We live in a beautiful world. Some times we wake up whether it be from a sleep or an anaesthetic and find that today something isn’t quite right. I guess that it is almost a daily experience for many at the moment as they awake to the restrictions of the coronavirus business with associated problems. Maybe the worst of which would be the death of a relative and realising that you are forbidden to mourn in public. The girl whom I am discussing now woke up from an anaesthetic, to face the realities of a very different life.
I never met her before her surgery and not for some weeks. She was 18. As you can see in the picture (even with the tube and the dressings) she is very beautiful. I have no before photos but I must assume that she had a pretty large mass in her neck. Goitres, sometimes very large are common in mountainous Ethiopia.
The largest I operated on was 2Kg but the world record is 13Kg.
I assume that some other medical therapies had been tried before she was taken for surgery as we try not to operate even in large cases in the young.
I think that in order her problems must have been increasing as the days went by.
- inability to speak above a whisper
- Pain on swallowing
- swelling under the scar, followed by the ooze of pus and soon everything she took in through her mouth. So she was kept on intravenous feeding.
- severe and very painful spasms in her facial muscles, hands and feet.
She had been operated on by a young surgeon several hundred kilometres from our hospital and was sent to me as the head of a University hospital to sort out the mess. So I was faced with a girl who was having severe calcium deficiency tetanic spasms, with a fistula from her oesophagus to her neck, an infected dehisced wound, and hardly able to speak – because of her spasms and the fact that one of the nerves to her vocal cords had been cut.
These were treated one by one. The spasms were controlled with extra calcium – which she will be on for life; the fistula was controlled (as you can see by the tube in her nose) by a tube for feeding passed into her stomach; the wound was treated with antibiotics and dressings; the voice will never be normal but is strengthened a bit by time and curing the other problems.
She was eventually discharged on her medication for her hypoparathyroid spasms eating normally but speaking softly. I loved it when she returned for further checkups. She a Muslim, me a Christian, and she gave me such warm hugs and special cheek kisses. Even telling the story still brings tears to my eyes!
Picture her without the tube and a healed scar (a bit puckered) in her neck.
PS the 2 recurrent laryngeal nerves, the 4 parathyroid glands and the oesophagus are intimate relations of the thyroid gland and sadly one nerve had been divided, the 4 glands removed and the oesophagus ‘holed’. Not ideal surgery.