This week I have been alone in the house with Agnes, our cook/housekeeper. All of my roommates are away in Kampala taking exams for a masters degree program they are enrolled in. Our next-door neighbor, Beth, is also in Kampala for the weekend and her askari (guard), Fred, is taking care of her house. (Every house has to have a night guard. Fred is unarmed, as is our askari, Lazaro).
At 4am on Saturday morning, my phone is ringing. I see that it is Agnes calling me. She would never call me at that hour unless it was urgent.
ME: Hi Agnes. What’s wrong?
AGNES: Doctor Veronica, I am here with Fred. He is crying.
ME: What? Crying?
AGNES: These people, they came to Beth’s house to steal and Fred, he stopped them but they cut him.
ME: WHAT?? What happened? Robbers? Where are they?
AGNES: They have gone. Doctor Veronica, there is blood.
ME: He’s bleeding? Where is he injured?
AGNES: Blood is pouring. BLOOD.
ME: I’m coming.
I jump out of bed in a daze. I look around, grab my headlamp and put on shoes. What the hell is going on? Where is Fred injured? What if they cut open his abdomen or something? Can I repair that? He doesn’t even have a uterus. OK, stop thinking about that. What do I need? I have no idea. OK, go.
I get outside and Agnes is waiting for me. We approach the fence that separates our yard from Beth’s and call to Fred. When he comes to the fence, he is leaning forward. Blood is covering his shirt, his face, his head. What the hell?? Where is he injured?
I realize that the majority of the blood is on his forehead, and then I see a 4cm horizontal laceration on his frontal scalp that is actively bleeding. I tell him we need to go to the hospital now to stitch it, but he refuses to leave. He says we will go in the morning.
I try to ask what happened. Fred normally has a moderate stutter, but now he is completely shaken up and can barely get a word out. I decipher that they hit him with a panga (machete), but that’s all I can get. I decide to let him calm down – we can find out later. He shows me that during his fight with the robbers, he managed to get the guy’s shirt, his shoes, his keys and his panga (which is really a large knife rather than an actual panga). Pretty impressive.
(We have the same knife in our house. It barely cuts anything, lucky for Fred.)
I encourage him to clean off the blood and put some pressure with a cloth to stop the bleeding. The scalp can bleed profusely, even life-threateningly. He repeatedly refuses to leave his post to go to the hospital. The bleeding seems to improve over 15 minutes. I instruct him to have Agnes wake me up if the bleeding returns.
Agnes tells me that she originally woke up because she heard Fred yelling for Lazaro, our askari. She and I go looking for Lazaro but we can’t find him anywhere. He is supposed to sit in front of the house and guard all night. His bicycle is there, but he isn’t. We walk all over the yard calling his name, but he doesn’t answer.
Fabulous. Eventually, I go back to bed, but sleep isn’t an option. I am wide awake and full of adrenaline. Our guard is MIA, and the neighbor’s guard has just been attacked. What if the robbers had tried to come to our house? No one would have stopped them. The house is locked, but should I lock my bedroom door? What about Agnes, who stays in a separate little house?
I lie awake for a couple of hours and eventually doze off. Agnes wakes me at 7:30 from outside my window.
AGNES: Doctor Veronica!
AGNES: Those people, they have returned. Fred has caught them.
ME: What?? They came back?
AGNES: They have come back, and Fred has caught one. He has him there.
ME: I’m coming.
I get outside, and Agnes calls Fred to the fence again. He comes, and he has a cloth wrapped around his head to cover the laceration. He drags over the robber he has captured, and I realize it’s just a kid. He looks about 16, terrified and miserable.
What am I supposed to do now? I call people from work to try to get someone who can go to the police station and send the police here. I finally reach someone and we sit and wait. Interestingly, the kid doesn’t make any attempt to run away, even when Fred dashes off and leaves him alone for a while. Fred brings a mzee (old man) who knows everyone in town, thinking the mzee will know this kid. As they are talking, I turn to Agnes.
