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."
"There’s no blood available here. Can't we just remove it?" Henry asks.
"It's not simple," I protest.
In Swahili, Henry explains to the boy's father that it may be possible to remove the tumor while saving the important structures plastered to its surface. But, he adds, the surgery could cause a stroke or even death.
"What happens if you don't operate?" the father asks.
"The mass will enlarge and become more entangled. There are risks both ways."
Henry relays the father’s reply. "They want to go ahead. Shall we schedule for Monday?"
Over the next few days, I mentally rehearse the procedure. I debate canceling. I think about the boy and his father. I alternate between confidence and anxiety. If we don't remove the mass now, it will be an even greater challenge next year or the year after. But, I think, is that reason enough to proceed?
On Monday, Henry, Susan (another American surgeon), and I begin the case. The procedure is bloody. We face a tangle of vessels, from fragile, corkscrew-like veins to large, pulsating arteries. There are dense, vascular attachments to the surrounding tissues and scars entrapping critical nerves.
The mass begins to ooze, a little at first and then disturbingly so. I cauterize the bleeding points, but that only makes things worse. I put pressure on the crucial points, but every time I release my hold blood begins flowing again. But when I maintain pressure, the bleeding remains under control. We plow forward.
Time telescopes. My whole body is on high alert.
Two hours later, a final cut releases the mass. Normal time resumes, and I realize I am drenched in sweat. The OR is 85 degrees. We close the wound. The boy wakes up and seems fine.
The next morning, I am still reeling. I look over the schedule, and we head back into the operating room for another day.