Yesterday I was in outpatient clinic as they were ready to open. I walked around to the back to the “waiting room”, a series of benches outside, and looked to see who was waiting. The first thing that grabbed my eye was a 12 year old boy that looked like he had hydrocephalous or a tumor growing out of his head.
The boy’s name is Samson, and he was accompanied by his aunt. I brought them back to the clinic and grabbed a translator. The story I got was so complex and ever changing that I ended up having to draw a timeline and clarify over and over again to get it right. The family is from the Lao tribe and 9 days ago, the boy developed a headache. His family believed this to be a curse, that someone had put nails in his head. The family believed that if he was taken to a medical doctor and received an injection the curse would kill him on the spot, so he was taken to the “natural doctor” or what we would call a witch doctor or a voodoo doctor in the US (you can find them usually working at GNC in the US). The witch doctor agreed that the boy had a curse and did some sort of operation where he cut into Samson’s head to remove the cursed material causing his headache.
You can see the 3 incision marks on his head from where the witch doctor cut him. The problem is that neither the family nor us knew how deep these cuts went. More worrisome is that Samson could not move his neck without severe pain. We were concerned for meningitis or epidural abscess when also considering he had a high white blood cell count and was febrile. I grabbed a syringe in the clinic and stuck it straight into the abscess to see what I could aspirate.
I got 2 syringes full of pus. There’s no MRI within several hundred miles to look for an epidural abscess, so the decision was made to do a spinal tap to determine if he had meningitis. The spinal tap was done and luckily it didn’t show any evidence of meningitis. So, the job of doing the incision and drainage of the biggest abscess I have ever seen fell onto me. Dr. Hardison, the attending physician, wanted Samson to be completely under for this, so we waited for the anesthesiologist to arrive the next morning. We brought Samson to the OR and gave him Ketamine (or special K as it’s known on the streets and occasionally on the breakfast table) to knock him out, while I cleaned and incised this massive abscess.
Pus and blood immediately began oozing out after the initial incision. What followed what a tremendous (40 cc, easy) amount of pus and blood clots, as I squeezed all areas of the abscess. I took my Kelly clamps and swept under the skin to break up any remaining abscess and feel for any bone fragments, if the witch doctor had decided to give Samson a frontal lobotomy. I didn’t feel any brain like texture, so I cut some gauze, soaked it in iodine and with the help of my assistant, packed it through the tiny 1cm incision I made before bandaging him up and sending him back to the floor. When Samson did finally wake up, he said he felt much better and wasn’t having the pain when he moved his neck (oddly enough). I hope Samson makes a speedy recovery and his family learns a lesson to stick with real medicine (such as colon hydrotherapy) from now on!
Hard lessons in Swahili
Guess you should have lived with your dad…
Babaye mkwe alimchapa nadi akafa
His father in-law beat him to death.
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