Surgeon On Call 24-7

By Harold P Adolph MD FACS

The inspiring and thrilling stories of surgical challenges around the world, which include the life situation of the patients, key elements of the surgery, and the providence and provision of God over many years to overcome what would be considered an impossible "on call" schedule. Born to missionary medical parents in China, Harold Paul Adolph felt called to medical service early in life. When his life was repeatedly snatched from death's jaws, he knew that he was on assignment from God. He felt led by God to work as a surgeon in places with few surgeons and later to train surgeons to carry on this ministry for the sake of the gospel. Since 1966, Dr. Adolph and his wife, Bonnie Jo, have served in Ethiopia, Wheaton, in short-terms around the world, Liberia, Niger Republic, the USA, and Ethiopia, setting up a two-hundred-bed surgical training center in South Central Ethiopia with a dedicated staff of expatriate and Ethiopian specialists. Both their children, David and Carolyn Joy, serve as missionaries in Africa.

• Language: English
• Publisher: Christian Faith Publishing, Inc.
• Release date: May 15, 2018
• ISBN: 9781641404587

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Surgeon On Call 24-7

Harold P Adolph, MD FACS

Copyright © 2018 Harold P Adolph, MD FACS

All rights reserved

First Edition

Christian Faith Publishing, Inc

New York, NY

First originally published by Christian Faith Publishing, Inc 2018

ISBN 978-1-64140-457-0 (Paperback)

ISBN 978-1-64140-458-7 (Digital)

Printed in the United States of America

1

In the Way of a Spear

Alion had been seen recently on the edge of the tree line as the sun was setting. They had never worried about the lions because the baboons had always been very active. In fact, the baboons were more than a minor problem to be solved. They ate more of their crops than the community. At harvesttime, multiple towers were constructed at regular intervals so that watchmen taking turns through the day and night could protect the crops. This, however, was never successful in saving the crops.

The new doctor from a place called California had the perfect answer to their threatened starvation each year. He introduced them to a poison that was colorless, tasteless, and odorless. This was of course very dangerous. They would carefully make a small cut in the potatoes with the wind blowing away from them. The liquid poison would be dropped into the cut of the potato. These potatoes would be placed where they would be found, and reliable guards would hide in a secluded location to make sure children would not steal any of the poisoned items.

Very soon the king of the baboons would choose a baboon that would come and test the tainted potatoes. When the baboon was noted to be fine even one day later, the decision was made to take advantage of this great gift of potatoes! Shortly afterward, the first baboon was noted to be sick, and it was not long before the harvest was completely safe. The hyenas were happy about this turn of events because they could feast on the baboons that were so tasty. They did not realize the mortal danger that was involved because the poison that killed the baboons was still present in the baboons. As it was tasteless, odorless, and colorless, it could not, therefore, be detected.

In this setting, one tribal group found themselves close to starvation and decided to invade their neighbor’s properties on a moonless night. Even though all the path intersections were secretly guarded by an assigned guard or guards, the security program was not without breakdowns. On this particular night, the thieves had spears to take care of those watching over the cattle. Even though many of the cattle were kept inside the peoples thatched homes at night, there were still many who were not so fortunate. I learned of the attack because one of the guards was brought into the hospital early the next morning on a stretcher by a group of twelve friends. They had traveled most of the night to reach us as quickly as possible. The spear was still in place. It passed through the left upper quadrant of the abdomen, through the spleen, and out through the back.

The patient arrived on a makeshift stretcher made of young eucalyptus tree poles and smaller interwoven branches covered with a thick layer of thatch straw. Each of the twelve friends had taken their turn running in tandem to get to the closest help they knew of. It was around-the-clock emergency service, even though they knew there was only one doctor-surgeon available. The patient was immediately taken directly to our preparation room that also serves as a minor surgery room for evaluation and arrangement for immediate surgery. The first major surgical case for the day was a large ovarian cyst the size of a six-month pregnancy. She was taken back to her bed to make room for the new emergency. The laboratory technician arrived for a hemoglobin and hematocrit test as well as type and cross match. Our living blood donor list would be consulted. Those with the correct blood type would be called in. Two large-bore intravenous lines were started and a catheter inserted after the vital signs were completed. The examination showed there was no major bleeding; the chest exam revealed no abnormalities, and the abdomen was soft to palpation and without guarding or swelling.

