At Vanderbilt a busy day in the surgical clinic could involve seeing 20-30 patients, all of whom are in the electronic medical record with their medical and surgical history, labs and imaging at your finger tips. You count yourself lucky and efficient if you can finish typing or dictating all of the notes by the end of the day!
Here at Kijabe, Kenya it’s a different story. Surgical clinic opens at 9am and ends whenever patients have finished being seen, usually around 6pm. Yesterday we saw over 120 patients with two attending surgeons, three residents, and two interns. Patients start showing up the night before if they travel long distances, and will sleep in the hospital hallways overnight. When we arrive to clinic the halls are crammed full with patients and their families hopeful to find an answer or a solution to what has been ailing them.
And we see a huge diversity of problems in clinic—far from the subspecialty clinics we staff in the United States. There is still a fair number of ‘bread and butter’ general surgery cases like inguinal hernias and gallbladder disease, but the advanced pathology is what has really struck me. A few patients from this week included
- 44yo woman with a massive thyroid goiter causing airway compromise when she lays flat to sleep.
- 65yo woman with jaundice who had been suffering for months with a myriad of symptoms and who, by then end of the day with a few simple diagnostic tests, was diagnosed with a pancreatic cancer (unfortunately not a surgical candidate due to the advanced stage)
- A 58yo woman referred for gallstone disease because of her right-sided abdominal pain. Her symptoms were very atypical, and with a few blood tests and a colonoscopy between OR cases the next day we found a large, almost-obstructing right colon cancer. She and her husband clapped and laughed with joy for finally having an answer to the pain she had been having for over a year, a surprising reaction! I am looking forward to being able to operate on her tomorrow.
- A 32yo M who has progressive abdominal swelling and weight loss. I could feel a large mass on exam and a CT scan confirmed an enormous tumor that had replaced most of his liver. He had traveled for two days to clinic only to be told he had a non-operable cancer.
The end of clinic finds me exhausted and dehydrated. My last patient is a 78yo M who I did a bilateral inguinal hernia repair on two weeks prior. He and his wife are so very excited to see me again, they didn’t even mind waiting for 6 hours to be seen. His post operative recovery has been better than expected, and he has more energy and less pain that he has had in years. We talked for a long time about their family and mine, about my training and plans for the future. Somehow the language barrier isn’t a issue at times like this. The day ended on a bittersweet note as I had to tell him and his wife I would not be in Kenya to celebrate Christmas dinner with him and his family back in their village, maybe another time.