COTW: My toughest case

As we travel around these days, one of the questions that often arises is "what is the toughest case you have done in these past two years at Tenwek?" My thoughts usually fall back to the time when a baby was born at Tenwek with respiratory distress. An x-ray confirmed that the baby had an abnormal left lung which was too big, thereby compressing the heart and the normal right lung. For those interested, the baby had Congenital Cystic Adenomatoid Malformation.

Although I had never done a pneumonectomy in a neonate, it was necessary to remove the entire left lung to save the baby's life. I was thankful to have one of my very competent residents, Agneta, operating with me on this 3-day-old baby as we removed the abnormal lung and tied off some very small, yet important blood vessels right next to the heart (see second picture if your stomach will not be queasy). One bad move and the baby’s life could have been in jeopardy. We finished the operation and closed the chest, and since there was then a big empty space in the left chest, we filled it with water (sterile, of course). The baby did quite well, and I recently heard from Agneta that she saw the baby back in clinic and the baby continues to do fine.

Although this child will likely never run with the Kenyan marathon team, it seems that God has granted her a normal life through this nervous surgeon and his resident.

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