Walking at the edge

This week we walked right to the edge with a woman that had presented with a massive parotid tumor that had grown to a size almost as large as her head. I was not scheduled for this case. Our Norwegian colleague was ill this morning so I joined on of the long term anesthesiologist to help a visiting ENT surgeon remove this tumor. This frail 40 kg West African woman had such a large mass that we needed to secure her airway awake. It was difficult but between 2 anesthesiologists and a surgeon her airway was secured and the procedure started.

Within minutes torrential hemorrhage ensued. Bleeding from everywhere, the surgeons struggled to gain control. Blood pressure was soon I recordable, the pulse oximetry quit working as her bleeding continued unabated. Her kidneys shut down, we used all of the B+ blood on the ship and searched for  any other crew that might be B+ and willing to donate. We finished the procedure but as the bandages were applied her wound swelled dramatically and we needed to re-open to try to control bleeding out of control.

Her clotting factors and platelets were exhausted. Blood oozed from everywhere. Her blood pressure had not been recordable for hours. As a last result 6 large surgical packs were sutured in place and the patient taken to the small ICU. The ship was praying but would she survive the night? If she did, had she stroked because of her severely depressed BP? Would she die a slow death from renal failure as her kidneys quit working?

Stable overnight, we returned to the OR in the morning to remove the packs and ensure there were no further bleeding sites. Back to ICU at noon, her kidneys started to work, she woke up, and by the afternoon was off all BP medications and was able to be separated from the ventilator. By evening, like so many of our facial tumor patients, she was asking for a mirror to examine our handiwork, ecstatic to be rid of this enormous tumor that had consumed her life.

It was truly remarkable to work with this team pieced together with members from many countries, working together for the first time on this case. Members of the crew lined up to donate blood for a frail African woman much closer to eternity than to the OR of a hospital ship anchored in the Conakry harbour. We offered all that we had and God did the rest.

Many remarkable stories play out each week aboard the Africa Mercy, but this week even the most seasoned of the medical staff were in awe as one poor, forgotten African walked to the edge of eternity for a chance at a new life.