2-23 Surgery Outcomes and Summary

I went into surgery on Monday afternoon. I tried very hard to convince them that I didn’t need a general anesthetic. I don’t like general anesthesia and I know it really knocks me out. Combine that with not having anyone in country to take care of me, I was a bit nervous about being put under.

They explained to me that because they were potentially working directly with the nerves, a nerve block might not work and that would be bad. Basically, if I felt something I could twitch and make them slip and that would be Bad.
I went to sleep

Three hours later, I woke up speaking Bislama. The nurse was a little confused. I’m just impressed with myself. I’ve managed to internalize Bislama to the point that I woke up in unfamiliar circumstances and immediately asked where I was in Bislama. Go me.
Once my brain worked enough to start asking questions, I did. The story as I understand it goes something like this.

They opened up the incision in my wrist to get access to the nerves. Once in there, they found the nerves fully intact. The surgeon cleaned it out really well and stitched it shut then wrapped it up in a lot of bandages.

I still don’t have feeling in my thumb. There are two explanations and no way of knowing which one is true. Explanation A) I damaged the skin nerves. They are too small to be repaired but will hopefully regrow on their own eventually. The problem with this explanation is the way the numbness maps to the nervous system and that it is such a large area. I’d have to have damaged/severed several skin nerves to take out that much of my thumb. Explanation B) I contused (bruised) the superficial radial nerve. It is now swollen and not letting the signals go through. I should get feeling back in a few months when the swelling goes down. The problem with this is that the surgeon didn’t seem to think I’d managed to hit it, at all.

Under either explanation, I will eventually get sensation back in my thumb. This is a good thing. I’d like to be able to feel my thumb.

Now, my hand hurts more than it did. I haven’t actually seen the incision. I know it is a lot bigger but I was told to keep it wrapped until the stitches come out in ten days. I’m not convinced with will happen because I know I’ll be sweating in Vila and that will make the bandages unsanitary. We’ll see what the Peace Corps Medical Officers have to say about it. I also want to know how many stitches I got. I’ve got a record to update…

All in all, this has been a pretty awful trip. I don’t like being cooped up inside. I don’t like waiting. I don’t like surgery. I spent most of it hungry and all of it lonely. It has been really hard to be on my own in a medical system I don’t know and to be without resources outside of myself to draw on. For instance, knowing that I couldn’t get checked out of the hotel unless I could get out of the ER but that getting out of the ER would mean I would have to officially refused care meant that I would then have to sit through the wait again to be seen. If I’d had someone available, I could have had them check me out and run errands while I waited. Not having an advocate at the hospital was hard, too. I had to both think about my own care and what I would tell me if I were not the patient. I had to run the line between being a pushy pain in the ass as my own advocate while being the patient that the nurses had to take care of. It was not fun.

I am now on my way back to Vila. I will write more about my one free afternoon in Brisbane after I fill out my immigration card.

2-21 Post Surgery

I finally had surgery. They came to get me around 3 today. I was down in the surgical unit until 7. I missed dinner which was really too bad since I was damn hungry.

I more or less have a functional brain again. Despite repeatedly trying to get a local anesthetic with a nerve block, I ended up under general anesthesia. I was out for about 3 hours. When I woke up, I confused the nurse. I wasn’t speaking English.

I was speaking Bislama.

I think I’ve learned the language pretty well.

This is short because my hand hurts and typing is both difficult and a little painful. As far as I know, they cut open my hand, looked at the nerve, decided it wasn’t damaged, cleaned it out and sewed it back up. I still have no sensation on my thumb. I’m a bit concerned.

I’m still on IV antibiotics. I’m really thirsty and my throat hurts. Stupid anesthesia.

2-20 Lost in Purgatory

Sorry it is sideways.
But this is my fashion statement.

