Hey everyone,
I just wanted to give you all a quick update and ask for your prayers for a few things. The guy I talked about in the last post who has the abscesses in the muscle layers of his legs has finally stopped having a fever! He had been febrile for the past week and a half. Please continue to pray for him as he still has a considerable amount of pus that is still draining. Pray for a quick and full recovery.
Two other prayer requests involve the supplies at the hospital. We have been using between 5-10 vials of anti-snake venom at the hospital each day over the last few weeks. We have been using more recently as the people are out in the fields working now that the rainy season is beginning. We learned today there is no ASV in all of Ghana! The hospital is in contact with people in Accra, the capital, but so far it does not appear to be looking hopeful. We need this stuff to save people's lives. Please pray God would answer this problem supernaturally and keep the people out of harm's way while they are in the fields.
The second request is we would be able to find x-ray film for sale. Apparently the hospital has not been able to find film available for purchase even in Accra. It is a regular occurence that we run out but are usually able to replenish in a few days. Please pray for the supplies to become available.
One more thing before I go. Greg and Wendy Nyhus, the family who is in charge of the volunteers and other things here in Nalerigu, has been working with the orphanage here in town that Steve and I talked about last week. Hopefully tomorrow we are going to return and put up mosquito nets for them as long as the supplies arrive.
I wanted you all to pray about something. There is a possibility of buying a chicken coup from a friend of the Nyhus's and buying chicks to raise to be egg-laying chickens. The chickens and coup would be donated to the orphanage and it would provide both nutrition
(eggs as a good source of protein) and a source of income (from selling the extra eggs). This is still in the idea stages and we are praying along with the Nyhus family to see if this is the best way to help them. We have some logistics to check on and are appreciateive of your prayers as we move forward. We are looking for guidance and leading from the Lord as to the answer.
Thanks for following along with us. We enjoy getting your comments.
Talk to you all again soon. Steve and I are well and having a great time. Continue to pray for us as we pray for you all.
Love,
Jeremy
Wednesday, June 9, 2010
Tuesday, June 8, 2010
Ghana Loves Obama
I thought I would give the topic a little change from the typical medical stories you have been reading, so I hope you enjoy this.
Love,
Steve
The title says it all. I would say that Obama’s approval rating and his popularity are higher here than in the US. He is on billboards along the roads. His picture is on many of the composition books the children have for school. There are Obama shirts with sleeves made like the American flag, with the slogan, “Yes We Can,” and some that say president-elect. There is even underwear with Barack Obama on the waistband instead of the typical Joe Boxer or other brands. Here are a few pictures for your enjoyment.
Obama composition book. There are several different varieties, this just happens to be the one I could get a picture of.
Obama Boxer shorts, complete in their packaging at the market. They have the name Barack Obama sewn into the waistband.
Obama shirt worn by a patient's son, who was happy to pose.
Obama shirts and other merchandise for sale at the local market, which comes every 3 days to Nalerigu.
Monday, June 7, 2010
A Wild Monday Night
Hello again everyone. We officially started week 3 of our stay here in Nalerigu today. Monday is clinic day and we were quite busy with various complaints and diseases. Between Steve and me, with our translator, we saw 91 patients. The triage people were sort of running behind today so I am pretty sure we could have broken 100 if things would have been running smoothly. Our goal is to have an “over 100 day.” We saw various things including plenty of hypertension, general body pains, fever (usually malaria or typhoid), vomiting, waist pain (my personal favorite, as this is different from abdominal pain), multiple women in their third trimester of pregnancy with low abdominal and low back pain, and various other complaints.
I did attend to a younger gentleman who was involved in a RTA (Road Traffic Accident), although in his case it could also be called a Rural Tractor Accident because while he was out working in the field, his left chest and arm were run over by a tractor. Amazingly he did not appear to have any broken bones in the arm or shoulder area (maybe a few fractured ribs), had clear breath sounds (no pneumothorax) and was able to carry on a lucid conversation. I admitted him mostly for pain control and further observation, but I think he is going to recover well. He is very blessed the accident was not worse than it was.
