If there is one thing that medicine has taught me, and taught me very well, its how to use my nose to my advantage. The sense of smell, an often overlooked sense,thought to be inferior to that of sight and sound, has become an extremely important tool to me.
I was working a month-end shift in casualities, which meant 2 things. Firstly it was going to be extremely busy and secondly there would be copious amounts of alcohol involved. I wasn’t surprised.- ‘let them come, from far and wide, let them pour into my space’ I thought very poetically as I sipped my redbull.
In short,I shoudnt have said that because, boy, did they come. They arrived in a bus load,literally. they came in the form of a minibus accident. An overloaded taxi with over 18 people proved to be too much for the back left tyre and so it popped, sending the vehicle flying into the oblivion of a nearby bush, catapulting 10 people out of the vehicle. A witness described it like popcorn flying out of a pot, and I understood this visual given the injuries.
Broken legs, broken arms, broken hands, broken pelvis’ thankfully no broken neck.
I shipped them off to X-rays and apologized to the radiographer on call in advance.
A good portion of my night and energy went into stabilizing the masses. I decided to rest my eyes for 30 minutes while I could. I could feel the effects of the redbull leave me as I slipped into slumber.
I slumped into a semi-deep sleep only to be awoken up by the ringing of my cellphone, a tone which I have come to dislike. I answered.
‘Doctor we have a gunshot’
“Gunshot, okay where? Im coming”
So I didn’t walk, I ran.
I smelled it before I saw it. I knew this smell better than any other smell. It was a frequent scent I could identify from anywhere within a 5m radius. Alcohol
but It was overpowered by the smell of all smells. Faeces.
I must add that very little can shock me these days. I’d be brave enough to say nothing can shock me. I had thought I had seen it all, I was wrong.
I understood why the nurse on the phone was silent. Its because she was speechless.
Before me lay a middle aged man, laying on his tummy with his buttocks propped up and a clear view of what appeared to be a gunshot wound just adjacent to his anal opening. I looked twice. Blood and faecal matter poured everywhere. It was the literal and proverbial shitstorm I had always heard about.
I kicked myself into gear and inserted 2 wide bore IV lines. All his vitals were stable so I concluded the damage must be contained for now. I ringed the district surgeons and waited for a call back.
I explored the wound with my finger and plugged it with a dressing. The bullet was still lodged in there but that wasn’t my problem for now.
The nurse who spoke to me on the phone arrived with the admission slip.
She whispered, ‘doctor did you see the gun shot ass hole?i didn’t know how to express myself on the phone. Shew, it just missed the bullseye hey isn’t he lucky?’
I whimpered beneath my breath.
She produced the admission slip which read the same. I politely suggested we change the admission diagnosis to ‘peri-anal gunshot wound’ to sound a little more politically correct.
She nodded in agreement.
After the man was stabilized, I couldn’t help but ask. I just had to know how one sustains such an injury.
The man narrated the story for me. Apparently he found himself in a dispute with a friend of his over a woman. The men had been drinking a lot that night and his friend found himself dizzy on his feet wielding a gun in his hand. The men had exchanged a few clouts and he thought they had settled the matter but when he turned to leave, his friend took the gun and shot him in his rear. He was aiming for his heart, but I guess that’s close enough.
My diagnosis read : Peri-anal GSW caused by alcohol use.
The following day I got a call from the district surgeon who wanted to discuss the case with me.
‘Dr Moosa thanks for the referral we took that patient to theatre last night. However I want to address your note keeping please. Ive seen you used the word alcohol, but the correct term to use is ETOH’ he said.
‘okay doctor, but why?’
‘we have to avoid using terms that create a stigma, you see.’
I accepted and the conversation ended.
However, I couldn’t help but feel otherwise. Alcohol is alcohol. The drunk man with a gunshot ass isn’t going to worry about being stigmatized over confidential notes written by the doctor. And even if he is, if that makes him drink less and sustain less gunshot assholes, wouldn’t that be better for everyone?