Last Weekend in Nigeria

Our last weekend in Egbe, I was called at 4 am to see a man with abdominal swelling. I quickly threw on my scrubs, grabbed my headlight, and rode my bike down to the emergency department. There I met the victim, a middle-aged vigilante security guard hired by the townspeople for protection. A few hours prior  three young men had thrown a large rock at him, hitting his left side.

the rock

His vital signs were stable, but he didn't look good. He was sweating and his abdomen was tense and tender. I did a quick ultrasound showing copious free fluid in his abdomen. Blood. Lots of it. We didn't have much time. He needed an emergency exploration right away to stop the bleeding. 

While waiting for the OR team to arrive, I asked the team to prepare blood for the patient. Their reply, "There is no blood in the lab." To make matters worse, the patient had an uncommon blood type for the region.  Dr. J, the family medicine doctor on call and medical director, took charge and started looking for donors among the nursing students and staff.  

Meanwhile, I helped transport the patient up to the operating room in an effort to get him on the table as quickly as possible. It wasn't fast enough. As the anesthesia tech was preparing the patient, the man's blood pressure suddenly dropped to 70/40 and his pulse became rapid and weak. Time was running out. 

There was no time for intubation. His blood pressure at this point was barely detectable, he pulse was very weak, and he was no longer responding to us. He was dying and blood was still five minutes away. I quickly gowned, gloved, and prepped the abdomen. We quickly gave what anesthesia we could before I grabbed the knife and opened his abdomen. Blood rushed out. I rapidly explored the abdomen and found the source of bleeding- a ruptured spleen. I applied pressure to stop the bleeding while we worked to stabilize him.

After what seemed like an eternity but was probably only a few minutes, the medical director arrived with two units of blood- one of which he had donated himself! We pumped the blood in as fast as possible while I removed the spleen (a difficult feat due to a stomach full of air and light anesthesia). After repairing an additional tear in the wall of his large intestine, I closed him up and we took him to recovery. After four units of blood and several warm blankets, his vital signs stabilized and we all breathed a sigh of relief. 

the spleen is out!

The rest of his recovery was uneventful and he was able to go home in less than a week. It was a great save, but it made it even harder to leave Egbe knowing there would be no surgeon coming to replace me for some time. If the man's injury had happened one week later when there was no surgeon at Egbe, he likely would have bled to death. The world needs more surgeons.