November 21, 2015
by Dr. Pat Rees
Jamelle came with two younger men to the emergency area yesterday. He is from a town 2 hours away that hosts the district hospital, but that hospital has no surgeon, and frequently little supplies. Jamelle is 60 years old, and has been in Gabon from his native Lebanon, off and on, for 35 years. By the cut of his clothes and how he understands English, I suspect he is a prominent businessman. 5 years ago, he had some heart issues and (reportedly) had some cardiac stents placed. The doctors then started him on two medications to prevent the stents from occluding. He has stayed on those 2 medications and another heart medication faithfully all this time. One of the side effects of these anti-platelet medications is that you can bleed from small wounds. You can also bleed from your nose---and sometimes that gets difficult to stop when your “blood is thin”. This is what had happened to Jamelle, and why his friends had driven him the two hours to Bongolo Hospital.
It was about 1 PM when my resident asked me to come to the ER where I first saw this very anxious, blood-covered gentleman. He had bloody tissues all around him and his friends were pacing back and forth. After I put on a glove, pinched his nose and easily stopped the bleeding, I started talking with my resident about plans on how to treat this. Jamelle was amazed and so excited that the bleeding had stopped with my pinching! Now, nothing happens fast here in Bongolo, so after talking to the resident and giving him a list of things he needed to “collect” so we could take care of this problem, he was off---for 40 minutes. The whole time I stood next to the bed, pinching Jamelle’s nose. He complained of discomfort, but would trickle blood if I let up on the pressure. He asked me for the time about every 10 minutes, so anxious that this would be over with. He also asked me multiple times if he was going to die and could we take care of this problem in Bongolo? I assured him he was fine, his vitals were fine, his blood count was fine, and we just needed to stop the bleeding that was made worse by his medications.
When the resident brought all the supplies, we had “instruction time” on how to place American style packs in the nose. (They all like the “new” ways of doing things so any American “cast offs” we have here are dearly loved by the residents.) Success! The bleeding stopped and we were all happy. I was praying that the bleeding indeed would be stopped with what we had done. We agreed to recheck the patient in 2 hours and see how things were, and I went back to the clinic to study (I have to do Continuing Medical Education before my next birthday to keep my American License.) About 45 minutes later I felt “prompted” to go to the ER. Indeed, the packs had “fallen out” and Jamelle’s nose was again bleeding. Play the previous scenario again. Jamelle is very upset. The friends are doing Face Time with his wife in Lebanon who is horrified at how her husband looks. They are all very afraid he is going to die. We pack his nose again, using packs and some epinephrine to try to stop the bleeding. Again things look “good” but I have a feeling we aren’t going to make it through the night without taking this poor man to the OR to cauterize his nose.
We hear Jamelle imploring Allah. My resident and I are both silently praying. Two hours later (at least I got dinner!) the call comes. I return to the ER and we wheel the cart containing the bleeding Jamelle (who has now figured out how to pinch his own nose) to the operating room. We wait for anesthesia, who is slow in coming tonight, and when we have all the equipment ready, and everyone in the room, Jamelle removes his fingers from his nose and……NO BLEEDING!
Jamelle knows that Bongolo is a Christian Hospital. He had told us earlier that he knew the surgeon who started the hospital here at Bongolo. He had overwhelming fear at the thought that he might die with this nosebleed. I arrived early before rounds this morning and walked by the room of a sleeping Jamelle who now has a bloodless hospital gown on and no signs of bleeding. My devotional this morning was talking about the right words at the right time (Proverbs 25:11) I am praying that this morning, we can say the right words to Jamelle so that he will know who really is the God who heals.