I’m pretty deaf, with combined middle and inner ear problems. I’d been taken in an ambulance to the Emergency Department of the local University Hospital. Years before I had been a consultant there for some time. After I had met the young Intern, a more senior guy came in. As you would expect he was masked and in a discernible slightly foreign accent said something, which was to me undecipherable. So with his mask down and me asking him to come nearer I understand that his name was Graeme and the accent marked him as a Scot. ‘I know you he said.’ I did not remember him at all until he said that he had worked, as an intern, in a country hospital about 130 Km away from my hometown and I had been flown in to deal with a young man whose motorbike handle had, when he hit a tree, gone into his upper abdomen and caused massive bleeding. I still didn’t remember the doctor but I did remember the incident – some stories you don’t forget!
There were no specialists at the hospital but the medical superintendent was a very experienced and highly capable GP. Early in the evening he called me and said that he had just ordered a plane to bring a team up to deal with the above described young man. ‘Could I come, urgently?’ ‘The plane will be ready to take off in half an hour’, he said. I owned a Mitsubishi Starion and (maybe illegally) had it up to 230 km per hour. Knowing how long it took to set up people and equipment for the journey by plane I told him that I would be there long before the plane was. And I was.
He was a very capable GP anaesthetist so I told him to get everything set up and knowing him to be a good diagnostician told him to be ready to start the moment I got there. The patient was shocked and being resuscitated as well as they were able, but the family were JW’s and refused a blood transfusion. The parents had, however, agreed to allow me to transfuse him with his own blood, which I knew was collecting in big volumes in his abdomen.
He had a massive stellate tear of his liver. I rescued as much of his blood as I could and by filtering it through gauze, we put it into an emptied saline bottle and transfused it back into him. But I was losing him and bluntly sent out the message to the parents that if I couldn’t give him more blood he was going to die. They agreed for a transfusion to be given, but there wasn’t a store of transfusable blood.
As I said earlier the GP Superintendent was a champion guy. He had previously, knowing that such emergencies arose from time to time, formed a blood bank of living people who all had agreed that, if called upon in an emergency, they would come ASAP to the hospital and be bled. Three of the right grouping came and donated their blood.
The bleeding was so massive that after my attempts to stop it failed, all that I could do was put a large number of packs into the traumatised area thus controlled (stopped) the bleeding. He was sewn up and kept under the anaesthetic.
About a half an hour into the surgery the plane had arrived and the medical crew were very helpful when they joined us in the operating room. After a bit more stabilising of his condition he was flown back to our local city hospital. The next day he was flown about 1,500 Km to the capital city of the state for further definitive treatment under much better conditions. What follows I have only heard secondhand and some of my assumptions may be wrong. I think that the big boys in the big city assumed that the probably rather limited ability-wise country surgeon was making a mountain out of a molehill. For them it would be a ‘cake walk’.
At any rate they took him back into the operating room, removed the stitches and the packs, but could not control the bleeding and had to end up repacking him and sewing him up again. Eventually he was transferred to the liver unit where he had about half his liver removed. He eventually recovered and went back to his local area. I hope that he and his parents were able to curb his desire to race his bike through the forest tracks!