14 May 2008

Will the real Mamie Kankor please stand up?

Yesterday morning we were expecting a 34 year old woman named Mamie Kankor to arrive for surgery. Mamie had extensive burns to both her legs, the scar wrapping all the way around her thighs and impairing her ability to walk. She had been seen at our screening early on in Febuary and later by Dr. Tertius, our South African plastic surgeon, who agreed that she would need skin grafts to her burns so that she could move about freely again. So when we called out her name and she came in, we went through the usual procedure of getting her demographic information, checking her blood pressure, heart rate, temperature, and weight, and of course explaining to her the planned surgical procedure and getting her consent for them. She readily agreed and signed all the neccesary paperwork. After being processed by the admissions nurses she moved to my desk so that I could do a history and physical and deem her fit for surgery. It was just another routine patient in another regular day.

Except that it wasn't. "Show me your problem," I asked her. She gestured in the direction of her head and neck. "No, I mean the problem you came here for," I said, as I pointed towards her thighs. "You mean do I have pain in my knees?" she asked as she lifted up her skirt to reveal smooth unscarred skin. I stared at my admissions packet, which had the words, "circumferential burns to bilateral thighs" printed in the diagnosis section. I looked at her again, now truly confused. She pointed to her neck, and I saw a navel orange sized lump at her Adam's apple. She had a goiter.

It's a long story.

Mama Korkor is a 40 year old woman who went to an ear, nose, and throat specialist at JFK Hospital, Monrovia's largest public hospital. There, the doctor diagnosed her with a large thyroid gland. He also noticed that her eyes were more protuberant than usual and after questioning her, found that she had been losing weight and frequently felt her heart racing. These are all signs of an overactive thyroid gland, and since he did not have the ability to perform thyroid function tests at his hospital (a very commonplace test in the United States but not here-people need to travel to Ghana to get this test), he sent Mama to us.

Mama arrived early in the morning to the dock. There, her referral letter was collected along with those of the other patients waiting to be screened and brought in for our patient care coordinator, Ans, to see. Ans went out and called, "Mama Korkor." She was brought in along with Comfort, one of our translators and apparently a friend of the patient. Ans, and later our ENT surgeon, Mark, noted that although the patient did have a lump in her neck it was not an enlarged thyroid gland, but rather something called a thyroglossal duct cyst, a congenital abnormality. She was given an appointment card to return in July to have the cyst removed.

However, Mama had never seen Ans. Someone else did. Mama was sitting on the dock, waiting patiently, until our hapless admissions nurse had called out, "Mamie Kankor." Perhaps unable to understand our English, perhaps afraid to miss her opportunity to be seen, she leapt up and identified herself as Mamie Kankor. Thus chaos ensued.

We often kid ourselves into thinking that we are perfectly clear when we are not. Mama had signed a consent form saying she would accept all the risks associated with putting her under general anesthesia and placing skin grafts on her two perfectly good legs. Thankfully the error was caught early on but this just goes to show how great the power differential is between us and the patients who come to us for help. The vast majority of the patients suspend judgment the moment they receive these precious green appointment cards for surgery, and place themselves under the care of Mercy Ships with complete childlike trust. I now think back on all my prior patient interactions here and wonder if a careless word I said could have crushed someone's self esteem or buoyed someone's hopes up. May we have the wisdom and discernment to do the right thing for those who come to us for help.

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