Gored

Gored

Palestine wanted a new pagne, a fabric cloth that is so versatile you use it for everything.  It’s not so easy to go shopping in Chad.  You can’t just jump in your car and head to the store.  Even 10 km takes a long time when you have to walk it.  

Palestine decided to take the family vehicle.  The ox cart.  

But one oxen wasn’t so happy to go along.  Before Palestine knew it, she had been pinned against the fence by one of those big horns.  “I’m going to die,” she cried out loud.  

Her mother soon ran out of the thatched mud-brick hut and chased the angry bull away.  

Wow that hurt, thought the 20 year old girl.  Did his horns actually go right through me?  Are my insides falling out?  She fell to the ground in agony.  Her mother checked her out, brought her inside the compound to lay her on a brightly colored mat.  For now she was okay.  Her skin had not been punctured, thank God.  

Palestine was still in quite a bit of pain.  The family decided to take her to the health center.  They prescribed pain meds and antibiotics.  

The next day her abdomen grew bigger.  Hmm…the doctors at the health center didn’t do any good, so maybe we should take her to the Marabou, the local witch doctor.  Maybe someone put a curse on her, and is causing her to have continued pain.  

The witch doctor just asks for a small nominal fee.  A chicken and 5000 cfa (10 dollars).  He kills the chicken and uses the feet to scratch over the point of her abdomen with the most pain, the part that is bulging out.  He promises health and recovery and a removal of all curses placed on her.  

She goes home, happy that she will soon be healed.  

No healing comes.  In fact, she gets worse!  

Four days from the angry bull incident, the family has no other choice.  They have to bring her to the little Christian mission hospital.  They have heard stories that sometimes miracles happen there.  Maybe it was possible that they could heal her there.  Doing nothing sure wasn’t helping.  The witch doctor’s chantings sure weren’t helping.  Maybe the mission hospital could help.  

Palestine presented to our hospital with an acute abdomen (a very painful abdomen that requires surgery).  She was quite distended.  She also had a bulging 4cm hernia in her left abdomen.  It was squishy, full of liquid.  Like a big water balloon attached to the left side of her abdomen.  I wasn’t sure if the liquid was in her intestines or outside of her intestines.  Whatever it was, it had to be opened.  

I looked carefully to see if the skin had been punctured, but it had not.  She just had a couple of scratches in the skin made from the witch doctor.  

With the history of her bull-goring, I knew it couldn’t be good.  If it was blood in her belly, she would probably be dead by now four days later.  It was either old blood, poop, pus, or intestinal necrosis from blunt trauma.  

We were full swing in busy season at the end of February, but this was an urgent case and had to be operated on.  I add her on to my already full day of cases.  

After obtaining spinal anesthesia, I make a midline incision to cut through her taught abdomen.  Liquid poop comes pouring out.  We do our best to suction it up, but much of it pours to the side of her and onto the floor, my scrubs, my legs.  

After exploring her abdomen and evacuating liters of liquid poop, I found a 2cm perforation in her small intestine in her upper abdomen.  

So apparently the bull’s horn did NOT perforate her skin.  But DID perforate her fascia, about 4cm of it.  The tip of the horn continued on to perforate her intestine, 2cm of it.  Either that, or the witch doctor healed her skin… unlikely.  So this was a blunt trauma case, with a very sharp bull horn.  

I would like to say that this is the end of the story.  I fixed her and she got better in a few days.  Nope.  Ha ha.  That would be too easy.  Since when is being a mission doctor easy?  

Palestine was my patient for almost two months!  Initially I closed her intestinal perforation.  I irrigated her a LOT, then I closed her fascia and put in a couple drains.  I also cut open the skin over the hernia since it had become a pocket full of poop.  There was poop infiltrated into her subcutaneous tissue (the part between the skin and the fascia).  It was a set up for infection.  I closed the fascia of the hernia and packed the skin open.  

But she got infected.  She kept leaking poop out of her subcutaneous tissue (the fat below the skin) of her hernia area.  The poop seeped out of her tissue for days.  

After a few more days I had to open her fascia and leave her open because of her infection.  I remember her mother commenting to me several days after the surgery as I was doing her massive dressing changes of her abdomen, “Is it possible that she is going to live?”  

I nodded to her, “Yes, by God’s grace, she will get better.”

Slowly, slowly Palestine’s pus that had been leaking from her abdomen cleared up.  I quit doing her dressing changes and left her in the capable hands of my post-op nurse on surgery, Emmanuel.  

I took her back to the operating room several times to re-approximate her skin and fascia with anesthesia.  Every week for the past month I let Palestine’s mother pick up mangos under our trees so they could have a little more to eat.  If I forgot, she would soon remind me that she would love some more mangos!

This week Palestine went home!  She went home in good health.  She went home very much so not dead.  I do hope she eventually makes it to the market to buy a new piece of fabric!  And that they sold that naughty bull.