Tobacco

"Docteur, mind if I interrupt?" Desiré pokes his head into the OR. Actually, I do mind because I'm trying to take out a large cecal mass that is hovering right on top of the major artery going down to the right leg while Sarah is trying to keep the patient alive with an Adrenaline drip.

"Yeah, go ahead," I say as I briefly look up before getting back to careful dissection. All I hear is mumbling, something about a boy and a horse and falling and a clavicle. Must be a clavicle fracture, not urgent.

"Ok, I'll come and see him later." I keep working and eventually am able to get out most of the mass and reattach the patient's small intestine to his large bowel. However, his heart rate and blood pressure keep tanking without the Adrenaline so we find a good rate for the drip, send up a quick prayer and release him out to the wards for lack of an ICU.

I've forgotten about the boy who fell off the horse until Desiré spots me from far away as I try to escape back home and calls me back to the ER.

I leave the darkness of the overcast sky to enter the even deeper obscurity of the ER who's light isn't working. I see a pre-teen boy, well formed and conscious sitting up on a dilapidated bed. He has a 5 cm open wound below his clavicle that is filled with nasty green clumps of grass or something. It's then I get the real story. He was riding from the fields with his throwing knife, fell off and stabbed himself in the upper chest. Well at least he seems to still be breathing. I go to my office and bring back my stethescope. Breath sounds seem to be equal bilaterally and he is in no respiratory distress. The wound looks deep, but maybe it didn't make it to his lungs. We take him to the OR for exploration.

After starting an IV, giving antibiotics and a sedative, I examine the wound. I pull out the clumps of dark green crushed leaves mixed with blood and dirt.


"What is this, some kind of traditional medicine?" I ask Samedi. He goes out and inquires of the family and then comes back into the OR chuckling.

"Doc, it's tobacco leaves."

I'm stunned. Tobacco? What will I see next? I try to wash it all out. The wound is deep but slanted up so it goes almost to the clavicle but not straight in thus avoiding the lung. If it would've gone any deeper it may have his the subclavian artery or vein and he'd be dead.

I leave a drain deep and close the muscle and fascia leaving the skin open with a diluted bleached soaked dressing.

I go to check on the previous patient. We have nursing students currently so I'd assigned one to take vitals every 10 minutes (exceptional for here). It's actually been done and the patient has maintained a normal heart rate and blood pressure. The IV bag is almost empty so I mix up another 500ml with 2 mg of Adrenaline and get it running at about the same rate by eyeballing it.

I leave him in God's hands.

The next morning he's talking and asking to have some water to drink.