Mounds of Stone: October 2013

Monday, October 28, 2013

Eulogy for Grandpa Ben...to me, the original Mitchell.

Serving the Lord across the ocean is never more difficult than when tragedy happens with your family back home and you long to be there with them. On Saturday October 26, 2013 my Grandpa Ben passed away. He had been suffering from vascular dementia and was on hospice, so we new the end of his life would come while we were in Kenya. However, anticipating his death doesn't make it any easier once it actually happens. As our family grieves, may they know that our hearts and prayers are with them. Below is the eulogy I prepared that will be read at his funeral this week. I'm sad that I won't be there to read it myself.

Eulogy for Benjamin Mitchell, from his grandson Eric.

It is good for a man to persevere through adversity and not let your handicaps define you.
It is good for a man to have the courage to venture away from home in search of a successful career.
It is good for a man to work with his hands; to build, fix, create, and be self reliant.
It is good for a man to pass on these skills to his sons both by example and direction.
It is good for a man to work hard and use the fruits of his labor to support and raise a solid family.
It is good for a man to instill in his family the importance of hard work, service, faithfulness, and truth.
It is good for a man to appreciate the beauty found in nature and to cultivate his surroundings, showing off God's creation.
It is good for a man to grow old with the girl he married, being an example of faithfulness through the good times and bad, through sickness and in health.
It is good for a man to enjoy the outdoors, to exercise his God given dominion over all the earth.
It is good for a man to have an opinion, and to know what he believes and why.
It is good for a man to be involved in his community, and to participate in the democracy so many take for granted.
It is good for a man to live a life that is an example to others. Some attributes as an example to emulate, others to improve upon.

For all of these, my grandfather Ben Mitchell, the patriarch of our family, was a good man. He will not be forgotten, as he leaves behind a legacy of good men that carry with them many of his good traits and talents. Grandpa Ben's legacy, three generations of Mitchell men, will carry on the good name he has given us. May his sons now accept with pride the position of patriarchs, and lead their families by example. May they invest in their children and grandchildren, making the most of each interaction. May his grandsons persevere through the business of life with hard work, discipline, character, and faithfulness. May his great grandsons grow up to be hard working men of good character who are trustworthy, respectful, truthful, honest, and faithful. May all of us Mitchells lead lives that bring honor and respect to both the Mitchell name and to The Lord Jesus Christ. May all the descents of Ben Mitchell honor this good man and his wife as we go forward today, carrying on the name he gave us.

Eric Joseph Mitchell

Thursday, October 17, 2013

The OR From An Outsider's Perspective

I got to do something this week that I would have never gotten to do in the States- go and watch Eric operate. I have always wanted to do this and we had a visitor here who volunteered to watch the boys, so I donned Eric’s scrubs (no one is going to mistake me for a doctor in two-size-too-big-scrubs and a huge grin on my face- though I did try to walk confidently by people and pretend that I was in fact the OTHER Dr. Mitchell) and headed for the O.R.

He first gave me the tour of the place and I got my hair net and mask. Right away I realized I could never be a surgeon for one simple reason- I don’t like re-breathing my old breath while wearing a mask- EW. Alas, I persevered and watched the end of a skin graft on a 12-ish year old girl. SO SAD. She had been badly burned on her back and stomach weeks ago and just came into the hospital recently, most likely because they hadn’t had the money and were hoping it would heal on its own. Poor, sweet girl.

After that, we were waiting for Eric’s case to start so we wandered around and hopped in an O.R. just AFTER a c-section took place. I was bummed, because that would have been awesome to see, but I did get to watch them sew her uterus back up and then tie her tubes. It was nothing like I thought it would look like. The ovaries and tubes were so tiny. Good thing I wasn’t doing it, because it all just looked like tissue to me. I got a good anatomy lesson from Dr. Kristin and asked 50 (ignorant I’m sure) questions.

Finally it was time for Eric’s surgery, the fancy name for it being “put two pieces of intestine back together”. There were 4 people scrubbed into the case so I was perched standing on a chair at the foot of the table. I watched the patient get intubated, and them re-open the cut (they had done his first surgery two days before) Then I proceeded to watch my super-hot-amazingly-talented-crazy-smart husband pull his skin apart (in ways that I didn’t think skin could stretch) and feel around and pull his guts out. Literally, lots of guts, outside of the body. How do all those intestines fit in there? It was like removing clowns from a car, they just kept coming! Wild. Somehow in all that mess Dr. McHottie (aka Mitchell) knew what to cut, burn, sew, etc. Pretty amazing. Maybe he really was learning something all that time he was gone in residency and not just off playing golf….. Anyways, the other exciting moments of the case (for me at least) where when the patients arm came awake and starting hitting Eric in the butt. That was pretty funny. Unfortunately, they just gave him more anesthesia and his arm went back to sleep. The other crazy moment was when they were sucking out his NG tube and a 4 foot tapeworm came out. Yep, this was big stuff, they were calling in everyone they could find to look at that sucker.

