Ann Marie Dewar doesn’t believe in coincidences.
A woman of faith and one of Montserrat’s foremost storytellers and cultural icons in her own right, developing a serious medical issue days before a team of neurosurgeons’ visit could only be a miracle, she says.
Dewar is a biology teacher, a former school principal, former permanent secretary, a poet, musician, masquerade costume maker and on and on.
It Was Only a Runny Nose
In late March 2022, she found it odd when she developed a spontaneous runny nose. It hadn’t been triggered by dust, a cold or any of the numerous things which can cause one. Having suffered with postnasal drip for decades, she had sold her apartment in London in the early 90s and returned to Montserrat where she felt the climate would be more suitable for health.
On this early March morning she was in her favourite room for reading and visiting with friends when clear fluid began to drip from her right nostril. She wiped it away but as she continued to read, so did the dripping.
“I had no symptoms of a cold, no headache, no sore throat, no nasal congestion or itchiness. Another drip. This time, it dropped onto the page I was reading. I got up and fetched a paper towel and wiped my nose. I sat down again and tried to continue reading. Drip, drip, drip. Every four or five seconds, like a leaking tap, and only from my right nostril. The fluid, clear and runny like water, dripped onto my clothes, and when I stood up, it dripped onto the floor. Very concerned by now, I got up and went to the bathroom, and looked in the large mirror over the sink. The dripping continued, but now I could see it, and it truly frightened me,” Dewar recalled.
This led her to search the internet to figure out what could be happening. The usual suspects of flu and cold were discarded as she had no other symptoms. As she continued her research, she came across two other options, one of which really concerned her.
“One of these did not fit the bill at all. But the other was called “cerebrospinal fluid (CSF) leak”, and what I read increased my heart rate. As a high school and college Biology teacher, I understood what cerebrospinal fluid is. It is a clear, watery fluid which surrounds the brain and spinal cord, cushioning them from injury, providing them with essential nutrients, and removing waste substances. From my swift internet search, I now learned that the membrane holding the CSF in place may develop a tear following severe head trauma, certain types of surgical interventions, or even (rarely) spontaneously, in which case, the fluid can escape through the nose or ear. I also learned that loss of cerebrospinal fluid can put too much pressure on the lower sections of the brain, as the brain sinks lower down in the skull, a condition called “intracranial hypotension”. The risk of infection, leading to meningitis, a potentially fatal condition, was also mentioned.”
Dewar eventually made her way to the hospital where she was checked and given some antibiotics and told to monitor the dripping.
As Montserrat has no CT scan or MRI machines to assess patients, she was concerned as to what could happen without further intervention.
The following morning, Ann Marie’s doctor asked her to return to the hospital as they wanted to monitor her. She was also told a neurosurgeon and his team from Harvard-Massachusetts General Hospital would be visiting in a few days and they would be consulted on her case.
Dr. Myron L. Rolle & the Caribbean Neurosurgery Foundation
Myron L. Rolle is a former NFL player and Rhodes Scholar and current neurosurgery resident at Harvard, Massachusetts General Hospital.
A Bahamian by birth, Rolle also chairs the Caribbean Neurosurgery Foundation which he founded in 2021.
Rolle told Discover Montserrat that losing his aunt ten years ago on Exuma, one of the islands in the Bahamas was the catalyst for the foundation. As Exuma had no critical care capabilities, his aunt did not receive the neurosurgical care in the recommended four hours after trauma to survive the injuries from a car accident.
“I told myself that when I became a neurosurgeon, I would do something not just for the Bahamas but the entire region,” Rolle explained.
Rolle knew that the issue in the Bahamas was the same across the region. Small island states without the capacity to care for patients who suffer traumatic injuries within a timeframe to provide the optimal care for recovery.
The physician reached out to healthcare leaders across the region, and he was invited to present the foundation’s vision to Heads of Government at a CARICOM meeting.
