As I cut through his skin the young man turns to look at me. He is lying on one of the couches in Resus, panting and groaning in pain, his face obscured from my view by his oxygen mask. He reaches out his hand to touch me and then rests his arm across my shoulders in a clumsy embrace. Just one hour ago he watched as his girlfriend was killed by the same gunman who shot him through the chest.
I work rapidly. The bullet entered just right of his sternum and exited in the right loin – ripping through the lung and liver on its way. From my quick assessment when I was called it is clear his chest cavity is filling with blood impairing both his breathing, and as the heart is compressed by the pressure, his circulation. As I enter the chest cavity there is a gush of blood over my hand. I insert the tube and connect it to the drain bottle. The blood pours out – 200mL, 300, 500. A litre.
“Someone run to the lab and get all the blood they have,” I bark. “Someone else, get some fluid running in that line.” One nurses squeezes a bag of fluid into the line in his arm and I get the biggest IV cannula I can find and stick it into the femoral vein. A nurse stands and squeezes a second bag into that.
The blood arrives – we set up a third line and soon there are three nurses squeezing various fluid. His blood pressure begins to pick up. I check the drain bottle – 1.5L of blood.
I go to the phone and start making the calls to get him transferred to the surgeons. The surgeon accepts him no questions asked. The ambulance service is more problematic – the phones are answered by clerks with no medical knowledge at all. I answer all her routine questions. “So what is the problem doctor?”
“He has been shot in the chest.”
“And when is this transfer for? Tomorrrow?”
“Now! Urgent!”
“Now?”
“Yes! Now now!”
The whole thing takes 30 minutes. I return to the man. “How is he doing?”
“Not so well doctor. The blood pressure is dropping and he is not responsive.”
“Shit.” In my absence he has filled another drain bottle completely – 4 litres of blood. The nurses are squeezing in the 4th unit of our stock. We have only 2 left in the entire hospital. I call one of the other doctors to come help me as I stick in a neck line.
The phone rings as I finish the line and the nurses holds it to my ear as I stitch – it is the helicopter coordinator in Pietermaritzburg. She sounds jarringly cheery. “Hello! How are you?”
“Fine.” I mutter.
“Good. I’m fine too. We were just called about your patient with the gunshot.”
“Just called? But I phoned the emergency service an hour ago!”
“Really? Well they only just called the helicopter service. How is your patient?”
“Not good.”
“Would you still like the helicopter?”
“Yes! As soon as.” She asks a few more questions and assures me it is leaving its base and will be there in 30 minutes.
The man is stirring a little now – his blood pressure is better, but he is increasingly unstable. I call for one of the sisters from high care – she arrives with the anaesthetic drugs. She explains to him what I am about to do. He nods, closes his eyes and I sedate, paralyse, intubate him and stick him on our portable ventilator. I offer silent thanks to ITU Southmead in Bristol where they taught me how to do this stuff. I look up – the resus room has filled with silent nurses in 2 rows watching. Standing at the back are some people who appear to be on a tour of the hospital. One pulls out a camera and takes a photo. I want to shout at them. But don’t.
We have used up all the blood. He is well into draining the 8th litre from his chest and it looks not so much like blood as rose wine – the majority of it being the saline we are pouring in. One of the doctors gets on the phone to an old boss to find out whether we can safely re-infuse what is coming out of his chest: auto-transfusion. But even as she does so the helicopter team arrives.
They take their time transferring him onto their equipment. I am getting agitated: don’t they understand he needs blood and surgery! Sod this! But they methodically continue. As we move him he gives a cough. A great flow of blood erupts from the chest wound – we stick on extra dressing and press hard. His blood pressure is falling and I give him a shot of adrenaline.
At last the helicopter team are satisfied. They wheel him out and load him on, finally leaving 3 hours after my call. As I watch I wonder whether he will even survive the transfer.
I suddenly remember I am supposed to be at a meeting at a nearby research centre – it started 2 hours ago. I phone to apologise. The organiser (a German – not that it is of significance) says I shouldn’t worry. No one else has arrived yet. I burst out laughing. That is so South Africa. “I am glad you find it funny because I do not,” he grumbles.
The rest of the day is a blur. At the end I phone the surgeon who took the man. He went to theatre – they removed the damaged lung and packed the liver. He is on ITU and stable.
