Emergent trauma surgery in Kenya is different. A 22-year-old male came to the operating theater area after having a tire explode in front of him as he was working on it. This is certainly not a safe practice, but it’s hard to argue with a young man doing what he can to make an honest living for himself and his family.

The blast injury was worse than we initially thought. This became apparent as I watched his left shoulder and thorax expand with hematoma. It became more and more clear he had suffered an arterial injury. We rushed him to the operating suite and I confirmed with an ultrasound that his arm was pulseless.

FGHL Marco Lopez

After a discussion between our anesthesiology team, the admitting general surgeon, and a local orthopedic surgeon, it became apparent that to save this young man’s life we would have to perform a proximal arterial repair or ligation and a four-quartering of the left arm – meaning a left arm amputation.

This case has weighed heavily on me. This man was doing what he could to sustain any type of living for himself and suffered a grave injury because of it. His life is forever changed. I am still proud to say that I contributed to him surviving at all, but his case seems to be a microcosm of the difficulty faced in developing countries in general.

Even with what I consider limited experience as a senior anesthesiology resident, I was able to contribute heavily to the proper care of this patient. The nurse anesthetists I was training during this case were fascinated with the active use of ECG monitors, for example.

FGHL Marco Lopez

First, the development of signs of cardiac ischemia on the ECG and the awareness of seeing it normalize as we transfused the blood that this young man needed to adequately deliver blood to his heart provided a clear example of this. One of the trainees pulled me aside to thank me for showing him these changes and their correction, as it was something he had read about but had never actively witnessed while caring for patients.

I revisited this patient while on call in the ICU and was happy to be able to transfer him to the stepdown unit. He is clearly doing better, but I fear his ability to care for himself and his family is in jeopardy with the extent of his injury. The mechanisms we have for long term care of this type of patient in the U.S. is quite different from what is available here in Kenya.

I’ll pray for this patient and think of him often, he certainly faces a long road ahead. For my part, I will continue to care for these folks to the best of my ability and hope that I can make a difference by helping those I work with become even more skilled.