I wish I were joking, or that this was a lead-in. This morning, a bus built to carry 22 seated passengers fell off one of the winding dangerous roads outside of Thimphu. Apparently the accident was about 40 km. away. A fleet of ambulances headed out and brought back the mass casualties. There had been 35 people on the bus. It is stated that the bus fell several hundred feet. Eight were dead at the scene, and 27 people were brought to Jigme Dorje Wangchuck National Referral Hospital.
This was the first time I had experienced mass casualties in my medical career. An "all hands on deck" call went out, and literally anybody and everybody who could function in a medical capacity descended upon the Casualty Ward. My first job was minor, figuring out how to take an AED out of automatic mode and put it into manual mode so that we could try and countershock a woman who had sustained massive injuries. After getting the damn thing to work, we tried several times to restore a rhythm, but my guess is that she had sustained a massive head injury or massive internal bleeding. We could not revive her, and she was the ninth death.
There were little kids with fractures. There was a young man with internal bleeding who went straight to the OT. There were adults with fractures, ultimately a total of 4 open fractures and a good 15 or so more with closed fractures. I shepherded a woman with a scalp laceration down to the skull to CT scan, and we confirmed that she didn't have a skull fracture or intracranial hemorrhage. There were lacerations everywhere. There were infants with bandaged heads suckling their mothers with fractures. I was utterly useless except for those two patients.
It looked like pandemonium. It looked like a madhouse. It was sublime.
In all my career, I have never seen anything like this, and I probably never will again. It's almost as though a collective consciousness arose among the caregivers in Casualty. I know that sounds nuts, but it's true. There was no jockeying for position, no posing to be the leader, no screaming, no yelling, no put-downs, no self righteous types telling everyone what to do. People figured out what they could do, and they did it. They cooperated, they documented, they handed off when they couldn't handle it. Patients simply disappeared to X-ray and reappeared with films. The adminstrator of the hospital was there, completely unofficious, once gently taking me by the shoulder and guiding me to the side of a patient who had not yet been seen by a physician. Wristbands are not generally used at JDWNRH, but the nurses spontaneously made wristbands out of tape. Casualties were stabilized and the Casualty Ward was under control and close to normal function in two hours. I feel as though I have been witness to a spiritual experience.
Patients who were here for clinic visits simply went home because they understood that the docs were busy. All elective cases in the OR were postponed. All docs who had any ability to work in the OR were told to stay put so that they could assist and work with any cases that could use their expertise, and they did. Later, the King came to the hospital to offer condolences and provide support to the families of the vicitms.
I talked to the chief administrator after things had calmed down. I told him I was profoundly impressed at the quality and speed with which the problem had been handled, and he was most gracious about the compliment. I asked him if this happened often or if they drilled regularly. He told me that the last time something like this had happened was about 5 years ago, and no, they did not drill regularly. This incident has further tightened my bond to this hospital and this country. I simply must come back.
It's worth observing that before this incident occurred, I was all excited about creating another medical entry because I had seen two conditions I'd never seen previously-- eclampsia (no, not pre-eclampsia, the real seizing thing with fetal demise) and tetanus. Maybe when I catch my breath I'll expound a bit.
That's all for now.
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