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South African Hospitals

Night Trauma

by Safiyya Bryce / 19.04.2011

It is my second trauma night call. The first wasn’t so bad. It was on Tuesday and not many people were drinking and stabbing each other. The only really eventful incident was the case of the 15 year old that was coming for his third visit this month with the same complaint. Tupac, we call him. He has been shot 5 times and he’s still breathing. The LODOX scan shows 4 retained bullets. The bullet through his head only pierced his cheek and he didn’t sustain any fractures. The one that is embedded in his chest is on the right. The one on the left is sitting comfortably in his trapezius with no accompanying rib fractures. The one troublesome bullet penetrated his abdomen but only destroyed a kidney. The other two bullets are from previous incidents. He has damage control surgery; a nephrectomy is all that is needed. Lucky fish.

So it is 9:45pm on a Sunday night and I’m already tired. I have been on call for 3 hours and 45 minutes, it is just beginning and the smell of booze and urine is unpleasant. I wander around trying to look busy and pretend that I’m not secretly hoping someone comes in. We, the students, moan about it “being quiet”. The registrars tell us to stop being idiots because if it is quiet we can go home early. Well if we are here we might as well be doing something.

The resuscitation bell rings.

We run behind the paramedic stretcher to the resus room. We drip the patient. She is having left focal seizures. The nurses hold down her fitting lower limb to make it easier for us to catheterise her. A gate fell on her head. She has a GCS of 8 and needs to see the neurosurgeons. There is not much left for us to do for her so we slowly walk back to the front room.

In the space of a resus 3 patients have arrived in the front: A woman with a blanket wrapped around her hand. A man with a swollen face, multiple contusions and a large bleeding laceration to the right cheek. A tall, weather beaten man with both arms bandaged.

The weather beaten man is in a wheel chair and has a drip in already. He is giggling to himself. He is one of those tall Afrikaans farm boys from the Eastern Cape. He speaks a mixture of incoherent Afrikaans/Xhosa/English. He has lacerated both arms by punching through a pub window, because “something came over him”. I un-bandage him while he is claiming he is a soldier from another time. He is saluting his dead soldiers and telling them he will join them soon. We ask him if he is confused. He says he is in between worlds and can see his wife and kids, “that are not yet in this world”. The bandages come off. He has engraved satanic symbols on his arm with a knife. I retreat.

The intern takes over. A CT brain is ordered. We are worried he has had severe head injury. The scan is unimpressive and no pathology is found. His wounds are sutured and he is sent on his way. The nurses were “kakking themselves” and we all are glad he is gone.

I want a smoke break but must see to the swollen, lacerated face first. He is calm and not moaning or jumping around like the fellow with a stabbed chest and in situ chest drain. The normal dosages of morphine are not working on the stabbed chest man. He needs higher doses because his liver is used to metabolising large daily quantities of tik. The guy with lacerated face has eyes so swollen he can’t open them. On further questioning as to how this happened he replies:
“I justi don’t know, this morning I woke up and looked to the mirror and I looked like this”
“Ok, so what were you doing last night? If you don’t mind me asking.”
“Just a small gathering with some few friends.”
“Ok, did anything happen? Did you argue?”
“No doctor.”
“Ok, were you fine when you went to sleep?”
“Yes doctor.”
“Ah ok, so do you think maybe you got assaulted in your sleep?”
“Maybe doctor but I’m not sure.”
“Did they steal anything from you?”
“No doctor.”
“Ok, it’s now 11pm. Have you been waiting for an ambulance this long?”
“No doctor, I walked here just now.”
“Ah ok, why did you take so long to come to the hospital?”
“Eh, this morning I just went to the bottle store to get some 3 or so beers first before, because I was just thirsty.”

The registrar walks past and says to the man that he should get married and “nyoba nyoba” at night so he doesn’t drink so much.
“Hayibo doctor, lobola is some R15000 – R20000. You don’t know my kaalcha.”

I leave them conversing about nyoba-ing and sneak off to lie down in the flea-infested student beds.

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