Wednesday, June 03, 2009

ruthless kindness

in my line of work there is sometimes a fine line between cruelty and kindness. sometimes the line can seem to blur. hang around me long enough and you will probably be shocked at some stage.

the guy had apparently fallen asleep next to his fire. when he rolled over into it his alcohol levels ensured that he only woke up once his legs were well done. someone found him and brought him in late that night.

when i walked into casualties i could smell him. you can almost always smell the burns patients. i took a look. the one leg actually wasn't too bad. it had an area of third degree wounds but they weren't circumferential. i could deal with that later. the other leg, however, had the appearance of old parchment from about mid thigh to ankle right the way around. this could not wait for later.

in third degree circumferential burns, the damaged skin becomes very tight. constricting is actually a better description because unless it is released the taught skin will so constrict the leg's bloodflow that if left untreated the patient's leg will die. it is like a compartment syndrome only the entire leg is the compartment. interestingly enough in third degree wounds all the nerves have been destroyed so in these areas the patient has no feeling whatsoever. that means when we do the release (an escharotomy which is cutting the dead skin along the length of the leg in order to release the pressure and thereby return the bloodflow) no anaesthetic is needed. you just cut the skin and as soon as you hit an area that the patient feels you've gone too far. if you do it right they will feel nothing. the longer you wait the higher the chance that he will lose his leg. i knew what i needed to do. i also knew my students might never get to see this again before they might have to do it themselves in some outback hospital in their community service year.

i asked for a blade and gathered my students around me. i sunk the knife through the dead skin and ran it down the length of the leg. the wound burst open as the pressure was released. the patient didn't flinch. quite a number of the students did. one excused herself and ran out. i think she might have been crying. despite me telling them that it wasn't painful and it was in the best interests of the patient to actually see it was more than most normal people could take.

when i wrote my last post and expressed a form of traumatic stress i found the contrast within myself compared to this incident quite interesting. everything seems to be relative and during the job there will be things that leave scars and many things that traumatise/desensitise us. i was ok doing what that one student obviously thought was gruesome and bizarre because i was convinced it was in the best interests of the patient. when i did this procedure which, on the face of it, is so much more brutal than taking someone to shower, i was ok, but the shower incident was terrible for me. i ended up hoping the student didn't see me as quite that monsterous. i also hoped she would get over the trauma i had inadvertently caused her.

the patient kept his leg.


rlbates said...

It is often difficult to explain to ourselves, much less someone else, why one event is so much more traumatic to us physically or psychic/soul. You do a much better job at writing about it than I can ever seem to do. Thank you.

Jabulani said...

Once when I was in a quandry over something, I was told "Cut deep, cut quick, cut clean; it's best."
Since the result was fairly unpleasant, I have always wondered whether the advice was true. Perhaps it depends on the circumstances hey.

Anonymous said...

I have witnessed too a boy hit by a big nail on his leg treated by doing multiple incisions.Can't understand then why the doctor added insult to injury because he just did it without talking.With you minding the patient and students' feelings gave truth to the word kindness despite the seeming ruthless act.Love reading your blogs.
-rsefel (p.s. ramona showed me your picture :)

Anonymous said...

keep blogging..........and definately write a book one day!!!
did you write Father Micheals lottery?

Bongi said...

no i did not write it. i haven't read it either. should i? (read it that is)

Anonymous said...

Father Michael's Lottery: A Novel of Africa
by Johan Steyn
A beleaguered doctor and his staff struggle to maintain a hospital in a remote, rural community on the front lines of the African AIDS epidemic in this inspirational and life-affirming novel. The hospital and its patients do battle against meddlesome superiors, find eccentric saviors from the village, and provide readers with an unflinching look at the human cost of ignorance and apathy. The good doctor's daily struggles for the people, land, and wildlife of Africa tell a story of humor, realism, and compassion.

capgrass said...

gosh i cant believe you have not read it.........ITS fantastic; even us british people have heard of it: but its out of date now: you need to write a book too. but also keep on surgeoning and blogging and dont get post traumatic stress disorder from all the pressure i put you under!