Chapter 20: Creature Crawling in Abdomen

American Hero

Dr. Dan chewed gum and diagnosed all my patients quickly and decisively, confidently suggesting treatment appropriate to a Third World situation. I cursed Philippe for making me show him round - I just wasn't impressive enough.

"But you will soon be his boss, yes? Dr. Emily, the Medical Superintendent of Serabu 'ospital," Philippe had teased, before trotting off to Outpatients. Dan and I continued our rounds.

The first three cases on Surgical had nasty wound infections. I knew they were all excusable given the poor condition they had been in on arrival and yes, they would all heal eventually, but it just didn't look good. Dan stayed tactfully quiet - until Ansumana.

"Ansumana fell out of a palm tree sustaining multiple intestinal perforations. Somehow he survived three days walk to the hospital," I told Dan. "When he reached us, he was septicaemic with a grossly distended belly."

"Really? Well ain't that amazing he's alive?" Dan enthused.

"Yes, isn't it," I preened. "It was tricky surgery, especially in a moribund patient."

Keen to show off my handiwork, I pulled off the dressing with a flourish. "Oh no!"

"Gee, what's that orange stuff and white flaky bits?"

The gauze dressing was soaked orange with palm oil and grains of half-digested rice oozed between the stitches. Having your patient's dinner coming directly out of the wound was not a good way to advertise your surgical skills. I was speechless.

"Hey girl, even with proper equipment, anaesthetic and a real surgeon in the States, he might never have made it." The newcomer slapped me encouragingly on the back and continued to chew his gum, no doubt wondering what sort of place he had come to.

Why couldn't I find a miracle recovery to show him? Jeneba for instance, or Christiana? Like the rest of us, Dan hadn't had any surgical experience before coming to Africa, and with three cases scheduled that morning, I was going to have to teach him. Or rather Tiange was.

"This is Tiange, Dan. She'll teach you everything you need to know about surgery."

"Real pleased to meet you, Tiange." Dan stepped forward and firmly shook her hand. Tiange actually smiled. How did Dan manage that?

"You don't mess with Tiange, our queen of theatre," I whispered to Dan as we scrubbed up.

"I'll remember that."

"Last week Tiange asked a patient five times if he was chewing gum. He denied it every time, despite her dire warnings of what could happen if he inhaled it whilst under unconscious under anaesthetic. When he woke up, she had plastered the gum across his forehead."

"I'm real glad I spat mine out," Dan laughed. "Where's the antiseptic?"

"We just have that bar of soap. Usually we don't have as many post-operative wound infections…"

"Hmm." Dan was not convinced. "Tell me about our patient today."

"A lady with a large abdominal swelling. She's quite elderly, although no one really knows how old they are here. Saloneans measure time by today, tomorrow and yesterday, or wet or dry season."

"So what do you think? An ovarian cyst"

"Probably. Just last week, I removed cysts the size of basketballs from two separate patients."

"Gee! That's amazing."

Pleased that at last I had the chance to impress Dan, I made a confident incision in the abdominal wall. Separating the sides of the wound with my hands, we looked inside. The nature of the mass became quite, quite obvious.

"She get belly!" Tiange exclaimed.

"She must be nearly six months pregnant!" echoed Dan.

Gulping back tears of humiliation whilst Dan and the nurses gulped back tears of laughter, I closed the wound without disturbing the foetus any further. Tiange reassured the patient, who was still awake under a spinal, that her pregnancy would proceed quite normally. The patient, apparently unconcerned, asked why we didn't just remove it as she already had eight children.

Once we were finished, Dan picked up her Outpatient card and succumbed to helpless guffaws. Embarrassed, I snatched the card from him to see what had caused such mirth.

The presenting complaint read: Creature crawling in abdomen.

Back to Extracts