One Night on Call…

I am sweating and my heart is racing. Twinges of panic appear but are then suppressed by thoughts: “How are we going to stop this bleeding?”   “Where is it coming from?”   “What happens if we can’t- I know the answer to that.” More twinges of panic. “Lord…help…” Blood fills the wound through a large crack in his skull. There are three of us working together: 2 residents and myself. I am supposed to be the experienced surgeon guiding the inexperienced through an operation that I have become confident doing through years of trial-by-fire. But I am not trained in neurosurgery and the brain seems a long way from the gallbladder right now. Bleeding continues. More sweating. We work together. One of us suctions, another elevates a fragment of bone away from the boy’s brain, and the other is ready with some packing to fill the hole to arrest the bleeding….

Several hours earlier, the young boy had been crossing the street when he was hit by a “boda-boda” or a “piki.” What we call a motorcycle. Motorcycles are a cheap form of transportation in a part of the world where the vast majority of people cannot afford a car. It is not uncommon to see 3, 4 or even 5 un-helmeted people on one motorcycle. But this child was just walking on the side of a congested street when he was struck. Following the accident his mother brought him to Tenwek where our team first evaluated him in “casualty”- the ER. He was 7 years old, but small for his age and had a big gash on his forehead. Fortunately he was awake and alert and it seemed that we would be able to just sew up his wound and get him home. But things changed. He started having seizures and became unresponsive to the point that we had to insert a breathing tube. Quickly he sent him for a CT scan which showed a depressed skull fracture with fragments of bone impinging upon his brain which was the likely source of his seizure. The fracture was located very close to a major blood vessel beneath the skull called the sagittal sinus. I would have rather avoided operating due to concerns of violating the wall of this vessel which can lead to heavy, difficult to control bleeding. But with his declining status, we did not have much of a choice so we proceeded to surgery…

With the packing, the bleeding has stopped for the moment. We gently lift additional bone fragments out of the wound and then wash out the dirt. There is a tear in his dura- the lining around the brain which contains the clear fluid that bathes the brain and spinal cord. With fine suture we carefully sew this up. I breathe a sigh of relief as it appears the bleeding has mostly stopped. A few fragments of bone are replaced like a jig-saw puzzle to fill the bony defect and then we closed his soft tissue and skin.

After taking him to the ICU still on a breathing machine, I walk home. It is late and I am having a hard time dodging mud puddles in the dark. The stars are out and it is a beautiful night. I am filled with contradictory emotion- I am grateful, I am relieved. But I am uncomfortable and humbled in this place where God has led me. I really want to sneak away to the airport, hop on a plane and fly back to the life I had. A life where I had most things figured out. But I know that that is not possible anymore. I am filled with passion for the work here- passion that could only come through grace. Passion that is impossible for me to generate on my own. Passion for the residents who are seeking to serve their people better. Passion for the patients who are enduring in the midst of incredible suffering

On rounds the next morning, the young boy is awake. He has already pulled his breathing tube out himself and he looks at me with an expression that says: “Dude, what was up with that breathing tube? And why do I have a killer headache?” He makes a great recovery and goes home a couple of days later. Have I simply failed to see God’s hand working in the past? Or is it only when I am stretched beyond my limits that I am able to see him working? Or is it that his strength is made perfect it my weakness? Likely all of the above.