I have walked past a stationary treadmill in the hall on the way to the bathroom at least twice a day for eight weeks but I have an allergy to indoor exercise, I mean, why would you do that when exercise is free, right outside the front door? But then you don't see many women out running in the streets in Ar Ramtha where I am working at the emergency medicine and surgical unit just a couple of kilometres from the fighting in Syria.
We can’t forget it, we hear the barrel bombs dropping and witness the Syrian people arriving in the emergency department as soon as they are allowed through to be treated. Not only have these people lost their homes, families and future, but also their immediate freedom.
Their limbs lost or severely injured, they are treated by the surgical and orthopaedic teams and nursed with tender compassion by the local staff. It doesn’t seem very long before these brave people are demanding to go to our step-down rehabilitation ward as they have heard that there is fun to be had, children’s chatter to lighten the atmosphere and general camaraderie to enjoy.
Posters and slogans written in brightly coloured paints share hopes and fears, encouraged by our amazing mental health team without whom the healing would take longer.
Occasionally we almost give up hope for very ill patients, struggling to hold on to life in the intensive care unit (ICU), but then I must tell you about Ahmad (not his real name)
He was delivered to our emergency department on a cold day in January, intubated but with no oxygen supplied to his fading body. His tiny teenage frame, bleeding from the traumatic amputation to his right leg, hardly breathing, fading fast.
We worked hard to resuscitate him and despatched him into the care of the surgeons. Long hours and careful surgical attention gave him a chance of survival and so he was admitted to our one bed intensive care unit. Tirelessly, our anaesthetist and ICU nurses looked after him and tried hard to wean him off his sedative cocktail. Without intubation he didn’t seem able to breathe alone and his oxygen saturations dipped too low for life. With some determination, he shook off urine and sputum multi-drug resistant infections against the odds and eventually survived a tracheosotmy as he had been intubated really too long.
He was moved to the ward and nursed with kindness and great care. Slowly, he began to respond to touch and words and finally opened his eyes and could respond with eye movements. He soon became our most visited patient with every caller giving him extra care and attention. We were worried that his nutrition wasn’t enough through the naso-gastric tube so another surgical procedure was endured to insert a feeding tube into the jejunum – part of the small intestine. This he tolerated and fed well.
Everything seemed to be improving, Ahmad was responding to everything appropriately.
We even began to contemplate assessment of his ability to swallow and thought that we might cautiously see whether he might manage without the tracheosotmy. Caution was surpassed by an over-enthusiastic relative who gave him a sandwich... he didn’t choke, the sandwich stayed down and Ahmad thoroughly enjoyed it, smiling from ear to ear!
All previous procedures were reversed and we watched in amazement and awe as Ahmad breathed through his mouth and nose, drank and ate freely, smiled and then, spoke our names.
He goes from strength to strength, our miracle patient. Now to be caught outside in the sunshine, sitting in a wheel chair still but awaiting a lower limb prosthesis. This young man, given up on by some, given a chance by MSF, may yet again walk.
I tried that tiresome treadmill a couple of weeks ago and quite enjoyed the challenge of a ‘bit of a work-out’. Then it broke and I felt quite cheated – never satisfied eh?
At least I have the freedom to choose.