Last Fall our pediatric neurosurgeon, Dr. Richard Anderson, went on a medical mission to Morocco. His one-week trip, that began in Casablanca, included an unexpected medical case, a side trip to Marrakech and an orthopedic surgeon’s Friday night couscous surprise.
On his first day in Casablanca, a city on the north-western coast of the North African country, Dr. Anderson met with a group of neurosurgeons from across the region. There he met a charismatic up-and-coming Moroccan neurosurgeon, Dr. Aziz Chafiq, who had been trained in France and also spoke English.
He and Dr. Anderson began to discuss the case of a 17 year-old boy in Casablanca who was about to undergo surgery to fix a severe case of scoliosis, or curvature of his spine. The curvature was progressing and the boy had begun to lose the use of his hands. An orthopedic surgeon, Dr. Chakir Ben Reddad, planned to straighten the boy’s spine using a series of metal screws and rods along the length of his back.
There were some additional complications with this boy’s case, however, and Dr. Ben Reddad had asked the Moroccan neurosurgeon Dr. Chafiq to consult on the case. He in turn asked Dr. Anderson to come in on it too. Dr. Anderson agreed.
“The boy had been diagnosed with a spinal cord tumor about 10 years earlier,” says Dr. Anderson. “Back then, he went to the government hospital and had it biopsied by a different neurosurgeon. Unfortunately, this resulted in the boy becoming paralyzed from the waist down and the tumor remained in his spinal cord. He’d had MRI’s done every 3 or 4 years and they were showing that his tumor was getting bigger; furthermore, he had developed a syrinx, or a fluid collection that was going all the way up into the boy’s neck which was causing him to lose function in his hands.”
A syrinx, also called syringomyelia, is a fluid collection inside the spinal cord that can be caused by a spinal tumor. The build-up of fluid can put uneven pressure on the spinal column and cause scoliosis.
Dr. Anderson met the boy and his father, and conferred with Drs. Chafiq and Ben Reddad on the case. Dr. Anderson says,”It was wild. Dr. Chafiq was translating from French to Dr. Ben Reddad, who only speaks French and Arabic, and then to me speaking English. Eventually it all became clear and we came up with a plan of care for the boy.”
“I suggested that if they took out the tumor first, it would make the syrinx go away and then his arm symptoms would get better. Unlike the complex scoliosis surgery that was planned, this procedure had a greater chance of preventing further deterioration in his arms. Further, if six months later the boy was still having trouble, they could bring him back and do the scoliosis correction then. This made sense to them and they asked if I could do the surgery with them that day.”
There was just one problem… Dr. Anderson couldn’t stay. He was scheduled to be in Marrakech, two and a half hours south of Casablanca by car, that afternoon. He told them he would have a small available window of time in two days, before flying out of Marrakech back to the United States. After numerous phone calls and no small amount of rearranging of schedules, Dr. Anderson was told a car would pick him up in Marrakech the following Friday to bring him back to Casablanca.
“That morning,” says Dr. Anderson, “I went downstairs in front of my hotel and a car was already waiting for me. I got in the car, and I couldn’t believe it—it was the boy’s father driving. He had borrowed a car from a friend and driven two and a half hours to pick me up so he could drive me back to Casablanca and I could operate on his son.”
The surgery was a success, and wrapped up that same afternoon. “We finished taking the tumor out and we started closing,” says Dr. Anderson. “About that time, I noticed that Dr. Ben Reddad said something to Dr. Chafiq and then he left. About 30 minutes later Dr. Ben Reddad still hadn’t come back so I asked Dr. Chafiq where he was. He told me he left to start preparing couscous with his wife. It is tradition in Morocco to have a big meal of couscous on Friday night and we were all going over there to eat after we finished.
The meal was amazing. There was a plate the size of my desk with couscous and all sorts of root vegetables and meats piled on top. We were just finishing the meal, and there was a knock on the door. It was the boy’s father; he had come back with gifts. (I have a framed Arabic passage from the Koran he gave me up on the wall in my office.) We got back in his car and he then drove me back to Marrakech.”
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