ME: So what happened before? How did Fred get cut?
AGNES: When those people came, Fred saw the first one, and he started to beat him. He was really beating him, and he was crying out “Stop beating me! I am going to die!” Then the second one came, and he had the knife and he cut Fred on his head with the knife.
ME: Does Fred recognize this boy? Was he one of them?
ME: Did he see the robbers?
AGNES: The first one, he saw. He saw him very well, because he was beating him with the torch [flashlight].
I can’t help but laugh at this.
ME: So this isn’t the first one?
AGNES: No. But maybe he’s the one with the knife, I don’t know. Fred did not see that one.
I call my coworker, Jesse, to see where he is with the police.
JESSE: I am here with the police. But they want money for transport.
ME: They want money?? For transport?? But they’re the police.
JESSE: Yes, the police. They want money.
JESSE: How many suspects are there? Are they many?
ME: Just one.
JESSE: Just one? They thought there were many, and they didn’t have fuel for a vehicle. I think we can come on bodaboda.
The police finally arrive with Jesse. They inspect the yard, and Fred shows them what happened and where. The Detective introduces himself, gives me his phone number and tells me to call him directly if we ever have trouble again. I am relieved. They take the suspect and Fred to the police station. I tell Fred to come and get me once he is finished making a statement. I give a small amount of money to Jesse to pay for the bodabodas (whaddayagonnado).
When Fred gets back, I am starting to feel my lack of sleep. I have had 2 cups of coffee already, but they are fading. Fred has covered his wound with a cloth and a baseball cap. We take a bodaboda to the hospital.
At the hospital, I need to call for the anesthetist to help me open up the supplies I need to close the laceration. The last time I repaired a scalp was in medical school (Interestingly, that person had been whacked with a machete, too. Ah, Brooklyn.) The only thing guiding me is the fact that a year ago, a friend of mine split his head open in a Harry-Potter-style laceration in a Frisbee-induced collision with someone else’s face. I took him to the ER and had extensive discussions with the ER physician and an acquaintance who is a plastic surgeon regarding the proper technique for repair. That incident was not very lucky for my friend, but is quite lucky for Fred, because now I have some slight idea of what to do.
I put together everything I need, and get started. Immediately, I am cursing myself. It is really hard to inject lidocaine into the scalp, and Fred is not getting much pain relief in some areas. The needle I have on the suture is not ideal – it’s too big. The more I manipulate the scalp, the more it bleeds, which makes it difficult to see. For crying out loud, I’m a gynecologist, why am I stitching up someone’s head?
Because there is no one else, that’s why. Fred is really brave about the whole thing. I can see him cringe occasionally, but he tries not to complain. I tell him to complain because then I know where he needs more lidocaine.
The laceration is not very deep. I suture one layer closed, but the superficial part needs better closure. The other needle I have is even bigger, and hurts Fred way too much. I hunt down someone to open a smaller suture for me, and I find a nice tiny suture with a tiny needle. It doesn’t hurt Fred at all. I close the superficial part in interrupted sutures. By the time I am finished, it actually looks pretty good. Not bad for a vagina doctor. I hope it heals ok.
I am so impressed with Fred. All day, I am showering him with praise over how brave he is. He is so sweet and modest, he just smiles sheepishly. He reminds me that he needs a tetanus shot, and that is another herculean task.
It turns out that the tetanus vaccine is only kept in Antenatal Clinic, which is closed on weekends. I go to Labor Ward, where I start a phone chain of calling people to try and get the key for the clinic. I have Fred waiting there, and I imagine he must be hungry, so I buy him a mandazi (Ugandan doughnut).
After more than an hour, a nurse finally arrives to give him a tetanus shot. I make arrangements for Fred to go home by motorcycle. By 3pm, I am completely exhausted and ready for a nap. After buying groceries, I head home, and Agnes and I recount the night, laughing at the insanity of it all.