After surgery, the scars will always remain

“To be trusted is a greater compliment than to be loved.”
– George MacDonald

As we adjust her position on the surgical table, I spot some short, vertical scars on the front of her neck. The parallel slashes sit directly over her enlarged thyroid — a goiter — and appear to have been deliberately placed. There are two sets of scratches, one set on either side of the neck, nearly identical in length and evenly spaced. I rub my finger across the marks; they are superficial and do not extend deeply into the underlying tissues. The scars are punctuation marks on the otherwise smooth, taut skin of the young African woman.

My Kenyan colleague notices my interest.

“Those are tribal,” my friend tells me.

“What do they represent?” I ask.

“They are not ceremonial markings. No, those were made by a folk healer. The healer cuts in the skin and puts medicines and herbs under the surface to make the goiter go away.”

“Does it work?”

He looks at me and smiles. “Well, no. But they try, anyway.”

We are working at Moi Teaching and Referral Hospital in Eldoret, Kenya and I am assisting the local surgeons as they perfect their thyroidectomy skills. Kenya has a high proportion of people with symptomatic goiters, many of which cause problems with breathing or swallowing. The surgery to remove the thyroid is usually straightforward, but there are some tricks that we can share. In sub-Saharan Africa, skilled, confident thyroid surgeons can stay very busy.

Soon, everything is ready. The neck — along with the scars — is scrubbed and draped. We are underway.

We create a horizontal incision over the lower neck and raise the skin off of the tissues to expose the thyroid gland beneath the surface. Back in the States, we would remove both sides of the gland because both lobes are enlarged and abnormal. That is not always true here.

“I talked to her when we met in clinic,” my Kenyan colleague tells me. “She cannot afford to purchase thyroid medication if we remove her entire gland. We need to save as much as possible.”

We remove the left lobe entirely because it is pushing her windpipe far to the side and causing symptoms. On the right side, we work to save as much normal tissue as possible.

The procedure goes well. The goiter would be considered very large at home but is fairly typical here. We finish the procedure and close the wound, returning the neck skin to its place. It is one of fourteen thyroidectomies the surgeons and I will share over the course of my month working in Kenya.

We take the drapes down and prepare to move her to a cart. “Look,” I say, “the little vertical scars are still there.”

“Yes,” responds my Kenyan friend, “but now she now has a new horizontal scar, as well.”

She has seen two sets of healers to get rid of the masses in her thyroid. Both the folk healer and our surgical team gave her recommendations. Now, at last, the masses are gone.

She wakes up and we stop by the ward later to see how she is doing. The next morning, she is grateful and ready to begin the journey home. She is breathing better, and the neck skin is a little swollen.

She should heal quickly, but the scars — those small vertical marks and the longer horizontal incision — signify two moments when she placed her trust in others. Those scars will remain.

Bruce Campbell is an otolaryngologist who blogs at Reflections in a Head Mirror.

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