Just another Night in the Pheriche ED...

Just after we went to bed last night, there was knocking on the clinic door. Always open for emergencies, I opened the door to a local Nepali who was covered in blood and holding his right arm at an odd angle. Arjun and I tried to get the story of what happened but it kept changing. After cleaning up his head and face, he had a large linear scalp laceration down to the bone which didn't match his story of a blunt fall. We also recognized him as a patient we had seen only six hours earlier for gastritis and had sent away with instructions to avoid alcohol and spicy foods. He had alcohol on his breath and was barely upright. He then admitted to getting into a "discussion" with someone over yak dung who came after him with a kitchen knife. Huh? I thought I left the drunken knife-and-gun show in Boston.

He also likely had a broken arm but he wasn't very cooperative with us examining. So we decided to just splint it and send him to Khunde for an X-ray in the morning. I wish I had paid more attention in residency splint lab on working with plaster splints. I made a terrible mess. But we stapled his head, splinted his arm, and put him to bed in our "observation" ward because it was after midnight, his home was an hour walk, and home didn't sound safe anyway. When I awoke in the morning to arrange for him to go to Khunde, he was gone. Arjun tracked him down on his cell phone. Today his story is his wife eloped with another man and took all their money. He tried to stop her, and they got in a knife fight. He agreed to go to the Khunde clinic later after securing child care.

For those who don't know my reputation, I have a bit if a "crazy cloud" where if there is someone running naked in the emergency department halls who thinks they are Ra the Sun god, they are likely my patient. Psych patients find me somehow. They might say their chief complaint is "rash" but that's because he has scrubbed his body with bleach trying to rid himself of "the black bugs" or they have constipation because "the man in the shadows" won't let her near the toilet. So really this frequent flyer, alcoholic, vague story of trauma guy was pretty run-of-the-mill except he seemed out of place in Pheriche.

The full moon has been up most of the day and it seems to be affecting our patients and visitors. A group of Americans wanted a tour and to all buy t-shirts before 7am. They were quite nice, but I was still searching for my lost patient and still had my plaster splinting mess to clean up. Then we had two girls from Denmark with migraines and knee pain who were later seen taking a helicopter down after not wanting to pay our $50 consultation fee. (Helicopters cost $7500 minimum.) Then another drunken local with multiple long-standing complaints came by who was still drunk at 8am. And that was all before we even opened for the day. The stories have been strange all day and the complaints could have easily been on the ED board back in the US: migraine, back pain, epigastric pain, ear wax... Just another day stamping out death and disease - the international version.