Around 10:30 pm Saturday night, I woke up completely when they told my neighbor they’d be closing the ward and we were all moving. I put my things back in my bag and fell back asleep until they came to move me. That ward was a six-bed room with three men, two women and me. My cubicle didn’t have a curtain, my neighbor was using it to double block his cubicle. My neighbor was also a bouncer, used to bouncer’s hours with bouncer friends who also keep bouncer’s hours. They were talking while I was trying to sleep. (It was probably like 8:30 at night, really.)

I fell back asleep waiting to be transported to a different ward. I got to my new ward around 11:30. They did all the usual things and shot some more antibiotics in my arm. Then the nurse informed me that in half an hour, I would be fasting and was there anything I’d like to eat or drink before then?

I had a glass of water and a sesame crackers. I passed out.

At 5 am, the nurse came back to wake me up. In an hour, I needed to be scrubbed for surgery, in a surgical gown and hooked to an IV with my antibiotics already pushed. I got up. I got my hands taped up again. Showering with plastic bags taped over both hands is really interesting.

I have no good hand
To explain that, at this point, I have a bandage on my left wrist where I cut it and an IV in my right wrist. Honestly, the IV is the more painful and annoying of the two. The lock keeps catching on things and the tagaderm is tugging at my arm hairs. I can’t feel the parts that should hurt on my left hand, which makes it worrisome but less painful.
I got myself scrubbed eventually. I even washed my hair, sort of. I put on the paper underwear they provided. (I didn’t have a choice. The nurse stressed that point.) I put on the lovely purple gown they provided. I got back to my bed in time for my breakfast IV and antibiotics. I braided my hair and brushed my teeth (without swallowing). I almost felt human.

Seriously, though I am writing this in a light tone, Saturday was a really bad day. I was having random crying fits all day. I am incredible lonely and I want someone to take care of me or at least to be my advocate. I still don’t want to be here and I am still struggling with a lot of things, including some of the fundamentals like lack of sleep and food, but at least I’ve had one place to stay all day.

My Purgatory
Since 6 am, I’ve been waiting for surgery. At noon, they told me I could eat lunch because the theaters are all full. I’d been pushed back to Monday.
I immediately pulled out my chocolate stash. An hour later, a different nurse came in and told me not to hold my breath about having surgery today because a trauma had come in the ER. I told her I’d been told to eat. She looked confused. She went to go talk to some people. She came back and told me I was right and she’d be talking to the surgeon, not the ones in charge of running each operating theater. I ate lunch. It was hospital food, but I was damn hungry.

It is now 7:30 pm. I’ve been playing computer games most of the day. When I got bored with that, I would go for walks or do yoga on the terrace. I found raspberry sorbet at the hospital store. That improved the world for an hour or two. I’ve gotten a lot of funny looks for my fashion choices today. I am wearing my black and pink flowered zuba board shorts, a white tank top, black flip flops and TED stockings. I have bandages on both wrists and I’ve been wearing my gown backwards like lavender jacket. People must think I’m nuts when I go wandering around in the hospital.

The terrace. This is what they call “outdoors.”
My neighbor is a lovely woman who has an iPhone. We got to chatting, I was listening to her story and being interested and sympathetic. She’d been in the hospital for way too long and it’s looking like she’ll be here for awhile longer, poor woman. Then she heard me lamenting the lack of internet. She let me use her iPhone for a bit. Awesome!

One of the other women in my ward is actually more of a girl. I think she’s about 17 and has also been in the hospital for too long with very little chance of getting out anytime soon. I’ve offered to play cards with her, but her family is great about being there almost constantly during visiting hours. I’ll play after 8 pm tonight when they have to leave.

Our last roommate is a cranky old lady. She is not a happy camper, but she also sleeps most of the time. I think this room is a total promotion from the previous one. It is a Gynecological ward, but hey we’re all ladies here!

At midnight, I go back on my saline-by-IV diet. Hopefully tomorrow morning I will get surgery and the sooner I’m out of the hospital and into a hotel the happier I am.

I got the impression Medevacs were swank. This has been a nightmare.

