Life is like playing in the surf. Standing in waist deep water, the waves hit. They are fun because it is the little variations that give life interest. Less often, a big wave hits and you jump to keep your head above water. If you see it in advance, you hold your breath and it passes. Once in awhile, you're caught off guard and come up with a head full of salt water.
I've gone running three times per week since I've arrived in Lubutu. Exiting Couvent, I run on a small trail before appearing on one of the main gravel roads leading out of town. The soil is brick red here. My shoes, socks, and legs, are covered with red dust each time I finish. It's a lovely run, 25 minutes in each direction. The most distant point is a long steep hill topped with a large brick church. From there I can see miles of hills and jungle, as well as the red ball of the sun rising.
Yesterday was typical. I got up before sunrise, put on my running gear, and off I went. I was happy to reach the top of the hill, as I knew I was halfway done. Once at the church, I turned around, admired the view, and smiled. On the way home the first 10 minutes is steeply downhill. I get to take a bit of a break, relax, and say "bonjour" to dozens of people, as I let gravity carry me along.
I don't know how it happened. Somehow my right foot got caught. On the steepest part and at the highest speed, I tripped. I landed on my right elbow and left outstretched palm. They were shredded. Blood began running down my right arm and red dust and rocks were ground into both wounds.
What could I do? I stood up, noticed that I had a big bleeding hole in my right elbow, and started running again. I had no other option. I couldn't phone anyone. I had to get home.
Many things passed through my mind. I was in a great deal of pain and didn't know if I had broken my arm. If I had, I needed to get to Nairobi or Europe for medical care. Even if the elbow wasn't fractured, the wound might be open to the joint. If that were the case I would be in serious medical trouble. Even if neither of these options were true, I had a big hole in the skin over my elbow and there were a lot of dirt and rocks in the wound. The flesh was gone- full thickness absence, not just skinned. In this best case scenario, if I didn't get an infection, I was probably going to end up with a big scar. I thought about Martine (pronounced "mahr-teen", accent on second syllable) our Belgian surgeon. She was my good buddy and had better be a good surgeon.
Twenty-five minutes after the fall, I arrived at Couvent. My first action was to wake up Martine, whose bedroom is right next to my own. In the hallway with most of the bedrooms, there is a sink. I turned on the water and stuck my right arm under. I started using my skinned left hand to clean the dirt, rocks, and dried blood, off my right forearm. By this time, Martine was up. Once I reached my right elbow, my left index finger entered the large hole in the skin. I had a vasovagal reaction. I was lowered to the floor pale, sweating, and nauseous.
That over, the two of us walked to the hospital and went directly to the operating room. She numbed me up and washed out the wound. The joint was not involved. She didn't think there was anything broken. After suturing she inserted a surgical drain. Drains are temporary conduits for blood, pus, or fluid, to reach the exterior of a wound. If a surgeon expects a large accumulation, they insert a drain to prevent the wound from swelling and the sutures being pulled apart. Washed out, sutured up, and with a piece of rubber hanging out of my arm, the whole thing was covered with a large sterile dressing.
From the operating room I went to the recovery room. Fifteen minutes later I walked home. I spent the remainder of the afternoon reading and relaxing. Early in the evening someone remarked that my dressing was dripping blood and serum. So it was back to Martine I went. Fourteen hours after she had first helped me, she was still in the operating room. After finishing her last patient, she changed my blood soaked dressing and inserted another drain. This was one of those life experiences best forgotten.
Last night I slept poorly. Each time I rolled over I was reminded of the accident. I'm lucky this happened here in Lubutu. If I was on a remote MSF posting with no hospital or surgeon, things would have been much more complicated. Here I knew I could count on sterile technique and I slept in the bedroom next to the surgeon. It could have been much worse.
I had dragged Martine out of bed and kept her in the operating room even later than she had planned. What could I do to thank her? I can't take her out to dinner, as there are no restaurants. I can't buy her a gift as there is nothing to buy. I can only thank her for pulling me out when an unexpected wave crashed over my head.