OPEN BOOK OF THE LION-HEARTED

In my practice in Cuba and in St. Vincent, I have encountered some unique cases which I still remember vividly. I am humbled to have seen such rare cases; some of which you only read about in medical textbooks. I am about to reveal some very interesting cases which I have encountered as a medical doctor, some of which are worth a whole book. Dextrocardia It was July 1996; I was fresh out of medical school and pursuing a six months rotation in general surgery at Comandante Manuel Fajardo Hospital. This is part of the programme of residents in Obstetrics/ Gynaecology in Cuba. A gentleman of African descent walked into the hospital with a strange look on his face. He was sweating profusely and came straight to the surgical emergency room where a cardiologist or resident in cardiology is always stationed. He had his hand holding his chest as though complaining for pain. I tried to question him but he was signaling wait with the palm of his left hand. He was gasping for breath. I looked around and realized that there was no one accompanying him. I checked his pulse which was 120 beats per minute; his blood pressure reading was 150/90. All this time the gentleman did not utter a single word. I placed the stethoscope on his chest, and at that moment I realized something was wrong. I tried to obtain the apex beat and was unable to. At this moment I saw the gentleman smiling and he pointed to the other side of his chest. I was a little perplexed but I proceeded to check the other side of his chest and bingo! I realized that the heart was located on the right and not on the left side of his chest. The left side is what is considered to be anatomically normal. By this time, he had relaxed and his clinical symptoms of ill health had subsided. “Don’t be scared, my heart is on the right side and at times I get these episodes of the sensation of the heart racing fast. The doctors call this Tachycardia. This is generally accompanied by shortness of breath, but I feel much better now.” I replied, “My, my, my, I have never seen a patient like this before.” “This is called Dextrocardia,” he interrupted, “And most doctors anywhere in the world do not see this condition regularly.” At this time the cardiologist on call had approached us to find out what was wrong. I then referred the patient to the cardiologist for continuous supervision and also a more in-depth diagnosis. I understood later that he was having some domestic stress which was having serious psychosomatic manifestations. The cardiologist assured me that he would have been alright and that he had placed him under a new regimen of medications. I never saw him again. Supernumerary breast In 1995 a young lady about eighteen years old visited my clinic complaining of severe headaches. I asked the pertinent questions to complete her clinical history and proceeded to have an examination done. While performing the examination I noticed that she was hiding her armpits and to my surprise she turned her face sideways awaiting a reaction. Close examination revealed a Supernumerary breast, a complete breast with a nipple to complete it. Supernumerary breast is a condition where the migration of breast tissue to the appropriate region was incomplete in the embryological development where breast tissue remains in the axillar region in this case. I consulted her and assured her that it was nothing to be ashamed of and that I could assist her in surgically removing the breast. She was then referred to a general surgeon to have the breast removed. Aplastic Anemia This is a medical condition characterized by a deficient red blood cell production and a disorder of the bone marrow. It is considered to be fatal. It is very rare in the Americas and Europe and occurs in one in every million persons. In Asia it’s a little more prevalent. Chloramphenicol is a known drug that can cause this condition and more so in the oral form of the drug (tablets). In Cuba in Manuel Fajardo Hospital I had the privilege of seeing such a case. We know that Chloramphenicol is used widely as eye/ear drops. In 1991 I was able to see a forty year old man of Indian descent succumb to this disease and the only information collected of him having exposure to this drug was the use of an eye drop which he said he used anytime he had an infection of the eyes. This case has changed the course of my medical practice up to this day for I have never prescribed this drug. Acrania In 1997 during my practice in Havana a twenty six year old female twenty weeks pregnant attended my antenatal clinic at Ramon Gongalez Corro Hospital. She stated that she had been unable to sleep for weeks due to rapid fetal movements. After examination I proceeded to have an ultrasound done. To my surprise the demarcation of the cranium was absent. The image on the ultrasound looked rather unusual. There were undulating lines not considered to be the normal ultrasonographic impression of the craneo of the fetus. The bones of the skull of the fetus were absent. This is called acrania. This is a condition that is unsuitable to sustain life. She was admitted to the hospital and an interruption of the pregnancy was performed and genetic tests were done on the fetus and parents after the interruption. She was also scheduled for continuous counseling.