2-20 From the ER to the Short Stay Ward

I got up Saturday morning and walked to the hospital. Do not pass go, do not collect $200. I didn’t eat breakfast, I just got myself there.

I checked in, was recognized by the staff from the night before and then sat down in the waiting room. Around 8:30, a nurse came to find me. Then I sat in a different chair for awhile. Around 9, the ortho doc sat down and we chatted. She poked my thumb a bit. She told me I’d be an in patient for a few days because they want to do a general anesthetic. She told the nurse to admit me.

By 10 am, I’d gotten through to the PCMOs who had in turn called our financial person who called the hotel. I had to go check back out of the hotel that I’d been in for three hours, except that I was admitted to the ER.

I chatted with my nurse about the situation. She asked me if I had family or friends in the area. I explained that I had exactly no one anywhere in this country. She decided I’d developed a sudden interest in smoking and told me to go take a smoke break and be back by noon.
I took off like the stereotypical bat out of hell. Not only did I need to go pack up my things and check out of the hotel room, I also needed to stock up on little things for my stay in the hospital like toothpaste, chocolate and Aussie cash. I caught a bus into a shopping district in Brisbane. (The bus card was courtesy of another patient in the ER who gave me her old empty card and a whole bunch of recommendations about places to go and things to see while she was between bouts of morphine.)

I stopped in at a camera store and got an SD card for my new camera. I stopped by the money changer and changed the US cash the Peace Corps had given me for travel expenses. The man in front of me there couldn’t have been slower if he’d been doing it with both eyes closed and counting with just his tongue. Then I went to a food court and got a real fruit smoothie. I miss smoothies. They are amazing and don’t really exist in Vanuatu. I also got a chocolate-nutella crepe. That was the first food I’d eaten since the airplane dinner the day before. After that I stopped in a hippy-food store and stocked up. Then I ran to catch my bus and make it back by noon.

I informed my nurse that I was once again not interested in smoking and would be in the waiting room when she was ready to start the IV. Around 1 she came and got me, only to be called away before she could actually start the IV. So, I chilled in a bed for awhile. She came back and put in another IV, this time in my forearm. I only have two good veins for needles. Both of them had been recently stuck. It took her two tries to get this one and she went for it at my request. The other option was my elbow and I didn’t want to deal with keeping my elbow straight for the next few days. It hurt, but she got it eventually and pushed another dose of anibiotics.

Then I hung out in that chair for another hour or so. They took the bed away for someone who the ambulance brought in. I wasn’t worried about it, just tired. I wanted to get admitted so I would at least have a bed to lay down in.

Dinner. Not appetizing.
Around 2:30, I was admitted. I did things like re-packed my bag to be able to find things and sorted my receipts into the “need to turn into Peace Corps” and “put in computer” piles. I charged my phone, camera and computer. I wrote part of these blog posts. I played video games. Around 7, they pushed more antibiotics. After that, I tried to eat dinner but nearly puked it back up. I decided fasting could start early and took a shower instead.

My shower never got warm. I usually take cold showers on Pentecost and it is no big deal because Pentecost is hot. The AC here was at about 65 degrees. I was freezing. The shower didn’t help anything. I went and got two more blankets and huddled under them until I fell asleep.

2-20 The Continuing Saga

That’s the arrow pointing the way…

I landed in Brisbane around 6:30, Brisbane time. Then I started going through immigration. That went pretty quickly, though honestly I read my book through most of the line. I stopped in Duty Free shopping and bought a cheap digital camera. I didn’t bring one and some things just require documentation.

