Cow Horns and Kangaroos

There is a lot of routine in my work, but there are also some unexpected things that come up. One night when I was on call, the ER contacted me around 7 p.m. about a 12-year-old boy who got gored in the neck by a cow’s horn. It was in Zone 2 of the neck where all of the important things are, and given his large hematoma, he warranted a neck exploration. The wound was about 8 centimeters deep. I could fit my entire index finger in it. Amazingly it missed his carotid artery, jugular vein, esophagus, and trachea. It took a couple of days for the swelling to go down, but he’s doing all right.

“There is a lot of routine in my work, but there are also some unexpected things that come up."

Another miraculous case happened on a night I wasn’t on call. Dr. Sheryl, my senior surgery colleague, called at 4 a.m. because she needed another set of hands. A young man had come in who was shot in the upper portion of his abdomen—straight through. Sheryl had already stopped the bleeding from his liver, but there was still massive bleeding from behind the liver. We cross-clamped the aorta and clamped the blood supply to the liver, but the bleeding didn’t slow down at all.

Abigail visits with a family on one of her palliative care excursions to a nearby village. The baby in the yellow outfit is the patient. Abigail was accompanied by a hospital chaplain.

This raised our concern for a hepatic vein or retrohepatic inferior vena cava (IVC) injury. Our hospital is not equipped like a Level 1 trauma center in the U.S., but even if it was, retrohepatic IVC injuries are fatal the majority of the time. The patient was very unstable, and it was hard to keep giving him blood as fast as he was losing it.

After discussing options, we chose to pack his abdomen—literally packing 18 surgical sponges inside in an effort to stop the bleeding with pressure. We hoped this would buy him enough time to be with his family before he would die (maybe a few hours) instead of dying alone in the OR.

To our amazement, he did not die. We don’t have an ICU where we could keep him on a ventilator, but he stabilized over the weekend. However, those surgical sponges were still in there, and we couldn’t leave them forever. We took him back to the OR on a Monday morning (three days after he came in shot) and removed all 18 sponges. There was no more bleeding.

A glimpse of the hospital’s highland setting.

We optimistically watched him post-operatively. He got stronger, ate, walked, and most importantly, didn’t bleed. Amazing! Venous bleeds can often stop with prolonged pressure, but the IVC and hepatics are very large. We told him that he is a miracle man and that God is watching out for him.

“In attempting to explain that we had left 18 sponges inside to stop the bleeding ... what I actually said was, ‘We put 18 tree kangaroos inside your abdomen.’”

On a much lighter note, as I was discussing with the patient our plans to take him back to the OR to remove the surgical sponges, I made a sizeable language faux pas. The Tok Pisin word for cotton is “kapuk,” which is the word we use for surgical sponge. The word for tree kangaroo is only one letter different “kapul.” So in attempting to explain that we had left 18 sponges inside to stop the bleeding and we now need to take them out, what I actually said was: “We put 18 tree kangaroos inside your abdomen, and we are going back to surgery tomorrow to remove them!”