Surgery Call

Since September 1^st, I have been rotating through General Surgery here at Tenwek. 6 am rounds have never been my idea of fun, but given the option of this or all-day rounds with Internal Medicine—I, like most future Emergency Medicine doctors, would prefer the quick, efficient rounds of the Surgeon. Plus, the Theatre has offered plenty of opportunity for procedures and I have had opportunity to evaluate acute abdomen cases.

My first two call-nights on surgery started out with a bang—literally. Mutatoos are the local public transport buses, and both casualties were the result of mutatoo road traffic accidents (RTA). Over the weekend, I experienced the mutatoo first hand—as I rode in one on our travel back from Uganda. Our bus was packed—with over fifteen Kenyans packed into a twelve person ride. On stops, there always seemed to be one or two guys hanging out the side door who had to jump in as the bus drives away. Fortunately, we arrived safely in Bomet on our bus ride. The individuals below sadly did not reach their destination.

The first mass casualty was on Thursday night last week. We got a call at 8PM that there had been an RTA in Naruk, and that they were coming to Tenwek. A bus of six people had hit a donkey and crashed. The injuries were catastrophic and the morbidity high. They arrived at 10PM. At first I focused on A., a lady who had severe wounds all over her right arm, cold extremities, no pulse she would require amputation that night. The saddest cases, however, were the children. One 5 year old boy (I.) presented having had a traumatic amputation in the field of his whole right arm. When we explored I. arm in Theatre-- glass, dirt, and blood gushed from where his arm should have been. Next a 4 year old girl (L.) lost the right side of her face, sustained a skull fracture, and right arm avulsion, all the while she was crying for daddy. Three more—a baby with open tib/fib fracture and avulsion of ankles bilaterally and two ladies—all required surgery that night. The team was up all night dealing with the tragedy. Dr. Carol Spears, a missionary General Surgeon who trained at University of Kentucky, led the team through the night. Tragedies like this are hard to put in to words; I found my heart broken for I., who will survive but must live through live without an arm.

The second mass casualty occurred two days later when twenty-three patients arrived to the hospital without warning from a nearby RTA. One patient was dead on arrival, another died shortly after our resuscitation efforts were started. Another patient I evaluated sustained a C-spine fracture, and before she had transferred to the regional neurosurgeon, she had lost all sensation and strength below her chest. Multiple dislocations and fractures were noted among the victims.

When tragedies like these occur, it may seem like God is not present. We may cry to Him as the Psalmist does in Psalm 10:1—“Why, O Lord, do you stand afar off? Why do you hide yourself in times of trouble?” or as Habakkuk pleads when Judah is oppressed—Hab. 1:2—“O Lord, how long shall I cry for help, and you will not hear me?” Sometimes there are no easy answers. We ultimately live in a sinful, fallen world, and the beauty of Christianity is the hope found in the redemptive work of Christ. God doesn’t promise all the answers now, but He does allow enough of Himself to be known that we can trust in Him through tragedy, as Habakkuk does in Hab 2:4—“…the righteous shall live by his faith.” Also God can use a tragedy to speak to us, as C.S. Lewis rightly notes, “God whispers to us in our pleasures, speaks to us in our conscience, but shouts in our pains: It is His megaphone to rouse a deaf world." Tragedy opens our eyes up to real life; we are forced to focus on things we would rather not think about in the routine day—life, death, our past, our future. If the Church is present during the tragedy, we can be Christ to the hurting. Our presence in the midst of tragedy is often more meaningful than any grand comments we can come up with.