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Unprecedented Accident,
Dr Mohamed Ahmed
Kampala, Uganda
Somali Medical Association
Unfortunate Accident
I hurriedly opened the door, dropped my school bag on the bed with my eyes fixed on a sports outfit in the wardrobe. It was time for my evening cardio exercise. It was around 5pm. My plan was to start with aerobics then proceed to weight lifting. I usually get to the exercise venue by jogging; that faithful evening was not an exception.
I was walking just outside hot-springs hotel when a commercial motorcycle operator who’s also a friend of mine waved at me. “How are you Bashir” he greeted me. I never planned to go with motorcycle; I never planned to ride it myself. “Am fine, just wait” I replied. “Why don’t you ride it, it’s easy” something inside me told me. “Are you going to KIU, I give you lift?” he offered. “Let’s go” I made up my mind. We were standing at a corner just outside the hotel. I sat on the boda behind him and we moved down the road diverting from the high-way. I heard about recent fatal accidents in the main road; I was an eyewitness for some of them. Whenever it is convenient for me, I often take the smaller and less busy route to get to school. I convinced the motorcycle operator to take this same route. After a minute or so, I stopped him and asked him to allow me to do the ridding. “Do you know how to ride” He asked skeptically. “I know how to ride bicycles” I replied as I grasped the steering and jokingly pushed him aside. I sat on the rider’s seat. He occupied space behind me. I didn’t inquire about the brake or clutch. I didn’t ask him where to start or even how. I just sat on the machine and squeezed the accelerator. It violently jumped once or twice. “Clutch ssebo”1 he screamed. I was supposed to press on the clutch before starting with accelerator. It was a naïve mistake.
It was at this point that I should have withdrawn from my stubbornness. It was clear to me and to him that I had never dealt with motorcycles before. The farthest I had gone with them was to ask them to take me where I want-school, market, bank etc. I never rode a motorcycle!
The next time when I touched the clutch, and then slightly pressed on the accelerator, it stabilized and moved slowly under my control. Few people who were watching us when I was struggling with the motorcycle now started to applaud. Some men who were washing cars nearby joined in. I sped away from their applause. “Thank you Bashir” an elderly man was saying when we disappeared down into the rough road. From there I lost control. Death was my sunscreen. “Brake!” the fellow was screaming. I several times tried to stop it, but every time I pressed somewhere looking for the brake the motorcycle got more energy and the speed increased turbulently! My entrapped friend behind feared for his life. He probably never rode a motorcycle at such a speed. “Please stop it” he pleaded with me thinking that I was enjoying the doomed ride. I didn’t talk to him. I was thinking of the kind of lacerations I’ll have to nurse after the motorcycle falls. I prayed to God “Oh dear, I don’t want internal bleeding”
At Masaka hospital during our special clerkship rotations we encountered many cases of head injury. Some picked up and survived. Others grasped their last breath and died. Still others reached our accident and emergency unit when they are already pulseless. I was preoccupied with these tragic memories.
When we curved with the road, the high way was bursting with cars of all sizes. Many trailers were passing it in both directions, some of them with 24 wheels!
This was the most crucial point to make a quick decision, a life saving one for that matter. Shall I continue struggling with the motorcycle and in the process find myself in a busy road and under speeding buses bound for Congo? During those few seconds many ugly pictures crossed my mind, the worst being death by hemorrhage. I have seen many people die this day, most of them from Road traffic accidents.
All over sudden I turned the motorcycle to the road side, into a fence. I almost crushed two women who were passing-by alongside the road. When they saw a flying machine that was coming their way, with the rider’s eyes closed, they knew that they had to flee for hills. They had to flee for their lives! I can’t describe the moment when it fell. It is vague to me because there was suddenly a blackout. We crashed into a bushy fence with barbed wires.
The first thing I did was to carry out a quick survey (ABC) on myself. My pulse was normal and I was not in any respiratory distress. The second task was to find out if there is any long bone fracture. I stood on my legs and it was perfect. I raised my hands in the air. No pain, no disability. Then in a few minutes a sharp pain organized itself, coming slowly from the right shoulder and from the outer side of the clavicle. I got so worried. I did not fear about pain or fracture. I feared for my subclavian vessels. I feared tear to these vessels and subsequent quick death! I did self examination on that side. I felt a sharp end of the clavicle pointing out but not pierced the skin. Medical student syndrome reached its maxim and it was tearing me apart.
Good Samaritans took me to our hospital, Kampala International University Teaching Hospital. Nurses did checkups. Everything was normal. A doctor who’s not familiar with me came in and examined me. “Could there be laceration to the subclavian vessels?” I asked him as a nurse injected me with pain-reducing drugs. “Young man you have a fractured clavicle but I’m not sure about lacerated vessels” he said writing something on my file. “You are just anxious, well, we’ll need an X-ray” he added. “And for your information, clavicular fractures are managed conservatively” he reassured me. “Please call the orthopedic officer let her examine him” he instructed a nurse. The officer told me the same thing, that management is conservative. “The only problem you will have to live with is swelling when the fracture heals” She said.
