just a quick update on my last entry about the gunshot wound. well, remember i said the spleen was enlarged and looked abnormal? because of that i decided to send it away for histology, thinking we might incidentally discover some underlying pathology, not that it would really change things. so we popped it into a bucket full of formalin. my medical officer filled in the relevant forms, requesting histology on it. the next day i was informed the spleen was stolen out of theater!!!! i kid you not!!! someone stole the spleen. now although we have no way of proving this, it is generally believed by all the staff at the hospital that it was stolen to be used by a sangoma (traditional healer or witch doctor. i use the word healer in the very loosest sense)
this now raises a number of questions with me. firstly, being totally untrained in their 'craft' i'm not sure what the therapeutic use of a spleen is. do the therapeutic properties change if the spleen came from a good man or a bad man, or must you just adjust the dose of spleen given? and what about the very real hiv risk in our country, or does one just mix the spleen with garlic and beetroot? (this being our minister of health's answer to the aids pandemic)
my next real concern is about the effect of the formalin on the healing properties of spleen. our man's spleen lay in formalin for some time. i suspect the average spleen used by a sangoma does not. have they done the necessary double blind studies to compare the therapeutic value of formalinised vs unformalinised spleen and where can one read this data?? there are so many such questions.
the next thing that i was later told, although, admittedly not necessarily from a reliable source, is what happened at the scene of the shooting before the man was taken to our hospital. apparently the paramedics initially only worked on the other guy (he was shot through his brachial artery and the bleeding probably looked more impressive) and just left my patient lying there. they only attended to him once the other guy had been packaged off to hospital. he was give plenty of time to move into the dangerous territory of shock. once they got him dripped and ready to transport, they apparently had to further wait for a police escort, seeing as though he was under arrest for attempted murder. this information explains slightly more why he did so badly with us. he didn't experience the benefits of the so called golden hour. he didn't even really get a bronze hour. maybe he got a lead hour.
now although this might be some sort of street justice metered out by the paramedics, i was pretty annoyed when i heard this. i don't think it is our role to play judge, jury and executioner. we don't know what happened. we should all do our best to do our job and save the man if we can. i also feel that we at the hospital mounted a great effort to save him at great cost, totally unaware our efforts had been sabotaged from the outset.
then again, maybe the other man was given priority because his on the scene injuries were more severe and my anger is unjustified. so if i have offended any hard working caring paramedics, i apologise. if i have offended any sangomas, i do not.