When a patient dies one always wonders what could have been done different to avert death. One died this am that was one day post-op prostatectomy that was uneventful and he was doing well at 0700 then at 0730 he suddenly got short of breath and died unexpectedly. Possibly a pulmonary embolus (blood clot to the lung) and I am still not sure what we could have done differently. We don’t have anticoagulants here other than aspirin but he was a low risk for problems. The other one was a large abcess and infection of jaw and neck and possibly the mediastinum. We had drained a large amount of purulence from the neck but she was not improving much then died this pm. I don’t know if a trach would have benefited or not but it is difficult to get good nursing for a tracheostomy. We have little children that die almost upon arrival from malaria fairly frequently.
We have had 4 ruptured uteruses recently but so far all have survived. But the death angel was really close esp for one of them that was having gasping or agonal respiration as we were beginning her c-section but with lots of IV fluids and blood and getting her bleeding stopped and emergency hysterectomy. She is doing well today. Not sure but we think all the ruptured uteri had been given IM oxytocin (medicine give to have the uterus clamp down to prevent bleeding) before they were referred here. One of the ruptured uteri even had a live baby. Miracles still happen. Another c-section for prolonged labor, dead baby, now has had some sloughing of her vagina and urethra. Not sure how much repair she might require later. We had also a severely necrotic (mostly dead) prolapsed uterus that was very very large. We had amputated it basically and it did not involve the bladder however the infection apparently ascended up the stump and inside the abdomen. We had to open her abdomen a few days ago and there was much purulence in the abdomen but no perforation of bowel so she was irrigated out and drained and so far the death angel is holding back.
Recently a liver abcess ruptured and patient was very ill and painful. The laparotomy for acute abdomen was done and the abcess was found and drains placed and now patient is doing ok and the death angel holding back.
We have 3 “in house” now with cancer of the bladder that could not have anything done. Today there was a 6 month boy with a huge mass in the upper abdomen (filled most of abdomen) growing rapidly past 3 months mass that is. Probably a large cancer. Parents decided against surgery which might not have helped anyway so the death angel will have that one soon.
Here in Chad almost half of children die before age 5 mostly from malaria, malnutrition, and parasites. So the death angel visits most families fairly frequently. Malaria especially can be very deadly.
We are all in good health except I recently had a “cold” but am recovered. Dolores is working long hours making costumes for a bunch of school children for their Christmas program which is next week.
We covet your prayers and emails.
Our emails are: drbland@sbcglobal.net and dfbland@gmail.com Our internet is operative only occasionally but we eventually get the emails. Unable to get on Facebook or Linkedin.
Love Rollin and Dolores
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