#top surgery scars both from the incisions AND also where the sutures that held my drainage tubes in

[cerbreus]

tied-up-teacup​:

marzipanandminutiae​:

scars in fiction: I got this trying to save my lover from an assassin- but tragically, I was too late. now I carry the mark of my failure with me always, and I can never forget~

scars in real life: so I was trying to open macaroni sauce with a paring knife

Tell me how you got your scars in the tags

[momscookingthebooks]

Living Out Loud, an all-new emotional standalone from Staci Hart is available NOW!

Bestselling author Staci Hart brings you another installment of the Austen Series, inspired by the works of Jane Austen, with a heartfelt contemporary retelling of Sense and Sensibility.

When Annie Daschle arrives in New York City, the only thing she can control is her list.

Not her father’s death or the loss of her home. Not the hole in her heart or the defective valve that’s dictated so much of her life. But she can put pen to paper to make a list of all the ways she can live out loud, just like her dad would have wanted.

See the city from the top of the Empire State Building: Check.

Eat hot dogs on the steps of The Met: Check.

Get a job at Wasted Words: Check.

What wasn’t on her list: Greg Brandon. And just when she thinks she’s figured out where to put him, everything changes. In the span of a few staggering heartbeats, she finds herself her caught in the middle of something she can’t find her way out of, with no clear answers and no rules.

List or no list, she realizes she can’t control anything at all, not even her heart.

Not the decisions it makes, and not the moment it stops.

Excerpt:

GREG

We chatted as we walked down Fifth to the bike rental station and unlocked one of the blue bicycles. And a little while and one park bench later, we were walking through the park in search of a grassy stretch off the beaten path.

We found what we had been looking for—a space lined with trees, somewhat shielded from the rolling, open knoll by boulders jutting up out of the grass.

“This looks good,” I said, lowering the kickstand before taking off my backpack.

She pulled off her bag, looking nervously at the bike as she took a seat in the grass. A thin sheen of sweat glistened on her cheeks and forehead, her face a little pale.

“You sure you’re okay?” I asked, eyeing her.

She smiled—her favorite way to answer. “It looks worse than it is. Promise.”

I frowned. “Really, maybe the bike is too much. Maybe we can do this after your surgery.”

“Greg, I’m fine. Come sit by me for a minute.”

I kept my arguments to myself and sat next to her.

“The cool air feels so nice,” she said, gathering up her hair and pulling it over one shoulder, exposing her neck.

“When they fix your heart, will you still feel like this?”

“No. I should be able to do anything physical I want within a few weeks of the surgery.”

My brows drew together. “Really? After open-heart surgery?”

“Really. It’s not like a heart transplant or anything. The hardest part of my recovery will be the incision and the fusing of my sternum back together.”

A shudder tickled its way down my spine at the thought of a bone saw opening her rib cage. “What all will they do to your heart?”

“Close the hole, repair my valve. I’ve had open-heart surgery before, but I was too little to remember anything about it. The scar is the only proof that it happened. Well, that and my mother’s stories. But this shouldn’t be too hard on the muscle itself, just some sutures when it’s all said and done. My body will work a lot more efficiently once the surgery is complete—like, immediately. I just have to get through the whole split-ribs thing,” she said with a little smirk. “All right, I feel better. Are you ready?”

She looked better. Her cheeks and lips were tinged with color, and the waxy quality her skin had taken on was gone.

“Ready when you are.”

We got to our feet, and I stepped to the bike to lower the seat. Once it was down, I waved her over.

“Come here and see if this works.”

She climbed on cautiously, her feet on the ground and her hands gripping the handlebars. The seat was probably too low, but I figured it’d be better for her center of gravity—plus she could stop herself easier if she tipped.

“Okay,” I started, one hand on the back seat and my other on the handlebar next to her hand, “I’m gonna hang on and hold you steady while you pedal.”

She shot me a worried glance. “And if I fall?”

“You get up and try again.”

She laughed, not looking convinced.

“Don’t worry; you’re not going to hurt yourself on the grass, but I’m not going to let you fall. I’ve got you, okay?”

With a deep breath, she nodded once. “Okay.”

