His broad, open smile met me as I walked into the exam room. I noticed his feet didn’t quite reach the floor, and he was wearing sandals. His feet were wide and squarish, the type of feet one would get from going barefoot their entire life. The type of feet my yoga teacher always asked us to emulate with toes spread wide and space between each digit.
From his history, I knew he was an immigrant from Burma who had lived twenty years in a Thai refugee camp. I said hello and then used a phone interpreter to ask him why he had come in today. He smiled again and asked if I could please remove the lump in his neck that was causing him some discomfort.
He hopped up on the exam table, and I examined his neck. The 2 cm mass on his neck was visible from across the room. It was superficial but not easily moveable and had some erythema and edema to the overlying skin.
I asked him multiple questions while thinking about my next step. He never smoked, he did not drink and in the refugee camp he had worked as a charcoal maker. I thought it was an abscess, but in the past, I had gotten into trouble treating a draining abscess in the neck of a pregnant patient who turned out to have tuberculous lymphadenitis. My patient really wanted me to incise and drain it, but I had strong misgivings. Luckily, the patient had insurance, and I could refer him to a surgeon.
When he came back a few months later, he again had a big smile on his face and was again wearing sandals on his perfect feet. We exchanged greetings, and I looked at his neck. There was a tiny line along his neck following biodynamic excisional skin tension (BEST) lines where his mass had been.
I complimented the surgeon for doing such a cosmetically good job. He laughed and said “Oh, I did not go to the surgeon. I did it myself.” I was floored and asked him to repeat and explain more.
He told me that in the refugee camp they had to do many, many things for themselves. He did not have transportation to the surgeon, so he did it himself.
I will not soon be recommending that my patients do their own excisions and biopsies and I’m glad this story has a happy ending. I continue to learn something new every day.
Susan Dirks
Coralville, Iowa
1 thought on “Self Treatment”
I’m not sure what surprises me the most: the man’s coordination and dexterity demonstrated by his removal of the lump and suturing of the wound, or his courage and confidence that he could do it himself. I’m glad it turned out well for him. Nonetheless, i doubt i’ll ever recommend self-surgery to anyone.