In the outpatient department, each patient gets a 4×6 index card for the doctor to record his finding, treatment plans and prescriptions. When the front and back are used up, another card is stapled to it. For some of the older patients who have been coming for many years, it is interesting to flip back through their medical history. Some patients are frequent fliers; others come only once in a blue moon.
One elderly lady showed up to clinic last week with a very swollen (about 4-5 times larger than normal) middle finger. Flipping back through her OPD cards, we realized that she had not been to the clinic in over 5 years. Back in 2002, she had come in with an infected and swollen finger. I think that had she followed up with her appointments back then, her finger may have been salvaged. Now, in 2007, the finger was all but dead. It was mangled and useless and only got in the way. She wanted to get rid of it.
She came to the theater for a finger amputation. At first, Dr. Faile attempted to anesthetize the hand by blocking the nerves at the level of the wrist.
It seemed to be working at first, but it quickly became evident that it was not working when Dr. Faile began his incision. We gave the patient ketamine instead.
A blood pressure cuff was inflated to act as a mild tourniquet. The finger was removed at the most proximal knuckle where the finger joins the hand.
Cleaning the site to be cut 
A scalpel blade is used to cut off the finger where it joins the hand 
The finger was removed at the knuckle
The edges of the wound were pulled together to close the gap over metacarpal bone.
Ketamine is an interesting drug; it gives people strange dreams. Some patients wake up in a panic, others talk nonsense. This old lady sang hymns and church songs in Mampruli. Out of the abundance of the heart, one speaks.