Abscess Makes the Heart Grow Fonder

So I’ve been terribly bad about writing this past month. My apologies for that, but it’s been a combination of being incredibly busy and not having good internet. The internet café in town changed their service, and the new internet doesn’t like secure servers very much. Also haven’t been able to get into my school server or (and this is possibly the most tragic) my fantasy football team. The insanity never really slowed down. So my last post about the 91 patient day we’ve topped 80 again 7 times, and only had three days under 50. The plus side of that is I’ve finally found my defined role in work at the clinic. I’ve learned enough to be able to work in the diagnostic station, and there are a few areas of treatment that I’m more comfortable with than Rogers’ is, so I just float back and forth between Station 3 and Station 4. It depends on who the clinicians are and what the patient flow is like. Violah likes having me in with her, I think mostly just because the two of us have become really good friends and she likes having me around. She is also a pediatric specialist and really doesn’t like trauma stuff, so she appreciates my comfort with those sorts of things. Irene also likes having me around, just because she and I are much more comparable in terms of training level and I think we both appreciate being able to bounce stuff off each other. James is more like a PA, so he doesn’t really have a need for the help, but he likes teaching me things, so I end up in with him a lot anyway. I have gotten to the point where I’ll see patients on my own if we are really slammed (saw about 20 the other day). I’m trying really hard not to think about how far out of my scope of practice the things I’m doing are. Rogers and I work our asses off most days, with him doing most of the dispensing and me doing most of the trauma work, then tag teaming any of the procedures that come up. We had a day last week where for some reason we just got swamped with procedures. We had to do two ear syringeings, set a fracture, remove two different sets of stitches, massage and wrap a sprained knee, treat two second degree burns and a third degree burn, clean and dress two separate machete wounds, and drain an abscess on the butt of a 2 year old. This was the hardest, as it actually qualifies as a surgical procedure, but we really don’t have the space to work as effectively as we would like. I spent most of the procedure standing behind Rogers working over his shoulder, with one hand on each side, so we could both be where we needed to be. This was actually the second time I’ve assisted him with an abscess drain, but this one was way easier, as it wasn’t on myself. Which gets me to badass story number 1, and the basis of the punny post title.

So about 3 weekends ago, Molly (one of the aid-workers at Arlington) and I went for a hike out to this waterfall way up in the mountains about 6 miles from the clinic. While we cavorting in the falls it started raining, and it rained hard enough that it washed out the already pretty much non-existant path we hiked in on. Rather than trying to find our way back through the forest on our own (at this point we’d hiked into Mt. Elgon Nation Park, so there was no one around for a few miles at least) we decided we should hike back through the river, as that way we couldn’t get lost. This plan had lots of flaws, though I maintain our logic at the time was sound. The short version of a long long long story involving epic treks and falling into ravines and carrying people through neck deep water and such is that I fell down a waterfall. Not a huge one, maybe about 15 ft. high. This resulted in two injuries on my part, a partially dislocated shoulder and a pretty minor cut on my chest. The chest thing seemed like a total non-problem, and I was a lot more worried about my shoulder, but it proved to be the bigger problem. The cut got infected by the river water and turned into a MASSIVE abscess. Abscesses have to be treated, so Rogers and Violah determined on Tuesday morning (36 hours post-hike) that it needed to get drained. Unfortunately, this is really a two-person job, and I was the only person at work that day who was comfortable assisting on it so… I gloved up for the SELF-ASSIST! The process of incising and draining in abscess goes like this: first, stick a big old needle full of lidocaine in it and try to numb it as much as possible (which is not very much). Then you make a 3-5cm elliptical incision at the “point of origin” of the abscess. Then, you stick a closed clamp in the hole, open it, and work it around a bunch, thus widening the hole, until all the pus starts draining out. After it stops flowing on its own, you apply pressure to it for as long as it takes for all the pus to come out. After that, the tissue pocket that had previously been filled has to then be stuffed with gauze (mine required 2 ½ feet worth). Needless to say, it is excruciatingly painful. My abscess was about 4 ½ inches wide, and had about 2 inches of depth. So, while sitting through this being done to me, I was also having to assist on the procedure. One of the staff assistants held a mirror so I could see, and we just kinda, got it done. I was all set to go back to work right away, but Violah and Irene couldn’t believe I was gonna do that. I powered through for about 20 minutes and then took their advice and went to lie down for a few minutes. A few minutes turned into about an hour and a half long nap, which while I felt guilty about no one really begrudged me at all. It took a few weeks for it to fully heal, but as of five days ago I’ve been able to stop keeping it covered, and the sinus has fully closed, so aside from the scar tissue forming I think it’s safe to say it’s fully healed. I was extra sympathetic for the kid we drained last week though, as I totally understand how much pain he was feeling.

See “Abscess makes the heart grow fonder”. It’s clever cause I had an abscess, and abscess sounds like absence, and I haven’t posted in like a month.