The following morning we did the x-ray. The fracture was severe and superiorly displaced. The orthopedic officer, a soft-spoken woman, was so sympathetic. She told me that such fractures are usually treated without any operation. I knew that from our surgical rotation during junior clerkship. “It heals by itself after about 6 weeks” she said. “But wait minute, let me consult with the surgeon” she walked out with the file. She came back after 10 minutes. “Mr. Bashir, the surgeon is against surgical correction” she smiled. “He says that the region where you have the fracture is risky and contains important blood vessels and major nerves” she added. “I’ll have to advise you to see an orthopedic surgeon, he’ll perhaps give you a better explanation” she continued.
She called Dr. Wafule, the medical director of kilembe hospital, about 2 hours drive near Congo-Uganda border and explained to him about my situation. “Let him come with x-ray” he said over the other end of the phone. When we reached his office, he was eagerly waiting reading some anatomy. Abbas, a friend, was accompanying me. “Young doctors from Mogadishu” he said before we could exchange greetings.
Dr Wafule is overly experienced in bones and their treatment. He is a senior orthopedic surgeon. We showed him the x-ray. “The best treatment for your fracture is ORIF-open reduction and internal fixation” he said when he saw the film. “Can you do it, Doctor, please” I said in a desperate tone. I knew he could. “This is easy, I do it in 30 minutes” he said as he looked at the film again. He told us to come the next morning at 10a.m.
I called my parents at home and told them about the operation. People were scared. They prayed for me. My mom was glued to the phone, calling us every second.
When we came the following day, my name was top on the theatre list. Unfortunately, emergency cases flocked in that morning one after another most of them C-sections. We were put on the list the following day. In the morning the medical officer did all the necessary preoperative checkups and a nurse inserted a canola into my arm. She also gave me a theatre gown and I signed a consent form. “Huh” I sighed. I was overrun by anxiety from all directions. “I’m undergoing a major operation under general anesthesia” I told myself. I, Abbas and Abdulkadir who joined us the day of the operation went into theatre. The doctor, the anesthetist and theatre nurse were waiting inside. “You are welcome” the surgeon said. We took pictures with him and with the other surgical team. The clicking sounds from the surgical equipments as they were prepared added even more anxiety. The anesthetist asked me to lie on the operating table. She was a polite young woman. She asked me if drink or smoke. “I’m a Muslim” I said defensively. “Some Muslims drink and smoke” she joked.
Abbas was standing with a tray full of surgical equipments. Since he was a 5th year medical student, the surgeon included him his team. He was the assistant surgeon. Abdulkadir took pictures and videos of every moment. The anesthetist planted a syringe with liquid drugs into the canola. “You are going to sleep” she told me. I was waving my hand when my vision blurred. Then I went into a conscious sleep. I was aware of what was going around me but I couldn’t intervene. Within another second, she gave me a second drug which made me breathless and paralyzed all my muscles. It was so frightening. I was aware that I couldn’t breathe but there was nothing I could do. I couldn’t move the limbs because my muscles were paralyzed, I couldn’t open my eyes and talk because I was in a medically induced sleep. It’s from here that she connected oxygen-containing tubes into my airway that some hope returned to me. She added more drugs and I went into a deep sleep. Immediately after that Operation started, I guess. I later watched the video. A lay person would naively confuse the theatre scene with a carpenter’s shop. The surgeon used hummers to screw the two bone ends together. He also used a saw to trim the ends of the fractured parts of the clavicle.
When I woke up from anesthesia an hour later, I had a severe headache. It felt as if I was being spun in a centrifuge. I couldn’t open my eyes. General anesthesia is notorious. I like surgery and I want to be a surgeon. However, I’ll think trice when I’m operating my patients. Abbas told me later that I delayed to recover from anesthesia and I vomited badly during the operation. Thank God, vomitus didn’t escape into my airway because it was secured with tubes. If it was not this, the outcome would have been tragic!
Friends are assets that are more precious than gold, at least in my description. Abbas and Abdulkadir were with me throughout the difficult time. When I was transferred from theatre there was only one bed and a chair in our room. They had to share the chair to get at least some kind of sleep through the span of that night. In the morning they had bruises and markings everywhere.
When the doctor came that morning we were worried about hospital bills. “Young doctors, I think he can be discharged now” he said after greetings. “How much should we pay doctor” Abbas asked anxiously. “I’ll talk to the cashier, you will only pay for the metals we fixed inside because we also buy them” he said. “The rest is free” he added. At the cashier, we paid 200,000Ugsh ($120). Relatively cheap, compared to some private facilities where the same procedure would have totaled to more than $2000!
I’m heavily indebted to friends who visited me at the hospital or at my place after discharge. Abbas and Abdulkadir are exceptional soldiers. Salute!
