“Doctor, we have trauma patients for you to see.” I run to Urgence.
I feel his neck. Crépitus like rice crispies popping is under my fingertips. Great. I should explore this zone II neck injury in the OR.
Oh there is another patient, an arrow penetrated his left chest...and oh, another patient is on the way.
More of the story comes out. A wonderful man named Solomon cooks lunch for us during the week. His nephew went to visit family out in a village. Suddenly, the sesame stalks they had harvested were on fire. The nephew ran out to see what was happening. He was unarmed. The nomadic cattle herders were waiting for him and after nailing him with an arrow they ran to him and broke his neck. Villagers are fighting back at the Fulani cattle herders and more people have joined the violence on both sides.
This man with the arrow in his left chest has developed a pneumothorax.
We place a chest tube. It has been fun to help the local Chadian docs learn procedures and in this case one did it without my help for the first time. We have no chest tube atriums so I jerry rig a foley bag tube into a container of water to act as a one-way valve water seal.
The military is out in the bush now. I have to be careful what I write. (If you know, you know.) I’ll just say that they used weapons not available to others. They protected the Fulani. I will admit the Fulani are a beautiful Muslim people. My friends and I here love them.
Now for the neck injury. I intubated him in the OR to secure the airway while attempting endoscopy. Too much edema and blood to see well. I opened the neck with the incision I’m most comfortable with for carotid artery surgery. The arrow had penetrated the thyroid cartilage right into the posterior larynx.
No problem right. Just like every other penetrating laryngeal injury I have seen... Just kidding. In 8 years of taking call in busy trauma centers I’ve never dealt with this. Even if I had, an ENT specialist would have been responsible. Here there is no ENT specialist available to the common villager.
We repair the injury in 3 layers and place a drain. I pray that the repair will heal. If not, he will have saliva pouring out his neck for a long time.
While in the OR more victims are arriving. These are no longer arrows, but rather targets of the military. Our guard’s brother finished bleeding to death from a thigh bullet wound while they carried him through the hospital gate. Another shot in the right shoulder was successfully treated with a compression dressing one of the local docs placed.
Now I’m placing combat gauze in a bullet wound to the head with gray matter and blood coming out. His mental status is surprisingly good.
We pray that people will forgive. Human retaliation will only bring more pain. Thankfully, our patients in the hospital are doing very well.