“We want to work in three areas: Policy – How do we upstream and provide the rules and regulations to prevent catastrophic neurosurgical disease further downstream? Making the laws strict around helmet wearing. The data shows that patients who fall and hit their head survive and live a long healthy life. Foliate supplementation in food so kids don’t develop spina bifida. Research and education – How do you tell CNN, WHO, PAHO, what is happening in the Caribbean around neurosurgery? They see paradise and not the healthcare deficit across the region. Clinical advancement – How do we arm individuals who are responsible for neurosurgical care with the research, technology, and skills to work when we are not around?”
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Dr. Rolle Meets Ann Marie
Rolle arrived on the island with the blessing of the ministry of health. The neurosurgery resident was accompanied by three other neurosurgeons, two nurses and a medical student. His father had also come along for the trip. He credits Grethlyn West for ensuring their time on island was memorable.
A list of patients had been identified who could use a neurosurgical consult. Ann Marie was by this time now a patient at the hospital when the two met.
No surgical cases had been scheduled for Montserrat as the island does not have the facilities necessary for operations of this kind.
After sending the nasal fluid for testing, the results confirmed it was cerebral spinal fluid.
“She was having a spontaneous leak. Spontaneous lateral sphenoid meningocele which had turned into Cerebrospinal Fluid Rhinorrhea. She had a defect that had probably been there for a while. She’d had no trauma, no bone disease. The defect had met its threshold.”
The problem was the connectivity between her sinus in the lower part of her skull and her nasal pharynx.
“The danger is that if the fluid is coming out then something can get in like bugs and bacteria. If bugs and bacteria get in, the patient can get meningitis and die.
Ann Marie most likely would have passed away if we had not been there,” the doctor explained.
Rolle and his team were going to Antigua the next day. He asked Montserrat’s Chief of Surgery Dr. Braimah Kassim to allow Ann Marie to be medevacked to Antigua for surgery. Rolle also reached out to Dr. Patrick Knight, a Trinidadian neurosurgeon who regularly consults in Antigua to meet him there to perform the surgery.
The Sir Lester Bird Medical Centre was contacted, and an ICU bed and an operating room were reserved.
A CT scan was also conducted to identify where the leak was, and nursing staff and other medical professionals were on hand to watch the procedure.
A lumbar drain was put in Ann Marie’s back to assist with relieving the pressure on her nose. They also performed an endoscopic endonasal procedure to plug the leak. They used fat from her right thigh to plug the hole through her nose. It was then packed with gauze, which made for a couple of difficult days of breathing but was necessary to resolve the issue.
A few days later the lumbar drain was removed.
“She has not had any more leaks. She’s doing really well, and Ann Marie is an absolute champion. Dr. Knight will do follow up as he is closer,” Rolle told Discover Montserrat.
“This is why the Caribbean Neurosurgery Foundation is needed. To provide equitable access to those who needed us the most and we provided that care. Not only with our hands but the coordination of care. Connecting all the dots, the flights, the labs, the operating rooms, the access to expertise so that the management of her care could be handled in an expeditious fashion.
“I am proud of Montserrat for listening to us and helping us to come in. Proud of Antigua for being welcoming and receptive to allow us to care for this special woman.”
“Ann Marie is an absolute delight and a remarkable woman. One of the best patients I have been around,” Rolle said.
“What were the chances that a team of skilled and experienced health professionals, in the exactly needed medical discipline, would arrive in the exactly required location at exactly the right time to handle my medical situation? This was nothing short of a miracle and caused deep reflection on the numerous ways in which so-called coincidences had occurred in my life,” shared Ann Marie.
She is doing well and is now writing a book about these serendipitous moments that have framed her life.
Dr. Rolle’s new book The Two Percent Way tells the story of his incredible journey, revealing how a strong work ethic, deep faith, and the family values instilled by his Bahamian immigrant parents set the stage for the transformative life philosophy that enabled him to overcome adversity, defy expectations, and create a life of meaning and purpose.