Thursday, November 24, 2016

Extreme Empathy

Extreme Empathy

Please do not scroll down if you do not do well with medical pictures….

(Story/photos posted with permission)

“Stop it kids!”  Stop it I say!”  The middle aged Fulani lady yelled to her teenagers who were fighting out in rural Chad.  Now this wasn’t just any fighting.  Apparently this was nomad extreme fighting, MMA-style.

This is no ordinary mother.  When they would not stop, she got all up into their business.  She ran over in the MIDDLE of their fighting to pull them apart.

Somehow in the midst of this, someone shot an arrow.  And she was the one who got shot.

Our doctor friends who were visiting Moundou texted and asked what they should do.  Since they were visiting, they preferred to send her to us since she was quite complicated.  The government hospital in Moundou was on strike too.

It happened about a month ago on Saturday.  A nurse came to my door at 2 am.  I couldn’t believe the patient had actually come!  She had gotten a taxi to come to our little mission hospital about 2-3 hours away.  I got dressed and went to see this amazing woman in person.

Yep, diagnosis given.  Arrow to the eye!  You don’t need to be an eye doctor to see that!  I looked hard, but couldn’t get a billable ICD-10 for this.

Someone had done an X-ray in Moundou, but they had forgotten it.  The visiting doctor in Moundou had told us it looked like there were hooks on the end of the arrow.  Great.  This is going to be really hard to get out.  To pull it back out would rip apart anything in its way that it did not damage on the way in! But to push it through, like you do with fish hooks, would damage vessels in the interior of the brain.  Not to mention, how would you get it through the skull on the other side?  And I’m pretty sure I recall a lecture in medical school where a professor informed us it’s considered poor care to push an arrow through somebody’s brain on purpose.

This arrow had already been in for a full day.  The thoughts of cerebral infection filled my mind.  How is this woman possibly going to live?

I counseled the family we needed to remove the arrow.  It would be difficult, and we weren’t even sure she would live.  She most certainly wouldn’t be able to see out of the eye.  And she had a high chance of losing her eyeball.  I made her NPO.

Before church, Dad and I went in to remove her arrow.  She was very courageous.  After a little while, we finally found our vice grip pliers.  After giving Ketamine for anesthesia, I removed the dressing that someone had put on, and we could see the eye to a fuller extent.  You could see pus already coming out from the side of the eye.

Well, it had to come out.  And there wasn’t anyone going to do it but us.  So we all braced in the operating room, while my Dad applied the vice grip pliers.  We held her head and Dad pulled.

Well, that came out easier than expected!  It came out in one pull.  I quickly applied pressure over the eye and surrounding skull.  After a couple of minutes I removed the compress to take a look.  She wasn’t hemorraging!  At least on the outside!

We praised God and hospitalized her!  Her family was overjoyed she was alive!  She was continued on IV antibiotics and given her tetanus vaccine.

Since she lived so far away in a very remote setting, she ended up staying for several weeks.  Her infection cleared up, but she was left with no vision in her right eye.

I would go see her and have her cover her left eye and joke I was testing her vision.  “Am I white or black?” I would say in French, and someone would translate into Arabic.  She would laugh and we became good friends.  I felt badly for her, but happy she survived.

Often patients are anxious to get back home.  It’s a normal thing to want.  One day I asked her if she was ready to go.  She replied she would stay a year if we told her to!  She just wanted to have her health!

It’s normal for doctors to have some empathy for their patients.  I remember learning about sympathy versus empathy in medical school.  I guess I hadn’t really given it much thought before.  Sympathy is the feeling of pity or sorry for someone else’s misfortune.  Empathy is the ability to understand and share the feelings of another.  It sort of sounds the same, right?

Well, there’s no better way to understand someone else’s feelings of sickness than by having the same sickness.

I have empathy for my patients because I have delivered babies of my own.  I have empathy for my Chadian mothers because my children also have malaria.  I haven’t developed much empathy for the huge hydroceles that I assist with when in a pinch… hmmm…

But wouldn’t you know it… two Saturday mornings ago while walking to the hospital, I developed a vision issue too!  I could tell that my vision was not quite right.  On the way home from the hospital things still seemed off.  I did a small visual test on myself and called Olen outside to recheck my vision.  We decided then and there… I needed to get back to America.

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