By FGHL Beth Helmink, MD/PhD
One of the first ex-laps I did here in Kijabe was a planned gastrectomy on a 74-year-old female for gastric cancer. She was thin and frail and had progressive difficulty with eating for over a year now with resultant profound weight loss. I feared the worst when I felt her abdomen after she had been put to sleep; when she was fully relaxed, you could feel a large mass in her upper abdomen.
I suspected then that the cancer had advanced beyond the point of resectability, and my suspicion was right. Once we opened the abdominal cavity, we began our evaluation for metastatic disease, the presence of which would preclude resection. Indeed, I palpated firm, enlarged nodes up and down the aorta. Rather than proceeding with the resection which is not beneficial in the setting of metastatic spread, we performed a palliative gastrojejunostomy which would bypass the mass and enable her to eat once again.
I had the opportunity later that weekend as I stopped by the hospital on a Sunday morning to meet her family who were visiting from hours away. I spoke to them gently about her prognosis, knowing the care with which death is broached in Kenyan culture. I tried to focus on her and her quality of life and her ability to spend time with her family.
She did quite well post-operatively and her spirits improved as she was able to eat once again and regained some strength. I happened past her room a couple of nights before her discharge and she was thoroughly enjoying a piece of watermelon, a huge smile on her face. I knew at that point, though we had not done what we had hoped or intended to do, we had helped her and that was quite gratifying.