The Third Arm

Plenty of interesting stories that bring back memories of my home and training. I think I was a first year resident when this happened. I was sat in trauma when a young man was rushed in. He had fallen in the path of a train and was extremely lucky to be alive. His arm (I dont remember which side) was amputated at the level of the mid-humerus (that is the bone in the upper arm). All we could do was to stabilise him, tie of the blood vessels in the stump and dress the wound.

A good half-hour later, two men came into trauma very agitated enquiring about this patient. I was attending to some paperwork and pointed in the direction of the patient's bed. However, something about one of these men was odd. He had his arms folded across his chest and for a moment I did not realise what was odd about that.

Then it struck me. Folded across his chest were not two but three arms. He was cradling the amputated part of his brother's arm that he had picked up from the tracks in the hope that we would be able to put it back together. But, unfortunately, the train had run over the elbow joint and the arm was missing a good 10cm chunk that was probably stuck to some wheel of some carriage of some train.

I wonder what hopes the man had when he picked that arm up from the dirty tracks.

Daughter, Wife, Mother

This is by far the most difficult story to tell. I want to write this someday but I am not sure I am just ready yet.

The Tribal

7.45 am Friday 2003
Trauma is usually quiet in the mornings. We were sat at the main desk, chatting. Very excited casualty porters wheeled in a young man, lying on his side on a stretcher. And, nothing excites them. So, this had to be something big. He was of small build, lying calmly on his left side. He had long hair and was wearing clothes typical of tribals. He appeared to be stable. For a second, I and my junior resident wondered what all the fuss was about.

Then, one of the porters removed the large gauze swabs lying across his right chest. And there it was. The largest laceration I had ever seen. His chest was split open from his right nipple to the tip of his right scapula - all the way to his pleural cavity. I could actually see the collapsed lung through that gaping hole. A sight enough to squeeze the juice out of any surgical resident's adrenals.

We got him into trauma OR and started the routine bits. I went to inform my boss ('the lion', we called him) who was reading the morning newspaper in an adjoining room. He, in his typical style, feigned irritation at being disturbed over such trivial a matter as a split chest. He came, took one look at the chap and said: "Well, what are you girls gawking at? Stitch that hole up and don't forget to put a chest drain in. I will be in outpatients if you need me." And, he left.

So, that's exactly what we did. I put my hand into his right chest, guided a chest drain in, washed out the pleural cavity with saline and stitched up the intercostals and the skin in layers. My junior resident (I will call him K) was keen to get some stitches in. But, I was selfish and did not want to share this one with him.

He improved dramatically over the next couple of weeks. However, the idiot refused to have his broken arm fixed by the orthopods (he had non-union due to soft tissue interposition) and instead decided to sought some silly traditional treatment. I saw him a few weeks before I left the hospital, on the verge of tears, his arm in bamboo sticks, with another 'joint' between his elbow and his shoulder. I referred him to the orthpods. .Don't know what happened to him after that. He had a wife and a very young girl child. (And his family upset the nurses on the ward by doing a tribal dance on the ward when he got better!!!)

How did it happen? He was sleeping on the roadside when a sheet of metal came of a vehicle carrying them while turning a corner and landed smack on his chest.