Other admissions between Steve and myself were: concussion in a child who had fallen from a donkey cart (used to haul 55 gallon tubs of water), a snake bite, the RTA and a gentleman with atrial fibrillation with RVR.
After clinic we go to the theater for any small procedures which need to be performed on the waiting patients. Today I performed repeat incision and drainage on a young guy in his 20’s. We did an initial incision and drainage several days ago for large abscess along the muscle layers in the left thigh and right buttock. Despite cloxacillin and bactrim he continued to have fevers in the 103F range. We decided to take him back again today for additional incisions. We made the incision and got some pus out but did not really get back as much as we thought we would originally based on the Ultrasound we had performed. Please pray for him as he has a very serious infection and the antibiotics do not seem to be helping. Today I changed him to another antibiotic regimen, please pray this works for him and the abscesses would dry up and he would recover.
************Interruption for an update in Real Life in the ER, Nalerigu*********************
As I was typing this post the surgeon came to pick us up because Dr. Jim had called him from his night rounds saying there was a lorry (truck) accident and many people were hurt and needing suturing. By the time we arrived he had already triaged several of the patients and decided one of them would need a skin graft on her shoulder in the morning. Others were receiving stitches from some of the OR staff. The lady who was the most critical had a large chunk of flesh out of her left shoulder, mangled skin on her fingers and the top half of her left face was shredded. The pictures are much too graphic to share but we did take a few to hopefully compare before and after. It was a blessing that most of the bleeding was stopped and it really is a miracle her temporal artery was still intact. You could see it pulsating along its course on the side of her head. She had not received any pain medication because she had just eaten and the anesthesia tech was concerned about not having digested food and giving conscious sedation. We gave her Demerol and plenty of lidocaine locally prior to starting. I was in charge of the fingers and am not sure how it is going to turn out. I just reapproximated skin as best I could and cut off the pieces which were no longer viable. Dr. Joel started on the area of the face and placed a few sutures but then decided it would be best to wait until the morning and take a closer look in the OR. He then moved on to the shoulder and tried as best he could to sew the shreds back together after cleaning out the gravel and glass. I know I am being graphic but there really is no other way to describe it. She was all bandaged up and will have her dressings changed again tomorrow and we will take another look at her wounds. It took about an hour with the two of us sewing and Steve and Dr. Jim being our assistants/anesthesia administrators to get it finished. She will have a long road for recovery.
Please pray for her and the other ladies involved in the accident. They were actually patients here today and were on their way back home from their visits when the accident occurred. It really is sad to know how hard life is here on a daily basis and then an accident like this occurs. I know the Lord must have a plan for all of it but you still ask the question “why?” Please pray for their recovery and quick wound healing and that there would be no complications with wound infection. We’ll try to keep you updated on the outcomes over the next several days.
Love,
Jeremy
****Continuation from Steve***
I echo much of what Jeremy has written for today. I was on call yesterday and it was much easier than the previous call was. No major trauma, only a few snake bites which had to receive snake venom, albeit one was at 5am this morning, meaning I had to wake up to give it out, since we store here at the house during the night (pharmacy is only open during the daytime).
On the pediatric side of the world today, we had a little infant a few months old pass away after battling pneumonia and likely developed sepsis. It was just in such respiratory distress it didn’t have a good chance from the time it arrived. We placed it on oxygen, which is an interesting task here. We have no nasal cannulas here, so they take an NG feeding tube, insert it into the nose on one side just a little ways, then tape it down. They then tape this to the hose coming from the oxygen generator (a portable machine). The hospital is equipped for oxygen in the different areas, but for some reason does not have an oxygen supply or delivery is malfunctioned. This can be a real stress in the operating room, and also when trying to save a child’s life. I am not exactly sure what all was wrong with the kid, because I sort of took over on rounds, after the child had been admitted by a medical officer. I was worried yesterday she may not survive, and today she was still in significant distress on my exam (although the staff said she was “much” better today).
