Well....not exactly. This 64 year old woman came into the clinic complaining of increasing abdominal distension. One look at her and you thought she was pregnant and at term. Hmmm....something isn't right. The ultrasound views quickly revealed huge masses on her ovaries and not a live baby. We scheduled her for surgery the next day.
With ultrasound as our only imaging we took her to theater to investigate. She began feeling abdominal fullness back in May, but did not come to the doctor until now. She really had no other symptoms. When we opened her up it didn't take long for the huge tumors to show their faces. This ended up being almost like a 15 lbs. c-section. Uff... The tumors were both cystic and solid, not a great sign. Careful not to rupture them, we disected them away from the other tissues and were able to take them out. It was amazing how instantly not pregnant this woman looked...I only wish we could have given her a tummy tuck to get rid of all the extra floppy skin left behind.
The truly sad thing was that as we looked around her abdominal cavity it became pretty evident that this wasn't benign. I hate cancer. It had spread to her bowel, liver and abdominal wall and it looked like the primary source was actually her stomach. That definitely leaves you with a heavy heart as you sew her back up knowing this is the begining of the end for this patient. We debated about how this would be handled back home. Would you try to take out the stomach and then send the patient for chemo or radiation? Even back home this would be a difficult case. Here the chemo option does happen for some, but they have to travel to Nairobi for treatment which is a long and costly journey. Chemo will often leave the patients so sick that they cannot come back to their homes in Kapsowar. "First do no harm" is a huge concept to grapple with. Saving a patient's life only to put them in so much debt they will never come out of it to give them a few more weeks to live isolated away from home, family and friends makes you question the good you are doing by pursuing treatment. The social and logistical aspects of medical care play a much bigger role here. Heroic measures don't necessarily make you a hero.
I cannot tell you how vital the chaplains are at Kapsowar. They act as both spiritual counselors and social workers. Their understanding of cultural and social issues makes all the difference. So much of medicine here cannot be separated from these things and having their help to tease out real issues or to see the problems more clearly is truly invaluable. Watching them in action has taught me a lot about the need to have someone available who truly understands the culture because often they are able to do more to help the patient than frank medicine itself. The most effective of physicians will understand both the science and the social - a very challenging thing for an outsider to accomplish both.
With ultrasound as our only imaging we took her to theater to investigate. She began feeling abdominal fullness back in May, but did not come to the doctor until now. She really had no other symptoms. When we opened her up it didn't take long for the huge tumors to show their faces. This ended up being almost like a 15 lbs. c-section. Uff... The tumors were both cystic and solid, not a great sign. Careful not to rupture them, we disected them away from the other tissues and were able to take them out. It was amazing how instantly not pregnant this woman looked...I only wish we could have given her a tummy tuck to get rid of all the extra floppy skin left behind.
The truly sad thing was that as we looked around her abdominal cavity it became pretty evident that this wasn't benign. I hate cancer. It had spread to her bowel, liver and abdominal wall and it looked like the primary source was actually her stomach. That definitely leaves you with a heavy heart as you sew her back up knowing this is the begining of the end for this patient. We debated about how this would be handled back home. Would you try to take out the stomach and then send the patient for chemo or radiation? Even back home this would be a difficult case. Here the chemo option does happen for some, but they have to travel to Nairobi for treatment which is a long and costly journey. Chemo will often leave the patients so sick that they cannot come back to their homes in Kapsowar. "First do no harm" is a huge concept to grapple with. Saving a patient's life only to put them in so much debt they will never come out of it to give them a few more weeks to live isolated away from home, family and friends makes you question the good you are doing by pursuing treatment. The social and logistical aspects of medical care play a much bigger role here. Heroic measures don't necessarily make you a hero.
I cannot tell you how vital the chaplains are at Kapsowar. They act as both spiritual counselors and social workers. Their understanding of cultural and social issues makes all the difference. So much of medicine here cannot be separated from these things and having their help to tease out real issues or to see the problems more clearly is truly invaluable. Watching them in action has taught me a lot about the need to have someone available who truly understands the culture because often they are able to do more to help the patient than frank medicine itself. The most effective of physicians will understand both the science and the social - a very challenging thing for an outsider to accomplish both.
How sad a case this was! I have a blogger friend right now, and her husband is going through this right now, with huge tumors in his abdomen and stomache. It is so sad. You write well, and give a clear picture of your experience~ ♥♥♥
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