Learning in the field in a developing world
By William Ergen
Today was hot.
After an “uneventful” trip to our church, we unloaded the gear from the trucks and moved in. Set up stations. Check. Register every patient with the local health administrators for records. Check. Students to their respective stations with assigned doctors. Check. The clinic was open for business.
The patients sat on their respective benches on both sides, and inside the church it was hot and humid. Amid all the noise, I could see each one of us sweating through our scrubs as we managed to take vitals, write prescriptions, and administer care in the best manner we could.
One patient sticks out in my mind, and will continue to do so for quite some time. She presented with a solid protuberance on her left big toe. Due to the high volume of patients, I thought it best to try and work her up as best I could and check with the physicians before I acted. The mass was not malleable, and it had the consistency of the skin surrounding it. It was about 4 cm wide and 6 cm long. I thought, “Abscess, I should drain this one to provide her relief.” I called two physicians over, and in the haste of the moment with hundreds of patients to care for, they agreed with me. “Inject some lidocaine in it, and see if you can take a sample just to be sure.” Having had some experience doing this in the Emergency Room, I prepared the syringe and injected it into the poor woman’s toe with supervision. She began to tear up and I felt horrible. In the midst of all the chaos, and after some misunderstood instruction, I had made up my mind to skip the extraction portion and was going to go straight for the draining procedure. What got me to that point, I don’t know. Maybe it was an intense desire to “operate”, or in the back of my mind I thought I was truly doing this woman a huge favor. Whatever the case as I begin to ready the scalpel Dr. Tupper comes over to investigate. He runs his fingers over the mass.
“This is not an abscess, this is a soft tissue mass!” Whoa. “Continue with trying to obtain a sample to be sure, but I’d bet it’s a soft tissue problem.”
OK….go on with the original plan. With supervision I prepared the needle, inserted it on the spot where the lidocaine had taken effect, and tried to withdraw something. Nothing. Some blood, but no pus. I felt awful. This was not an abscess, but a soft tissue mass that needed the hand of a trained surgeon and not a second year medical student. We cleaned and bandaged the small needle wounds, and instructed her to go to the hospital to have surgery to remove it. After some serious consolation from myself and many others on our team, we gave her some pain medicine and antibiotics and sent her on her way.
Did I do more harm than good? I obviously caused her some pain and distress, and for that, I am sorry. But I followed the physician recommendations and we ruled out an abscess. A good 3 or 4 of us gave her a big hug after the procedure and wished her well. I still felt sad for the pain I caused her. I had to assure myself, investigative procedures in the United States carry some risk of pain, right? Using the translators, we informed her how the mass should be dealt with. Despite a short lapse of judgment for a few seconds, I only meant to help her. I learned a hard lesson, and in the future I will learn to take my time before moving forward with any procedures, whether in Haiti or in the United States.
Dr. Tupper, early in our trip had told us of the importance of “being there”. That is to say, being in this remote location in Haiti and treating these human beings with respect and dignity actually provided some relief in their difficult lives. Despite the physical pain she endured, some good I think came out of the situation with the poor woman and her foot. Here’s to hoping she is walking around Haiti soon with a mass-free foot.
Now I look forward to working another day in another hot church, being there for those that suffer in this amazing and beautiful place.
William Ergen is a second-year medical student at the University of Tennessee College of Medicine.