buff and turf

the concept of the buff and turf is common to all the disciplines of medicine. sometimes it works. sometimes it doesn't.

the call came in, but i struggled to believe it. yet i had to go to casualties anyway. i mean how do you tell the casualty officer that you don't really believe anyone can survive a lion attack? lions are killing machines. any normal human being who gets attacked by a lion should have the decency to expire and maybe even be eaten. and here i was expected to believe the patient on the way had actually survived. the upside was that i would probably be home in about half an hour or so. that is about how long it would take to look at a mangled piece of flesh and declare it dead and maybe partly digested.

he arrived. not only was he alive, he was stable. he even greeted me in a friendly manner. we chatted a bit. after all i was quite interested to hear how it came to pass that he was attacked by a lion and more specifically how was it that he was alive. it turned out that he works in the local game reserve and was out in the veld when it happened. apparently he had managed to fire one shot with a standard issue national parks rifle and blown the lion's jaw clean off. the lion that had done the dammage was therefore only capable of using its claws and could not finish him off with a bite. that is why he had survived. i quickly checked him out. both his arms had massive lacerations from the elbows down to the hands, but other than that there was nothing wrong with him. it is quite amazing that a lion could maintain an attack after taking a bullet in the head and still do a substantial amount of damage. still, i started having evil thoughts.

lacerations of the arms below the elbow is an area of overlap between general surgeons and orthopods. in my rotation in the old days in orthopedics, their profs were pertinent in telling their underlings that any laceration below the elbow should be explored by an orthopod and not a general surgeon. i think they thought us mere common or garden variety surgeons might miss a tendon or nerve injury and they felt they could do it better than we could. i had no objections. so i started playing with the idea of turfing him off to the friendly neighbourhood bone doctor. i turned to the casualty officer.

"he doesn't seem to have any injuries needing my attention. consult the orthopod!" i tried to sound authoritative, but just in case, i added, "and if he refuses, then call me and i'll operate him. with that i left. after all i still had an appendix or two waiting for me in theater.

it was a relatively quiet call and i soon found myself sauntering out of the hospital on my way home. i knew the orthopod would be operating next and i knew what he was going to be doing. just before going home i quickly checked casualties to make sure there was nothing else waiting and also to ask what reaction the casualty officer had gotten from the orthopod.

"he was not happy," i was informed. "he went on for quite some time about the general surgeons being lazy and turfing cases to him, but in the end he accepted the patient." oh well. what could i do about that now? going home sounded like just the right thing.

one of the things i hate the most about being on call is when my phone rings the moment i get home. the phone rang the moment i got home. immediately i was tense and irritated.

"hi bongi, it's rb here. how are things there with you?" it was my friend, the vet from the game reserve. that meant it was a social call. well anything is better than a work related call once i was at home so i was actually quite excited. and what a coincidence that he should call the very day that we received a patient from his neck of the bush. for a moment i even forgot i don't believe in coincidences. "bongi, i'm actually phoning about a friend of mine who was sent to your hospital. he was attacked by a lion. you wouldn't possibly know who is treating him would you?" i knew very well who was treating him. more than that, i knew why that doctor was treating him. it was because i was apparently lazy and had turfed the patient. i decided rb didn't need to know the gory details of hospital politics. a simple "yes" would suffice.

"well you see, bongi, working here in the park, i've seen quite a few attacks by wild animals and quite often the city doctors close the wounds primarily. i know i'm just a vet but i've seen enough of these to know that this simply doesn't work. these animals have all sorts of nasties growing in their mouths and if the wounds are not debrided thoroughly and then left open for a few days, they will all become septic." i knew all these things to be true. i also knew that if i had been operating the patient i sure as hell would leave the wounds open and only close them a few days later. the only problem is i wasn't operating. he went on. 

"so, bongi, if i could ask you a favour?" i cringed. never mind my usual reservations about favours, i knew what this favour was going to be. if only i hadn't turfed that patient, it would be easy, but i had turfed the patient and this wasn't going to be fun.

"sure! no problem." i lied.

"great. could you maybe speak to the doctor handling my friend and just tell him not to close the wounds primarily?"

"ok." the lie was less convincing. my hesitant voice betrayed me. but somehow rb didn't seem to notice.

"great! thanks a lot, bongi."

moments later i found myself phoning theater where i knew the orthopod was busy debriding the wounds of a lion attack victim that the surgeon was too lazy to treat. i couldn't help wondering exactly how i was going to word it.

"remember that patient that i dumped on you? well now that i'm snugly at home and you are still slaving away in theater, let me now tell you how you should be doing your job!"