“We’ve got an interesting case here if you’d like to come have a look, it’s an amputation so you don’t have to come if you don’t feel up to it.”
I hang up the phone and briefly think if I’m up for the offer to observe and learn about a new type of operation that I have not seen before. It gives me a chance to see how all the equipment that I’m responsible for in the operating theatre is used and ensure it is being used properly.
I wash my hands carefully after having spent the last two hours up to my elbows in soot in the two-stage diesel-fired incinerator used to dispose of medical waste – this is made clear by the remains of bones, syringes and bandages I find inside. Some technical problems, now fixed, have prevented it working properly for the last six months.
At the door to the operating theatre, I slip out of my dusty sandals and into a set of green clogs to go with my clean blue OT outfit, stained pink from too much bleach in the wash. The patient arrives through a set of swinging doors, groaning softly. All the surgical instruments required are neatly lined up on a sterile work surface nearby. The patient is transferred to the operating table and sedated; the moaning stops as antiseptic is spread liberally around the wounds to his left leg. There is a sense of efficiency in the room; each person knows their role and does what they need to do.
His blood pressure is dropping, heavy blood loss is taking its toll. Someone calls to the lab to get more blood, to convince his family to donate more, urgently. The femoral bleeding on the left leg is stemmed as best as possible by a nurse applying almost their full body weight to the gaping wound. Bag after bag of blood arrives, warm from the lab situated in a shipping container nearby, precious life-sustaining fluid.
Knowing the severity of his leg injuries, the family pleads for us to amputate below the knee. It is discussed and considered, but impossible. The lower right leg injury is exposed and the severity of the injuries become clear. Bones splintered, muscle crushed. The amputation begins. Feeling light headed, I have to sit down and breathe. His blood pressure plummets to 47/23; it’s not looking good.
I leave with a strange feeling inside; this is something totally exceptional for me, to see a human body in this state. To understand the challenges faced by the surgeons and medical team with each case, to admire their skill, calmness and dedication to doing the best they possibly can for each and every patient. I take my hat off to them. I leave hoping for the best for this young man.
Unfortunately, a day later, he became another person who got up in the morning, left and never came home.
Ben’s blog posts are published retrospectively. He wrote this post on 2nd November 2012.
Ben is the Biomedical Referent for Afghanistan. His main task is to make sure all medical equipment in the four hospitals where MSF works are up and running. Read more about Ben and the MSF Afghanistan blogging team…
MSF Field Blogs reflect the views of the author alone and not necessarily those of Médecins Sans Frontières