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.
|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.
|Loreen and Auntie Margaret|