“All right. Put your feet on the pedals.” My grip tightened when the balance was all on me. “Ready?”

“Ready,” she echoed with determination.

“Now, pedal.”

She did, moving us both forward, the bike only wobbling a little bit under her.

“Good, let’s go to that tree. Just keep it slow like this.”

Her tongue poked out of her lips, her hands white-knuckled on the handlebars until she got to the tree. And when she smiled, it was with more confidence.

“I did it!”

I laughed. “You did. Come on, let’s go back. Ready?”

She nodded, and we took off again. This time, she wobbled a little less, speeding up until I had to trot next to her to keep up.

When we stopped at our backpacks, she cheered. “Again!”

“All right,” I said on a chuckle. “I’m just gonna hang on to the back this time. And…go.”

I did just that, my hands on the back of the seat, the handlebars swerving a little but nothing she couldn’t correct. And then I let go.

She didn’t notice, wholly focused on staying upright, and I kept jogging, pulling up beside her. When she glanced over, I held my hands up in the air and wiggled my fingers.

Her face opened up with joy, and a whoop passed her lips—just before she swerved into me.

A string of expletives hissed out of me as I tried to grab her, but it was too late. She tumbled into me, bike and all, taking us down to the cold grass.

Annie was lying on top of me, her hair tossed across her face. The ground was cold and damp under me, and the handlebar of the bike was jammed into my ribs, but I barely even noticed. Not with Annie sprawled out across my body, her green eyes sparkling and her laughter ringing in my ears.

My own laughter met hers like an old friend.

“Are you okay?” I asked, sweeping her hair out of her face to tuck it behind her ear.

She flushed but made no move to pull away from me. “I’m fine. Are you okay?”

“I’ll live.”

We watched each other for a moment through the rise and fall of my chest, the movement carrying her like a rocking ship. And then she giggled again, climbing off me before reaching for the bike.

It was then that I began to fully comprehend the depth of the trouble I’d found myself in.

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Wasted Words

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About the Author

Staci has been a lot of things up to this point in her life -- a graphic designer, an entrepreneur, a seamstress, a clothing and handbag designer, a waitress. Can't forget that. She's also been a mom, with three little girls who are sure to grow up to break a number of hearts. She's been a wife, though she's certainly not the cleanest, or the best cook. She's also super, duper fun at a party, especially if she's been drinking whiskey.

From roots in Houston to a seven year stint in Southern California, Staci and her family ended up settling somewhere in between and equally north, in Denver. They are new enough that snow is still magical. When she's not writing, she's reading, sleeping, gaming, or designing graphics.

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[ktkski2017-blog]

Getting comfortable

February 17, 2016

After our safari adventure we returned to work bright and early Monday morning. Chapel was a bit easier to swallow as the sermon didn’t involve sinners and homosexuality and other cultural/religious intolerance. We then proceeded to the morning rounds to hear about the admissions/discharges/deaths  from the weekend and to create a plan for the week. Jason and Derek left for a conference in Thailand and Dr. Ikunda, Dr. Christine (Ob/GYN) went on vacation as well, so Emily, Provi, and Clark were the attending physicians on the wards along with two surgeons that were sharing call. So to divide and conquer: Provi and Jen both started on the pediatric’s ward, Clark joined Janet and Musa on men’s ward (and Jen joined them after Peds), Lena held it down with Eric on women’s ward (and Provi joined them later), and I followed Emily and Boase (spelling?) to the OB ward (and then would make cameo appearances on men’s ward in the afternoons). It sounds like over our safari weekend they were even more short-staffed as Provi was trying on wedding dresses in Nairobi and Clark was with us on safari (sorry Emily and Jason!)