After the induction of general anesthesia with an endotracheal tube in place, the automatic blood pressure monitor was attached and worked well. An esophageal audial pulse monitor was attached to the surgeon’s ear for monitoring. The patient was temporarily placed in a right lateral position to allow good antimicrobial preparation of the skin of the abdomen and chest wounds of entrance and exit. The section of the spear exiting the back was removed with a saw from our workshop and the antimicrobial preparation repeated while the patient was moved to a supine position with the legs wrapped with ace bandages and the feet slightly elevated as well as sterile drapes applied.

With the anterior portion of the spear draped out of the field, an incision was made in the left subcostal region to include the entrance wound of the spear. The procedure allowed a complete evaluation of the injury before removal of the spear and possible increase loss of blood. An enlarged spleen related to repeated malaria attacks was found. It had been penetrated, and minimal bleeding had occurred. With the entire injury in view showing no involvement of the left kidney, pancreas, stomach, or left colon, the spear was removed after the splenic artery and vein, as well as the short gastric arteries and veins had been carefully divided and separated. The spear could then be removed from the patient with the injured spleen. The tissue next to the spear was removed. The diaphragm was carefully inspected and found to be intact. A Foley catheter drain was put in place through the posterior excised spear wound and the abdomen closed after a repeat total evaluation of the abdominal cavity and hydrogen peroxide sterile water irrigation.

The patient made an uneventful recovery, which included tetanus prophylaxis and penicillin. Most important to mention is the fact that the group that had been attacked had previously become Christians. They met together to pray night and day for two weeks for the group that had attacked them. An envoy went to the other group and the end result was the return of the cattle that had been stolen, and an offer was made for a more lasting peace. The government asked the group that had been attacked to assist them in other disputes of a similar nature because the result had been so successful.

Our family growing up in Ethiopia

Just as i’m finishing my last surgery of the day

At the end of the spear

2

272 Stones

Having one stone in the ureter can be a life-changing experience! But think of having 272 stones of varying size and shape from the size of a green pea to an irregular brownish orange golf ball. This patient came at the end of a busy day with seven major operations being carried out in our one operating room constructed in 1947 with wood having been carried down from the capital city of Addis Ababa on the backs of camels as we were on the Cairo to Cape Town road. It was a three-week trip past tall mountains up to ten thousand feet in height and beside the Rift Valley Lakes. Some of these had high salt content and thus were frequented by beautiful flamingos. Others were infected by the Bilharzia parasite and were best avoided because of the complications of Schistosomiasis which was not so easily treated at the time. The usual length of the camel train was fifteen camels, and they were attached by a rope from tail to neck all the way to the last one with their guide and director leading the first one and another following the last one.

Mohamed Abdulla said he thought he was forty-seven years old. At that time, he looked much older and very sick. He lived far away from any village and was considered a nomad. Like many of his friends, he had never seen a doctor before. He had never been to a clinic to see a nurse or medical auxiliary. He had never been to a hospital of any kind, small or large. They were not part of his life, nor were they part of his friends’ lives. What he did know was the way of the nomad, the way of the desert, the life of the desert, and the life of the camels and goats.

He said he had had his trouble for about twenty years. Sometimes he would have excruciating pain on the right flank with radiation into the right groin. Sometimes he would have excruciating pain in the left flank that radiated into the left groin. His pain would cause him to writhe and scream with pain. The attacks could easily last for over one day. The witch doctor of his community would take a hot poker from the red coals or fire and touch certain areas of his abdomen to chase the pain away, but always, the pain returned.

He admitted that he even passed what appeared to be stones with his urine, but he had never collected any to show me. Some of these were the size of a large coffee bean. He also admitted to not being able to pass