nerve. His arm is fractured?”
“Seems so.”
“Any other injuries?”
“No, I don’t think so,” Mohamed replies.
“Well, I guess we’ll have to wash it out and sew it up. Splint it. I’ll look for the nerve, I guess. We have ketamine, right?”
“Yes.”
“If you get me some, I’ll start. It’s going to take a long time.”
It does. Over an hour. His arm is broken in half. Thin spicules of bone keep snagging my glove, ripping it. I can’t find the nerve, can’t see enough of the bone to trace its route. I am reluctant to cut any farther. Sweat drips down my forehead and into my eyes. My stomach cramps, and it makes me feel nauseated. I wash out the wound, cutaway the black pieces of crushed tissue, sew his triceps together, then close the skin. Lastly, with Mohamed’s help, I put him in a long arm-cast.
I finish wrapping it and open the door. A man in military fatigues pushes quickly past.
“Doctor. Tell us what is wrong.”
“Well, sir, this man has some scratches on his head. He is going to be fine.”
“Good.”
“The other soldier has broken his arm, and has a large cut in it, at the break. I have cleaned it out and sewn it up. It’s possible he cut the nerve as well. Right now, he can’t move his hand. That might recover, but possibly not. Time will tell.”
“You must take him to Khartoum.”
These guys must be SAF.
“Sorry?”
“You have to fly him to Khartoum. He is one of our soldiers. He needs an x-ray.”
“He doesn’t need an x-ray. The bone’s broken. I can see it. The rest of his arm is okay. These fractures usually heal very well.”
“You said he can’t move his hand.”
“I know. The nerve has been bruised or cut. He could use a neurosurgeon. But not urgently, not today. He can wait a few days.”
The patient starts to groan behind me, his anesthetic worn off.
“You must fly him to Khartoum.”
Another soldier enters the room.
“Listen. We don’t have a plane. We have a Land Cruiser. We can take people as far as three hours from here, to a bigger hospital, but only if it is going to save their life. And there is no neurosurgeon there. And we can’t take people to Khartoum. We simply can’t.”
“Why are you refusing? I know you are going to take the civilian who was run over. Why won’t you help us?”
I need to get out of the emergency room. I need some air.
“Excuse me, excuse me.”
I push past and step into the courtyard. The scene has settled. Bev has done her work well and only a few mothers of children in the feeding center remain. One of the injured men on the veranda is gone, and the other is sitting there, his leg bandaged, sipping tea.
The soldiers follow me out.
“Doctor, I don’t understand …”
“I’ve explained things as clearly as I can.”
“I think it would be best if you took our man somewhere he could get better help.”
“I agree,” says a man who has come to join us from the veranda. His hair is gray, and he is wearing a large white tunic. “I think you should listen to this soldier here. You’re new. I understand that, and you don’t know me yet, but I am one of the leaders around here, and …”
Bev turns the corner.
“Bev. Can you help me out over here?”
I take her by the shoulder, lead her a few steps away.
“I mean the guy needs a neurosurgeon or an orthopod I’m not sure maybe a general surgeon can handle it but he would have to dissect the triceps away look for the nerve sew it up but it’s not that straightforward maybe in Khartoum I don’t know and these guys they’re all—”
“James. I’ll take care of it. Gentlemen, come with me.”
And with that, she leaves. The soldiers follow. My anxiety quiets. I walk back to the tent. Sandrine is scribbling out a referral note.
“You okay?” I ask.
“Yeah. You?”
“Yeah, I guess. Some drama. Is it always like this?”
“Not always.”
“Wow. Anyway. I think Mohamed has taken care of the rest of the patients. I’ll make sure.
“Seems so.”
“Any other injuries?”
“No, I don’t think so,” Mohamed replies.
“Well, I guess we’ll have to wash it out and sew it up. Splint it. I’ll look for the nerve, I guess. We have ketamine, right?”
“Yes.”
“If you get me some, I’ll start. It’s going to take a long time.”
It does. Over an hour. His arm is broken in half. Thin spicules of bone keep snagging my glove, ripping it. I can’t find the nerve, can’t see enough of the bone to trace its route. I am reluctant to cut any farther. Sweat drips down my forehead and into my eyes. My stomach cramps, and it makes me feel nauseated. I wash out the wound, cutaway the black pieces of crushed tissue, sew his triceps together, then close the skin. Lastly, with Mohamed’s help, I put him in a long arm-cast.
I finish wrapping it and open the door. A man in military fatigues pushes quickly past.
“Doctor. Tell us what is wrong.”
“Well, sir, this man has some scratches on his head. He is going to be fine.”
“Good.”
“The other soldier has broken his arm, and has a large cut in it, at the break. I have cleaned it out and sewn it up. It’s possible he cut the nerve as well. Right now, he can’t move his hand. That might recover, but possibly not. Time will tell.”
“You must take him to Khartoum.”
These guys must be SAF.
“Sorry?”
“You have to fly him to Khartoum. He is one of our soldiers. He needs an x-ray.”
“He doesn’t need an x-ray. The bone’s broken. I can see it. The rest of his arm is okay. These fractures usually heal very well.”
“You said he can’t move his hand.”
“I know. The nerve has been bruised or cut. He could use a neurosurgeon. But not urgently, not today. He can wait a few days.”
The patient starts to groan behind me, his anesthetic worn off.
“You must fly him to Khartoum.”
Another soldier enters the room.
“Listen. We don’t have a plane. We have a Land Cruiser. We can take people as far as three hours from here, to a bigger hospital, but only if it is going to save their life. And there is no neurosurgeon there. And we can’t take people to Khartoum. We simply can’t.”
“Why are you refusing? I know you are going to take the civilian who was run over. Why won’t you help us?”
I need to get out of the emergency room. I need some air.
“Excuse me, excuse me.”
I push past and step into the courtyard. The scene has settled. Bev has done her work well and only a few mothers of children in the feeding center remain. One of the injured men on the veranda is gone, and the other is sitting there, his leg bandaged, sipping tea.
The soldiers follow me out.
“Doctor, I don’t understand …”
“I’ve explained things as clearly as I can.”
“I think it would be best if you took our man somewhere he could get better help.”
“I agree,” says a man who has come to join us from the veranda. His hair is gray, and he is wearing a large white tunic. “I think you should listen to this soldier here. You’re new. I understand that, and you don’t know me yet, but I am one of the leaders around here, and …”
Bev turns the corner.
“Bev. Can you help me out over here?”
I take her by the shoulder, lead her a few steps away.
“I mean the guy needs a neurosurgeon or an orthopod I’m not sure maybe a general surgeon can handle it but he would have to dissect the triceps away look for the nerve sew it up but it’s not that straightforward maybe in Khartoum I don’t know and these guys they’re all—”
“James. I’ll take care of it. Gentlemen, come with me.”
And with that, she leaves. The soldiers follow. My anxiety quiets. I walk back to the tent. Sandrine is scribbling out a referral note.
“You okay?” I ask.
“Yeah. You?”
“Yeah, I guess. Some drama. Is it always like this?”
“Not always.”
“Wow. Anyway. I think Mohamed has taken care of the rest of the patients. I’ll make sure.
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