OB was a nice change of pace from the medical wards, as is to be expected when you switch from sick patients to young healthy ones. Certainly there were still complicated cases and unfortunately infant deaths – however this OB unit was much better managed than in Blantyre, Malawi when I was a medical student. In the antenatal ward we had quite a few “rule out labor” patients who were then admitted not in labor and kept for 4-5days as we waited for urinalyses and QBCs (CBCs) to be completed and to convince everyone that they were actually not in labor (although some of them stayed long enough that they became term or then naturally ended up going in to labor). Some mothers were anxious because they had had previous bad outcomes (a nice way to say they lost their previous babies for various reasons related to complications during pregnancy or poor resources after delivery or some infectious disease when the children were no longer newborns). We had one patient at 32 weeks with uterine fibroids, one of which was the same size as her unborn child – they had been trying for 16 years to conceive and carry a child to term. The fibroids were pushing on her diaphragm and making it difficult for her to breathe – typically these patients go in to pre-term labor due to lack of room for the baby. Unfortunately the survival rate for infants that young is very poor, so we encouraged the mom to keep it up and try to keep baby as long as she can (with close follow-up in the outpatient clinic they have at the hospital). Other mothers presented not due to anxiety or any major complaint, but “their husbands told them they needed to have the child.” This is a very confusing cultural thing as we at the hospital are certainly not going to deliver a pre-term newborn by c-section in an otherwise normal pregnancy. This mother said that she couldn’t return home until her baby was born… which meant that she was going to be in the hospital for another month as she was 34-35week estimated gestational age and we wouldn’t deliver a normal baby by repeat c-section until 39weeks or she is in labor.

In the post-natal ward we saw a variety of moms post-delivery – from a cursory post-vaginal delivery once over/ “any questions”? To checking incision drainage and evaluating patients for retained placenta for the post-c-section mothers. The babies were managed solely by the nurses on this ward so we didn’t ask any newborn questions or provide any education. Similarly the nurses supposedly discussed post-delivery birth control with the patients. As I am nosy, I would often ask the mothers how their baby was doing after we had discussed the mother’s plan. This sometimes changed the flow of rounds but there were a lot of nursing students who seemed interested in checking out the babies and translating questions for the mom. Besides, Emily and the clinical officer were the main plan creators and I was mostly useful in the differential diagnosis and work-up planning for patient’s that were not doing as well. We did visit several moms who did not have babies with them. In Malawi, the post-natal ward had a routine rate of 50% of moms without their babies. Here the ratio was more like 15-20%. Unfortunately the moms without babies are often times mixed amongst the moms with crying babies, which I think would be difficult for me if our roles were reversed and I had just lost a child.

We also would round in the surgical ward on gynecology patient (or OB patients that had pre-viable-in-Kenya-standards fetuses up to 24weeks gestation). We had one patient who had had post-op infection of her cesarean scar and showed up with pus coming out of her uterine incision (which was low-transverse and then later converted to a vertical incision). Quick (graphic) anatomy lesson for non-medical people: with c-sections you typically cut the skin horizontally across the abdomen, just above the pelvis, unless it is an emergency – although there are a notable number of vertical incisions here in Kenya to make it seem like it is relatively routine. Then you separate the abdominal muscles (without a scalpel) which are naturally separate in a vertical manner (think washboard abs and the vertical space between then). Then you enter the abdominal cavity and separate the bladder from the very obviously large uterus, and finally you cut horizontally in to the uterus and deliver the baby’s head. For this patient – the wound was doing very well, with no more pus, and very little dead  tissue (that typically needs to be debrided). However the surgeon (supposedly ’at a different hospital’) had made a transverse incision through her abdominal muscles (maybe they thought it was her uterus?) and put in non-reabsorbable (read: permanent) sutures. We had left those sutures in place because we were unsure what they were attached to. The actual uterus? The peritoneum? Fascia? Eventually we will need to remove them as they are likely the source of infection (any foreign object in the body has risk for holding on to infection even after the infection seems to be resolved) – however we wanted to ensure that she had good healing prior to removing them and exploring what is present underneath, should the suture removal lead to opening of the abdomen or uterus. I will interject here and inform those who might not know that often c-sectins are done NOT by experienced surgeons, but by medical interns and residents that have received a limited amount of instruction by the hospital’s attending surgeon and then are later left to perform surgeries un-attended. In Malawi the attending OB-GYN surgeon was sometimes not even the person who would instruct the new interns (it would be another intern or a resident). They would begin their OB rotation and within 2-3 surgeries be performing surgery without supervision, often late at night after working all day. Here at Chogoria the residents are trained by the attending OB/GYN and she continues to attend the surgeries until she feels comfortable that they know how to perform surgeries.

