We know that we haven't done an update in 2 weeks, so I thought I could do a little piece I like to call "Tales from the Casualty".
Rusty and I have worked every weekend night shift in the past 2 weeks, which has made for some intense stories. I don't need to go into all of the victims of violence that we see here, but I just wanted to share a few highlights (for lack of a better word).
Two weekends ago, I was standing in the Resuscitation Room (aka Trauma Bay) and I glanced over my shoulder and there was a young man who was just wheeled into the ED and he looked at me through the glass doors of the resuscitation room, then his head dropped and he died. So I jumped up, ran over to him, and immediately noticed that his shirt was completely covered in blood. By the time I got to him, the nurses and doctors did as well. So we grabbed him, threw him onto the gurney and attempted to resuscitate him. I cut off his clothes and saw the wound--he was stabbed fatally in the axilla (armpit) and his axillary artery was severed. Rusty and I got his IV started and simply did chest compressions. 20 minutes later, we got his heart rate and pulse back, then the surgeons took him and he died during surgery.
The next day, and a few resuscitations later, an older man was brought in on stretcher in respiratory arrest, so I intubated him while Rusty did compressions and got his arterial blood gas. Again, we got his pulses and heart rate back, and he died later in the ICU.
The night was finished off with a young girl, 6 months pregnant, whom was hit in the face with a brick and fell onto her abdomen. The girl and the baby ended up fairing well, and I got to do my 2nd fetal ultrasound (and stitch her face).
Then, last weekend, we were told that all the action happens on the first weekend of the month, because the government checks get sent out and people party, get drunk, get high, etc and as a result, Casualty is crazy. This proved to be true.
Last Saturday, there were two rival gangs walking around the neighborhood and assaulting anybody in the street. The police ended up arming themselves with machine guns and drove around the city streets arresting anybody outside, for any reason. Sure enough, the victims of the gangs, would come in, one after another. In addition to the typical busy Saturday, we had about 15 extra people who were bleeding from stab wounds and head injuries from gang violence. So Rusty and started sewing these people back together. We got through about 6 patients and we realized that we had run out of suture kits. After a hospital wide search, we found out that the entire hospital had run out of suture kits and that the bleeding patients just had to stand in the corner and bleed on the ground. After about 3-4 hours of watching these people moan and bleed, we finally got some Debridement kits (not suture) and separated out the tools in the Debridement kits that we could use for suturing. Eventually, 6 hours later, we finally got all of their lacerations sewn up. T.I.A.
One couple that I treated had been out drinking with a "friend". At some point, during the night, the "friend" hit the female over the head with a beer bottle a few times, until the bottle broke, of course, then took the jagged end of the bottle and stabbed the male in the face. The friend then put the female and the male in his car and was driving them to the countryside where he was going to murder them. The male finally regained consciousness and jumped from the moving car, the female followed him, breaking her leg.
Another 3 people that we treated were all family. A gang member just broke into their shack and attacked the whole family in their sleep. He stabbed the teenage daughter in the face, he stabbed the 60 year old mother in the chest and he stabbed the brother in the back. These 3 people all ended up surviving, but in my opinion, the teenage girl got the worst of it, because her face will be scarred for life. Rusty did a great job on suturing her face, with our make shift kits. I sewed the mother, who had an arterial bleed that sprayed in my face a few times (I wore goggles).
Lastly, Rusty and I work the Casualty Department, so that we can teach the doctors and residents how to use the ultrasound machine in a trauma situation. Sure enough, we had a young man who was stabbed in the chest, just anterior to the heart. The doctors and surgeons were voting on whether to take him directly to surgery, or watch and wait, because they couldn't tell if his heart had been stabbed, or just his lungs. Rusty and I grabbed the ultrasound machine and scanned him. We immediately picked up on his pericardial effusion (meaning that his heart had in fact, been stabbed). The surgeons immediately took him to the OR. Later that night the surgeon came out of surgery and thanked us, because the patient had a right ventricle stab that they saw during surgery. As we like to joke here, "Another life saved". Haha.
Rusty and I have also had the opportunity to do several lumbar punctures (spinal tap) on meningitis patients. Additionally, the doctors here have promised us the chance to do all the chest tubes that come in while we are working (how many CU students are doing that??)!!
As for fun stuff. Ofer got here a week ago and we have been trying to entertain him by showing him around a bit, between shifts. The four of us (Megan, Rusty, Ofer and I) got a chance to climb Lion's Head at sunset and watch the full moon rise over Table Mountain. We then climbed down in the dark and went to our favorite 2 for 1 burger joint! It was amazing!
Right now we are in our final push to finish the research portion of our time here. We have had some major set backs, but we think it is possible to finish the research project. Wish us luck!
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