Another interesting case was in regards to circumcision, which is common in some groups here, and not common in others. We had a patient come in on Friday with parents requesting a redo of his circumcision. He is about 1 year old and had the initial one done at home soon after his birth. We brought him in on Saturday to do the procedure. After much hassle and examination, we determined that the child’s circumcision could not be redone because when they had performed the initial one they had actually removed the foreskin and the glans penis (the tip) which is termed glans penis amputation. So basically this child still has a lot of swelling and a little urethral opening to urinate through (amazingly has not closed off) and will be deformed all his life now. It was very sad to see this and to see his parents’ disappointment with the whole situation. A few of the children who have been here for the whole two weeks have actually been able to go home in the past couple days, so there is some good coming from the work with all the kids.
On a more positive note, we are expecting some new short term physicians over the next week or so. The first is supposed to arrive tomorrow. She is a pediatrician from Kansas City. We are looking forward to having more medical staff, and also to having more people to divide up the call schedule. I am not sure the dates, but I think a surgeon and a few others are coming in the following weeks.
We are all preparing for malaria to continue to increase in frequency. It is now rainy season, although here in Nalerigu we seem to be getting less than some of the surrounding areas. With the increase in water, comes more mosquitoes and hence more malaria. Currently on the peds ward there around 10-15 patients per day, but when this happens, the story is that there are usually around 2-3 patients per bed in the peds ward (which has 30+ beds). So, as you can imagine, it could get busy very quickly.
I think I will leave you with that for the day. I see this is already 3 pages long. Please keep praying for our work here, and for the patients now and after we have returned home. It is a situation that words and pictures will never be able to describe, but is filled with wonderful, happy people who love one another, and show us love for the work we are doing. We will post again soon.
Love,
Steve
Saturday, June 5, 2010
Relaxation Saturday
Hi everyone,
Below you will see a few pictures of our Saturday adventures. We did not necessarily have the day off, but we did have a little excursion after rounds were finished this morning.
A few updates from the hospital. The young man whose pictures were posted yesterday continues to do very well. In fact, today in the town we visited for our excursion, we ran into his dad, who was again thanking us and telling us that is son is completely normal mentally. Overnight, we had 2 deaths on the pediatric ward. First was a young child with horrible malnutrition and an illness we could not really fully diagnose or treat, other than some severe malnutrition, which obviously didn't help her chances. The other is the infant I admitted a few days ago, who would have been 8 days old today, if I remember correctly. Regardless, despite our best efforts to treat what appeared to be sepsis, she ultimately ended up in multisystem organ failure and died overnight. She was very interesting, because when the nurses told me her name, they had to explain its meaning. The name (which I will not even attempt to spell) means infant girl. They don't actually give the child a name until is 8 days old (having survived the first week on earth). This is whent he child technically becomes a person to them. I was surprised by this, but to the credit of the mother, she never left the bedside of the patient from admission until death.
We also were able to get some sun today. Even with SPF-30, Jeremy and I both have a little more color now. It is amazing what just getting outside the hospital will do for you. Of course, riding in the back of pickup truck along dirt roads, we also had a bit of an orange tint to us until we showered and removed all the dust.
Today we drove about 45 minutes to another town called Nakpanduri, where there is an escarpment....basically a giant cliff which looks out onto the plains leading to Burkina Faso and Togo, two of the neighboring countries with Ghana. This is a view from the bottom of the hike.
This is Jeremy trying to get through what the kid's call "Fat Man's Squeeze." And for those who were wondering he did make it.
This is part of the view from the top with our group today. It really was an amazing view. The pictures don't do it justice. We were up high enough there were birds flying below us.
This tree is called a Baobob (I have no idea if this is the way to spell it) The trunk itself is huge and the branches are so little. Many people here believe the Baobob tree holds special powers. I just think it is a cool looking tree.
