Tuesday, August 04, 2009
usually i try to avoid the sensitive issues. i mean this blog is mainly about entertaining stories. but the next story by its nature forces us to ask some heavy question.
"bongi, i think you need to come and see this. we have a hippo attack patient."
"sure thing. i'm on my way." strangely enough a few years previously i had treated another hippo attack patient so i wasn't totally blown out of the water...so to speak.
i walked in. there were blood soaked bandages on both legs. but she looked too sick to only have leg wounds. besides any self respecting hippo isn't going to merely nibble on its victim's calves a bit. chihuahuas do that. hippos put a bit more oomph into their bite. but the one thing that really stood out in my mind was how overweight the patient was. i groaned. no matter what the injuries obese patients are prone to all the risks associated with surgery, and i'm not even taking about being the hapless chew toy of an animal that is not known for mouth hygiene. lie all day in your own sewerage water and see how clean your teeth are after a few years. i knew this wouldn't be easy.
"wow!" i said, "if the hippo is that badly injured i can only imagine how bad my patient must be." i suppose i couldn't help it. i just needed to find something light hearted in the whole situation. after enduring evil glares from the casualty officer and the sister i approached the patient.
she had massive lacerations in her legs, which i'd need to debride and clean out thoroughly. she also had a large gash on her back. these were all that she was complaining about. it was also all i was consulted about. but as is my habit i checked out the rest of her too. her abdomen was slightly tender, but not too bad. with deep palpation she grimaced. to be honest through all the fat i could feel nothing so i asked for a ct scan.
the scan showed bowel outside the abdomen in the more than spacious subcutaneous tissue. she also had a cracked rib and a mild lung contusion. this case was no longer simply a debridement case but a laparotomy case too.
the operation went well. i learned that it is not a good idea to get chomped by a hippo. one tooth had actually penetrated the abdomen without breaking the skin. but the hippo had managed to deglove almost all the abdominal fat from the abdominal sheath, creating a massive cavity between the fat and sheath. this is where most of her bowel lay, already becoming mottled from strangulation. the pancreas was bruised but ok. the rest of the abdomen was fine.
i sorted out what needed sorting out. i placed drains everywhere i could and closed. as expected, she needed icu admission where she sounded like darth vader for a day or two. then she slowly got better and finally went to the ward.
during this time i spoke to her daughter who was admitted in the orthopaedic ward with a fractured ankle (apparently a hippo had trodden on it). i asked what had happened.
there are guided walks available in the kruger from pretty much all of the camps. you go out with an armed ranger and learn a bit about the bush. you may get to see some wildlife too, but you might want to keep in mind wildlife tends to be, well, wild. these people wandered a bit too close to a pool which had a hippo in who was generally having a bad day. he took exception. he came charging out directly at them. the daughter was in front. she turned to her mother, behind her and screamed,
"run!" she then promptly tripped and fell. the hippo came rushing right past her, luckily only stepping on her ankle in its headlong charge and grabbed her mother, my patient, for a quick chew. then, just as quickly as it had started the hippo left.
my first thought was why bother telling someone who is so overweight to run when they clearly can't? a waddle just won't suffice in the face of an oncoming hippo. but more seriously i actually thought what were people like that doing on a walk in the bush? if you go for a walk in the kruger you should at the very least be able to climb a tree and that at high speed. surely they should have a weight limit for these walks?
and that is where the difficulty comes in. the idea that to put a weight limit on something like that is discrimination against the overweight. my mind wanders back to the overweight lady who refused to be told she could not go on a cave guided tour because the weight restriction was supposedly discrimination. they caved in (an occasional pun is good for the soul) and allowed her to go. she got stuck in one of the smaller tunnels. fact is she was too large.
from a medical point of view, obesity is a disease with associated co-morbidities and increased risk of death. there is definitely a much higher risk with any surgery. it is just so. it is. i am not discriminating by stating the facts.
so let me conclude that i am fully in favour of no discrimination against the overweight. but because it is a disease it must be seen as such and not just swept under the rug.