Wednesday, May 28, 2014

ER Stories 12: Motor Vehicle Accident (MVA)

It's almost one.


Uh.. it's sort of almost one.


We've stopped accepting new patients at this point. (That's the nice part about working in a health clinic in Ecuador: we can close up shop for an hour a day during lunchtime without much consequence.)


I fill the waiting time by cutting out more blank patient identifying cards (since Fernanda, my coworker, is hogging the only computer).

Left to right: Chamni (GCY 2014), Fernanda (my coworker at Patronato, 2012) and Denise (coworker 2013)

The clinic doors are wide open and the coastal Ecuadorian architecture leaves open space between the top of the walls and the tin roof. I can hear every rooster crow, every motorcycle and every laughing colegio student coming home for lunch. The sounds blend into a lull of the normal background noises. I only notice them when I am bored enough to pay attention.


I put my scissors away in the desk drawer. Fernanda, the doctor and I are finally start to pack up.


Almost lunchtime.. 

I refill my water bottle.


The clock is moving so slowly.


Fernanda grabs the key to lock up.


Screeeeeeeeeeeech. A car hits its breaks hard right outside. 

Before we have time to react, a man sprints inside the. He is out of breath: "My friend... my friend.. he was in an accident.. come help.."

Fernanda tosses her purse on the desk and hurries to the car. I throw my purse next to hers and follow. I intend to help, but Fabian, the office manager (and retired CNA) who works in the building next door is already at the car. I watch as he helps a teenage boy out of the passenger side. The young man is wailing and repeating "Me duele.. me duele.. me duele.." As soon as they step out from the shield of the car door I see why. He is covered in scrapes and burns and cuts and blood. Fabian has his arm around the young boy's shoulder and the patient is half-heatedly, barely hopping on one leg.

We rush him into our little emergency room and help him onto the exam bed.

This is my first very serious medical case ever, and everything seems to happen in a blur from this point on.

Our small emergency room seems even smaller than usual, because it is now full of people. The doctor is looking the boy over and asking him questions. The boy explains that he crashed his motorcycle and slid on the pavement. He was wearing a helmet, but no protective clothing. His words get faster and less clear and I can't make out his words anymore. Fabian is putting in an IV. Fernanda is cleaning wounds and holding the patient down as needed. I am helping where I can, but mostly I am running back and forth retrieving suture kits or IV fluid bags or bandages.

"Grab the scissors," Fabian tells me. He uses two fingers to imitate scissors, because this is the very beginning of my bridge year and I do not understand much Spanish yet.

I bring that back just as Fabian finishes explaining that we will need to cut the boy's jeans off. "No! No! No!" he begs. Fernanda cuts the jeans.

Two things become very obvious: his knee and his hip.

His knee is rubbed raw. There is no skin, or even muscle that I can see. The bone of his knee is completely exposed.

[To see photos that remind me of the incident, but are probably a bit too graphic for this blog, check out ]

The doctor shows me how he knows the boy's hip is dislocated

One leg seems shorter than the other and is bent inward.

His skin is covered in asphalt burns and cuts and scrapes. We've given him pain medicine but he is still crying in pain.

The boy's parents arrive to the clinic and we let them see their son. Mom is sobbing and Dad's eyebrows are curved in concern. Dad asks Doctor every question under the sun. The boy cries for his mom and Mom holds his face. His cries make her cry more.

More people arrive at the clinic and each one wants to see the boy. Soon the entire waiting room is full of family and friends and neighbors. Some are crying. All are worried. The boy has become much more uneasy since his visitors came and Fabian orders everyone except medical staff to the waiting room. Mom kisses her boy goodbye.

Our tiny clinic cannot handle an emergency of this magnitude. The boy needs x-rays and easy access to vital medications and specialized doctors. With this in mind, we are more focused on stabilizing the patient for transport than details of his treatment.

We immobilize his inwardly-turned knee with a makeshift splint, using a belt.

We put the boy on a backboard, and we send him to a bigger hospital in a nearby city via a truck similar to this one:

The boy's injuries are serious. 
He is eventually transferred to the biggest hospital in the country,
in Quito.

He survives.

Next Wednesday, June 4th: ER Stories 13: Longboarding & Steep Hills, #senior2K14

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