This is why we do it.

It was back into the thick of things today, with another very busy outpatient clinic. I quite enjoyed myself, which might seem surprising in many ways not least because the senior surgical AMO had been seconded to running examinations for the week (an interesting decision from my perspective) and the other one was feeling distinctly under par – a high fever, but malaria test negative. Like so many healthcare workers all over the world, he came to work and we just got on with it. The week would have been decimated without him, as I really do not have the depth of Swahili language to run an outpatient clinic effectively on my own. It was another hot day here and as I walked through the door of the clinic room, I looked up hopefully at the ceiling fan. Have you been fixed? I thought to myself. It stared back at me lifeless. No amount of fiddling with the switch could persuade it stutter into life. Clinic was to be another stuffy affair. I have gotten rather used to sweating.

Once again, an interesting and eclectic mix of patients came to see us today, which I really do rather like. It is a very different practice to that which I enjoy back in the UK; where, driven by the complexities of specialist practice, we see a much more selected group of patients. It is certainly challenging, but refreshing in many ways too. Furthermore, I have definitely rediscovered my love of paediatrics and if nothing else, the opportunity to provide such a service here has been a real pleasure for me (albeit a slightly stressful one anaesthetically).

However, the real highlight of the day came when a certain familiar face walked through the clinic door. She was smiling from ear to ear and brought the ‘sunshine’ in with her (but without the heat I hasten to add). Blimey she looked well. This was the 49 year old lady I described in ‘complicated complications’ back in November. She had had more than one close shave with death and with inevitable wound complications (and lack of community support or clever wound management systems) had been an inpatient in Muheza for over two months, including Christmas and New Year. She was finally discharged about 6 weeks ago.

If you had met her for the first time today, you would have had no idea what she had been through. There was not even a subtle hint that she had been ill (nor newly diagnosed with HIV). And further good news was to come when I inspected her abdomen. Her scars bore testament to her ordeal, but the wounds had completely healed. The sinus that I was suspicious might have become a long-term issue, had dried up. What an absolutely fantastic result. For me this was a really special moment. Here sitting before me, was a lady we had rescued from the very brink of disaster. She was alive, well and thriving. As we talked about how she had been getting on, she then wanted to hear about news of my littlest daughter (who had taken her sweets just before we went away for Christmas). It was a delightful conversation. She was patient with my Swahili, but sometimes the words don’t matter all that much. As I discharged her from clinic giving her a ‘clean bill of health’, I couldn’t help but think she was starting another chapter of her life that she very nearly did not have.

It is cases like this that make all the years of hard work and toil as a surgeon worth it. Investing so personally in the outcomes of our patients does carry a significant burden when things don’t go so well. But the flip side is that moments such as this are that little bit sweeter. They are that little bit more powerful. And seeing such a person thriving brings with it a certain special sense of deep satisfaction that we have used our skills well. The attention to detail, the perseverance. All worth it. I blink and my mind momentarily flashes back 3 ½ months to the chaos I found when operating; the torn bowel, the hole in the colon, the enteral contents. My lids open; and walking out of the door is a beautiful healthy human being.