Prior to our operations in July, Nancy Escobar came to see me for pain in her upper abdomen on the right side. (For those of you who know Nancy Ferrin, Gonzalo´s wife – this is not she – this is a different Nancy). The source of her pain was not difficult to diagnose, she was having gall bladder problems – and it needed to come out.
At the time of her operation, we found that Nancy also had Mirizzi’s syndrome – a condition where part of the gall bladder or its duct causes obstruction of the main bile duct. This made her operation more difficult and left me with a decision to make. The decision was whether or not to open her bile duct and explore it for another source of obstruction (a stone). As it appeared that the obstruction had been caused by the gall bladder and its duct – I felt that removing her gall bladder would relieve the obstruction and an exploration of the duct was not warranted. I decided to follow her closely after surgery, and should she show signs of an obstructed bile duct, we would obtain an ERCP (an endoscopic, and less invasive method of removing stones from the bile duct) to remove the stone(s). In our earlier years I never would have considered this, as it was extremely difficult to obtain an ERCP. Now, ERCP is more readily available, and we have a gastroenterologist colleague in Quito who is available to help us with such patients.
I saw Nancy back one week after surgery. She looked good and was having much less pain. One week later, however, was a different story. Her eyes were a bit yellow, her skin itched – and a lab test showed that likely had a stone in her main bile duct. We called our gastroenterologist and made plans for her to travel to Quito that night to have an ERCP the next morning. That was last Wednesday – and since then it has been nothing less than a constant headache.
Because of some bleeding tests that were abnormal, our gastroenterology colleague didn’t want to proceed with the ERCP. Nancy was then transferred to a large government hospital in Quito, and plans were made to perform the ERCP the next day. That was four days ago – and Nancy still has not undergone her ERCP.
Nancy – two weeks after her gall bladder operation
It can be difficult to navigate the system in the government hospitals. Every patient needs a family member to accompany him – in order to help obtain blood work, do paperwork, obtain other exams… Loida (one of our employees at the Clinic) is in Quito and has been helping Nancy and her daughter-in-law wade through all of these requirements. In theory, the care in the government hospitals is free. But some medicines are not always available, and they must be bought outside the government system. Also, Nancy and her daughter-in-law are from the coast, where the weather is hot and humid. They are not accustomed to the cool weather in Quito, and neither do they have appropriate clothing for the climate there. So we have bought them some warmer clothing for their stay in Quito.
We are hoping that sometime this week Nancy will get her ERCP. I will post an update later this week to let you know how her situation is progressing.
