It’s Monday and my last day. I’m doing a hysterectomy and I hear there is a woman who is out there that has a neck infection. Oh no, another one? Most commonly from a dental abscess that’s untreated a long time. Its near the end of the day, and in between cases I go out to look at her in the pre-op area. The whole area smells aweful!!! She is laying on the one bed in the area alone and semi conscious. I call the family in and tell them to stay at her bedside so she doesn’t fall off the bed. I look over her and they say she has been sick about 2 weeks and in an altered mental state for three days.
So I ask myself why bring her in now? Because they have had pressure by family or friends to bring her in. They have already tried the traditional healer (witch doctor) and not gotten better. And now that she is ready to die, they bring her in so that she can die at the hospital and they will be able to say they’ve done everything they could. So that the neighbors and distant family will not criticize them.
Well at this hospital we operate on emergency cases without requiring money first. That sure is a great thing, because they would never give money for her in her condition- they know she will die. I KNOW SHE WILL DIE. But it is God who can do something about her situation that we have no control over. I pray for her and send the family to the pharmacy to buy medications… I ask the “nurses” to start an IV and get fluids going.
I do my last surgery that was scheduled that day and come out to check and see if she is ready. The family didn’t go to the pharmacy, as I anticipated they wouldn’t. She does have and IV and we take her to the operating room.
I will not attach pictures, but if you’re interested you can email me at my usual email directly and I can send some. They are graphic and disturbing of the reality of her surgery.
What follows is graphically descriptive- if you do not want to hear it- then skip the next paragraph.
GRAPHIC paragraph- I want Phillippe to give some ketamine, but he is concerned about her airway as she can’t open her mouth because of trismus. If I push on her neck she will slowly grab my hand a push away, but definitely altered consciousness. Im going to be debreding her neck so I think a trach is a bad idea. He doesn’t think a nasal intubation is a good idea. So to say there are no good options. He finally gives a whiff of Ketamine and we start. She groans at each cut but is less conscious and will not remember this. The resident, Anna, who is with me does a lot of the debreding. It is a horrible process. We open where there is a open area of her neck with pus and grey tissue. At each movement more of the dead smell wafts out. We start cutting off dead tissue and go from her left ear, down her neck to her upper chest. We can put our finger undreneath all along this area easily. Underneath this flap of semi-dead skin, there is a grey layer of fat, then under that some black muscle and some live muscle. The platysmus muscle is partially alive a and partially dead. We end up taking off all her skin in an area of about a 10 x 10 inches of chest in the center and then back up the other side of her neck to her other ear and a little on the side of her forehead, then around the base of her chin to complete the area. We then take off all the grey and dead tissue we can get off. All while she is groaning at times and Im asking Phillippe to give a little more- which he doesn’t want to do. As he is conservative with it, she does breath fine and keeps her saturation up during the entire thing. We take off a little more skin in some areas and the area is looking and smelling better. (Im grateful in cases like this, that my nose doesn’t work as well as some peoples) So she survives the surgery and as we bring her out to her family with all the dressings covering everything. I tell them it is their turn. They brought her here to die, but I have asked God to heal her and help her live. They need to go to the pharmacy and get the IV and medicines that she needs now!
We leave the next morning. I hear that she survived. Then a couple days later I hear that a NG tube was put in for feeding and later that day she died.
The other girl with pus coming out her mouth and ear is doing well and has minimal pus on the dressings now.