Thursday, May 10, 2007

Ears – Three brief patient encounters

Today was all ears. My first patient had white drainage coming out of both but was too intrigued by the oversized and brightly-colored building blocks in the exam room to mind.

She liked to stack them, destroy the stack, and start over.

(Children are marvelous, resilient creatures, so resilient that they are capable of enjoying Sisyphean tasks, even self-imposed ones, while pus drips down both cheeks.)

My second patient had cemented wax blocking her ears and was having trouble hearing as a result. When I put a small plastic spatula in her ear to clear the obstruction, it made the sound of fingernails tapping on glass. Each time I tapped, she winced.

After three winces, I desisted, for I know how wince-inducing an ear excavation can be. (I always had very waxy ears as a child, and my mother is a pediatrician.)

I asked the pharmacist if we had colase, an oral stool softener that just so happens to also treat constipated ears. Unfortunately, we had none.

My expertise on compacted ear wax was not exhausted, however, and I quickly moved to plan b: I wrote “earwax removal drops” on a prescription pad and told the parents to go to the nearest pharmacy and follow the instructions on the box.

Since the blockage had left the girl unable to hear well, I wanted the parents to know how much wax they should expect to fall out before stopping the drops. I looked about the room for something the size of a large plug of ear wax when I noticed my plastic baggy of mixed nut “trail” mix. (I always get hungry mid-morning.)

“Eureka,” I thought, reaching for a raisin. I tore one of the desiccated grapes in half and found that not only does it approximate the size and shape of a glob of ear wax, but the fruit also has the same color and texture of the dry, hard, somewhat disgusting wax that was stubbornly blocking sound from reaching my patient’s ear drums.

“The drops are greasy, but they will dissolve that wax so that your daughter will be able to hear better.”

Another satisfied customer.

Qiniso, my third patient, had a thick scale covering his ears, with several small cracks in the skin. He also had significant hearing loss. The cause was unknown (probably HIV) and it was thought to be irreversible.

Qiniso was one of those kids who liked to shake hands. He is good at it too.

Qiniso’s fingers, fully extended, would barely extend beyond my palm, but he is not bothered by this.

He first gave me the typical, three-part “hello-how-are-you-I-am-fine” handshake.

Then, he began to offer me several high-fives, jumping higher and higher to reach my hand until he resorted to hanging on my elbow with his left arm while aggressively smacking my sinking hand with his right hand.

He repeatedly slapped my palm as if to say, “Ha! Gotcha! How tall and big are you now, hand!? Take that!”

Qiniso really enjoyed it. I found that it stung a bit.

After freeing myself, I sat at my desk to write a prescription for an anti-fungal (and anti-scaly-ears) cream. After a moment, with my peripheral vision, I noticed Qiniso approaching me from the right. I braced myself.

Feeling nothing, I looked up. He was holding out his hand expectantly. As I shook it, he lifted his thumb.

“I know this one” I thought, and snapped my thumb against his.

This is another typical handshake in Swaziland, one that is in vogue among young Swazi men. It is a man-to-man handshake that is usually reserved for someone that you know. Once the shake starts, the thumb snaps can continue for some time. Often, the handshake ends with the shakers actually holding hands for a few seconds, sometimes longer.

Such hand-holding is an everyday, commonplace gesture of affection between men here. This cultural nuance takes some getting used to, but there is much kindness in it.

Qiniso snapped my thumb against his about thirty million times before I reached backward with my left hand and clumsily tore his prescription from the pad. The snapping continued as I stood up, fumbled for his chart and opened the door.

Qiniso pulled me into the hall. The snapping continued.

With one firm, conclusive snap he released my hand and disappeared in the direction of the pharmacy.

Sounds of cries and laughter came from our waiting room, as is always the case mid-morning.

I wondered how much of it Qiniso could hear.



At 1:33 AM, Blogger Cabrini Ministries Swaziland said...

Hi Ryan,

I am a blogger in the NYC area that has become connected to the Cabrini Sisters in St. Philip's Mission, Swaziland. I've created a blog for them, at (I know the pediatricians at Baylor Clinic help with some of the HIV+ and ART children at the Cabrini hostel for OVC.)

I've really enjoyed your blog and learned a lot from the pediatrician angle. May we provide a link to your blog from our blog? (Yay Blogger!) Our official blog launch is this week and we will be sharing info about our healthcare outreach, OVC, agricultural, and educational programs, as well as general info about the issues affecting the people in Swaziland.

The Cabrini sisters talk about making a "circle of love" to surround these communities and their children. I've found it's hard not to fall in love with these kids. Keep up the great work.



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