I walk home and decide that I will have a (very brief) weep. Of relief.
So I do.
I work rapidly. The bullet entered just right of his sternum and exited in the right loin – ripping through the lung and liver on its way. From my quick assessment when I was called it is clear his chest cavity is filling with blood impairing both his breathing, and as the heart is compressed by the pressure, his circulation. As I enter the chest cavity there is a gush of blood over my hand. I insert the tube and connect it to the drain bottle. The blood pours out – 200mL, 300, 500. A litre.
“Someone run to the lab and get all the blood they have,” I bark. “Someone else, get some fluid running in that line.” One nurses squeezes a bag of fluid into the line in his arm and I get the biggest IV cannula I can find and stick it into the femoral vein. A nurse stands and squeezes a second bag into that.
The blood arrives – we set up a third line and soon there are three nurses squeezing various fluid. His blood pressure begins to pick up. I check the drain bottle – 1.5L of blood.
I go to the phone and start making the calls to get him transferred to the surgeons. The surgeon accepts him no questions asked. The ambulance service is more problematic – the phones are answered by clerks with no medical knowledge at all. I answer all her routine questions. “So what is the problem doctor?”
“He has been shot in the chest.”
“And when is this transfer for? Tomorrrow?”
“Now! Urgent!”
“Now?”
“Yes! Now now!”
The whole thing takes 30 minutes. I return to the man. “How is he doing?”
“Not so well doctor. The blood pressure is dropping and he is not responsive.”
“Shit.” In my absence he has filled another drain bottle completely – 4 litres of blood. The nurses are squeezing in the 4th unit of our stock. We have only 2 left in the entire hospital. I call one of the other doctors to come help me as I stick in a neck line.
The phone rings as I finish the line and the nurses holds it to my ear as I stitch – it is the helicopter coordinator in Pietermaritzburg. She sounds jarringly cheery. “Hello! How are you?”
“Fine.” I mutter.
“Good. I’m fine too. We were just called about your patient with the gunshot.”
“Just called? But I phoned the emergency service an hour ago!”
“Really? Well they only just called the helicopter service. How is your patient?”
“Not good.”
“Would you still like the helicopter?”
“Yes! As soon as.” She asks a few more questions and assures me it is leaving its base and will be there in 30 minutes.
The man is stirring a little now – his blood pressure is better, but he is increasingly unstable. I call for one of the sisters from high care – she arrives with the anaesthetic drugs. She explains to him what I am about to do. He nods, closes his eyes and I sedate, paralyse, intubate him and stick him on our portable ventilator. I offer silent thanks to ITU Southmead in Bristol where they taught me how to do this stuff. I look up – the resus room has filled with silent nurses in 2 rows watching. Standing at the back are some people who appear to be on a tour of the hospital. One pulls out a camera and takes a photo. I want to shout at them. But don’t.
We have used up all the blood. He is well into draining the 8th litre from his chest and it looks not so much like blood as rose wine – the majority of it being the saline we are pouring in. One of the doctors gets on the phone to an old boss to find out whether we can safely re-infuse what is coming out of his chest: auto-transfusion. But even as she does so the helicopter team arrives.
They take their time transferring him onto their equipment. I am getting agitated: don’t they understand he needs blood and surgery! Sod this! But they methodically continue. As we move him he gives a cough. A great flow of blood erupts from the chest wound – we stick on extra dressing and press hard. His blood pressure is falling and I give him a shot of adrenaline.
At last the helicopter team are satisfied. They wheel him out and load him on, finally leaving 3 hours after my call. As I watch I wonder whether he will even survive the transfer.
I suddenly remember I am supposed to be at a meeting at a nearby research centre – it started 2 hours ago. I phone to apologise. The organiser (a German – not that it is of significance) says I shouldn’t worry. No one else has arrived yet. I burst out laughing. That is so South Africa. “I am glad you find it funny because I do not,” he grumbles.
The rest of the day is a blur. At the end I phone the surgeon who took the man. He went to theatre – they removed the damaged lung and packed the liver. He is on ITU and stable.
I walk home and decide that I will have a (very brief) weep. Of relief.
So I do.
Comments
You are going to be so bored when you come back to England.