Monday is supposed to be the busiest day of the week as far as patients coming to be seen in the offices of the doctors. Today was definitely such a day. As we went in to worship, it seemed like no one was at worship so we waited. About 15 minutes after eight a nurse came by and said they needed us in the ER. That there had been an accident and many people had been injured in an accident when minibus hit a parked semi. Later we found out that the minibus had broken down and that the driver decided to have it towed by another vehicle. As they were being towed, the towing vehicle went around a parked semi that had broken down on the road and the minibus driver didn’t miss the semi. So he crashed with many people in his minibus. As we walked into the ER there were patients in all the beds and IVs were running and all was very still. That’s unnerving. Severely injured with brain injuries and the non-injured lay still. Others should be writhing around in pain. Apparently it had occurred about 6am. But none of the doctors had been called till now. The other surgeon also happened to go by then so he stopped to help figure things out. It seems like he does 80% of the work at the hospital when it’s only him and the GYN here. We don’t know what it’s like when the general practitioner is here, he’s on vacation. I quickly start glancing at each patient to try do decide who is most injured and most likely to have something fatal. Audrey zeros in on a kid who has blood all over his face and is still bleeding. He ends up being the most injured. They all have small cuts or abrasions and bruises as does the driver of the minibus. We each choose a patient and start taking their story of where they hurt and examining them head to toe, focusing on the areas that hurt or look deformed.
Bed 0- old woman had pain in her left hip and right wrist was deformed. Later x-rays showed she had a normal appearing pelvis and a right wrist radius fracture. So late in the day she was sent to have the OR crew reset her wrist and place a cast
Bed 1- middle age heavy woman had pain around her right eye with swelling at the temple, and a hole at her right elbow. Some pain at her right knee. I ordered x-rays of her face, elbow and knee. She refused all. But later in the day I took her to the OR to fix her elbow laceration and I was concerned about the olecranon being fractured so I opened the skin a little more so I could feel it well. Yes there was a fracture. So I washed it out well and closed the skin, and gave her antibiotics and then she agreed to an X-ray. With the views obtained I couldn’t see the fracture anyway.
Bed 2- a man who had a headache and had no apparent injuries other than a scrape on his shin. And a child with a forehead laceration that was small and superficial and didn’t need to be closed.
Bed 3- was the one Audrey chose who was a 5 year old that had blood all over his face. He cried out in pain whenever he was touched. I ended up taking him to the OR to close his facial lacerations, pull some glass out of his face and felt a small depressed skull fracture. Some of his skin was gone, but I closed what I could. Xrays of his head showed a slight depression in his skull. I admitted him and gave him antibiotics and dressing changes and antibiotic ointment for his face
There was also an old woman with him who complained of neck swelling. I got out my ultrasound and looked at her neck. It appeared her swelling was a thyroid goiter, but she was adamant it was new. So we just asked her to stay with the boy and I checked on her many hours later and she was unchanged and felt a bit better.
Bed 4- had a mom with three little kids. Two of them had small superficial lacerations on their heads. The third was more concerning. She was a little girl with a chubby face that mom said her chin hurt. She appeared to be drooling and crying. I felt around her neck and couldn’t feel anything wrong. I ordered an x-ray to see if her mandible was broken. Later I found it wasn’t. I rechecked the kid a few hours later and she was still about the same, crying and so I examined her further. Her two bottom teeth seemed stable, but now under the tongue I could see a bruise. Ohhh. So a sublingual hematoma is more important. I verified that the child wouldn’t breast feed and was still crying intermittently. I have no way to intubate here and airway protection was a concern. So I told the mom we should admit them here an watch her and if she got worse then we may need to operate on the child (which would be awful to try to evacuate a hematoma under the tongue and neck.) The mom said she wasn’t ok with that and would go home with the child. The nurse in the ER today was a very poor translator and all communication seemed to take forever. She was also very disorganized with the charts, so I knew that trying to reason with the mother was impossible so I just told her I wanted to keep the child and do what was best for her. I think they left.
Bed-5 was a 6months pregnant young woman with some arm pain. She later got an ultrasound that was normal and her arm X-ray was fine.
Bed 6- The driver of the minibus who had some small lacerations above his right eye, which the OR crew sewed up. Also another man standing by who wanted some pain medicine but was just bruised.
Bed 7-A 30 something guy who has a deformed wrist and broken wrist on x-ray and right chest pain without any deformity. So his arm was later aligned and casted by the OR crew.
I know Im missing some because we saw 13 people total in about an hour and a half.
Then I was off to do the suturing in the OR of the boy and the woman mentioned above. Audrey went to the office. I think between she and the other surgeon a total of 82, where she saw somewhere near half. It was blazing hot and humid today, supposedly about 92. HOT in an office with minimal ventilation and no AC.
One that I saw there was a boy of about 15 who had a lump on his outer lower leg for more than a year and has been growing. Then this past month grown much quicker. He was seen in the capital where a CT scan was done and he was told he needed surgery. The family was convinced by people of their village that it could be treated in the village so they took him home for their treatments. Now it’s bigger and painful. X-rays today show a tumor eating the bone- likely a cancer called osteosarcoma. Now he also has enlarged inguinal lymph nodes. So it’s spread. He needs chemotherapy and radiation and an amputation. So we sent him back to the big hospital he had seen before to be treated. Very sad that when you don’t know certain things – you can be easily convinced to do the most simple thing- more frequently wrong medically. Am I biased- yes. I believe in surgery and also in medical treatments that are supported by researched studies and not personal beliefs. I’m not interested in pushing anyones agenda or business. I just want the best for my patients and people I encounter.
After a busy day we got home about sundown, 7PM. It’s in the 80’s and we are still sweating. We are tired! Plan on a cold shower then hope to be able to sleep in the heat with a fan.
