Living Pains

While the actual lab research is off the ground and has been keeping me busy, I’ve still found some time to get into the operating room to observe surgeries. The constant stream of patients with advanced hernias, hydroceles, and various other ignored maladies continues to flow through the doors. Learning the details about the procedures has been nice, but I’ve also been trying to keep my eyes open to the unique cultural experience of medicine in Kenya.

As I previously mentioned, most of the surgeries here are done using spinal anesthesia, which involves sticking a long needle into the spinal cord of the lower back, and injecting lidocaine. It sounds a lot more dangerous than it is, as the only real risk is a headache if you let too much cerebrospinal fluid drain out. As you might imagine, the procedure is not comfortable, but it is usually pretty quick; 10 seconds if the anesthesiologist is good. If anyone has ever had or seen a “spinal tap”, or lumbar puncture (LP), performed, it appears to be the worst pain imaginable. During my neurology rotation in medical school, we had to perform an LPs on patients in the hospital for various reasons. The first one, I watched the second year resident as she injected copious amounts of lidocaine into the woman’s back around the site where she was going to place the longer spinal needle. The women screamed and cried and cursed, despite the lidocaine. This scene was repeated when it was my turn for an LP.

Now back to Kenya. I watched the anesthesia tech as he positioned the patient, cleaned the lower back with alcohol, but then skipped the “critical” numbing step, and simply inserted the needle into the patient’s spinal cord, injected lidocaine, and removed the needle. Not a peep from the patient, barely a flinch when the needle was inserted. Huh. I have watched this scene repeat probably 100 times, and only a handful of times has a patient even so much as reacted to a needle being inserted into their spine.

I have a few theories to explain this:

1) The anesthesia techs here are more skilled than anyone in the states with a spinal needle. Considering the number of “reps” that they get here compared to the nervous residents and medical students who do LPs every few months, I fully believe this.

2) Patients in Kenya have different expectations regarding pain than patients in the US. Stoicism is highly regarded in many tribes in Kenya. For example, some tribes practice adolescent male circumcision, and if the boy cries or shows that he’s in pain, he is ostracized by the community for some period. In general, there is just much more physical pain associated with everyday living in for many in Kenya. Especially the population at our hospital, who are primarily rural laborers, backbreaking physical work, accidents, and chronic medical conditions that they can’t afford to properly treat are a fact of life. Just as there’s no expectation for a life without danger (as E mentioned), there’s no expectation for a life without pain. By the time many of these people reach the OR, they have been living for years with a condition that we would consider unbearable. Maybe they’re being stoic and the spinal needle hurts like hell, or maybe it is just another discomfort, and this fleeting pain is not a big deal.

In fairness, I’ve never had an LP, and I don’t know if I’d cry like a baby during the procedure, but I think that most people in the US are used to a life devoid of much physical pain. If our back hurts, we take some ibuprofen, and if that doesn’t work, we ask our doctor for some of the good stuff. We have the right to a pain-free life. When you’re making $1 per day and struggling to feed your family, not much income goes to relieving that backache, or the festering two week-old machete wound that I saw a few weeks ago.

No value judgments here; I appreciate that I can choose to alleviate my pain should it arise, but I think that it’s important to remember that not everyone has that luxury, and that the expectation of a pain-free existence can actually make otherwise tolerable situations (like an LP), excruciating.