56YOF consulted me regarding an abdominal pain starting at t | Figure 1

TheFastDoctor

Family Medicine

56YOF consulted me regarding an abdominal pain starting at the umbilicus and spreading to the RFI. Eliciting rebound tenderness, I typed a covering letter, sending her to the closest (government) academic hospital with the presumptive diagnosis of appendicitis. She could not afford private care.

There, she was given analgesics and sent home.

2 days later and desperate for help she called an ambulance. This led to an emergency laparotomy, appendectomy but now with peritoneal sepsis. The next day she was sent home to heal. The wound opened (first picture) and I noted there was an infected drain scar but found no sutures (nor scars of sutures) in the skin of either the drain or the laparotomy.

I wrote another cover letter, adding pictures of the wound and once more sent her back. She was VERY reluctant, preferring to travel about 300 kilometers to her rural home and their local hospital but I convinced her they would not have adequate facilities. At the academic hospital she was given wound care dressings and applications...and sent home.

So, she returned to my facility in desperation. We are not a hospital but a health Hydro. (Dealing with subclinical conditions).. yet I arranged a (guest) room and we started wound care around the clock. Picture 3: No, that is NOT her breasts.. the upper part of the picture is her umbilicus...

Accommodation was "on the house" and the nursing staff gave their time for free. The wound slowly healed, the sepsis subsided.

She returned to work about 6 weeks later.

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