It was futile from the beginning and we went on far longer than we should have, 4 hours to be precise, but I refused to let another one slip through the cracks of death.
It was storming on a summery Tuesday night and a young gentleman was brought through with a stab to the neck. The bottle pieces scattered within the bright red tissue which bled until eventually dry, glistening and reflecting under the ugly fluorescent lighting.
The bottle had took off a considerable amount of tissue but luckily for him (and me), the carotid artery was untouched. I was drenched in blood and my plastic apron was soaking but if I had decided to move, he would empty his blood contents on the floor. I tried to attempt bandaging and compressing yet as soon as my finger was off his neck, the padding would slump off, soaked and useless.
I decided to attempt to ligate any obvious bleeding vessels. Im not a vascular surgeon even when I pretend to be. I moved closer to the neck shielded by a visor which certainly did not feel adaquate. He poured more clots onto my hands. I searched and saw the tissue oozing with bleeders maneuvering beneath the sternocleidomastoid. I went for the kill and clamped it with an artery forcep. Yet it oozed venous blood like nobody’s business.
He began panting as his heart struggled to cope with the loss of blood. It was racing to pump any few drops left. His eyes were beginning to dilate. i slapped his back, tugging at his shoulders, to somehow keep any life in him alive.
In those few minutes I stood so helpless and lost, knowing i could do nothing for him. But what if?… I thought
He bled out in a matter of 10 minutes right in front of my eyes turning pale as a sheet. I pumped litres upon litres into his collapsing veins yet the blood seemed to leave him so easily. The severity of the vascular injury was too much for his heart to maintain and pretty soon he was turning blue.
The ambulance was on its way and I paused. I left him under the observation of a nurse and I grabbed the phone and decided to try my luck.
You see in south africa there is a definitive referral pattern of patients. Peripheral primary health care clinics refer to community health care Clinics who refer to district or regional hospitals who then refer to a tertiary level hospital.
I reasoned with myself; I happened to be so far down the referral pathway, if this gentleman had to go to a regional hospital where there is no vascular surgeon, he would then need to wait and be a sitting duck before being sent to a tertiary hospital. And by the looks of his vascular picture, a dead duck.
I decided to cut the middle mad out of the picture. This gentleman will die if he began loitering around ambulances in regional hospitals.
This system is adhered to, to assume order and functionality but in this case I knew what i had to do. I dialed the most tertiary hospital in the province and waited, my heart racing.
I cleared my throat and tried my utmost best to ooze confidence. “Yes Dr so and so. Vascular surgeon on call..” he sounded pretty nice, young and enthusiastic”
The moment of truth. I told myself I had to sell this case like a life depended on it ( it did) and I would refuse to take no for an answer.
“Dr moosa here calling from so and so(I intentionally left out the fact that I’m at a clinic ). I have a patient who is critically ill…” I rumbled off. I was hoping in the best case scenario he would assume I was calling from a regional hospital as these people in their ivory towers seldom know the whereabouts of those calling.
“Huh. Wheres that? Which area? Whats the dialing code?” He quickly butted in.
I ignored all of the above and went on.
“Doctor this young gentleman of 18 years old was stabbed with a bottle to his neck and i suspect his jugular has been nicked, he has no arterial bleeds but he is oozing out right in front of my eyes. He needs a vascular surgeon”
The doctor on the other end sounded confused. Im sure he had never received such an absurd call before. I imagine he began puzzling the pieces together.
“You see im calling from a clinic. It’s 20 minutes away from you. He needs theatre to repair whatever has been damaged but if I send him to a regional hospital, he will die long before he gets to you” i mumbled defeated.
Click. He hung up.
I couldn’t blame him. Im sure he was a young registrar who was slaving away in the vascular department overworked and overlooked.
I looked down at the phone; the thought of writing a death certificate for an 18 year old cracked my motivation wide open. I decided to try again, this time aiming higher up the medical food chain. The consultant.
The consultant usually does calls from home, called in only when necessary. I was hoping this would mean he would be bathed, clothed, fed and in a generally good mood. I phoned the hospital and asked for the Vascular consultant number on call. I lied and said I happened to be a doctor in the department.
The ringing on the other end made me sweat. The phone was answered by an unsuspecting elderly well mannered gentleman. I apologised profusely for bothering him and I began my tale of tragedy.
I could hear him snigger at me. My morale fell. I was ready for the phone to be slammed down in my left ear.
“Young lady, my registrar had communicate the same 5 minutes ago, we are preparing a theatre for him , I am on my way to scrub up in theatre. He was just about to inform you”
I was flabbergasted. I couldn’t believe my ears.
I thanked him with mounts of relief. I ran to check if the patient was still alive and sure enough, he was still fighting. His blood pressures were low but acceptable.
I organised the paper work and informed the ambulance of the rerouting. They had admitted to seldomly transferring a patient from a clinic to a tertiary hospital before and were skeptical until i provided phone numbers of the surgeon.
I watched them drive off as I sat on the edge of my seat. I Hope he survives i thought.
It wasnt until weeks later that I had realised the outcome. This young gentleman who turned 50 shades of blue in front of my eyes was now walking, talking and of course complainig, about his flu. I was amazed and overjoyed I almost cried.
I had never been so happy to see anyone have the flu in my life!