Fieldset
"Nothing short of a miracle": The trauma team that refused to give up

It's night-time and anaesthetist Kariantti has been called into MSF's trauma hospital in Bujumbura, Burundi, to help treat a badly injured man who is bleeding heavily. The team must act fast to find the source, stop the bleeding and save the patient's life... 

Patients at MSF's L’Arche de Kigobe trauma centre in Bujumbura, Burundi

Last night, I was once again called to the hospital together with our surgeon

A 39-year-old man had suffered a severe abdominal injury and was bleeding heavily internally.

When we arrived to the hospital, he was already in a state of shock. He also had a wound in the head and probably bruising on his brain, as well as a nasty open fracture in the right leg.

Nobody knew what had happened since no one had witnessed the accident and the patient was in no state to tell us either. 

No time to lose

With little time to spare, we transferred him to the operating theatre and rapidly started the anaesthesia and the operation.

The surgeon performed explorative laparotomy – an incision into the abdominal cavity – during which we found over two litres of blood in the abdomen.

I was filled with gratitude for having worked with such competent and skilful people, who weren’t ready to give up on the patient in the darkest of moments and instead persistently kept on going

There was a laceration in the liver, which was not actively bleeding anymore, and no other site of the bleeding to be found either. Therefore, there was little more to be done.

And, after some units of blood, he was stable enough to be transferred to the recovery room.  

Back to theatre

The bleeding started again.

In a matter of a few hours, his blood pressure deteriorated again and his haemoglobin (the oxygen-carrying protein in red blood cells) was going down fast. So, we had no choice but to transfer him back to the operating room for a re-laparotomy, where we once again found the same massive amount of blood.

He was still deteriorating and most likely bleeding from somewhere else. To make matters worse, we had problems finding blood for him.

Luckily, the lab eventually managed to find more blood units, which we rapidly transfused to him. 

Finding the source

Meanwhile, the persistent surgeon found the bleeding in the most unlikely of places, in the small pelvis. 

A small artery had begun to bleed after the blood transfusion when the patient's blood pressure normalised.

Despite the very difficult site of bleeding, the surgeon managed to perform good haemostasis (a process to prevent and stop bleeding) and once again the patient started to stabilise.

To prepare for the possibility of further bleeding, the surgeon packed the liver with compresses to be removed in a "second look" operation after stabilisation – hopefully.  

Intensive care

To everyone’s amazement, the patient once again woke up very rapidly from the anaesthesia, considering the fact he had lost the total amount of his blood volume, which we had replaced with blood units.

Later that day, we were able to transfer him to the intensive care unit for further surveillance. It wasn’t over, however.

The following days kept us occupied with his elevated renal and potassium levels, most likely due to the massive blood loss and numerous blood-transfusions.

Nobody knew what had happened since no one had witnessed the accident and the patient was in no state to tell us either

He was also still tachycardic, with an elevated heart rate, and breathing heavily.  

But, he wasn’t bleeding anymore. And, after a few days, when he had stabilised more, we took him back to the operating theatre for the second look operation and there was no bleeding to be found anymore in the abdomen.

So, we could remove the packing and close the abdominal wound completely. We were also able to fix his broken leg during the same anaesthesia. 

A miraculous recovery

The fact that the patient ever survived all of this, from what was pretty much a certain death sentence, still amazes me and I guess is nothing short of a miracle.

In the end, I was filled with gratitude for having worked with such competent and skilful people, who weren’t ready to give up on the patient in the darkest of moments and instead persistently kept on going.

It was a group effort on many different levels, to say the least. 

The following days we witnessed him starting to recover slowly and a week later we could transfer him to a normal ward for further recovery.  

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