A Chelsea smile.

I am currently recovering from a busy weekend on call. Most of my war wounds, however, are on my hands and back after spending a little too much time gardening in the sun on Sunday. I have a glaringly red back and a delicious raw blister on my right palm from all the digging. I think I was slightly delirious after an insanely busy Saturday on call and didn’t really think about the fact that I was excavating beds in the midday sun whilst half naked. As I may have said already, there are two of us on call at the weekend – either you run the show Friday and Sunday or you take Saturday – the other Doctor is just on standby for emergency caesarean sections or when your colleague just wants a reassuring hand (I tend to be the one wanting that hand, especially in obstetrics). We only had one c-section on Sunday, hence all my gardening and wounds to show for it.

Saturday was full of fun. I started at 7 am and, with the exception of a 15 minute lunch break and 45 minute lull in the evening, I finished at 3 am. It was nonstop, wet your pants, fun. Here’s a brief summary of some of the more interesting cases: I had a guy who was run over – he had a massive bit of bone sticking out of his right leg; an eight year old boy who’s father slashed open his shoulder – exposing the bone, cutting right through his deltoid muscle – all because he lost their cows; a young drunk guy that was shot in the chest, but who had no obvious injury in his lung or heart; an old drunk guy that was stabbed in the neck – when the nurse gave the wound a clean a large artery, possibly his carotid, erupted and a steady spurting fountain of fresh blood soon covered my arms and white coat as I attempted to tamponade the bleeding (don’t worry mum, I was wearing goggles, mask and apron); a young boy that was thrown off the back of  a pickup truck, or “bakkie” as it is called here, who sustained a terrible head injury and degloved most of his scalp on the left, from which he lost a lot of blood; the usual stabbed up, occasionally belligerent, drunk boys and girls; a middle aged gentleman with severe respiratory distress who’s left lung was engulfed with fluid (pleural effusion) that I drained to his relief; the usual old boys and girls with chronic conditions such as high blood pressure and diabetes that present with the classic symptom of “pain in my neck veins” that get a bit of paracetamol , a sleep over and sent home.

Along with all of the above I saw a 22 year old male who works at KFC (he was wearing his work clothes you see, it’s not something I tend to ask about, but it did mean that his English was rather good) who was stabbed in the chest and face by his younger brother. I had to put a chest drain in for all the blood and air that had built up around his lung (pneumohaemothorax). I’ve only ever put a chest drain in on pig and cow thoraces in courses that I have attended in the past. A fresh human chest is a little tougher than a well hung piece of beef, but without gloating too much, I think I did it rather proficiently without the mere mention of a tremor in the hand or bead of sweat down my brow – probably because I was quite sedated with sleep deprivation at this point. Putting a tube in his chest was the easy part; his face was the problem. The laceration was, to put it quite simply: nasty. It bisected his nose almost in two then proceeded to go diagonally down and extended deep into his right cheek. His teeth and jaw were visible despite his mouth being closed – my doctor sense told me that this wasn’t quite right. Over the next two hours I slowly performed my own kind of maxillofacial/plastic surgery. Fortunately the good people of Flagstaff didn’t bring their next bleeding patient in until just after my work was complete. I must say I was rather proud of the end result – the guy looked good as new and had no functional or neurological deficit as a result of the injury or my “surgery”. I’m becoming a bit of a dab hand at these facial wounds – last week I sewed an ear back on (the girl hasn’t yet returned saying it has come off again or become infected, so no news is good news in that respect). Anyway, the chap was very pleased with the results, and despite the tube hanging out his chest, he kept on telling me “doc, you saved my life.” I asked him what he was going to do about his younger brother – the assailant that did this. The answer was: “Kill kim, I’m going to kill him.” I nervously laughed this off, but I fear there may have been a wince of truth in that statement. If he doesn’t attempt to murder his brother and stays in work, then maybe he’ll give me a good deal on a bucket of chicken if I ever get desperate enough to eat at his stomach churning establishment. My boss saw the wound today and all he could say was: “Beautiful.” This was probably a slight overstatement, but nice to hear nonetheless. I’ll upload a picture of his wound pre and post suturing.

I said that the weekend was fun – it was. However, it is deeply saddening when you see all the victims of violent crime, road traffic accidents and domestic violence. I couldn’t believe the father who put a bush knife to his own son. However, maybe those cows were their livelihood; maybe it was everything they owned. I can see how the dad would have turned red in a moment of disbelief and possible rage, but violence can never be the answer. The gentleman has since been arrested and the boys Mum lives far away. Now this 11 year old has a dysfunctional shoulder, a Dad in prison and probably no one to look after him.

More to come