“Hold your breath,” the technician states.
The thirteen-year-old boy sits in a battered ENT exam chair. Henry, my Kenyan colleague, hands me a blurry CT scan. “His neck mass has grown for two years,” Henry says. “We think it is a glomus vagale tumor. Do you agree?”
I hold the scan up to a window. The vascular mass fills the side of the boy’s neck, displacing his carotid artery. “That’s probably right,” I respond. “At home, we would get more studies. We would prepare for bleeding. This kind of surgery can be very dangerous, even fatal.”
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He was in his younger middle years, generally well. Before he had a wife and kids, he had been a competitive cyclist, an Olympic hopeful. He stayed active, ate thoughtfully, took no medications. But in the mornings, first his hands and within months other joints would swell and ache terribly, refusing to move. His primary doc sent him to a rheumatologist because, based on his symptoms, it appeared that an inflammatory process was to blame. The rheumatologist ran tests and then more tests; all were negative, but she agreed–this was rheumatoid arthritis.
He was started on a medication that made him feel better. Not fully better, but generally able to get up and move in the mornings without significant pain, which he certainly preferred, and his life went on.
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