The Most Useless Organ in Your Body

Now that we're back in the city, we've been shoved right back into the hustle and bustle of the hospital. Because there's so many of us, we've been put on set rotations, allowing a few of us to be in different areas at all times. This past week, my roomate Joyce and I were in the ER.

The cases we saw included a broken wrist, lots of gastrointitis, enteric fever (another name for typhoid fever) and even frostbite (the sherpa had gotten stuck at Camp 2 on Everest.) The ER at Helping Hands is considerably less busy than any ER's in the States, due largely in part to the fact that there are only 5 beds in the ER ward. Because of this, we are allowed to wander to other parts of the hospital and attend any surgeries that are available.

Yesterday, there were three surgeries: a hernia surgery, an appendectomy, and the removal of a fistula in the sphincter. These surgeries are all back to back, in the same room with the same surgeon.

So, after a heated debate over lunch at our favourite fry-shack, the other interns and I finally decided who would see what. Mike, Devin, and I would go to the appendectomy; Kelda, Maddison and Yujin would go to the hernia, and Nate and Joyce decided that their laundry back home was more appealing than the sphincter operation. The girls went to the hernia operation at about 4, and at 4:30, the boys and I started scrubbing in.

When we walked in the room, the patient was awake, and sitting naked on the operating table. She was a young girl, about 20 years old, and was terrified. After a few seconds, I realized that the anesthesiologist was crouched behind her, injecting a local anesthetic into her spine. After he had finished, she lay down, and the nurses doused her entire body in iodine, to keep the patient clean. They started the procedure, cutting and burning through the thick fat, making sure to not let her bleed out, and eventually tied off and cut out the appendix (which is much smaller than you might imagine--think earthworm.)

The room is tiny--3 interns at max can fit in the room, along with two nurses and an anesthesiologist. It holds a surgery bed, two gas canisters, a large bureau of a variety of drugs, and two buckets of bleach, where they clean their latex gloves, tools, and vials (to reuse at a later use.) The OR is more sterile than the rest of the hospital, but that isn't saying much. Only the surgeon and the nurses taking part in the procedure wear masks and gloves, but the other doctors will come in and out of the OR, without changing clothes or re-scrubbing their hands. The general rule is that if you stand back 2 feet, you don't need to be completely sterile.

This is a huge change from the amount of sanitation in the US hospitals, where you wash your hands every time you leave/enter a room. When I watched a procedure in a cathader lab in the States, I wore new scrubs, a little overcoat, new gloves, and a new mask. And all I did was stand in the corner. But despite that, hospitals in the US have a fair amount of transmitted diseases in the hospitals--people get diseases from their neighbors, develop staph infections, etc. But here, where they have a man with TB in the same small, cramped, dingy room that's filled to the brim with 8 other patients, they have no records of any diseases transmitted throughout the hospital.

This could be from lack of records, because I think that if it can happen in the terribly sterile environment of the hospitals back home, the Nepali hospitals can't be that lucky. But when asked about it, they reply that they've never seen it happen, and that nobody has ever come back to complain about it, or charge the doctors with malpractice.

When I asked Dr. Gupta about whether or not patients claim to have caught diseases from the hospital, like they do in the U.S., he replied, "I do not practice in the US because there, doctors are the scapegoat. Here, doctor is god, and the hospital is his heaven. People expect to come to the hospital and get better--not worse. If a patient became sick with something in this hospital, they would never believe it was from the hospital, or the doctors."