Fieldset
Day 5: goats and gunshots

Surgeon Tomas blogs about everyday life in the hospital discussing goats, football and saving a boy shot by his brother in the chest.

Let's just say that today I experienced a more direct feeling of having saved a life than usual. He is fourteen and came here with a bullet through his heart, probably. But first things first...

Where we live

I'm right on the roof of a two-storey villa almost exactly in the centre of Kunduz. I'm sitting in an armchair made for about 15 people which our local logisticians designed. Opposite is a large canvas sheet and every night some kind of film is screened on it. The origin of the film is usually in accordance with whoever brought it and from where it came. It's a sort of endless film-festival! While the others chat, I am writing these few lines.

There are actually two villas, side by side with concrete backyards around them. In total they hold 30 people so everyone lives in his or her own room. On each floor there is a shared shower and toilet, the usual Turkish style. There is one washing machine and in the kitchen there are two local chefs who cook perfectly; today it was goat...

 

The kitchen where the MSF volunteers have their food prepared. ©Tomas Sebek/ MSF

 

In the basement there is a drying room and a gym, nearly as big as a football field as well as a communal dining room. In the backyard there are our two field Landcruisers, so typical for MSF or the Red Cross. There is also a booth for the MSF guards and the radio operators. The whole thing looks like a sheikh’s palace. The house has a red and white ball the same size of a weather balloon on the roof. I do not understand its functioning but it’s a local design. Somewhere else they might have a crescent, for example...

"Funny ball" on roof of our guesthouse, does anyone has clue what is the function? Nice anyway

"Funny ball" on roof of our guesthouse, does anyone has clue what is the function? Nice anyway ©Tomas Sebek/MSF

Afghan football in the basement

If you want to get into contact with an Afghan, just open your mouth however it can be difficult when he or she does not speak English.

Yesterday I was running twenty times up and down two flights of stairs and then I did about a hundred circuits of the basement; I have started training for the ultra marathon inside the barracks. One guy from our guard came to see me.

He stares at me for about five minutes so I kick a football that we have in the basement towards him. He juggles it in the air, two loops and he scores a goal. Damn it! I cannot play football, it's not a power-sport! So, I kick it with all the force I have. He goes after it like Petr Čech from Chelsea, leaps on top of it and kicks it into my half.

After half an hour we are completely bathed in sweat, I shake his hand and say "Tashakor" (Thank you) the only word I have learnt so far. He says something too, probably in Pashto. Perhaps something like: “Bro, you are playing like an amateur!” We did not say a single word apart from those at the end and we are friends.

The next day, in the parking lot, he pretends to pass the ball to me ... As a part of the humanitarian aid in war zones all over the world I would distribute footballs and it would all be finished, peace. Everybody would just play football!

Morning report with a goat

Before the morning report starts I run to the ICU. The champ from yesterday, the one with the torn liver, is lying calmly on the bed asleep. In the night he got one more dose of blood and his morning haemoglobin level is 110.The bandages around three drains are only somewhat drenched.

In the hospital in Prague they taught me a trick with stomach bags installed around the drains. When I am attaching the bag in the morning and in the evening there is only up to 200 ml of a kind of brown liquid (old blood mixed with bile) and the other two drains lead only a small amount of reddish water - either I did something wrong or a miracle happened! I got advice from home from really experienced people. So far I am ecstatic, this guy does not need anything; his abdomen is calm. Well, we shall see in the next few days...

They killed a goat in the hospital. It is not my cup of tea, but it was not an arbitrary act. Eva from ICU wanted to teach the emergency room doctors and also my surgeons how to insert a drain into the chest. It is better to try it out on a goat than on a patient. Together with Dr Samir we gave a great lecture.

 
Practical training on a goat

Practical training on a goat ©Tomas Sebek/MSF

 

I was surprised how Eva deals with the ultrasound. I want to have it fine tuned by next time. I was in charge of the practical training on the goat. Green flies kept us company in multitudinous numbers and so we, about fifteen doctors, were in the backyard behind the hospital sticking chest drains into the old goat, one after another. From a distance it might have looked like some very strange ritual. Then we pulled the goat out of the hospital grounds and in the evening, in order not to waste it, we ate it.

Shot in the heart

At lunchtime, my phone rings. It’s Dr. Safi, a young and rather gung-ho doctor. Apparently I have to come to the Emergency Room immediately as they have a patient with gunshot wound to the chest and he already has a drain in the chest with 250 millilitres of blood in it.

I already react to these things much more calmly than during my first mission. When you hear it at least twice a day it leaves you icy-calm. Like an emeritus professor I drift with deliberate steps to the emergency room and there, somewhere by the door, I forget my calmness...

A brother shot his brother in the heart...

A little boy is lying on the table as pale as the wall at the edge of consciousness, breathing hard. A chest tube has already drained 400ml of blood and is draining more. What’s worse is that the connected monitor shows a pressure level of 45/25. At that moment I sweat like those poor local doctors who were waiting for their lax comrade expat to crawl in. But from my interpretation of the call I did not get that he was dying!

Eva from ICU has been running around him selflessly for a long time while I was just strolling about somewhere. She looks at his chest using ultra-sound, his lungs with the monitor and the effusion from his chest. I listen through a phonendoscope to the lung, at least two-thirds of which is breathing. He has not lost too much blood either. It is running through the drain and the amount is not enough to kill him, so what the heck is wrong with him?

When your brain is dominated by adrenalin, all the cells in your head breathe it in, it aerates a little, it sparks the little grey cells. In my case it was just a single cell, however today it has done wonders. He has haemopericardium (an injury when fluid fills the space between the heart and its outer lining)! I'm yell my diagnosis to Eva. She zooms the ultrasound to the heart.

It is there. The heart is swimming in blood and the sheath which surrounds it is compressing the heart more and more tightly. In a minute it would be the end. This is called a cardiac tamponade. Eva praises me, I feel like Dr. House, but we are only half way there; I have not completed it yet. They give get me a broad twenty centimetre long spinal needle and a large syringe.

Before I think about it and imagine the appropriate image of how to pierce the heart, I thrust the needle six inches deep where I think that the heart is. It's on the left, right? At first, nothing. Visualising via ultrasound fails. I back up and there it goes! I pull out a hundred cc's of blood. Before I pull out I ask Eva to check it. According to the ultrasound a few millilitres remain over the apex of the heart, otherwise nothing. Nothing!

 

Treating a patient with gunshot wound on his chest

Treating a patient with gunshot wound on his chest ©Tomas Sebek/MSF

 

After two minutes, his pressure is 60/40 and after five minutes 100/90. He is breathing calmly now and reacts to his name, moving his hands. Only minimal liquid has been collected through the chest tube. This is good. He still has not won yet, however. If the bullet passed through the heart and the boy survived, it can still swell tight from the pressure. It could also just have glanced off the heart with the lung sustaining the most damage. However, even according to the drain it now does not look like thoracotomy (open chest surgery) will be needed. The boy is stable, unlike me!

We will put him in the ICU for monitoring and I'm leaving. Even as a professor emeritus, I have not lost face there. Dr. House, dude. This is simply the role of emeritus professors, but since I am not any kind of professor and I'm not emeritus, behind the door the floor starts to swing a little bit and the horror is making the hair on my back rise. The endorphins that pour out beat that. So, I probably helped to save his life. That's great; at home this does not happen so often. I also watch the boy in the evening, he is all right. Eva also reports this, so I hope so...