Last week was exhausting. For three days straight we were
overwhelmed with emergencies, traumas and difficult cases, but through it all I
saw God’s provision. I especially saw God’s hand at work in one
patient, a young mother of 3 who was stabbed in the buttock. At first, we
thought the knife had just injured muscle and that we could treat it with local
wound care. However, the patient quickly convinced us otherwise when she became
hemodynamically unstable and dropped her blood count dramatically. While Dr.
Bill and Dr. Mathew worked to stabilize the patient and start blood
transfusion, I explored the wound and found it tracked much deeper than
previously thought, and that there was a persistent arterial bleed coming from
deep near the pelvic bone. In the operating theater, exploration of the abdomen
revealed a large amount of blood collecting behind the inner lining of the
pelvis: a retroperitoneal hematoma. This brought back memories of a case on my
surgery oral board exam of a penetrating trauma to the pelvis with iliac artery
injury, so I quickly got control of the major vessels leading into the area
before uncovering the injury. Incredibly, the knife had gone through the
gluteal muscles, down to bone, through the natural hole in the pelvis (the
greater sciatic foramen) and had poked into the side wall of the rectum. The brisk
arterial bleeding from deep in the wound lead me to believe the superior gluteal artery, which exits the pelvis through this canal, was severed.
On a
skeleton, this hole is easy to identify, however after adding several layers of
muscle and pelvic organs, it is quite difficult to visualize in real life. In
the States, we would have performed angio-emobilization: placing a catheter
through a feeding artery and injecting coils to stop the bleeding from inside the injured vessel. Unfortunately, we do not have this
technology in the highlands of Papua New Guinea, and the only way we could
control the bleeding was balloon tamponade. She had already lost a significant
amount of blood, so we opted for damage control surgery: leaving the balloon
and packing in place, diverting the colon injury and closing up with plans to
bring her back to the theater in a day or two. That night, I read everything I could find about
pelvic artery injuries in order to form a backup plan if the balloon failed
to stop the bleeding.
The next day, our patient was in stable but still guarded
condition, so we decided to wait a full 48hrs before re-exploration. In the
meantime, we got into trouble with severe hemorrhage during anther case, a
cesarean section. All the usual maneuvers were not controlling bleeding from a
tear along the sidewall of the uterus going down toward the cervix. Thankfully,
the night before, I had read about internal iliac artery ligation to control
severe pelvic hemorrhage, and we were able to employ this technique, along with
packing, to stop the bleeding.
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| Praying in the operating theatre |
The next day, we took our trauma patient, Loreen,
back to the operating theater. There was a slight delay, so in the
meantime, Auntie Margaret, our veteran scrub nurse and OT team supervisor,
chatted with her and found out that she hadn’t been going to church for the
past 10 years. After talking with Auntie Margaret, Loreen decided to rededicate
her life to God and the two of them prayed right there in the operating theater.
After 96 hours, we were finally able to remove the balloon and obtain
hemostasis, but only 2 days later, Loreen started exhibiting signs of a
pulmonary embolus: a blood clot in the lungs. She had suddenly become short of
breath with pain in her chest and an elevated heart rate. I sat down and honestly explained the situation to
her: a severe pulmonary embolus can be life threatening, but the medication to
treat it would thin her blood and risk re-bleeding from her injury site. We
were walking on eggshells. She nodded understanding. Then we prayed for God’s
healing touch. She later told me that all day long she felt the pain and
shortness of breath, but around 6pm another staff member also came and prayed
with her, and almost immediately her symptoms improved. Call it coincidence,
call it psychology, but I choose to believe that God miraculously
intervened.
Many people ask why bad
things happen. I don’t believe God causes bad things, but I know he uses them
to draw people to himself. Through her traumatic experience and her subsequent treatment
at the hospital, Loreen re-established a life-giving relationship with God. She
went on to explain that after she was stabbed, she was sure she would die, but
she kept hearing the voice of her 7-year-old daughter in her head crying,
“Mommy, Mommy”. She looked back on the life of anger and fighting that she had
lived and saw where it had brought her. She realized, through Auntie Margaret’s
counseling, that she could no longer go on living this way and that she needed
God to forgive and restore her. She now gives God all the glory for saving her
life, not once, but twice during this hospitalization and for all eternity. I also give all the
glory to God who gave our medical and surgical teams the wisdom, the strength and the ability to care
for Loreen the best we knew how, then he took care of the results. In the
process, he also showed us how to save another life with the knowledge learned after researching Loreen’s injury. As the motto of the hospital says: "We treat, Jesus heals." When I trust in my own strength and abilities,
I am constantly disappointed by how often I fail, but when I trust God to use
me, broken as I am, I see his grace shine forth. Truly, “we have this treasure
in jars of clay to show that this all-surpassing power is from God and not from
us.” (2 Corinthians 4:7). To God be the glory forever and ever.
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| Loreen and Auntie Margaret |
