January 10, 2010

Hernia Surgery in Short

Hernia Surgery in Short

I wrote this story once. Bloody power failure occur ed mid upload onto Blogger followed by the power coming back on with a surge that caused the bulb above me to explode. Fortunately the office has a couple very good power stabilizors and surge protectors and though my computer survived the upload did not. Major ambition killer it was. Glass shards in my hair, darkness reigning the office, alone, combined with the gas not working that day and the pissing rain outside I decided to go to Baku to get my monthly shower and let this project set for a bit.

But now Im back. The holiday season is over and Im ready to get some work done. Lets start today with the conclusion to the Hernia Saga.

Chapter 1: Preperation

Remember last October. 5 months+, nearly 6months after first being diagnosed with an inguinal hernia I received word from the PC Medical staff that Washington DC in its infinite wisdom finally approved me for an "elective" surgery to sew shut the large hole in the muscles in my lower abdomen that are supposed to keep my intestines on the inside. It seems Washington believes that aslong as a hernia isn't currently strangulated then fixing the problem is elective rather than priority. Most common cause of strangulated hernia is constipation or similar gastric distress. Most common medical complaint of PCVs in AZ – gastric distress. Meh.

I travelled to Baku to inspect Tusi Hospital where AZ-PC Medical wanted to do the surgery and to meet the surgeon. I must say that the AZ PC Medical staff is very caring, informative and effective. Thank you Irena, you're damn good at what you do. We first went to meet the surgeon. He office was at the Oilworkers Hospital in Baku but he often handles surgeries at Tusi. The Oilworkers Hospital was a crumbling Soviet relic, marble floors in the lobby disintegrating, a doorway boarded up with an overturned table and warning tape, we waited a few minutes in the doctors office on a couch with ancient cracked pleather revealing old discolored foam before the doctor arrived and met with us in a conference room. I have been told that in the last few years the government has dedicated many millions of manat to buying equipment and refurbishing but I saw no evidence of this. Dear reader you may gather I did not expect much. The doctor, a tall, balding Russian I expected brusque arrogance, an expert who would disdain the questions of an ignorant patient questioning his "expertise". Let me say here that while this is a frequent attitude presented by "experts" here this is less a commentary on the local or even post-Soviet culture but based more on my experience with doctors in other parts of the world. In Japan I had a few experiences with hospitals and while ta few doctors I dealt with there were very professional(in the idealized Western sense) a very significant number were unwilling to answer questions or to take my concerns seriously. Fortunately there, in the last couple years at least, my language & cultural understanding was such that I could argue, be obstinate, and force them to take my concerns into account. Sadly my Azerbaijani & Russian aren't up to that task here.

Taking a seat in the conference room while my PC Medical escort and the doctor spoke in rapid Russian I expected the worse but insisted on introducing myself. In Azeri "Salam alekum müəllim. nim adım Kriş. Çox şadam.” (Salam alekum doctor. My name is Chris. Its nice to meet you.) to which the doctor responded “It's good to meet you to. My name is XXXX. Irena has been telling me about your hernia and I hope we can take care of it quickly.” in slightly Russian accented but quite fluent English. A wee bit taken aback I quickly learned that this doctor had done much of his training and residency in the UK and occasionally went on work trips to Canada. Indeed if he was to do the surgery it would be necessary to schedule within the next month because he was soon going back to work in Canada. As we spoke I learned more about his qualifications and the procedures used in repairing a hernia. He asked me a number of questions about my condition, listened to and answered my questions, took my concerns and requests seriously and promised to accommodate them to the best of his abilities. My main concern was that I not be knocked out by anesthetic. Rather I wanted an epidural(spinal tap) so that I could remain conscious and watch the surgery as I had when they reconstructed my leg & knee after the motorcycle accident back in Japan. The doctor was of course a bit concerned that most patients become distressed by the site of blood and such but seemed to appreciate my interest in his art and all similar engineering puzzles. I was assured that this wouldn't be a problem.

Next we went to visit the hospital where surgery would be completed. This hospital was newly built and indeed as we looked through one of patient rooms one could still find price stickers on some of the furniture. The bathroom was clean and well tiled with a hot shower and Western-style toilet. The nurses were polite and seemed able. On closer inspection later I began to realize that everything, though new, was of low quality and would in a few years fall into disrepair. The doors and corridors weren't built large enough to allow easy access by the patients beds and were severely scuffed and dented. The doctors and nurses where all apologetic but I couldn't be allowed to inspect the operating room for hygienic reasons. This was very reassuring as I had already decided I wouldn't allow surgery to be done in a hospital that would allow such a breach.

A final note about the hospital. When you enter the patient wings of Tusi hospital or the fancy expat dentist Peace Corps sends us to they make you put on little blue plastic baggies over your shoes with elastic bands to hold them on around your ankles. Presumably to keep the street dust, animal feces and dirt out of the hospital. I Japan schools, dentists and lots of hospitals made you leave your shoes at the door and wear slippers. In hospitals these slippers were “sanitized” under UV lights when not in use. I haven't decided yet if this is all still a good idea or just a hold-over from the old, dirtier days. In Japan it doesn't seem necessary anymore but in this country it seems like an excellent idea. It just feels odd to wear plastic bags on your feet.

So it was decision time. Did I feel comfortable doing the surgery here in Baku with this surgeon and hospital or would I insist on being sent either to Washington or to the PC medical center in Thailand? Tempting as a week or to in either place was I could find no rational reason to insist so. Though simple emotional obstinence, “I just don't feel comfortable doing it here!”, would have been sufficient in the end ethics and respect for the tax-payers dollar won out over my desire for a nice vacation.

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