The CT Scan Part 1

Thursday morning, I woke up with an excruciating pain in the back of my throat. I had developed an esophageal ulcer from a freak accident where my doxycycline pill (antimalarial prophylaxis) got stuck in my throat during the prior weekend in Fort Portal. While I was busy trying to find a good position to swallow my breakfast without the feeling of a knife running down my esophagus, I noticed that Mr. and Mrs. M were not in their usual state of chatting with me about our mutual plans for the day. I thought they might be discontent with me eating only the insides of my morning margarine sandwich and neglecting to finish my African milk tea. While gathering the bread crusts on the edge of my plate, I apologized to Mr. M that my throat hurt and could only tolerate the soft sandwich innards. With a blank stare on his face, as if preoccupied with thoughts far from the breakfast table, he assured me that my new dietary requirements were not a problem.

On the ride to Mulago, the only thing that I could think about was finding some sort of painkiller or antacid to fight off the burning in my throat. Like Mr. M, Mrs. M also seemed much quieter than usual. But unable to deviate from my one track mind, I let the morning drive pass in silence, broken occasionally by the brakes shrieking as we bounced over decrepit speed bumps and weaved our way through pedestrians and livestock congregating in roundabouts. At the hospital, I found the ultimate cure, 2% lidocaine, a recommendation by one of the residents in the MUYU office. A little timid at first of putting a little PPD syringe full of lidocaine in my mouth, and aiming it in the mirror like a squirt gun around my uvula, I was euphoric to find my pain vanish in a matter of minutes (no viscous lidocaine or anesthetic sprays could be found). The freedom from torment, however, only lasted a half hour before I’d sneak away to the bathroom again for another fix.

With my pain under control, and my syringe and vial of lidocaine in my white coat, I made my way to the cancer institute at the top of the Old Mulago hill. I spent the last two weeks rotating there with Dr. Fred, an old friend and former visitor to Yale through the MUYU exchange. While waiting in his office for clinic to start, I got a phone call from Mrs. M. She was down in casualty (the emergency department). There had been an accident and Mr. M’s brother, P., was badly injured. She reported that there was a long line to see a doctor, and asked if I knew anyone that could help. I reported the situation to Dr. Fred and he gave me a letter for a friend down in casualty who he thought could help. I ran down the winding walk way of Old Mulago, skipping over sets of broken stairs, and taking the red dirt path shortcut snaked in between the TB and prenatal care wards.

Once inside the Eastern bloc edifice known as New Mulago, I scurried through semi-lit hallways lined with patients and their family members and down a flight of stairs to the casualty ward. There I found Mrs. M standing on the edge of a row of benches in front of a caged-in reception desk. She told me that P. had just been taken into a room and being seen by doctors. The casualty ward corridor is a series of concrete cells cut off to the outside world by wooden doors, whose opacity is enhanced by the white paint pealing at their edges. Mrs. M guided me to one of them, and unsure of what I would find behind the veneer, I pressed down on the handle and swung it open.

Inside the room I immediately noticed two young muzungu men in white coats and two plain clothed Ugandans struggling to hold down a man squirming on an exam table. They were trying to place an IV, and though P. looked half-sedated with his eyes closed and a swollen contusion across his forehead, he was doing everything he could to throw these guys off him. I shut the door behind me, and moved in closer to the action. The young munzugus were rapidly calling out in German to another young blonde woman in scrubs around the corner. She handed one of them a new IV needle and cannula, as P. began flexing his arm away again, I spoke up, “you want some lidocaine?” One of the German’s jokingly responded, “why, you know where to get some?” I pulled it out of my pocket and handed it to him. With a little bit of the numbing medication, and a big help from some Diazepam, an IV finally got situated in his right arm and P. rested easy on the table.

After the room settled down a bit, I asked who was in charge because I had a letter requesting a certain physician’s involvement. The Germans laughed again and said they weren’t sure who was supposed to be managing the ward. They introduced themselves, Thomas and Marcus, and told me they were senior medical students doing a rotation abroad as well. They advised me to check in the neighboring cell for a doctor who might be able to help me, but I was unsuccessful at finding any physician who could help. I abandoned my plans to find Fred’s friend, and realized these German medical students might actually be P.’s best shot. I returned to his bedside and asked their assessment and plan. Thomas told me P. had been hit by a matatu (minivan taxi) while walking on the street a few hours earlier and came into the ward with a GCS of 7 (severe head trauma, not making any verbal communication or opening his eyes, but localizing pain). He absolutely needed a CT scan, which everyone had written off as impossible because he came in with tattered clothes half hanging off his torso and dirt crusted to his skin. Even if he could afford it, they noted Mulago’s machine is down for at least another week. Next step would then be a neurosurgery consult, but the Germans added that they’re not going to do anything without a CT. I told them that I was a friend of his family’s and we would figure something out.

More to come soon...