My second week at Kijabe, a clinical officer came for advice
on a perplexing case of a young, 12-year-old boy with multiple joint pains and
fevers. “I think it’s a case of juvenile
rheumatoid arthritis,” he said, “but it could also be infection.” “Let’s go take a took,” I said curiously, as his
lab work showed a markedly elevated white count and ESR, findings more
consistent with a diagnosis of septic arthritis. However, this condition is rarely seen in
multiple joints simultaneously, unless the patient also had some hidden source
of infection, showering the bloodstream with bacteria.
When we came to Adan’s bedside, his body was burning with
fever, and he looked rather ill. Everywhere
I touched hurt, but the slightest movement of his right shoulder, right elbow
and left ankle caused excruciating pain. A quick aspiration of his shoulder joint with
a large-bore needle confirmed what we suspected: pus. Thus, plans were made to take him to the
operating room for urgent washout of these multiple joints.
In theatre, Dr. John Deng (general surgery resident) and I
started with the shoulder as Dr. John Weston (a visiting resident from Mayo)
worked on the ankle. As the capsule of
the shoulder joint was pierced, pus under pressure oozed copiously and
continued as we "milked" the arm upwards. After opening the elbow joint, we found the
same. The entire fibrous covering
(periosteum) of the humerus was elevated off the bone and a large pocket of pus
communicated with both joints above and below.
Dr. Weston also found pus in the ankle, less than the shoulder and elbow,
but still present. Cultures were taken, and
antibiotics were started. Although we
weren’t certain why multiple joints were infected, after these thorough
washouts, we expected the pain and fevers to quickly diminish.
However, this was not the case. Over the next 48 hours, this fevers climbed
even higher, and his white count was not dropping, despite being on strong
antibiotics. Cultures eventually grew
staphylococcus aureus, a common bug for musculoskeletal infections, which was
sensitive to the antibiotics he was receiving. Daily, on morning rounds, I kept hoping to
find him better. However, he continued
to spike fevers, and still looked quite ill.
“What are we missing?” I asked the team, as we examined him daily. Finally, after about a week, one of the
nurses noticed a small amount of pus
oozing from a wound on the lateral side of his leg, opposite the original
incision made to wash the ankle.
“Let’s just take him back to theatre and wash all these joints again” I
said, still not convinced we were on to the true source of his ongoing fevers.
In the operating room, after Adan received general
anesthesia, I was able to do a more thorough exam. I noticed that the left thigh was slightly larger
than the right…subtle, but notable. To
confirm my suspicion, I stuck a needle in his distal thigh and pus rolled into
the syringe. “This must be the problem,”
I thought as I prepared to again wash out the joints and make new incisions to
wash the lateral leg and thigh. As I
opened the thigh, I was shocked to find about a liter of pus that tracked
in a pocket up to the level of his hip.
“How can so much hidden pus escape the examining eye of so many
providers?” I thought to myself, now fully
convinced I had found the culprit of the ongoing fevers. As expected, over the next few days, Adan’s
temperature and white count finally normalized, and he slowly gained strength
as he was transferred out of the ICU onto the general peds ward. We never found the exact cause for his
polyarticular septic arthritis and osteomyelitis, but we are thankful that he
is on the mend.
The spiritual parallels to Adan’s story are salient. Hidden sins of the heart, when left
un-confessed and un-addressed, continue to fester and cause soul-sickness. Perhaps even more deadly than the “spectacular”
sins, the “small” sins of jealousy, greed, pride, anger, selfish ambition, and unbelief
are more easily hidden and, as such, are commonly left untreated. As a result, they can grow into an ugly
abscess, jeopardizing our very life and faith.
Let’s be honest with each other.
We are all sinners and that is why we so desperately need a Savior – Jesus,
the great physician. Only He can perform
divine surgery to open the hidden areas and place us on the path to healing.
Thanks for all your prayers and support!
Mark 2:17
“On hearing this, Jesus said to them, ‘It is not the healthy who need a
doctor, but the sick. I have not come to
call the righteous, but sinners.’”
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