More adventures

This was a pretty busy week here for me, so there is plenty to write about. As mentioned earlier, Caleb is feeling better, but I think now he has caught a little cold from me, so he's been wiping his nose on everything! We got together with almost all the missionaries on Friday night for a "game night," we went to Suicide Rock this afternoon, and I saw the worst chopchop injury of my short time here. I suppose I'll start with the medical stories.

I was on call Friday night, hanging out at the above mentioned game night, when I was called down to the ER by Graham, the nurse who was staffing it at the time. I've gotten to know Graham a bit, and I always kid him about making a mess of the ER with blood and pus and people everywhere. He is (at least in my limited experience with him) what we in the States would call a "dark cloud," meaning he is always busy with more/sicker patients than usual. Well, that night was no exception. Graham said a guy came in, was pretty unstable, bleeding quite a bit, and that a limb had almost been amputated by chopchop. Now, in medicine here, everything from the nurses on the phone is understated, so I expected to see someone half dead when I walked in.





He was actually not looking too bad, except for a blood stained shirt with vines wrapped tightly around his right arm. He also had some makeshift bandages on his left forearm and right foot. He was, of course, covered from head to toe in dirt and blood. I asked Graham what had been amputated, and he said the right hand, though he hadn't seen it yet. One reason he was so worried was that his blood pressure (per Graham) was 60/40, and there was no way to know how much blood he had lost. When I came in, though, he was screaming in pain, and I knew pretty quickly that his bp wasn't nearly that low. At any rate, we got an IV going pretty quick and started assessing his injuries. His left forearm was open with his ulna broken and clearly visible. His right foot had a large lac across the bases of his toes, cleanly breaking all his metatarsals (long thin bones connecting the ankle to the toes). He also had some more superficial cuts on his face and fingers. Nothing terribly exciting. Finally, though, it was money time, and we took the homemade bandage of his right hand. What we saw was straight out of a horror movie. He had a cut from a bush knife (a.k.a. machete) that almost completely severed his entire right hand from his arm, save his thumb. The guy had obviously tried to catch or stop the (evidently pretty hard) swing with his hand, and his hand lost. The chop went diagonally down from the webspace between his thumb and first finger all the way through his ulna on the opposite side of his wrist. It was hanging on by just some skin and sub-q tissue. At this point, it was just full of old clotted blood, and was not really bleeding. I called my backup and subsequently the surgeons, and we got the thing cleaned off and packed for surgery the next day. Normally, even with open fractures and pretty severe chops, we just assess the patient's wounds, clean them out, stop the bleeding, and loosely sew them shut so the surgeon can look at them in the morning and do a definitive repair later. The big question with this guy was whether we should just amputate what was left of his hand right there, do the usual clean and sew, or just pack it and bandage it together. The final verdict was to just pack it and see in the morning what was alive and what was dead. For the other wounds we did the usual to await repair sometime this week. Internet is extra slow tonight, so here is a picture of his hand after we cleaned the clots out a bit. Ask me later if you'd like to see the rest of his injuries.



We all thought the hand would die for lack of blood supply, save for a strip of skin we could use to help close the wound after amputating. The next morning though, the family was insistent that they wanted him to keep his hand if at all possible, even if it would be non-functional. Now, I must take a little time out to say that in the States, this guy would have gotten a STAT surgery consult and a hand specialist, if he were at a big enough hospital, would have operated on him for untold hours repairing all the tiny nerves and arteries and tendons, resulting in (possibly) a mostly-usable hand. Sorry buddy, but this isn't Johns Hopkins. So on Saturday morning, after rounds, I went over to watch part of the surgery. There are a few more good pictures from that, including the finished product, but time tonight is limited. As I was saying, the family wanted to keep the hand, and amazingly, there was a reading from the pulse oximeter in his middle finger. so, it was decided to make an attempt and give the hand the benefit of the doubt. In a pretty delicate surgery, Kevin and Felix (a native doctor doing the equivalent of a fellowship month) repaired a major nerve, artery, and tendon, hoping to give him the ability to feel and pinch with his thumb and first finger. They also pinned some of his wrist bones back together and sewed his hand together. The end result actually looked pretty good. However, the pulse ox was not getting good readings from his fingers in the OR after the surgery, so we'll have to wait and see if it survives.

As to why/how the chop happened, it was apparently relatives who were quarreling pretty seriously with this young man about land. I will never understand how in a culture where family is so important, it is not uncommon for family to chop each other in pretty brutal and life-threatening ways.

In another call Friday night, I saw a woman who was in a state of shock, almost catatonic. She had put her one-year-old twins to bed in the customary way, hanging a few feet off the ground in a large bilams from a hook on the wall. It is a bit like a hammock, but the kids are snuggled in there pretty well with cloth or blankets or things. Well, the little girl twin somehow managed to get out, and fell maybe a meter onto a mattress (in PNG, this = straw mat). The family said she heard the noise and went in to find her little girl dead. At this, she started wailing, then collapsed and went into this semi-responsive state. I felt just terrible for this poor lady and her family. There was nothing I could do for them but offer to pray with them, which they accepted. Especially with such terrible loss, it is nice to be at a mission hospital where I can offer God's comfort even when there is nothing medicinal to offer. After praying, the woman slowly began to respond and went home to with her family shortly after. If you think of it, remember this poor broken family. I hate to think about what life would be like if we lost Caleb.

In other news, the man with TB and HIV whose chest xray I posted earlier did end up coming back to the hospital, but he died in the middle of the week. (And no, it wasn't from the pneumo) I don't know if starting TB meds earlier would have helped him turn the corner soon enough or not, but he was looking pretty ragged when he came back. I think the worst thing for him was finding out he was HIV +. After that, I think his will to live kind of dwindled.

Moving on to the non-medical, we have really been enjoying our time with the missionaries around the station. They are without exception good, honest people who are doing their best to live out the calling they feel in their lives. Most of them also have a pretty good sense of humor and are fairly laid back, perhaps from living in this culture. Even though I missed much of the game night, it was really fun to have everyone together playing games. One nice thing that's not as common in the states was all the kids and teenagers playing games with us. It is just really nice to see families enjoying leisure time together. See Dr Erin's blog for some pictures.

Today, as mentioned earlier, Stephanie, Caleb, and I made the trek out to Suicide Rock with a couple of the missionaries. It is a spot a couple miles from our house where the river has cut a nice little waterfall out of the rock with outcroppings on either side. There you jump into the river, and the current takes you a couple yards down stream where you pop up and can stand shortly after. Then you make your way to the edge and climb back up some pretty darn slippery rock. We all made it back safely with the help of Sam, one of the missionary kids (he's a senior in high school... kind of hate to call him a kid). Even swims-like-a-rock Ben jumped in and had a pretty good time. Caleb, of course, stayed only in the calm water and definitely did not jump off any cliffs. Our camera, unfortunately, did take the plunge as Stephanie was taking pictures of our friends with their camera. She stepped back and kicked the darn thing off the ledge and into the water. I was already down stream with Caleb, so I was able to hand him off and jump in, rescuing our camera with Herculean effort. I'm not sure it was worth it, though, because as of now it is still drying and refusing to work. We'll see what happens, but I don't think there will be any more picture posting for awhile!

And now, I would just like to give a couple of shout outs to our friends who sent us packages with snacks and treats we are thoroughly enjoying! The Huebners, the Majewski's, and the Olathe Kumors: you guys rock!