When I got out to Customs, I was appalled by the number of people. Please try to understand that the island of Vanuatu has about 8,000 people on it. The line for Customs was probably 400 people long. It went out of the zigzag and wrapped back around the baggage carrousels. I haven’t seen that many people in one place since I left New Zealand’s airport 6 months ago.
I got through the line, again I read my book for most of it. (Young Warriors edited by Tamora Pierce, if anyone cares.) I stopped at a mobile phone kiosk and bought a new phone. It was an expensive night. From there, I caught a taxi to the Brisbane Royal and Women’s Hospital. This place is huge. There are more people staffing the hospital than live on Pentecost. For those of you in the Cities, this is the HCMC of Brisbane and sprawls like it, too.
I checked into the ER around 8 or 8:30. Around 9, I was seen by triage. I was put in the fast track waiting room. I stayed there until 12:30 or so when I was brought to X-ray. I waited in the X-ray waiting room for another half hour, got an X-ray and went back to the fast track waiting room. I didn’t break any bones. Around 2:30 in the morning, I was put in a consultation room. I stayed there for another hour.
There were lots of signs, that one is above the bus station
Remember how I got up at 4 after about 4 hours of sleep? With that time difference, I was pushing 24 hours without sleep. I was in a place I didn’t want to be, worried about my hand and frustrated by being caught in the system. I was lonely and miserable.
By the time the nurse came in again, I was crying. She decided something had to be done with me, sooner rather than later and left. I sat by myself for another half an hour. The doc came in. I cried at her, too. They told me that the ortho doc would be in a 7 am and I had the choice of staying in the ER until then or going and checking into the hotel. It was 3:30 in the morning, I had to be back in under 4 hours. I figured I’d stay.
Then they took away my bed.
The ER was too busy to let someone like me use a bed when there were other people still waiting to be seen. I changed my mind. I checked out, they pulled the IV and I caught a cab to the hotel at 4am.
At the hotel, I took a shower and fell into bed. I slept off and on for an hour and a half. I got up a little after 6 when it was clear that I was too keyed up to sleep and it was time to get back to the ER.

2-18 Epi to Vila to Brisbane

It is ten o’clock at night. I’ve been up since 4 am.

We got up and left Epi at daybreak this morning. Between the plane check and the weather, we didn’t get in until 7:45. The Peace Corps Medical Officer met me at the Vila Airport and gave me a ride to the office. Once we got to the office, Nelsine looked at my hand and it confirmed her initial impression. There is likely nerve damage.

I still have no sensation in part of my thumb, though my range of motion remains intact. If I tip my hand sideways, I get a tingly feeling next to the numb part. If you look at a diagram of the nervous system of the hand, where my thumb is numb almost perfectly maps onto the branch of the radial nerve the feeds the top and outside of my thumb.

There is no microsurgery in Vanuatu. There is no guarantee of a sterile environment. Given the position of the incision, an infection could have serious effects on the movement and sensation of my entire wrist and hand. They sent me to Brisbane, Australia.

After I met with the PC doctor, she got an appointment at the hospital to talk to a surgeon. He looked at my hand and agreed with her assessment. From there, a lot of paperwork happened. A lot of running around happened. I was in and out of the medical office enough that one of the PCMOs started joking that I should just get my own key.

I signed a lot of forms. I got a visa to go to Australia. I got given my per diem in US dollars for the visit to Australia. I signed a few more forms. I got an insurance card. Eventually, I went to lunch with a few friends. It was nice to see people and pretend like nothing was wrong. Then I went back to signing forms.

My flight was leaving at 4 pm. By 1 pm, the Brisbane hospital hadn’t gotten back to my PCMOs about a hand surgeon. I couldn’t leave Vila without the Brisbane coordinator giving the ok for me to go, which she couldn’t give until she’d found a place that could give appropriate care. The next flight was on Sunday, which would have been fine, except that there is a tropical depression over Vanuatu which is likely to turn into another cyclone over the weekend. That would mean I couldn’t get out until sometime next week, which is not ideal for getting my hand put back together.

At 3:10, the paperwork came through. Did I mention I was getting on a 4:00 flight? I grabbed all my stuff, stuffed it in my bag and ran out the door. We got checked in by 3:30 and through security. When I tried to call Jason to tell him I’d made it on the plane, I found out my phone had to credit. One of the security guards was nice enough to take my money and go top up my phone. I called and left a message for Jason saying I was leaving, on a jet plane.

