Wednesday, December 9, 2009

He who lives by the sword...

December 16, 2009
I turned a year older yesterday. All in all a good year I would say. It has had its adventures. Also its learning experiences. Hopefully I am the wiser from them. Anyway, last night the neighbors had a little birthday party for me. Somehow they made a pizza. Also we had my traditional birthday carrot cake (thanks Mom, for sending that!). Unfortunately, I was working at the hospital last night... Our night shift starts at 3pm. I had a nice suprise at 6pm though. Two of my off duty nursing friends showed up to help me give evening meds, so I could finish quickly and get away for a little bit. I had just sat down and was eating my first slice of pizza when there was a knock at the door. A trauma had just arrived at the hospital. Possibly a partial amputation.. So much for cake... I suspected it was a milling accident as we had seen some pretty bad lacerations from belt driven rice milling equipment before. As we unwrapped the forearm splint made of millet stalks, palm leaves, and a wrap skirt, it was obvious that this was no accident. This was the doing of a sword or machete. The man's left arm was cut at a diaganoal midway between elbow and wrist. The radius and ulna were both cut through. The only only thing keeping the hand attached was flap of skin on the inside of the wrist. It was not salveagable. Other injuries: about a 1/4 inch thick slab of skin/meat shaved off the left side of his face; 1 inch deep x 4 inch long gash on the back of his neck, a hack into the right shin bone (didn't go through), and many misc. smaller cuts on arms and shoulders. The details of the story were somewhat lost to me in translation but the basic idea was that the cattle of a herdsman were eating the harvested rice of a farmer and things came to blows.
Dr. James is gone to Njamena for two days, so Samedi did the amputation. He is our head nurse and lives just across the street. He started working here as a janitor 30 years ago and now is also our surgeon number #2. He has been to highschool (I think) but no formal medical training. All on the job. He did a smart job of the operation, while one of the surgery techs and I cleaned and stitched up the other wounds. After a few liters of fluids he had stable vitals and was doing well.  All the beds were full in the men's ward (and women's), so we wheeled him into the middle of the room and left him on the surgery gurney.
By this time, it was time for 9pm meds. One of the nurses from the birthday party had kindly stuck around to help me out, but just as we go started the nurse from Urgence ran in. Traumatisme encore!! This time it was two. The police had transported them in. One guy looked just a bit bruised/scratched and shook up and the other one had multiple deep head lacs and appeared to have a severe concussion or more serious closed head injury. I asked it they had been in a motor vehicle accident. No, this was reprisal. When you cut off a man's arm, his family may get upset and come looking for you. How does the saying go? An eye for an eye, a head for an arm? Last year, I hear that there was a similar incident escalated into clan warfar. 22 people were brought to the hospital over a several hour period with spear/arrow/or machete wounds. Several were killed. As I am writing this, there have been no more attacks today that I know of, so maybe it will end with the two. Both patients are still with us. We are keeping them in seperate wards as to keep family attendants out of sight from each other. There has been no trouble so far. Maybe everyone has learned their lesson.
I ended up having over 30 patients under my care by this morning. Didn't get much napping in... got off work at 9:30am. in bed by 10. slept like a rock until 2pm. Well, such is a day (night) in the life of a nurse at Bere. I found some couscous left here by a former volunteer. I am going to go cook it up and treat the night shift to a snack. They were kind to me yesterday.
        But I say unto you, That ye resist not evil: but whosoever shall smite         thee on thy right cheek, turn to him the other also. Matthew 5:39