right hip, knee, and tibia (his shin bone), with the result that his pelvis and
groin pain won’t allow him to lie flat or sit in a chair. He has reached a
truce with his infection, but is imperceptibly ceding ground as his leg pain
becomes more crippling. Joseph has very dark skin, an anxious smile with
beautiful teeth, and piercing, despondent eyes. I know he was told about
my coming here, and in his adolescent mind, I wonder what his hopes are.
I pull back the white sheet covering his legs, and with my coterie of nurses
and aides crowding in, quickly ascertain which leg is infected. His left leg
is twice the size of his right, and he holds it perfectly still. His right leg is
smaller, at least in part, because he’s not been out of bed once in two
years. But his left leg is swollen, with tight skin from his waist to his toes.
The nurses warn me not to move his leg, and I’m rapidly losing hope that
his leg is treatable. Through the interpreter I tell him that I will look at his
X-rays and will return to discuss the plan. Quietly he replies, “murakoze,”
which is “thank you” in Kinyarwandan.
Here in this remote hospital on the shores of Lake Kivu, there is small
X-ray unit and a certified X-ray tech. The equipment and the film quality
are like stepping back in time, and as I snap the X-rays onto the viewing
box, my heart sinks. Joseph’s femur and tibia are three times their normal
size, wavy and deformed, moth-eaten and crooked. From his hip joint to
his ankle, his bones are being eaten alive by the TB bacteria. I wonder,
what would I do right now in America? Would long-term antibiotics and
multiple operations save his leg? Or would we end up replacing his hip
and knee after multiple operations? Would an orthopedic oncologist be
able to save this leg and get Joseph out of bed and off his back?
After contemplating Joseph’s plight, his two years in bed, the fact that
both parents were murdered in the 1994 genocide, understanding that he is
an orphan in every sense of the word, I think the only reasonable treatment
is amputation. If Joseph is ever going to have a chance of getting out of
bed and leaving this hospital alive it will be as an amputee. How do you
tell a child (through an interpreter, no less) that he must lose his leg in an
attempt to save his life? It’s a short conversation surrounded by patients,
staff, and concerned family members from the surrounding inpatients.
Joseph only says, “Okay.”
Cutting off Joseph’s leg is among the hardest things I have ever done.
Performing an amputation at the hip joint is challenging technically. There
are enormous blood vessels that must be treated expertly so that Joseph
marcin
(Marcin)
#1