Thursday, March 2, 2017

Motorcycle vs. Bull

I'm just sitting here in Jinja with my niece and nephew waiting for my parents to arrive so I though I'd take a quick minute to update the blog.
A few days back I mentioned on FB that I had my first patient who had been impaled by a bull. On Sunday at church a couple of the members told me they were worried about a neighbor of theirs who had had an accident with a bull and was only in the hospital one night and had been sent home. They were wondering if I would be willing to check in on them. So after church a couple of us headed over to check on Sam. Sam had busted his face up pretty badly, had put three teeth out through his top lip (never to be found again), displaced his jaw and split his bottom lip down to his chin. So, though he really wanted to tell us about the accident, we got only minimal details as speaking (and understanding him) was limited. His wife knew a few things from the police that arrived on the scene so she tried to answer my questions. Sam was coming home on his piki, downhill, and on the side of the road a male cow was trying to get frisky with a female cow. The female dodged and the male lunged into the road just as Sam passed. This is not at all how the Ugandans described it to me but there is no way I can do their description justice (and honestly you wouldn't have understood half of it anyway as it had a lot of innuendo in it along with Ugandan's characteristic vague/strange English phrases). Anyway, the motorcycle hit the bull, the bull hit back. Sam has road burns on both arms and legs along with his smashed up face. But the whole thing that just made the story was that he also has a very deep, tunneled puncture wound that starts in front of his right hip, goes around his side, through his right butt cheek and exits just above and to the right of his ischial tuberosity (take that Dr. McKelvey!). I could put my whole fist in the entry wound in front and the exit wound is roughly the size of a quarter. Needless to say there is also a lot of swelling, bruising and foul drainage.
He had overnighted in the hospital where they stitched up his face, cleaned out the wounds and started him on abx. Then sent him home. He was weight bearing on his right leg but he can't walk. He can't eat anything solid. And he still has significant post concussive symptoms. Seems like a perfect candidate for discharge.
Anyway, I cleaned him up and packed the wound. Taught them how to make bone broth. Discussed neuro symptoms to watch for.
Then they asked me if I could also treat the cow. Here, when livestock cause accidents, the law is that the injured party gets to keep the animal that caused the problem. This is usually as payment for damages and because the owner of the animals is supposed to be responsible for keeping them out of the road. So Sam was fighting for possession of the bull. But it has a broken leg so it is still at the owners house and they can't go get it until they can walk it to their place. So they REALLY wanted me to plaster it so they could bring it home. I had to explain that this was very much outside my scope of practice and really, really too much for a Sunday afternoon.
I've been back every day to change the dressing and by now his wife can do it.  I don't have any pictures of this craziness so instead you get a selfie Ellie took while I was typing.

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