After our time at the escarpment we visited with a man and his wife (he is from Holland and she US) who have lived here for over 50 years. They originally came with the Peace Corps and helped with reforestation of the area. These are some of the animals people have dropped at their doorstep.
The baboon did not like his picture to be taken.
One of the monkeys was enjoying groundnuts (AKA peanuts)
After returning from Nakpanduri, we went to the local market here in Nalerigu, which happens every three days. It is a market for the everyday Ghanaian, not really for tourists. It was interesting to see all of the produce, grains, cloth, clothing, junk, etc. available. This picture only serves to show a very small portion. To get the feeling think lots of people, hot, some good smells...but mostly not, plenty of color and little kids saying "Suminga, Suminga" (again sorry about the spelling), which means "white person, white person!" Many of the kids also want to touch you...kind of like being a rockstar I guess. Anyway it was fun and we are planning to go back again before we come home.
I think that is about it for today. We will update again tomorrow. We are trying to catch up on some sleep. We are not used to working all day post-call, so it has been a bit of an adjustment for us, but preparing us for real life after residency. In the meantime, please keep us and our patients in your prayers.
Love,
Steve and Jeremy
Below you will see a few pictures of our Saturday adventures. We did not necessarily have the day off, but we did have a little excursion after rounds were finished this morning.
A few updates from the hospital. The young man whose pictures were posted yesterday continues to do very well. In fact, today in the town we visited for our excursion, we ran into his dad, who was again thanking us and telling us that is son is completely normal mentally. Overnight, we had 2 deaths on the pediatric ward. First was a young child with horrible malnutrition and an illness we could not really fully diagnose or treat, other than some severe malnutrition, which obviously didn't help her chances. The other is the infant I admitted a few days ago, who would have been 8 days old today, if I remember correctly. Regardless, despite our best efforts to treat what appeared to be sepsis, she ultimately ended up in multisystem organ failure and died overnight. She was very interesting, because when the nurses told me her name, they had to explain its meaning. The name (which I will not even attempt to spell) means infant girl. They don't actually give the child a name until is 8 days old (having survived the first week on earth). This is whent he child technically becomes a person to them. I was surprised by this, but to the credit of the mother, she never left the bedside of the patient from admission until death.
We also were able to get some sun today. Even with SPF-30, Jeremy and I both have a little more color now. It is amazing what just getting outside the hospital will do for you. Of course, riding in the back of pickup truck along dirt roads, we also had a bit of an orange tint to us until we showered and removed all the dust.
Today we drove about 45 minutes to another town called Nakpanduri, where there is an escarpment....basically a giant cliff which looks out onto the plains leading to Burkina Faso and Togo, two of the neighboring countries with Ghana. This is a view from the bottom of the hike.
This is Jeremy trying to get through what the kid's call "Fat Man's Squeeze." And for those who were wondering he did make it.
This is part of the view from the top with our group today. It really was an amazing view. The pictures don't do it justice. We were up high enough there were birds flying below us.
This tree is called a Baobob (I have no idea if this is the way to spell it) The trunk itself is huge and the branches are so little. Many people here believe the Baobob tree holds special powers. I just think it is a cool looking tree.
After our time at the escarpment we visited with a man and his wife (he is from Holland and she US) who have lived here for over 50 years. They originally came with the Peace Corps and helped with reforestation of the area. These are some of the animals people have dropped at their doorstep.
The baboon did not like his picture to be taken.
One of the monkeys was enjoying groundnuts (AKA peanuts)
After returning from Nakpanduri, we went to the local market here in Nalerigu, which happens every three days. It is a market for the everyday Ghanaian, not really for tourists. It was interesting to see all of the produce, grains, cloth, clothing, junk, etc. available. This picture only serves to show a very small portion. To get the feeling think lots of people, hot, some good smells...but mostly not, plenty of color and little kids saying "Suminga, Suminga" (again sorry about the spelling), which means "white person, white person!" Many of the kids also want to touch you...kind of like being a rockstar I guess. Anyway it was fun and we are planning to go back again before we come home.I think that is about it for today. We will update again tomorrow. We are trying to catch up on some sleep. We are not used to working all day post-call, so it has been a bit of an adjustment for us, but preparing us for real life after residency. In the meantime, please keep us and our patients in your prayers.
