The Small Things

The elderly man came to the San Salvador Lutheran Medical Clinic nearly blind and almost completely deaf. Our interpreter helped me figure out what he wanted.  

“How can I help you?”  we shouted.

 "I have a cough and get headaches sometimes. Can I get some medicines?”  

“Sure,” I said. “Let me take a look.” The interpreter moved to another of our physicians while I performed an examination.  

The patient had undergone cataract surgery at some point which had improved his vision a bit. I peered in his nose and focused my headlight in his mouth. His last few teeth were in pretty bad shape. Otherwise things looked pretty good. No obvious infection and nothing worrisome. The neck was okay. His lungs were clear and his heart was steady. His belly was soft and there was no swelling of the ankles.  

I peeked in his ears. Both were full of wax.  

“Would you like me to clean your ears?” I peeked at my cheat sheet with a few Spanish words. “¿Limpio los oídos?”  

I’m not at all certain he understood my question, and I wondered if I had chosen the correct word for “ears.” Nevertheless, he turned his head and let me dig in his ear canal.  

The wax was very adherent to the canal wall. I continued to work and the man was clearly uncomfortable.   

Just as I was about to give up, the plug of wax moved. I reset my instrument and slowly worked the solid mass of wax from deep in the canal to the opening. Suddenly, I triumphantly pulled out one of the biggest plugs of ear wax I had ever seen. Clearly, he had been working on this masterpiece for all of his 85 years. Now it was out.  

He blinked and stared at me with his softened gaze. I suspected he was hearing from that ear for the first time in 20 years.  

“The other?” I attempted in Spanish.  

He grinned and turned his head to present the other side. Soon, despite some discomfort, I had delivered another plug of wax as large as the first. He stared at the plugs of wax on the gauze. He wrung my hand enthusiastically. “¡Muchas gracias!” he said.  

“De nada. You are welcome. Thank you for coming!” Pretty soon, he had received a flu shot and was heading home with his small bags of vitamins, calcium, and acetaminophen.  

I’m not altogether certain how many patients I helped while visiting El Salvador, but I am pretty sure there is one 85-year-old nearly blind man who is very glad that I was there.

The following is feedback received for this blog:

Very nice story. As always, thanks for sharing!

- Jen

Awww ... that's such a neat story. You made his day. I'm glad I read this.

- Leigh Ann Otte

http://thedoctorwriter.wordpress.com/

Just the small things can make a world of difference for everyone. Thank you for sharing.

- Scot

Go figure, all the years of training and skills acquisition and removing ear wax is still one of the most gratifying thing we do. . .enjoyed the story.

- Merry Sebelik

I *hear* the biggest difference we often make, is often one we don't realize.

- Jabulani

Awww.... I loved this story! I'm so glad you took the risk to visit this memorable place.

- Penny

Just had to add this. I am a physician, a radiologist, but somehow keeping the wax out of my ears has always been a problem, I mean really, getting somebody to dig around in my ears, nobody seemed interested, maybe the ENT guy's nurse if I was lucky. I didn't see anybody interested in going after that awful stuff. Even the nurses never seemed to get it all. At least in my own clinical days I used to soak that stuff with drops of soap held in with some cotton balls for about 30 minutes which allowed me to blast it out with the little water gun we had in the back office. Yes I really enjoyed doing that!! But good luck when it came to my issues!!

Finally I picked up on just soaking that wax with hydrogen peroxide. Only takes about 20-30 minutes per side and after awhile all that bubbling is pretty pleasant and one has to be careful not to fall asleep which might possibly lead to H2O2 burns. When all the wax is gone the bubbling stops, it's that simple.

Cheers.

- Steve D.

What a great story. In pediatrics - we use a liquid stool softener (Colace). Fill the canal with the nice pink stuff and flush in about 10 minutes. Sometimes we have to repeat the process. We flush with warm water in a 10 cc syringe connected to a cut-off butterfly tube. The one inch or so of tubing slips into the canal nicely.

Works every time - then you can see to China or through to the other side as we tell the kids. Thanks for the story and for your trip to help those people.