Joe first noticed the swelling in his leg about 6 months ago. Joe lives in the far, far end of the Jimi Valley. If he lived just a little farther away he'd be in Madang Province, not in Western Highlands Province, and he'd be out of our hospital district.
About 3 months ago his family took him to the near-by health center (a sort of miniature hospital in the village, operated by nurses). They gave him some antibiotics and pain medicine, but the swelling continued to increase. Finally they were able to arrange a flight out, and he arrived in Kudjip this morning.
When I first saw his leg it was one of those "I've got a bad feeling about this" moments. Ultrasound showed that it was all solid tissue, and not fluid-filled. X-ray showed that the mass had eroded into the bone of his lower leg. And a blood count showed that Joe is very anemic. My eyes showed me that he is thin and wasted.
This mass is obviously a cancer, probably an osteosarcoma. Although there is an enlarged lymph node in his groin, there are no masses in his liver or lungs that we can detect. He is too weak and depleted for surgery now, and Dr. Jim is leaving on Thursday for a trip of over 2 weeks. I've admitted Joe and will give him blood, and try to get him built up and ready for surgery by the time Jim gets back.