20 December 2009


Sometimes our patients survive, despite our best efforts.

I was reminded of a remarkable patient I looked after a while back. I use the term "looked after" in it's loosest sense. He was a resident in my ward for a while, and I made conversation with him everyday while he was there. And didn't do much else.

He was a young man, who had gotten in a fight, and had been skewered by an assegaai as a result. It had entered just to the right of his sternum, and had exited in the right flank. His GP had removed it at laparotomy, but didn't have the experience to sort out the damage, so placed a drain and closed up. He had then referred the patient across the border to me. Referral in his case meant he was given a letter, put in an ambulance with his passport, wished good luck, and told to find a hospital in South Africa that would treat him.

When he arrived, he was already a few days post laparotomy. He was admitted because our hospital had some sort of cross border arrangement with where he had come from. This created a difficult situation for me, as I was the most senior doctor working in the surgical department at the time, and I definately did not have the experience to tackle this.

He was draining bile from the drain in his right flank, and from the entrance wound in his chest. We placed stoma bags over these, and monitored their output. This made it look like we were doing something. His CT scan showed a large, 2cm diameter tract right through his liver.  I tried unsuccessfully to refer him to a bigger center, or find a surgeon for him, but none of them would have anything to do with him. I tried all the local guys, but they were either not interested, or were away, or there were other politicians obstacles standing in the way. Try as I might, I couldn't work a deal for this guy.

A month passed of me making idle conversation everymorning, and checking the colour of his drain content. He patiently listened, with no sign of disapointment, to me relate my unsuccessful efforts at finding a solution to his problem. Then one day one of the interns pointed out that the hole in his chest was much smaller, and had stopped draining, and the one in his side was also draining much less. A week after that, and it had stopped too.

Unexpectedly, he did not develop jaundice, or any kind of obsrtuction. He was eating well, and had no complaints anymore. So I sent him home. He left smiling, and thanked us for all we had done for him!

On day one I would never have imagined this outcome, or even thought of managing it conservatively! Sometimes I am truly amazed at how the body is able to heal itself.

1 comment:

Bongi said...

you handled him perfectly, like a surgeon would have done. no more was needed. well done.