During my week on OB, both Emily (Family Medicine boarded with OB Fellowship) and Boase (Resident, post-internship) were both doing c-sections while I was rounding with them. I joined Emily on several c-sections and was able to explore how the theatre (operating room) is run. The theatre is separate from all other buildings and has an entry room, recovery room area, and then operating room. When we entered the side area, left our shoes at the front and walked to the back changing room in our socks. Then we changed to scrubs, white rubber galoshes, and scrub caps. When we entered the OR right next to the table where the sterile instruments were being opened and placed on a tray, we had not yet scrubbed. We put on heavy aprons that reminded me of a butchers apron – heavy plastic fronted and soft coated back – that were long enough to skim the tops of my white galoshes. We scrubbed at the sinks that didn’t have drainage pipes and just emptied in to the free air and splattered in to a kind of gutter that surrounded the room. The scrub soap was a bar of some kind of mystery soap. I proceeded to drop it on the floor and was told to just pick it up and start scrubbing again. Mmmmmk. Once I turned off the sink, creatively using my bicep to try to keep my elbows and lower sterile, I dried my hands on a provided sterile towel and then they helped me step in to a green canvas re-useable gown that had sleeves big enough to fit around my head. I was instructed to use my washed hand to hold the sleeves closed/folded up so that when they helped me put my gloves on they would tuck in to the gloves. In the US your hand is considered dirty until covered with a glove, despite just scrubbing your hands sterile – so this was a bit different. Sweating heavily in my scrubs, boots, heavy apron, and canvas gown in a non-air conditioned room in Keyna at 10:30am, my glasses continually slipping down my nose, I did understand the utility of our attire when I realized that once the baby is delivered (and the amniotic fluid goes everywhere) the apron prevents the moisture from reaching your scrubs beneath – and anything less than galoshes would mean certain trash for any shoes. All surgeries begin with a prayer and a timeout. The patients, trapped under all of the draping and shelf-like contraption around their chest (having received spinal anesthesia) are introduced to the surgeons and everyone else in the room. I have this image of the baby’s nurse waving from the corner and the patient smiling and waving back with her hand that is held lateral from her body on a 90degree side extension from the operating table like she is lying on a cross. The surgeries went smoothly (Emily as the surgeon and myself as first assist – I am not scalpel- happy) however it would have been nice to have electrocautery to zap the bleeders. Nonetheless the bleeding slowed down and we closed up. The babies are kept in a warmer with like 10blankets off to the side. After the initial evaluations, if the baby was doing well the nurse would leave the baby unattended and help out with cleaning up etc. The only way you knew baby was still alive at times was a small rise and fall of the blankets or occasional cry and hand movement. The babies did well and I saw them again at discharge in the post-natal ward.

On Tuesday, after rounds, I joined male medical ward because Jen had reported that there were a lot of very sick people that needed to be seen again to ensure that they were getting the nursing care or procedures that they needed to survive. We proceeded to spend over an hour trying to get an IV site on a very sick patient who had lost his previous IVs and whose blood pressure was in the 70’s systolic. This poor patient had been admitted overnight with encephalopathy and then proceeded to fall on to the ground. The nurses had helped him back in to bed but left his bleeding face to clot on its own and his right arm swollen with possible fracture – this guy also had a bleeding disorder from liver disease and we suspected a brain bleed. All hands were on deck looking for an IV site: Jen leading the charge along with Gat, a resident rotating on surgery, Musa, myself, and even Clark tried for several veins. Nursing was difficult to find once we were handed four 500cc normal saline bags, so we spent a lot of time looking for more materials ourselves. After numerous tries Jen managed to get one on his wrist at the base of his thumb, so we secured it with strapping (after many repositionings and replacement of strapping). Due to its precarious position, we were unsure that it was going to be reliable, so Musa had gone to look for an intraosseous line drill. He arrived just after placement of the one tenuous IV, so he proceeded to place his first IO line in the patient’s left tibia. The US tubing does not match up with the syringes or IV bag tubing here in Kenya, so Jen quickly swabbed her hunting knife and cut the tubing so we could fashion a connector between the IO and the IV fluids – it worked! After he had to workable IVs he was stable for CT scan of the head to rule out bleed. Unfortunately he needed oxygen and other obstacles delayed his scan (including the CT tech going home for the day). I was told that eventually Gat and a nursing student hand-carried the patient to the CT scanner to get his scan done. Luckily the patient did not have a bleed and today we rounded on him (three days later) and he is much improved. He is still encephalopathic but stable and the next step is lactulose to clear his ammonia levels. Today the nursing staff was very much present and before we had even seen the patient, they were hanging normal saline. Unclear whether that order was placed several days prior or not – but it was a notable improvement.

