They hadn’t eaten since before starting work that morning and by the time they arrived at the clinic, it was late in the afternoon, the hottest time of the day.
This is when I met him for the first time.
“Doc Shazam, we need you. We have a machete injury…” said the 3rd year resident.
While minor trauma and fractures is run of the mill for me, the family practice docs that typically staff the medical clinic in the rural mountain village seem to find relief with my presence whenever the presenting complaint is trauma. So a machete laceration that is right up my alley is gladly referred to me by the other docs.
This was the first machete injury I’d seen on this particular trip. Usually we have at least a handful. It makes me wonder what the villagers do the other 48 weeks out of the year when there is no physician present, let alone an ER physician who is happy to poke around in tendons and muscles and such.
I had prepared myself for this patient’s visit more than a year in advance. 18 months ago, during my last trip to the mountains of Honduras, I had seena similar case. A young man with a machete laceration, this one due to carelessness, and not a snake, had lost the use of his index finger. I performed a gentle and timid exploration for a proximal tendon without success.
Upon returning home I consulted with my uncle, an orthopedic surgeon with over 40 years of practice. He’s very familiar with my global antics, even from before I went to medical school. I’ve asked him about the very situation I was now facing. Having never done an extensor tendon exploration or repair during my residency and subsequent clinical practice, I have since visualized the exploration I would do and the repair that would be needed.
When these boys and men have no other recourse aside from what they find at our clinic, how can I go wrong but to do an exploration, with the worst possible scenario that they recieve a sterile incision (due to my exploration) and leave with an injury no worse than when they came (only cleaner)
So the senior resident, 2 months away from starting her sports medicine fellowship and I began an exploration in anticipation of an extnesor tendon repair. Others were skeptical…”Are you going ot try and repair that?” they asked. “Why don’t you just send him down the mountain?” another questioned.
I knew that sending him down the mountain was an expensive proposition. First of all, he had no money for the ride down in the pickup truck. It would have to be gathered from the group of us, or deducted form the health committee funds, which are limited considering a clinic visit is the equivalent of 50 cents, which sometimes covers a family of six or more. THis boy had no money at all.
Had I been assured that once down the mountain he would be able to see and follow up with an orthopedic surgeon, I would have given the $20-$40 dollars it cost to take an “emergency” ride down the mountain in one of the three pickup trucks in town. (More than a months wage for many people). But i knew that once he was in the Emergency Room in El Progresso, and had sat there for many hours, all he would get was a few superficial stitches in the skin, and he’d have lost the use of his left hand for good.
That was not an acceptable alternative for me. So, betadine in hand, bandana on head, and LED headlamp in place, I began my exploration for the extensor tendons of his 3rd, 4th and 5th digits on his left hand…
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