After 36 hours without power, I'm happy to have my tablet charging its very dead battery, and to be able to type up this entry. This Wednesday seemed to be the agreed upon day for urgent situations in Mpigi. We were finishing with one of the first patients of the day, a man with a large growth on the sole of the foot that would require excision, when a large crowd appeared at the door of the clinic. The crowd parted to allow the passage of a man carrying the very limp looking body of a 19 year old boy. He rushed through reception and back to the procedure room, his passing marked by drops of blood.
The 19 year old had been in an accident involving two boda bodas, which are small motorcycles used as one of the primary means of transportation over rutted dirt roads and through snarled traffic. This boy had apparently been driving and collided with another boda. The driver of the other motorcycle was part of the crowd, and sank into one of the plastic chairs alongside the procedure table. His face was bloody and his lip clearly torn through, but he was faring much better than the 19 year old. The boy lay moaning on the table, one of his pant legs soaked through with blood. His head was also blood covered, and several large areas of swelling were visible.
By a stroke of extreme luck, both Dr. Faisal and Dr. Lydia were in clinic that day. IV fluids were started as Dr. Faisal cut away the bloodied pant leg to reveal boy's leg injury. Just below the left knee the boy had a deep wound, roughly the size and shape of a golf ball and bleeding heavily. Dr. Faisal determined that he would require stitches for the leg and head wounds. At that time, the boy seemed relatively stable. However, as the local anesthetic was applied and the stitching began, he became increasingly restless, first moaning and writhing, and then ultimately convulsing on the table. His pupils became nonreactive to light, suggesting that beneath the blood and bumps on his head there was a traumatic brain injury. Anticonvulsants were given, but he continued to grow more agitated and restless. Several of us were required to hold down his limbs to prevent him from moving too much during the stitching.
Meanwhile, the driver of the other boda had begun to slump in his chair, and he became increasingly less responsive. IV fluids were started for him, as well, but he continued to deteriorate, and soon could not sit upright. He lay down on the floor, which was splattered with the boy's blood, and stared vacantly at the legs of the procedure table upon which the boy still lay. A blood pressure check revealed hypotension, and soon after he began to shiver, concerning for shock. Dr. Lydia switched her focus to him as Dr. Faisal continued to stitch up the head wounds of the 19 year old, who struggled throughout the procedure. The stitches complete, he was carried by his family to the ward. He would be transferred to the government hospital later that day for a ct scan of the head to assess the extent of his head trauma. I winced to see him loaded into the ambulance, which was a pickup truck. He was forced to sit up in the backseat for the ride into the city.
The other man had suffered a laceration through the entirety of his lower lip and into the gum. He received stitches to his gums, where the root of a lower tooth had been exposed, and his lower lip. He ultimately was stable, and was able to go home that night.
From a personal perspective, the whole process was frightening, impressive, and confusing. My training didn't include emergency care or procedures, so I just tried to help where I could. In addition, the conversation in the room was in lugandan, and therefore passed by me completely. I was able to appreciate the confidence and calmness with which the staff treated both patients, even in the face of declining physical conditions.
Though that case was the most dramatic, several other urgent situations made their way to DCMC's door that day. The morning patient did have his foot growth removed, and even after removing it seeing the tissue underneath, Dr. Faisal was unsure of the etiology. A 2 year old girl came in with a bean stuck up one nostril, and she managed to fight, twist and scream through its removal even after receiving sedating injections. A woman was rushed in by her friend, appearing at first to be soaked with water. The wetness was actually cooking oil; she had sustained burned to her face, hand and chest while cooking over the stove. Fortunately, the burns proved to be superficial. A 6 year old girl came in with severe malaria, and began having febrile seizures on the exam table as her mother anxiously sponged her forehead with cool water.
At the end of the day, Dr. Lydia bought the staff sodas and cookies as a thank you for working together through a frantic, chaotic day. Dr. Faisal was all smiles, as always, most of us were ready to fall into bed. It was a crazy, but successful, day.