After reading our blogs, you might be asking yourself, didn’t you go to Zambia to do surgery? The answer is definitely “Yes!” Much of my day is filled with surgery or taking care of those with surgical and medical issues. So, I guess, it is time that I share with you some interesting cases.
The weekend after arriving in Zambia I was called upon to make my first house call. We received a call from Wes Wilcox, the director of New Day Orphanage to see a patient. I say “house call” because I saw the patient at a house but not the patient’s house.
A child, 3 years old, who I will call Pretty (a common Zambian name, but not her real name) is not an orphan but had come to New Day with her mother seeking help. Pretty had a major bowel blockage at the age of 9 months and now had two ostomies. Surprisingly the mother was well informed and had arrived with the little girl’s records from 3 years ago, which showed that the child had developed an obstruction and the surgeon at that time had divided the transverse colon and brought both ends out, one on the left and one on the right, to decompress the bowel. The provisional diagnosis was Hirschsprung’s disease. A disease in which the nerve endings of the colon have not developed resulting in nonfunctioning bowels. The problem, at this time, was that the left sided ostomy had started prolapsing and was in need of surgical repair.
If the child indeed had Hirschsprung’s then putting the 2 ends of bowel back together was out of the question (At least here in Zambia). If it was not Hirschsprung’s then reconnecting the bowel was worth considering. So, after discussing the case with the mother, it was decided she would come to the hospital and have a biopsy to determine what surgery we would perform to correct the current problem of bowel prolapse. So, facilitated by the Wilcoxes the child came the 45 minutes’ drive to Macha and had her biopsy. Biopsies are sent to the capital, Lusaka (7 hours away), and usually take 3 months for results. Thanks to the staff at New Day, who personally took the specimen and retrieved the results, this process was shortened to 6 weeks. I received the report from Wes and the results were good. There was no evidence of Hirschsprung’s, Good news! Unfortunately, this good news was followed with some not so good news. While in Lusaka, Laurie Wilcox had a CT scan and was given the provisional diagnosis of metastatic ovarian cancer. So, on the day before leaving for South Africa to seek medical care, the Wilcoxes arranged for Pretty to come to Macha for a second time to have her colostomies taken down. The next day we took Pretty to surgery and were able to put her bowel back together. Then we waited. Waiting for a 3 year old to move her bowels seems unexciting but it is nerve racking when you consider all that was riding on this simple function.
After 3 days, pretty began to move her bowels and there was much rejoicing. By one week, Pretty was walking around, happy, smiling, and moving her bowels. The day came for her to go home, but like always in medicine there is always another patient waiting to be cared for.
I will call her Patience (again not her real name). I think however it suites her. She also had had surgery, like Pretty, as a child, but about 10 years ago. She also had had a problem with her bowels, but the family was not as clear as to what had been done, other than that it was something with the bowel. She really had no pain but was complaining of feeling full and having long periods of constipation. By the second day of her admission, it was clear her bowels were obstructed. Her x-ray showed very dilated loops of bowel including the colon.
One of the common problems in Zambia, because of the high fiber diet, is twisting of the bowel (sigmoid volvulus). Clinically this didn’t fit her picture but given the large amount of air in the left colon it was a consideration. What we knew was that the patient needed surgery. So, we took her to the OT (Operating Theater – from the British influence). At the time of surgery, we found, as expected, dilated loops of large and small intestine. I have seen some very large bowel over the years but by far this was some of the most dilated. I wish we had taken a picture but alas, we did not. After decompressing the bowel, we were able to take a better look around. Initially we had seen 2 spleens one larger and one smaller. (this can happen sometimes with patients developing an accessory spleen). As we looked more carefully, we realized we were seeing a normal spleen on the left and a liver just above it. For those of you who don’t remember your anatomy class, the liver belongs on the right and the spleen on the left. A small part of the population has what is known as “situs inversus” which can be partially or complete. We more commonly hear of “dextrocardia” where the heart is on the left instead of the right. More often in bowel obstructions in kids we see malrotation of the bowel in which the left and right colon are switched. In this case, the bowel had a normal position but just the liver and gallbladder were flipped. This had created abnormal adhesions obstructing the transverse colon. By releasing these adhesions, we were able to release the obstruction and restore bowel function.
After seeing the insides of this patient, we were able to go back and look at the x-rays and they made perfect sense. The dilated bowel we thought was on the left was in reality dilated bowel on the right. The film was backwards, or maybe you could say the patient was backwards. When looking at the film we put the liver shadow on the right, where it always is supposed to be, but this was backwards. Seeing the real thing helped us to put the x-ray into perspective and see more clearly the shadows we were seeing on the x-ray. Paul says that “Now we see through a glass, darkly” I Corinthians 13:12, but some day we will see things the way they really are.
As these 2 surgeries were going on, it was confirmed in South Africa that our friend Laurie was diagnosed with stage 4 ovarian cancer. They are good people! People who are doing exactly what James says to do; taking care of widows and orphans. I contemplated why. Why do things like this happen? This case of situs inverses showed me that, I was not looking at things the right way. Here in this life I am only seeing x-rays of the real things. Things I don’t have access to or can’t even understand, not until they are shown to me completely by the Father. Like a surgeon, I plow ahead in life making plans based on what I think I see. Most of the time with good results because I have come to recognize when surgery needs to be done, but often changing “my” plan when I realize the reality of Gods truth.
As a child when I read the verse “He sends the rain on the just and unjust” Matthew 5:35, I equated rains with the bad things that happen in life. After all rains mess things up. That’s why we have “rain dates” and we talk about it “raining on our parade”. Rains interfere with life and our plans so they must be bad. Living in a country which has suffered from a drought, I have come to realize that rains are a blessing. Every time it rains, we praise God for his provision. Last week we had 4 days of steady rain. This happened right when the community had its annual disc golf tournament. They played in spite of the rain. It did seem inconvenient and by the end of the 4 days, those of us who had been asking for the blessing of rain were hoping they would stop soon and not erode the corn which was growing so nicely. As the rains poured, I was reminded of the song “Blessings” by Laura Story. “Cause if your blessing come through raindrops, what if your healing comes through tears… What if the trials of this life are your mercies in disguise?” What if I have been looking at the x-rays of life backwards for all of these years? What if the things that I think are bad are really for my good? What if Romans 8:28 really is true and God does work ALL things together for the good of them that are called according to His purpose?
Please prayer for the Wilcox. They are now back in the US and Laurie will be starting her cancer treatment soon.
Warning!!! Graphic Surgical Pictures shown below
Do Not Continue
If you are sensitive to these types of Pictures
Mark and Maggie BICWM 