Love,
Steve and Jeremy
Friday, June 4, 2010
A Photo Tour
At the hospital
Steve in the outpatient clinic. We share this office with one interpreter between the two of us.
There is a small exam table behind that curtain to my right. Very old and very small but it works great.
The "Clean" procedure room. Site of various lipoma removals, suturing, paracentesis (or this is also done in the hallway), foreign body removals and amputations.
This is the room where steve did plastic surgery with our battery operated head lamp because the power went off at least twice.
The "dirty" procedure room. This is where we do various I&D (incisions and drainage), wound debridement and ultrasounds.
The bucket of sutures Steve had to choose from in the dark!
The on-call vehicle for nighttime rounds....our insurance policy from needing to use the anti-snake venom supply on ourselves. But at least it is in our refrigerator if we need it quickly!
House #6...home sweet home..or is that home sweat home? Hey but it is nearly mosquito free.
One of the main streets in Nalerigu after a brief downpour.
Naomi's Fund - This is a biweekly program with the 1st Baptist Church (there is a 2nd and apparently a 3rd) which provides grain for widows and blind people as well as their children. The Nyhus family took us along for the ride and we were able to hand out the shorts and dresses Jeremy's grandmother and her friends made for the kids. We were caught for the second time in an absolute deluge. Steve protected the camera while Jeremy passed out the gifts and was soaking wet.
So, here we are at the end after the madness of trying to hand out the clothes. We managed but the rain made it a little difficult to be civilized.
Steve caught this little guy sneaking some food while the people were listening to Wendy talk. I think he might be eating a relative...not sure.
Passing out the clothes with the help of some local boys to translate and push when needed. They were crowd control. We had to tell the older ladies these clothes were only for children but it didn't really help, hence the older looking hand at the bottom of the picture.
One of the dresses. Perfect size.
A pair of the shorts. The kids were all very happy to receive their clothes. Next time we will bring more for sure.
A child listening to the devotion. Steve's shot of the day.
Steve in the outpatient clinic. We share this office with one interpreter between the two of us.
There is a small exam table behind that curtain to my right. Very old and very small but it works great.
The "Clean" procedure room. Site of various lipoma removals, suturing, paracentesis (or this is also done in the hallway), foreign body removals and amputations.
This is the room where steve did plastic surgery with our battery operated head lamp because the power went off at least twice.
The "dirty" procedure room. This is where we do various I&D (incisions and drainage), wound debridement and ultrasounds.
The bucket of sutures Steve had to choose from in the dark!
The on-call vehicle for nighttime rounds....our insurance policy from needing to use the anti-snake venom supply on ourselves. But at least it is in our refrigerator if we need it quickly!
House #6...home sweet home..or is that home sweat home? Hey but it is nearly mosquito free.
One of the main streets in Nalerigu after a brief downpour.
Naomi's Fund - This is a biweekly program with the 1st Baptist Church (there is a 2nd and apparently a 3rd) which provides grain for widows and blind people as well as their children. The Nyhus family took us along for the ride and we were able to hand out the shorts and dresses Jeremy's grandmother and her friends made for the kids. We were caught for the second time in an absolute deluge. Steve protected the camera while Jeremy passed out the gifts and was soaking wet.
So, here we are at the end after the madness of trying to hand out the clothes. We managed but the rain made it a little difficult to be civilized.
Steve caught this little guy sneaking some food while the people were listening to Wendy talk. I think he might be eating a relative...not sure.
Passing out the clothes with the help of some local boys to translate and push when needed. They were crowd control. We had to tell the older ladies these clothes were only for children but it didn't really help, hence the older looking hand at the bottom of the picture.
One of the dresses. Perfect size.
