Elvis

(Click Photo to Enlarge)

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Over the years, I have developed a routine when I first enter a trauma room... time is always of the essence... In a matter of seconds I take stock of the situation as I initially see it, process everything around me as quickly as possible and prioritize what my first response should be before taking action to treat the patient.

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The difference on this day was that this was not a cardiac case and I would not be participating in the care of this patient. My initial impressions were that there was very little in the room but the anesthesia machine, the patient on the OR bed, and the nurses back table with a few instruments. There were very few people in the room as well; the anesthesia technician was starting an IV on the patient, the nurse was setting up her instruments and Dr. Russ was evaluating the patient, formulating his thoughts and letting everyone know what he thought he would need during the course of the ensuing operation. They all appeared to be moving in slow motion as my mind was racing to take in everything around me during my first-ever exposure to surgery in Kenya.

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At first glance I didn't see any of the expected signs of a brutal fight; there was only a small piece of metal protruding from the front of the patient's neck as he lay on the OR table intubated and asleep. As I approached the patient, I was alarmed and saddened to see that he was a young man probably 19 or 20 years old. Really only a boy, just a few years older than my own son. The next thing I noticed is that his feet looked too old for his age. They appeared to be the feet of an old man who had walked barefoot for decades along the dirt roads of Kenya.

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As I walked over to the view the patient's X-rays on the viewing box I was alarmed to see what kind of arrow he had been shot with. As Dr. Russ explained to me, the Kipsigis make their arrows out of 10-penny nails. The flat head of the nail is is hammered into the tip of the arrow and the portion of the arrow-head that we could see protruding from his neck was the sharp end of the nail. That's not all. If you take a close look, very sharp barbs are somehow fashioned along the length of the arrow-head that make it virtually impossible to pull out once it is embedded in the unlucky recipient. The only way to remove the arrow is to push it forward in the direction it was shot. One more thing; the arrow-head is attached to the wooden arrow in such a way that when it hits the intended target, the wooden shaft detaches from the metal arrow-head to prevent anyone from getting a good enough grip on the embedded arrow-head to pull it out.

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As you can see from the X-rays above, the arrow entered the front of his neck from the side at a 45 degree angle and although we could not see an exit point on the back of his neck, there was a full 5 inches or more of a jagged metal weapon lodged in his neck in close proximity to his spinal cord, jugular veins, carotid arteries and esophagus. The amazing thing was, that he was able to talk when they brought him into the hospital, although Dr. Russ said his voice was raspy. No one was sure what his story was except that he was shot around midnight and he did not arrive to the hospital until approximately 10 am that morning. I was told that the Kipsigis will retaliate like this for 3 reasons; if you mess with their women, their cattle, or their property... three things that I would be keeping a very long distance from during my stay in Kenya.

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Across the bottom of the X-ray his name was clearly written... Elvis.