Why trauma ticks me off
Monday, July 24, 2006
(a) The team will lose, and a pile of people will then drown their sorrows, and then stab each other.
(b) The team will win, and then a pile of people will celebrate by getting drunk, and then stab each other.
This Saturday, the latter occurred.
I was fortunate enough to be on call when the victims started coming in. To say that they were all stabees is in fact a generalization: some of them had been shot, and some had been beaten with bricks. When asked what happened, the patients generally gave an answer that went along the lines of 'I was walking down the road, and then I looked at this guy, and then he stabbed me/shot me/pounded me with a brick.' Some are fairly candid, choosing just to sigh 'Ai, iDronka...'
They started to pour in at around midnight. Iwan and I were summoned from our nice university beds to come and suture. The corridors of casualties were lined with stretchers piled with individuals in various stages of intoxication. Most of these people were scheduled to be stitched up by casualty nurses, who do so much of this type of thing that they have suturing skills to rival that of the average plastic surgeon. Being on call for surgery, Iwan and I were called to see a (drunk) patient who was found to have developed a compartment syndrome in his left leg.
By the time we got there, he'd already been booked for his fasciotomy, and was scheduled to be in theatre within half an hour. We quickly sewed up some minor cuts on his back, face and right leg, and then followed him into the operating room.
At 2am we scrubbed up. At 9am, seven hours later, we took our gowns off.
See, this guy had been stabbed in the back of his left knee. After opening the posterior, anterior and lateral compartments of the leg to relieve the pressure, the surgeon (who had fortunately just completed his vascular surgery rotation) went to look for the bleeder, only to discover that the patient's popliteal artery and popliteal vein had been lacerated. Now, what you basically need to know here is that these are each the biggest artery and vein of the lower leg respectively. Without your popliteal artery, you'll lose your leg; without the vein, you'll develop venous hypertension.
What ensued was an extraordinarily delicate and complicated procedure that involved harvesting some vein from the patient's contralateral groin area, opening it up to create a flap about the size of your pinkie nail, and suturing it over the holes in the damaged vessels. I was the little girl that stuck her finger in the dyke: my job was chiefly to apply pressure to the spurting areas and to pull on the vascular loops that controlled the bleeding from further away.
The entire matter was exceptionally costly (to the health system, not the patient - who just pays a nominal fee). There's seven hours of theatre time, seven hours of anaesthetist time, seven hours of vascular surgeon time, seven hours of scrub-sister time. Then there's the cost of a few days in ICU, the cost of the procedures still to come (this morning, there was still no foot pulse and the operation had to be re-attempted). There's the cost of the materials: the sutures, the antibiotics, the autoclave time for the five different sterile sets that were opened. And then, of course, there's the value of the limb that's future still hangs in the balance, which (in the words of Mastercard) is priceless.
And all of this was completely unnecessary. Call me conservative, but sometimes I wish alcohol and all hand-held weapons were banned entirely. The majority of the trauma I see (and I see trauma very much on a daily basis) is due to a combination of the two of these, and it's completely preventable. That’s why trauma ticks me off.
posted by Karen Little @ 6:36 PM,
11 Comments:
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At 8:57 PM,
John said...
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Dear Karen,
I followed the link from NHSblogDr, and am enjoying your blog tremendously.
Would you mind translating the Afrikans for us who don't speak it? Or, is is simply to be left to the imagination of the student!
Best wishes for a quiet week,
John -
At 2:20 AM,
Vesper said...
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you wrote that SO well. i'm always super impressed...
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At 1:01 PM,
arcadia said...
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jis karen, that's hectic. do you have similar repercussions after other events in the city? like after the rugby?
also - were you by any chance in the pedeatric section of pretoria academic on sunday afternoon? -
At 2:33 PM,
Lexi said...
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like arcadia said thats hectic.....if ppl want to drink they should just do so in the privacy of their own homes where [hopefully]they'll do nor come to any harm
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At 3:00 PM,
Wendy said...
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At least it is always interesting?!@#! Never a dull moment. I can't say it will get better next year in Cape Town - it is prob the same or worse!
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At 5:04 PM,
The Electric Orchid Hunter said...
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Yeah, it's a shame that alcohol and aggression go hand-in-hand. I wouldn't mind having guns banned - if it would actually take them out of the hands of the law breakers.
Why is medical autoclave time costly? You can come and autoclave things in my lab for free anytime. Well, that's if you're prepared to work with equipment that smells faintly of LB broth. -
At 11:58 PM,
theinjuredcyclist said...
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Yes, I agree. All alcohol and offensive weapons should be banned. When we've achieved that, let's stop silly cyclists causing open fractures as they're taking up a lot of theatre time in London too.....ooops!
Great article Karen. -
At 11:52 AM,
Karen Little said...
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john - some of the 'foreign' words you see are Afrikaans, and some are colloquialisms that are a hybrid of the multiple languages we speak here. I'll add a glossary page (check the side bar) - hopefully I'll be able to translate without losing too much of the words' effects.
vesper - thank you! I see there are a few typos and symbol oopsies though... wil try to fix.
arc - dis eintlik 'n baie spesefiek groep mense wat mekaar aantas, as jy weet wat ek bedoel? Hierdie tipe trauma gebeur nie veel nie na goeters soos rugby an krieket... And no, I wasn't there - I was in the hospital out West.
lexi - don't be so sure. You can get nice and drunk at home and the fall down the stairs or get electrocuted.
wendy - Anne says CT is worse. I'm keeping my fingers crossed... You know the western cape has the highest incidence of fetal alcohol syndrome in the country?
leon - autoclaving is free, naturally. What costs money is the salaries of the people who operate the autoclave, and who fold everything up into their nice sterile packs. It sounds ludicrous, I know, but you have no idea how often the sisters will say that only one person can assist because not wnough gowns have been sterilised for everyone to have one.
cyclist - injured cyclists (and pedestrians and so forth) are a whole new story. Wear your helmets, dammit! -
At 1:43 PM,
theinjuredcyclist said...
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Interesting point you make about helmets. A helmet will give some protection obviously. However, what a lot of cyclists aren't aware of is that even in a low speed impact, you can still experience a fatal head injury. They offer some protection but are not the panacea that they are held up as in my opinion.
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At 10:06 AM,
Lexi said...
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the alchol fetal syndrome is cos they're still using the dop system and some ppl are stupid
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