So there seems to be a trend in injuries. Some people say that medical things come in three’s. To me this is superstitious, and I do not believe it. But last week we worked on the man with an epidural hematoma. I.e. burr hole with much nibbling leaving a larger hole and a drain.
The following day a boy came in who had been hit by a soccer ball on the side of the head and was unconscious, agitated, and only moving one side of his body. God healed him, for today, one week later, he was laughing, playing, talking and moving all extremities. This brings us to last night:
Many things have been going on and I have had a hard time going to sleep at night this last week. I lay there and mull over the things I need to do or try to solve some of the day’s problems. Audrey tells me to stop moving. She says I’m thrashing about in bed. So I turn over and try to go to sleep again. I toss and turn for a while then I hear a knock at the door. I feel groggy like I must have just fallen asleep. It’s midnight. Mbitomou tells me that there is a ten year old girl with a head injury she sustained after falling from a tree, and that he hesitates to even bother me as she has brain matter all over her head. She fell during the day and lives in a village very far away. He thinks she has broken her skull in a large area. So he takes me to the hospital on his motorcycle. This gives me a minute to think of what I will do on physical exam. She is laying on a gurney, the right side of her head rather flat. She has a skin wound about 5cm long with brain ma
tter bulging from it and smeared across her black kinky hair. She flops back and forth using only her right arm. She doesn’t respond to sounds and doesn’t say anything. Her pupils are both reactive and small. I palpate her head and I feel what I think is a large depression; blood is coming from her nose. The family says she has lost a lot of blood, and she looks pale. I describe to the family my findings, and tell them her only chance is to operate on her, and that her chance is small. The father says he has no money. I reinforce that this is necessary for a small chance of helping her. He agrees to surgery saying that he brought her all the way here to see if we could help her.
In the operating room I call Audrey and Ganava. After shaving her head and prepping it, I incise in a huge semicircle. I see many fragments of skull, brain and dura all in different levels. The skull has been fractured in maybe 7 pieces. The fragments sit at strange angles to each other. I free up the dura from beneath a few and raise out some large pieces. The dura is torn with blue brain matter below with pieces of skull down in it. I debreed the material from the brain. I see an area of subdural hematoma, so I open the dura over that to evacuate it. I repair the dura. Next I use some periosteum to create a dural patch. It seemed more accessible than fascia lata, though I had prepped the leg. One fracture went behind the ear and down to the base of the skull. Blood started welling up from this area. Nothing seemed to stop it and I couldn’t get under the brain enough to find it. So I elevated the head of the bed and it subsided, Praise God! I set the bone fra
gments back in place and sutured the skin closed. She stayed stable throughout the case regardless of her condition.
Before leaving work this evening, she is moving her right arm slightly. Pupils are still reactive. I’m praying for a miracle. Please pray with me, for her. Her name is Mounagui. Greg
Shanksteps #125