Cool, time for story number 2! This actually happened before the whole abscess thing, but that’s ok. This is the story of Mary (not her real name, but I’m not supposed to post her real name for obvious reasons). This is mostly interesting because it was one of the first times I’ve really gotten to use my medic skills in the field. This happened during what we started calling “seizure week”. Between in clinic cases, two that I dealt with outside of work, and one James and Irene had near their house, our staff treated 11 seizures in a 5-day period. Just the way it goes sometimes I guess. Anyway, the story of Mary. Mary was the wife of Joseph, a stone-mason from Arimithea…kidding. Mary is a P5 student at Arlington. She’s about 12 years old, maybe 5’ 2”, 120 lbs. Anyway, Friday of about a month ago, Arlington was having a “marathon” as part of the celebration to finish their 3-month reading initiative. The “marathon” was a 5k race, and the school staff asked if I would run in the group with the teachers and the 12 and up students. I said sure, it seemed like fun. I knew I’d probably get my ass kicked, which I did. In my defense, we’re at a couple thousand feet of elevation, which they are all used to, and I was definitely not, so I think that makes up for the fact that most of them were only like 14. (7 teachers and I ran, the rest were all students. I finished 68th out of 92. I’m ok with it). Anyway, I got to the final stretch of the race, and a bunch of the kids who’d already finished ran out to meet me yelling “Doctor, doctor, hurry”. I thought they were cheering me on, but it turned out that one of the girls (Mary) who’d been running had finished the race and then collapsed and started convulsing. A few of the staff had been trying to help her, but doing nothing right (trying to stand her up, dumping water on her head, etc). Apparently, Molly had called Ryan and asked what to do, and Ryan had said to just wait for me (not really much else to do, and I was closer than anyone else on our staff). She’d also sent a Boda, assuming (correctly) that I might need it. Anyway, I got to the girl, and she was completely unresponsive and had clearly had a massive seizure. It took me all of about 20 seconds to decide there was nothing I could do for her there (especially since I’d been running a race and didn’t even have my basic first aid kit) and that she needed to get to the clinic. However, there is no EMS system and no ambulance or anything in the district, hence the Boda. I basically just scooped her in my arms and hoped on the back of the motorcycle. The driver was totally freaked, he just got told to go to this house and all of a sudden this sweat-covered shirtless white dude is jumping on the back of his bike with a half-naked unconscious girl in his arms yelling at him to go. Jankiest version of a load-and-go I’ve ever done for sure. Anyway, we got her to the clinic, which involved a dramatic motorcycle ride, a nasty burn on my leg, a nearly head on collision with a pick-up and some other just generally absurd occurrences. We got her in and got her treated, but almost ended up sending her to Bududa, because she remained post-ictal for really concerning amount of time. I got to her around 8:30, we got her to the clinic sometime between 8:40 and 8:50, and we got zero neurological response from her until about 2 PM. James and I had a pretty hefty disagreement about her treatment course, he thought her seizure was caused by heat-stroke or fever (which in fairness is about 80% of the time out here), while I was maintaining it was epileptic. The problem we ran into was being unable to confirm anything without getting a history about her, since we have no scan or EKG ability or anything like that. The problem we had was that the number AAH had for her parents didn’t work, so we couldn’t find them. Eventually we found another student who knew where she lived (about an hour and a half walking from the school), and Godfrey sent that girl with one of the teachers to find her parents. Her dad finally made it to the clinic around 4:30, at which point she had just regained consciousness. We found out from him that her family has a huge history of epilepsy (something like 5 people in her immediate family suffered from it). At the time that the clinic closed she was still weak to even consider going home, so we put her up for the night at Godfrey’s place. This got sort of absurd too. Godfrey’s house is just up the hill from the clinic, maybe 400’ away. Unfortunately, it had rained a ton that day, and the hill was crazy muddy. I was barefoot, as the shoes I’d had on were my running shoes, which hadn’t made it to the clinic with me when I brought her in in the morning. Mary couldn’t walk up the hill, so I was carrying her, but with the mud and the lack of shoes, I got about halfway up and then started sliding back down. Godfrey, in an attempt to help, put his shoulder into my back and started pushing us up. This wouldn’t seem that absurd, but Godfrey is about 5’ 4” and maybe weighs 140 lbs. So you’ve got this tiny little Ugandan man trying to push me, carrying this not insubstantial girl, up an absurdly slippery muddy hill. SOOOOOOO ridiculous. After a few moments of brief and absurd struggle a few of the AAH farm hands noticed our situation and came to our rescue. I felt super ridiculous, but they seemed to think it was mostly just funny, so I guess that’s good. Anyway, Mary was out of school for a few days, but we’ve gotten her onto epilepsy treatment now, and it seems like she is doing pretty well.

Way more has happened in the last month than I could attempt to make up for, so I’ll try to get back on top of posting for the last stretch of my time here. If you’ve made it through the last stretch, well done. October was ridic, we saw 1,258 patients, which breaks down to like 62 per day.

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3 Responses to Abscess Makes the Heart Grow Fonder

  1. Margery Wolf says:

    Nathan, You are amazing as a medic and as a writer. I was holding mt breath all the way through. Thanks you for sharing your experience with us. I may put you in a novel yet!
    Take care of yourself, better.

  2. shelley s krompier says:

    What an incredible life changing experience you’re having, Nate. I really appreciate what you’re doing and taking the time to share it with others. Take care of yourself and come home soon!

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