A pair of the shorts. The kids were all very happy to receive their clothes. Next time we will bring more for sure.
A child listening to the devotion. Steve's shot of the day. (Note the umbilical hernia common to every child and almost all adults here)
Well that is all for now. It took us several tries to get this all up at the same time. We hope you enjoy it and we will talk to you all again soon.
Love,
Jeremy and Steve
A Miracle (with some gross pictures--Warning!)
Hi everyone,
I am writing early this evening to update you on the young man I wrote about in the post last night. Amazingly, when I walked into the hospital this morning, I found the young man sitting up in bed talking to his mother and the staff. Yes, he was talking and completely mentally intact. I walked over and talked to him and he had a brief conversation with me in English, thanking me for working on him last night. His only problem this morning was pain, and as I mentioned earlier, he likely has a fractured arm which we will address in the next day or so. X-rays were scheduled for sometime today. i have to say I am impressed and pleased with the way he looks today.
His neurologic status was intact, his vision is normal, he could talk and swallow, and he was moving all of his extremities. He could remember some parts of the accident. After he and his mother repeatedly thanked me for working so hard on their son, I obviously told them they were welcome, but that the thanks should be to God because he is very lucky to be a live and it really is a miracle he survived. I emphasized to them again how close to death he was. To my surprise, he did not have to get blood last night, despite the large amount he had lost because his level was still in the low-safe range.
Below are some pictures of him today. Sorry, I didn't have my camera with me last night when it all happened because I didn't take it to the hospital with me in the rain.
As for his friend, he did well overnight and was discharged home today with some minor bumps, bruises, and a few stitches.
More pictures and stories from the week to come later this evening as I get them loaded onto the computer.
Thanks for the comments and prayers,
Steve
Thanks for the comments and prayers,
Steve
Sitting up in bed. Where there is a bandage there are a LOT of sutures!
Face shot.
Lip and Nose. Left side is where all the work was done. You can see only a couple of the many sutures. Also has sutures below the eye and on the chin.
Thursday, June 3, 2010
TRAUMA! Real Trauma!
Hello all,
Sorry we haven't written in a few days, but we have been quite busy. Hopefully the weekend will give us some more time to update everyone.
As for the title, I am sure your curiosity is piqued. I am on call tonight. Just as I was fininshing my evening rounds at about 8:30 the staff came to get me to see a pateint at check in. I walk around the corner and here is an 18 year old man on a stretcher with an obvious head injury and blood literally everywhere, and on the ground lying is a 20 year old man who looks like he has just been beaten up very badly. On questioning, we found out the two were riding in the back of a truck and either jumped or fell out. the rain returned today, so I am not sure if this had anything to do with it or not. The 20 year old, ended up only have a small laceration to the back of his scalp and to one of his fingers and lots of road burn all over him.
The 18 year old is another story. I have honestly just spent the past 4 hours suturing his head. His scalp was almost completely removed, his lip and lower nose were completely mutilated, he had a large laceration to his temporal area and a few small lacerations on his face. (keep in mind I am just talking about his head now). Wendy, the wife of one of the missionaries, who is also a nurse, happened to be there as well and stayed to help. We sutured for nearly 4 hours, using almost every suture available whether it would have been appropriate or not in the US. He was bleeding profusely from his scalp, literally pulsating blood out onto the table. He also had what looked like a gravel embedded in his skull in the front top part of his head. I tried to get it out, but given the large blood loss he was having, I opted to just clean it well and start sewing to try to save his life. I would venture to say there are more than 100 stitches in his scalp alone. One I had it all closed up, though, the bleeding seemed to slow down significantly and only remained with a little oozing. As for the gravel, I hope it didn't penetrate the bone completely, because it could set up an abscess and cause infection near his brain on the inside.
As for the remainder of him, I crafted him a new form of a lip and nose on the upper left. It was completely multilated when I first looked at it and I thought there would be no good way to fix it, but after a slow approach, it finally came together and I am proud to say looks semi-decent given how terrible he looked on arrival. He has many other lacerations as well on his face, elbow, and knees that were sutured, and hopefully will heal well. His teeth are also dstroyed. He has several missing, the majority of the rest are displaced, and his palate is more swollen than anything I have seen in a mouth before. He does talk some though.