2-17 To Start at the Beginning

Who’s the biggest klutz on Pentecost?

The answer to that used to be Sarah who managed to fall down on a knife and had to get medevaced into Vila for six stitches within the first month of getting to site. I think today I took the cake.

I was opening a coconut with my bush knife. I was making banana bread. I thought it would be improved with some coconut milk. I was about three-quarters done with skinning the coconut. The skin was wet, which makes it less brittle and harder to pierce with a bush knife. My bush knife bounced. The second bounce landed on my wrist.

I haven’t had sensation in the back of my thumb since then. That was about eight hours ago.

After I did it, I called the Peace Corps doc. She told me to clean it up and that she’d call me back in half an hour. I told her I thought it would be alright. She called me back to tell me to be at the airport at 4 for a chartered medevac to Vila. I told her I didn’t want to go. She said too bad. Conveniently for one of the volunteers on North Pentecost, we picked him up on the way. He is supposed to be flying out of Vila for a trip to New Zealand for a month but his flight was cancelled.

I am going to interject here, that I don’t want to go to Vila. Though Vila is a lovely, if over stimulating place, it is not my place. It is not my island, my house with my partner and sleeping in my bed. Not to mention I’m going in again in 2 weeks for my training. I tried to convince the doc that 2 weeks would be plenty of time. She didn’t buy it. I spent the next hour packing my bag and cursing at myself.

Jason called a truck to ask for a ride to the airport. The driver said sure, he’d pick me up shortly because he was going to Ranmawart which is about 20 minutes north of the airport. Jason and I walked down the hill to wait at the main road for the truck. After about 45 minutes, we called him again. He’d gone past the village and wouldn’t be back for a bit because he had to find diesel for his truck. I’m not quite sure what happened there. I think he forgot me.

Luckily, my uncle who owns a truck happened to drive by. I asked if he’d give me a ride to the airport. He agreed so, at 3:00 we left for a 4:00 flight. The airport is about 45 minutes away.

We made it. My uncle even had time to stop for cigarettes and to ask about diesel for his truck. Then we sat at the airport for 45 minutes.

The plane landed, much to my chagrin. I think the truck I rode in on the way down to the airport was bigger. It certainly had more leg room. We spent a bit of time discussing weights and weight issues. The guy from up north is not small and he’d brought his bags for hiking. I pulled out a couple of books and asked my uncle to take them back for me. I dumped out my water bottle. We figured we’d be alright. We got in the air.

About 15 minutes into what should have been an hour flight, the pilot says, “Do you want the good news or the bad news first?” The guy from the North says, “Bad news.”

“We won’t make it to Vila.”

Can I point out at this juncture that I didn’t want to go in the first place? Now, I’m not even going to get to Vila. My hand doesn’t hurt but I’m a little crabby about the turn my day has taken. And the part where I have to go to Vila for an unknown period of time. Now, I wasn’t even going to make it to Vila. I think it was a good thing I held my tongue. I was working on a nice string of profanity.

The problem was purely legal. There is a law in Vanuatu saying something about small planes landing at the airport after civil twilight and how that is not ok. We were going to miss civil twilight by ten minutes. If we’d left slightly earlier, if we had slightly less weight, if, if, if…but none of those ifs were true. The pilot tried calling ahead and giving the subtle hints about needing permission to land after twilight. It didn’t do any good.

We diverted to South Epi. We are staying at a lovely guest house. It has hot and cold running water and hydropower electricity. We were fed an amazing meal of curry and chocolate icecream. I’ve spent the evening BSing with interesting people. Really, this is a really nice guest house. I would happily recommend it as a place to come for a chance to see the area in comfort.

I don’t want to be here. I want to be in my own house, working on surveys and Aid Post Committee meetings. I don’t want to be on Epi, I don’t want to be heading to Vila. Hopefully, I’ll make it through to Vila in the morning.