Courage

Courage
Bravery, guts, nerve, valor, daring, audacity…….
Some people seem to come by courage naturally. Some create a false image of courage for the outside world to see yet suffer greatly on the inside. For some, courage comes involuntarily as it is thrust upon them. In these people we see indomitable spirits from which we all can learn. Take F.N. who has been with us now for a year in the hospital. She was 16 when she became pregnant and delivered her first and only baby that she will ever deliver and it was dead. She had obstructed labor like so many other woman and did not have access to emergency obstetrics care and labored at home for 2 days. She experienced such a horrific injury to the soft tissues of her pelvis from compression of the fetal head that we were unable to even attempt a traditional fistula repair. She was one of a handful that we cannot attempt a repair with a relatively safe, quick vaginal surgery. She had both a vesicovaginal and a rectovaginal fistula and leaked urine and stool constantly. When we saw her on an AMREF (www.amref.org) fistula outreach surgery week, she was malnourished, lethargic, depressed. She had the stench of someone who lays in their own concentrated waste for days with no one to attend to them. Her skin was broken down from the constant wetness and she had deep, painful ulcerations of the labia and buttocks. She had nearly given up hope, abandoned by her family. With Dr. Masenga’s guidance and help from funds from the Blue Jean Ball donations, we transported F.N. to KCMC for care. After countless examinations and tests it was concluded that the Urologists would assume her care because of the complexity of her condition. Despite valiant attempts at diverting the flow of stool and urine and 5 separate surgeries, she had a recurrence of her rectovaginal fistula and because her urine had been diverted in to her colon, she was having stool and urine leaking constantly through the same residual hole in her vagina. One year in the hospital and no hope in site, but she had regained an ever present smile and sense of humor that belied her wretched state.

One last desperate attempt at repair: She arrived in the operating theatre that morning with her usual calm, determined smile, without a hint of anxiety or worry which most of us would have. After so many surgeries, she had very few iv sites and served more as a pin cushion for the anesthetists. Two failed spinal anesthesia attempts added insult to injury. As she lay there after her second spinal attempt and her 7th painful iv start the urine and residual stool from the bowel preparation filled the canvas on which she lay and because of her positioning ran up and around her head. It was disgusting to watch and we hastened to clean her up and apologize for the mess, but she just patiently smiled and reassured us that she was ok as she finally went off to sleep with general anesthesia. What kind of person can endure this level of prolonged suffering and still hold her head high the next day and smile, laugh and walk the corridors of her familiar hospital with her fistula friends? A woman with courage beyond measure and one from whom I will always be grateful for teaching me about humility and equanimity in a way greater than any doctor could ever teach.