The past few days, Dr. Tinkah (who I normally work with) has
been out, so I’ve been working with another doctor who doesn’t have the best
reputation and has been known to not show up on occasion. I preface with this because I don't think I would've been put in this situation had Dr. T been around. Anyway, about 4 days ago, we had a patient
come in to the female medical ward with palpitations, headache, and
dizziness. When this 30 y/o lady came
in, I was outside and saw the nurses wheel her in. I thought they were horribly mistaken taking
her into the female ward because she looked just like a man. Strong jaw, muscular, t-shirt (i.e.-no obvious female characteristics visible). I literally waited
for them to wheel her back out and take her to the men's ward…but they didn’t.
Instead, I ended up rounding on her.
One of the struggles with people out here is that there is a great deal
of denial and so when there is a bad prognosis (usually cancer) they have been
told about, they pretend they’ve never known anything and expect you to
rediagnose them with something different.
So when this lady came in and refused to let us run any tests on her (looking
for secondary causes of high blood pressure), we thought she was hiding
something. We had managed to look at her
chest during her heart exam and noticed she had absolutely no breasts. Trying to to an external genital exam was the biggest
fiasco ever and never actually happened for reasons not worth going into. Eventually, she let us do an abdominal U/S
which showed that she had no uterus or ovaries.
For numerous reasons also not worth going into, I found myself in the
position of having to break this news to her.
Alone.
I can’t even begin to explain how difficult it was to get
the courage to do this and the circumstances that led to me finally being able
to- were undoubtedly from God. If I thought I could explain concisely, I would, but the timing of everything was just too perfect and far
too intricate to do so. If you remember when I get back though, I would love to share.
Anyway, the whole time I’m preparing to do this, I’m thinking
of those “dumb at the time, but now are like the Holy Grail to me” doc.com
videos we had to watch during intersession.
I didn’t have tissues (I have actually yet to find a paper product in
all of Uganda), but I did manage to find a private room for us to use. I was a little extra worried because I knew I
would be working through a translator, but luckily the patient actually spoke a
little bit of English. I explained what
we had found and the implications of it and how I thought it was related to her
blood pressure. Her reaction was actually
kind of cool. She got really quiet for a
second then said “I always wondered why I hadn’t developed breasts like the
other girls”. That blew me away. For at least 15 years, this lady wondered why
she didn’t look like the other girls and had just accepted it. I can’t even imagine the psychological damage
that would’ve caused me and I can’t help thinking we offered her at least a
little relief. Here at Kagando, we
don’t even have a way to measure electrolytes, so we will never be able to tell
her why she doesn’t have female organs, but as is often the case….we do what we
can. For her, that means we are trying to control
her BP and will start her on OCPs in hopes that the estrogen will help her at
least a little physically.
I like the autonomy I’ve had out here with this other
physician in so far as I have quickly learned to trust myself a little more and
feel able to manage things without always running to an attending, but I’m
really looking forward to the guidance I’m going to have as an intern- just
someone to make sure I’m not making huge mistakes. Get excited. :)
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