I had to leave half-way through the surgery to get back to the midgets, but it was good times and I hope to get back there soon to “help” out! J

Thursday, October 10, 2013

Reduce, Reuse, Recycle

Living in Kenya doesn't make it easy to keep tabs of what is going on in the US. I had no idea that the government was on shutdown because of budget issues until I was emailing with a very good friend back in the States who is employed by the government. He mentioned that he was in the middle of an unpaid vacation because Congress couldn't agree on how to spend its money. It appears that the big sticking point is paying for Obamacare. If I remember correctly, the bill increased coverage and tightened regulations on insurance companies, but did very little to control the escalating cost of healthcare in the United States. With increasing coverage, and continued increased costs, there is a lot of unrest about where the trillions of dollars are going to come from to fund healthcare.

Well, I have a few ideas on how we can control some costs. It may only be a small impact, but it is a start. I've learned these methods from working the past 6 weeks at a mission hospital in rural Kenya.

Lesson #1. Reuse everything.
In the states, everything in the OR is disposable. Use it once and throw it away. At Tenwek, everything is reusable. Use it once, clean it, and use it again. Repeat until it falls apart. Even the disposable things are reused. It's like washing your plastic cups and using them again, instead of filling up the garbage and then going to the store to buy more plastic cups.
One example is Bovie pens and the grounding pads that accompany them. Bovie pens are cool little instruments that use electricity to cut tissue, and seal off small blood vessels. A grounding pad is put on the patient so that the Bovie Pen will work. In the states, they get one use and then are thrown away. Here at Tenwek, they get used until they no longer function...then we improvise and get them to function again. A single bovie pad will get hundreds of uses. When the stickiness wears off, we tie them to the patients leg. When the electroconductive gel wears out, we squirt KY jelly on them.

What else do we reuse besides Bovie pads? Ventilator tubing, C02 monitor tubing, SCD's, Bowel Staplers, Ligasure, all laparoscopic equipment, light handles, all drapes and gowns, pleurovac containers, suction tubing...and the list goes on. This is just a list I made from looking around the OR. I haven't even looked into the wards. Some of these items are inexpensive, but others are upwards of $400-500 each. If it ain't broke, don't throw it away.
Some of you may saying to yourself, "I'd be worried about infection and cleanliness with using a bowel stapler for a second time." Well, we soak things like bowel staplers in Cidex to re-steralize them, and studies show it is effective and safe.

Tubs of Cidex containing "reusable" instruments.

#2. Give your post op patients Demerol and Tylenol for post op pain control.
Having surgery can be painful...especially with an incision all the way up your abdomen. In the states, we drown our patients with pain medication after their surgery...because people expect surgery (and most of life for that matter) to be pain free, and the hospitals expect the nurses and doctors to keep their patients happy. Vicodin, ocycodone, morphine, dilaudid, fentanyl etc. are used quite frequently and does a great job of making patients not care about the pain. However, one downside of narcotic pain medication is that it also numbs your bowels and slows them down, giving you an "ileus". (Ever gotten constipation after taking Vicodin? Imagine what happens when you take something 10x more powerful than Vicodin). Getting an ileus can prolong your hospital stay by days to weeks. You can't go home until you are able to eat and poop. Some estimates put the total collective cost of ileus at around one billion dollars per year. I'm convinced that Kenyans are tougher than us wimpy Americans. They take barely any pain medication after surgery...sometimes only Tylenol. And I've never heard them complain. One benefit of no narcotics...I haven't seen a patient with a post op ileus yet. Ironic? I think not!

#3 Make people eat Ugali and Sukamawiki everyday (the staple foods of Western Kenyans.)
It is fun to do surgery when 95% of your patients have no other medical problems. Perhaps this is because they don't go to the doctor much, but my guess is that it is because Kenyan's bodies are being treated how the human body was designed to be treated. Very few Africans are overweight, almost no one smokes cigarettes, processed food means that your corn and flour are in a bag, and just about everyone works outside for a living. I was in clinic the other day when I saw a lady in her 70s who needed thyroid surgery. Whether I am in the US or in Kenya, I always ask a few questions to assess whether the patient is physically fit to undergo surgery. When I asked this weathered lady (who looked more like 85 than 70) if she could walk a city block without getting short of breath she responded by saying that she walked 2 km to see me today at the hospital. Lets just say she sailed through surgery.
The latest statistics show that obesity and obesity related conditions will cost the U.S. about $190 billion dollars this year. Type 2 diabetes will cost us $174 billion. We could trim our waistline and tax bill by eating only Ugali (a corn meal) and Sukamawiki (collard greens/kale).

I'll leave you with a picture of me operating on a guy with anthrax in his throat. Never a routine day here!