16 March 2008


Have you ever had a patient dance for you? Seriously—have you ever walked into your exam room and had your next patient break out into spontaneous fits of jive? Or, have you ever sat on a doctor's examining table and decided that what she really needed was a little soft-shoe number?

I wrote last week about the fact that medicine in Africa can be frustrating. But it can also be a trip. We may never leave.

Meet Marie. Marie had a large left-sided goiter, and two weeks ago she came on-board for her hemithyroidectomy. Her story should have been relatively humdrum, but that's because I'm coming from years of training in detachment. She was someone we would treat, and then she'd go home, and we'd congratulate ourselves on how big a goiter we were able to take out. And we'd send show-and-tell pictures to our doctor friends—look what we just did! And we'd hope for the requisite affirmatory pats on the back. And in all this, we'd never get involved in Marie's actual story—why she wanted this thing out, what it meant for her to have a mass in her neck, and what it felt for her even to be offered the possibility of having it removed.

Little do you expect the pat on the back to take the form of a careening conga.

See, what I didn't realize is how stigmatizing goiter is. In my mind, goiter is almost synonymous with Africa. It's endemic. It's something you read about. Everyone, of a certain age, has it. So, of course, that same everyone is used to seeing their mothers, sisters, grandmothers with goiters, right?

Marie proved me wrong. For her entire time on the ship, she barely met my eyes. Or anyone else's. The stigma of goiter, it turns out, is the stigma of the unclean, the demon-possessed.

Her surgery was hitchless, but her post-op course was complicated by significant, often unarticulated fear. Was coughing OK? Could she turn her neck? Would the stitches come out? And then came her first post-operative visit. After years of averting her eyes from the overly-curious gazes of her neighbors, she had a hard enough time meeting ours. She had to be reminded. But when I asked her if I could take her picture, she broke out into an ear-to-ear grin, wider even than her incision, and she started dancing. Right there on the examining table. No amount of pleading would get her to sit still.

I can only believe in a God who dances, wrote Friedrich Nietzsche. So, here she is, a woman reintroduced into society. And my first dancing post-op picture.*

*Apologies for the obtrusive black bar.

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