Given the mechanism of injury, there is still a good chance he may not survive because he could easily have an intracranial injury that could be lethal. When not under the drugs I gave him to do the repairs, he was moving everything well, and seemed to be somewhat consciously aware of what was going on. I placed him on strong antibiotics, steriods for brain swelling, and ordred some labs, so that he may get blood if his blood counts are very low.
Please keep him in your prayers. I can honestly say this is the worst injury I have ever sutured and I could not have done it without the support of Wendy, and a lot of prayer to guide me as I went through the wounds trying to close them. I explained to his family the possible outcomes of death, neurologic impairment, and the slim chance he may be normal, and they seemed to understand, but they are not religious and need prayer for support and strength.
I will update you tomorrow when I have some time in the evening.
Love and prayers,
Steve
Sorry we haven't written in a few days, but we have been quite busy. Hopefully the weekend will give us some more time to update everyone.
As for the title, I am sure your curiosity is piqued. I am on call tonight. Just as I was fininshing my evening rounds at about 8:30 the staff came to get me to see a pateint at check in. I walk around the corner and here is an 18 year old man on a stretcher with an obvious head injury and blood literally everywhere, and on the ground lying is a 20 year old man who looks like he has just been beaten up very badly. On questioning, we found out the two were riding in the back of a truck and either jumped or fell out. the rain returned today, so I am not sure if this had anything to do with it or not. The 20 year old, ended up only have a small laceration to the back of his scalp and to one of his fingers and lots of road burn all over him.
The 18 year old is another story. I have honestly just spent the past 4 hours suturing his head. His scalp was almost completely removed, his lip and lower nose were completely mutilated, he had a large laceration to his temporal area and a few small lacerations on his face. (keep in mind I am just talking about his head now). Wendy, the wife of one of the missionaries, who is also a nurse, happened to be there as well and stayed to help. We sutured for nearly 4 hours, using almost every suture available whether it would have been appropriate or not in the US. He was bleeding profusely from his scalp, literally pulsating blood out onto the table. He also had what looked like a gravel embedded in his skull in the front top part of his head. I tried to get it out, but given the large blood loss he was having, I opted to just clean it well and start sewing to try to save his life. I would venture to say there are more than 100 stitches in his scalp alone. One I had it all closed up, though, the bleeding seemed to slow down significantly and only remained with a little oozing. As for the gravel, I hope it didn't penetrate the bone completely, because it could set up an abscess and cause infection near his brain on the inside.
As for the remainder of him, I crafted him a new form of a lip and nose on the upper left. It was completely multilated when I first looked at it and I thought there would be no good way to fix it, but after a slow approach, it finally came together and I am proud to say looks semi-decent given how terrible he looked on arrival. He has many other lacerations as well on his face, elbow, and knees that were sutured, and hopefully will heal well. His teeth are also dstroyed. He has several missing, the majority of the rest are displaced, and his palate is more swollen than anything I have seen in a mouth before. He does talk some though.
Given the mechanism of injury, there is still a good chance he may not survive because he could easily have an intracranial injury that could be lethal. When not under the drugs I gave him to do the repairs, he was moving everything well, and seemed to be somewhat consciously aware of what was going on. I placed him on strong antibiotics, steriods for brain swelling, and ordred some labs, so that he may get blood if his blood counts are very low.
Please keep him in your prayers. I can honestly say this is the worst injury I have ever sutured and I could not have done it without the support of Wendy, and a lot of prayer to guide me as I went through the wounds trying to close them. I explained to his family the possible outcomes of death, neurologic impairment, and the slim chance he may be normal, and they seemed to understand, but they are not religious and need prayer for support and strength.
I will update you tomorrow when I have some time in the evening.
Love and prayers,
Steve
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