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Of Warthogs and Wardens

Nicky twitches the curtain of the cubicle in which I am seeing patients. “Ed, can you come and have a quick look at this knee?”

I excuse myself from the patient I am seeing (another “query TB”) and go to Nicky’s cubicle next door. On the couch lies a man, his left leg slightly bent, the other extended. The entire back of his knee has been ripped open. I can see tendons and layers of muscle. When I ask him to move the leg I can see them move over each other.

“He was hunting in the Game Park,” Nicky tells me, “and a warthog attacked him from behind!” I admire how gross it looks but cannot think why Nicky wanted me to look. I am not an orthopaedic surgeon. I ask why. “No reason. Just looks gross,” she smiles.

Later that afternoon I am asked to see a man who has been brought in unconscious. I walk into the cubicle. The stench hits me immediately, almost to the point of making me gag. I don’t do smells.

The man is indeed unconscious and his left arm is swollen and covered in bandages soaked right through with pus. With the nurses assistance I gingerly unwrap the bandages all the while wishing my gloves reached to my armpits. His entire forearm is red and hot. The skin over the back of his hand has disappeared. I can see the tendons and muscle. All down his arm areas of skin have died and pus is pouring out. At his elbow I can see bone poking out through a hole right on the joint.

“How long has he been like this?” I ask. His friend does not know. He last saw him 3 weeks ago when he was fine. The wound is typical of a snake bite. He must have been bitten a couple of weeks ago and did not seek any help then. Chunks of muscle and skin died as a result of the cytotoxic poison and then became infected. He is now septic and shocked. I start fluids and antibiotics and ask our surgeon to come and see him. He will need all the dead tissue removed – probably an amputation this late into the proceedings.

My last patient of the day is wearing the green outfit of the KwaZulu-Natal Wildlife service, the organisation that runs the regions parks. She has sprained her ankle. I look at the X-ray taken earlier. It looks fine. I ask how it happened.

“She was running away from a charging rhino and twisted her ankle on a stone,” the nurse replies. It sounds the coolest reason for spraining an ankle I have ever heard. I ask whether she enjoys her job, naively thinking it must be quite amazing to work in the open with this kind of full-on wildlife. The nurse translates my request and the lady gives a small shriek by way of answer and speaks rapidly in Zulu. A slow grin spread across the nurse’s face. “No doctor. She does not like it. She hates the animals. There are all kinds of dangerous animals. Who would want to work where lions might jump on you at any moment?!”

I suppose if you look at it that way…

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