"So, how did you get shot?" I asked the 12 year-old boy in front of me. I had heard what had happened, but I wanted to get his account. Here is the story he told me. His family had lived in a village called Niania. At about three in the morning, they were awakened by people shouting and gunfire. His father went to the door and was shot and killed. His mother was also killed. I didn't ask too many questions. Sometimes you don't want to hear all the details. It was unclear who the attackers were. 12 year old Alili tried to hide but he was struck by a stray bullet which passed through the shoulder. He fled into the bush, bleeding and terrified. He stayed hidden for a week. He ate cassava and raw sweet potatoes which he found in the fields. His arm became gangrenous. I can only imagine the horror and terror that he lived through.
An uncle did not find Alili's body in the village and he went searching. He finally found him and brought home home. More than a week later he finally received medical care and underwent a "guillotine" amputation (exactly what is sounds like) at the level of the shoulder. Some time later he was sent to Nyankunde for management of the dead scapula which was protruding from the wound.
It was a close brush with death, but an even closer one was ahead. I saw him in the ward and we scheduled him for a revision of the amputation. It seemed like a relatively simple matter of removing the dead scapula bone and closing the wound. Well the operation got delayed a bit. It seemed like there was always something more urgent. Several days went by. Near the end of the week, I decided that we had put him off long enough, he smelled bad enough and we needed to operate that day. I sent for the patient and was surprised to hear that he had been transferred to the ICU.
As it turns out, that morning he had started having difficulty breathing. He was transferred to the ICU and put on oxygen, but he deteriorated rapidly. By the time I saw him he was in severe respiratory distress. Something seemed to be compressing his trachea. To make a long story short, the bullet and the subsequent infection had caused the superior lobe of the lung to die and the infection had entered the neck and was compressing the trachea. I opted for an emergency tracheostomy, and with a bit of luck I found the trachea, pushed way over. I didn't have an appropriate tube, so I put an ordinary endotracheal tube in. We were able to ventilate the patient, sighs of relief all around, but in performing the tracheostomy, I had stirred up some pretty major bleeding. Not exactly "audible bleeding" but close. I ended up ripping off the clavicle to ligate the subclavian vessels. I was tying off bleeding arteries without actually knowing what they were.
The patient had entered the OR in a state of severe anemia and he went into shock. There was no blood pressure or pulse. There was only one family member with Alili and he had an incompatible blood type. I asked the blood type...B+. Oh well, time for me to give again. I asked for an empty blood bag and poked the huge needle into that little scar in my left antecubital fossa. I've stuck it so many times that I have no nerves working in that area and I feel no pain, just the slight queasiness of sticking a needle into my own body and watching the blood flow. I had just stuck myself and was sitting down, when Ayiko, the head anesthetist told me not to bother. It wasn't worth wasting my blood. He's usually pretty optimistic, and usually pretty accurate. I decided that I'd come that far, I might as well continue.
As soon as I'd filled up the bag, I pulled the needle out of my arm. There was only a tiny IV in his hand. We needed something bigger. I got the ultrasound machine, located his jugular vein and stuck a 16 gauge IV in. Unfortunately the puncture site in my arm had not yet clotted and I was dripping blood all over the table and floor. One of the other doctors grabbed a gauze and held pressure on my arm until I had fixed the IV in place. We poured the blood in. I squeezed the bag and got it in in a couple of minutes. Alili came back to life. There's no other way to put it. He started breathing again, his pulse came back, and he opened his eyes.
Since that day, he's actually done quite well. We got the tracheostomy tube out after a day or so. We took him back to the OR to remove the scapula and pull the wound together. He looks a bit funny, but he is doing well. After all he's been through, I've kind of concluded that he is a tough kid. He is still missing a good portion of one lung and he still has a large infected wound, but he's alive.
Anyway, I don't have any real conclusions to make. It was a case that moved me. This kid has suffered more than I can imagine. He has been so close to death, but he seems ok. He smiles, he laughs, he's really a pretty cute kid. This can only be the grace of God. For me it is a reminder to go all out, to not give up easily. We've had a lot of disappointments in the surgical department, a lot of death. Still, there are those cases which make me believe that it is possible to make a difference.
Right now, I'm sitting in the airport in Entebbe, Uganda. In a couple of hours, I will get on a plane and return to the US. It is a focused trip. I am bringing back some endoscopic equipment that needs to be repaired. I'm hoping to learn how to do service and repair of this equipment. I'm not looking forward to going back alone, and I already miss Lindsey and Emmanuel. I'll be back in Uganda in about ten days and then we will spend a couple of days together in Uganda before returning to Congo.
Pray for us as we give our blood, sweat and tears. Pray for Alili, that God will comfort him and give him the strength to go forward.