Prior to the code blue situation, I had seen a young man in the morning who had either a cyst, lymph node, or small lipoma on his face (my guess was most likely sebaceous cyst given that it was located where his sideburns are). One of the techs, Jay-Jay, asked if I would be willing to see him, to which I replied of course (after all, that’s what I was there for). The patient reported the lump had been present for approximately 2 years and had increased a little bit in size but wasn’t particularly painful. Jay-Jay asked if I would be willing to remove it. To me this was a no brainer. Simple cyst excision, at most 30 minutes of time and could be done without having to call in the anesthesiologist. Done and done.
At the time, we had told the patient to come back around 2pm to have the cyst removed so that we could make sure everything I needed was available (again this is Haiti – need to check and double check that all the instruments are available and sterilized as well as lidocaine on hand for local anesthestic). Of course, the patient came back promptly at 2pm… and then had to wait while Danielle, Dan, Jamie and I were dealing with the Code Blue next door in the ICU. He didn’t seem to mind much, but I felt bad making him wait. On some level, he was probably not surprised by the wait – after all, he had waited two years for someone to remove whatever this thing was on his face… a few more minutes probably would not matter much.
The surgical details are not that interesting – it turned out to be a sebaceous cyst. Total procedure time was maybe 20 minutes; it only took that long because I was struggling with the small incision I made in order to minimize the potential scar on his face. Danielle and Dan came into the operating room as well – Danielle acted as my assistant and Dan as an interpreter. At some point midway during the case, I dropped the Adson forceps I was using. Now, in the United States this would likely garner a joke (one of the scrub nurses at Northwestern said that some days I had “the drops” because I tended to drop instruments) and either the surgical kit would contain another Adson or the circulating nurse would go grab another sterile set of Adson forceps. Not so in Haiti. Not only did my kit only contain only one Adson but there were no other sterile sets already prepped. Dan eventually went and grabbed a sterile suture removal kit (which contains a pair of forceps) and we made do. Finally at the end of the case, I was planning to clean the area where I had been working as well as some blood that had dripped into the patient’s ear… only to discover I had no sterile saline. Nor was there any stocked outside of the operating room. I asked Danielle to go get some (probably not the best idea since she doesn’t speak Creole… and apparently the pronunciation of saline normal is not the same as in English – a hilarious tale that hopefully I can encourage Danielle to tell) and she returned several agonizing minutes later, and then we were finished.
I’ll admit, I thoroughly enjoyed the whole procedure. Granted this is extremely minor in the grand scheme of all surgical procedures, but there was something about being back in my own element and for once being the guy in charge rather than the resident assisting an attending that felt really great. Beyond that though, the best moment was when the patient asked Dan when he needed to come back to have stitches removed. The look on the patient’s face when he found out he would not have to return for suture removal was priceless; it was some combination of dumbfounded and perplexed. All I knew was this kid walked out happy, and for the first time in two years, he was not ashamed of the “thing” on his face.
I don’t think I quite knew just how happy and grateful he was until the friend who brought him to the hospital to see me in the first place (who also happened to work at St Damien’s) saw me the next day, shook my hand, and gave me a huge bear hug. Each day thereafter, this man thanked me, shook my hand, and gave me a hug. At one point, I believe he called me “chief”.
I mention this detail not to brag about how wonderful a job I did, but to point out how something that in my eyes was so miniscule created a huge and lasting impact on a young man. This was a man who walked around for two years ashamed of what was on his face. A man who was either too afraid to ask to have it removed or simply assumed the answer would be no in a country where emergency surgery reigns and elective surgery is rarely done. In the grand scheme of things, I had done little – something so routine, ordinary, and common in the United States that it is often relegated to interns to perform. But the gratitude for even that simple action was enormous. I can’t help but think that even though the surgery program we are trying to create may only start out taking care of minor elective procedures (hernias, cysts, etc), even these small surgeries can have a profound impact on the people who’s lives have been affected. I know this sounds very touchy feely (unusual for me), but for anyone who has an inkling of a heart – you can’t help but be touched by tremendous gratitude at even the smallest of gestures.
It is often said that there is very little that one person can do. But I guess what I’m trying to get across here is that sometimes it really is the little things in life that matter most. Sometimes, a small change can make a lasting difference. It certainly did for my patient. And in turn, I suppose I’m challenging all of you to see what small changes you can make that may making a huge impact on others. Who knows what might happen?