On Wednesday after rounds, Leonard had arranged a tour of the hills behind Chogoria. We had originally hoped for a tea plantation tour, however due to the dryness of the season, no one was currently harvesting and the tea farms were closed. We loaded up in to a very nice vehicle and braved the non-graded dirt roads leading up in to the small mountains/large hills. We stopped to look at some tea fields and waved “Hi” to a very confused looking farmer who typically doesn’t see Mzungus walking through his tea. We then wandered around to get some good aerial-ish shots of Chogoria. We eventually ended up on a very narrow road that obviously does not have cars on it very often as it was barely large enough to fit and eventually ended on a walking path with a small field to the left. Leonard and his driver got out with smiles on their faces and walked us through someone’s backyard. We waved “Hi” to the owners who also looked confused – I called “Habari!” and the woman grinned at me and said “Mzuri sana” (I am doing very fine) and we spied a waterfall nearby (the secret mission Leonard was aiming for evidently). So we walked (occasionally slid) down the gorge to the base and enjoyed some nice waterfall photo ops. Leonard and his friend were snapping photos too. We hiked our way back out of the gorge and I wondered to myself “am I crazy to summit Mt Kenya?”

On Thursday after rounds we were invited to lunch by Leonard and the hospital for a “going away brunch” even though we are going to be staying another week – however because Luke and I are leaving this weekend and Clark/Jen/Lena are headed to Zanzibar before we descend the mountain, today was one of the last days we were going to be all together. They served a buffet lunch at Lenana’s for us and a few hospital administrators said some very nice things about us being welcome to their home and a part of the family. Leonard last-minute suckered Musa and Eric in to saying something nice for us and it was very kind of them to oblige with thoughtful words and repeating the sentiment that we were welcome. We let them know they are welcome in Michigan or wherever we end up afterwards. Clark said a few words on our behalf, and then we were given T-shirts to remind us of our time in Kenya. We were paired with hospital staff and my partner insisted on attentively helping me put on my t-shirt and holding my hand afterwards, welcoming me to the group. It was really heartwarming and kind. The minister said a few words and the head nurse said a prayer. Selfies occurred afterwards with Musa aallllllmmost as talented as Ethan regarding composition and certainly less enthusiastic looking – but he still held down the role like a champion. Thursday evening Clark hosted Provi, Janet, and Musa for dinner. Musa taught us how to cook ___ (unfortunately I forgot the name!) a greens dish with onion, carrot, tomatoes, and a local Kenyan spice combination. Luke and I taught Musa how to make a yellow curry. He stated there were too many steps to remember afterwards but I will send him a recipe he can follow. Prior to making food he had said he didn’t know how to cook and that he better find a wife soon so that she can cook for their guests. He later showed up to our meal preparation with a mandolin that he was given by his mother and that he travels with (no one travels with a mandolin that doesn’t know how to cook). Provi made some traditional Ugali and Clark put together a fruit salad. We had a supremely filling meal on Clark’s porch topped off with some fruit juices. We chatted for a bit about life in different places – we learned that negotiation is not typical in the markets around Chogoria (phew – I’m not a good negotiator and for the most part was just paying what they ask for anyways. How can you say no to a 20cent mango or one dollar pineapple?). However negotiation elsewhere is necessary (start with 50% of their initial offer). We also talked about foods in different places and Provi showed us some wedding dress options that she found in Nairobi. Unfortunately Musa was on call and we had to break up the party, but it was so nice and we all wondered why we hadn’t done this sooner and more often.