By Dr. James Appel - September 1, 2014

The man is complaining of abdominal pain like pretty much everyone who comes in to the hospital. I often don’t even examine them. For some reason, this time, I put on gloves and have him get up on the exam table. He has a palpable mass in the upper center (epigastrum) of his abdomen. I order an ultrasound. Dr. Martin is in his office, which also happens to be where the ultrasound is, so after the man pays, I take him into Dr. Martin’s office and ask him if he’ll do the scan. He pleasantly agrees. A few minutes later he comes out and gets me to come in. He shows me a well-circumscribed lesion with fluid in it.

“He has an amebic liver abscess here in the left lobe,” Dr. Martin moves the probe around and I clearly see normal liver and then another, smaller fluid collection. “Here’s a second, smaller one in the right lobe.”

Dr. Martin goes to look for a large bore spinal needle and a syringe and a few other things to drain the large abscess using the ultrasound as a guide. He comes back and hasn’t been able to locate a large bore spinal needle. We decide to hospitalize him, put him on IV Flagyl to treat the amebas and try again tomorrow when staff are around to help us find the materials we need.

The next day is really busy, lots of OB patients, lots of out-patients, Dr. Martin does a c-section, etc. So it’s not until the evening that Gillian has a chance to go drain the man’s liver abscess. I’m making supper when she comes back.

“That’s not a liver abscess! That’s a huge abdominal aortic aneurysm!”

“Are you sure? I swore I saw a liver abscess.”

“Let’s go look.”

“Yeah. Let’s.”

We go up and I take the ultrasound and jumping out obviously is an enlarged, calcified, pulsating mass: abdominal and thoracic aortic aneurysm. Not good. There’s no hospital in Liberia equipped to do it. The closest possible place, according to Gillian, is probably Nigeria. Not that they really want to take anyone from Liberia since it was a Liberian who brought Ebola to Nigeria. We explain to the patient and he assures us his employers will be able to arrange things. We tell him to try and relax and we go back to eat supper.

After supper, I go to write emails and Skype with my family. A midwife pokes her head in my office door.

“De patient in N3 goin' into shock.” 

I’m trying to think which OB patient it could be since the midwife is the one getting me. I arrive at the door of room N3 and see it’s our patient with the aneurysm. He is contorting in pain, his legs lifted high up and rocking back and forth. He is moaning and saying “I gonna die! I gonna die!” I try to calm him down as I ask the nurses to bring Diazepam. Getting anxious and increasing his blood pressure will not be good for his aneurysm.

“What is his blood pressure?”

“It wa' 160/100, den it quickly drop to 80/40 and now I don’ find anyting, doc.” Calmly says the nurse in green scrubs and plastic apron, looking up with a stethoscope still in his ears and the hand pump on the blood pressure cuff still in his hand.

I feel his carotid pulse: nothing. He’s gasping for air. The gasps get less and less frequent as his contortions slow and then stop. His aneurysm has burst, causing him to bleed out in a matter of minutes right before our eyes. It’s an eery and helpless feeling. He has no family with him. One of the nurses takes his cell phone and starts calling numbers trying to find a relative.

I pull of my gloves and snap them into the trash can and go home.