Tuesday, June 9, 2009

Trauma on the Trans-Flores Highway

If only we had left the hotel five minutes earlier. If only lunch had taken 1 minute longer. If only we hadn't pulled over at the drivers' aunts' house to get a pair of pliers. If only we had to pause for a bathroom break.

If the timing had been 1 minute off, we wouldn't have rounded the blind corner at the exact moment the motorcycle came barreling downhill in the other direction, hugging the curve a little too far inside.

But our timing was perfect. All I remember is the crunch of plastic, the sound of headlights shattering. The thud of his body hitting the side of our SUV. The wide-eyed frenatic face of our driver as his neck whipped around to watch the motorcyclist flip over. My moment's hesitation before I opened the door and ran outside, to where the motorcyclist lay moaning on the ground. The blood spilling from his head and leg. The bone protruding near his right knee.

The medical student among us whipped off his t-shirt and used it as a tourniquet. I ran to grab our first aid kit, not knowing how far away the nearest hospital might be. Locals rushed from their homes to stare. Three Indonesian men grabbed the motorcyclist, picked him up by his arms and legs, and carried him to the backseat of our SUV. My friends scrambled to get out as the local men loaded the victim inside. Our driver sped off with the motorcyclist moaning in the backseat. Our medical student friend, still holding his t-shirt against the victim's leg as a tourniquet, rode along, elevating the motorcyclists' leg and not letting him see the wound.

We got directions to the nearest clinic. By stroke of luck, it was less than 2 kilometers away. We walked there, single-file. Taxi drivers and touts shouted at us during our walk, wanting to make a quick buck off the Westerners, as they always do -- "you want taxi?", "hello, hello, where you go?" "I sell you pearls?" -- but their words sounded especially hollow. How could they even think of goading us into spending money at a time like this?

The clinic was bare, empty, white. It had 4 rooms with not much more than a bed inside each room. When we arrived they were operating on the victim's leg. The injury wasn't as bad as expected. Nothing had shattered. His bones were intact. The gash in his knee was severe. He looked like a cadaver; tendons and muscle visible. A man in a green military uniform and flip-flops was sewing up a flap of skin over the gash. It fit together like a bad jigsaw puzzle, leaving a border of visible muscle around it. The room had no lightbulbs. The man in flip-flops was operating by the light of the afternoon sun streaming through west-facing windows.

A Muslim woman in a white headscarf and flip-flops was swabbing at his superficial cuts with cotton balls. She placed a blue trash can under the operating table, where his blood was flow into. Sometimes the blood barely dripped into the trashcan; other times it gushed like a broken dam.

The motorcyclist kept moaning and groaning, his voice low like a dying animal. He never screamed, never yelped in pain, never raised his voice. He seemed to be in shock. Occasionally he'd lean over to vomit off the side of the operating table. I later learned that was a symptom of head trauma. All I could notice at the time was that he was regurgitating mostly rice.

A crowd of children with dirty clothing and bare feet stood in the open double-doorway of the operating room, watching the gory sight with passing curousity. They were all boys, around 8 years old, distracted from their football game. None of the adults paid attention to them.

A man with glasses and good English came to speak to me. He said he'd seen Michael Moore's movie "Sicko" and asked how much this operation would cost in the U.S. "I don't know - $10,000?" I said. He asked for $16 for the ambulence that would come transfer the patient to a larger hospital.

The driver told us he'd have to stay in town for at least 2 nights, sorting things through with the police. Apparently under Indonesian law, when a car and motorcycle collide, it is always presumed to be the car's fault, even if (as in our case) the motorcyle had crossed over into the wrong lane. Ultimately the final arbiters are the police, and our driver was now faced with the task of convincing them of his innocence. He told us to catch a bus to the next town and be on our way.