like a baby."  He immediately dropped the gun and ran.  The owner picked up the gun and shot the fleeing criminal in the leg.  The owner very proudly told me that before the police came, he put the gun behind his counter and that is where it is today.  I don't think anybody else will be trying to steal from this guy in the near future...

Christmas in Cape Town

This was the first Christmas I have experienced in the summertime, so I had to take full advantage.  I hiked up to the top of Lion's Head peak and had an incredible view of the entire city.  This picture shows Camps Bay and part of the Table Mountain National Park.  It was about 90 degrees the entire day and hardly a cloud in the sky.  It felt strange spreading Christmas cheer on such a beautiful day, but it is something I can definitely get used to.  I had dinner on the beach at the bay you can see below and then watched an incredible sunset over the water.  I hope you are all enjoying the holidays with family and friends.  I miss you all but am making the most of my new environment.  Remember, I'm always open to visitors...

Extremely rare hernia

It's been a pretty eventful week here in Cape Town.  Summer is coming into full swing and Christmas is around the corner.  It's a strange feeling.  I am planning to spend Christmas day on the beach.  It was about 95 degrees here today, and with the air conditioning being broken in the the operating theatre, it felt like we were operating in the tropics.  With a gown, mask, hat and gloves on, you can only imagine how hot 95 degrees feels.  Just putting on the gloves becomes a difficult task.

This series of pictures I'm showing you today is from a young man that was trapped in a car after it rolled into a tree.  As you can see in the first picture, he was pinned by the roof of the car, which left a rather large bruise on his stomach.  They had to use the jaws of life to extricate him from the car.  When he got to the hospital, his stomach was benign.  The next day however, he was complaining of right lower quadrant pain.  We got a CT scan and it appeared as if the trauma had given him a very large Spigelian hernia.  For those non-medical folks out there, a Spigelian hernia is a rare hernia that is caused by a defect just next to your six pack (or keg depending on your body habitus).  This guy was approaching keg status, so it was hard to really appreciate his hernia on physical exam.  It is extremely rare to have this type of hernia from trauma, and I only found 1 citation in the literature talking about "giant" Spigelian hernias caused by trauma.  That paper cited one case in which the hernia was 10cm in diameter.  That was the biggest Spigelian hernia the authors had ever seen or heard of.

Later that day we took this young man to the operating theatre.  When the anesthesiologist put him to sleep and placed the ET tube, he started coughing and we could finally appreciate how large the hernia actually was (second pic).  Once we opened him up, we discovered that his hernia was a 20cm!  There was no overlying peritoneum as you can see in the third picture which further proves it was the result of his recent trauma.  As you can see in the final picture, we placed a Parietex mesh (the biggest one they had at our hospital) and fixed the hernia.  He did very well post-op and walked out of the hospital 2 days after surgery.

This place is amazing.

My first night in Cape Town, I woke up at 2am hearing a lot of commotion from outside.  I went out to see what was going on, and saw my first knife fight in the streets.  The guy who pulled the knife got pepper sprayed by the lone security guard on the scene, and then was promptly pummeled to the ground by the other bystanders.  They tell me that this doesn't happen that often near to where I live, but the surrounding areas are a different story.

Here's a picture of a guy that came in last weekend.  He had a rather large stab wound that was temporized by another hospital before he came to us.  They have been trained in the field to stick foley catheters (which they call "Foley's") into wounds that are spurting blood.  They inflate the balloon and suture around it, and ususlly the bleeding stops.  It does a pretty good job of saving lives.  We take them out 48 hours later in the OR just in case there is some bleeding and we have to put them under.  Otherwise it's just under local anesthesia.  This guy did great.  We pulled the Foley's and sent him home the next day.

Hello everyone, I'm stoked you're checking in on my first blog.  I've never done this before so hopefully it will get better and better as time goes on.  I promise to give you all the nitty gritty details of what I'm doing and experiencing in the Cape, and after my first couple of days here, I can already tell you that you'll be in for a most interesting ride, so be forewarned.  I will not hide anything and will try to give you the most accurate account of what is going down in Cape Town.  Proceed at your own risk...