Bad Day for a Bus Crash

The doctors are young here..........

Of the many personal goals I've satisfied in my 25 years of doctorhood, among them is the ultimate conquering of my work schedule.  Until now.  I've worked possibly fewer Saturdays than any of my  peers (excluding the Psychiatrists of course).  If you work hard, you have to play hard.  And if you play hard you need to free up your Saturdays.  Otherwise, you only think you are playing hard.  Gone are the days when I could work all day, party all night, catch an hour of sleep, shower and show up to work looking reasonable.  Long gone. You are probably saying the same thing regarding your job, but the advantage of working in the medical field is that you can wear a mask to prevent breathing alcohol all over your client.  And if you work in the Emergency Room, you can usually blame it on the patient much in the way that you can blame a dog in the room when you fart.  I'm not suggesting that doctors show up to work drunk, but we are human and metabolize alcohol at the same rate as civilians.


Now in my retirement  it's different.  I work six scheduled days a week, every week.  Sundays if there's an emergency.  As a retired person I am a failure.  Back when I lived in LA even an act of the Buddha couldn't get me to work on a weekend.  What changed?  What was so heinous back in civilization that I'd rather get a tooth pulled than drive to Beverly Hills on the weekend to see a couple of patients?  The answer: the system.  In America they  took the fun out of doctoring.  The fun and the purity.  Take that out of a man's job and he'll hate every second after he leaves his home.  These days to get to my office I happily travel through packs of filthy monkeys, five foot monitor lizards, poisonous Green Tree Vipers and insects the size of my foot.  And that's just getting out of my driveway.  Even on Saturdays.


Then again there was last Saturday, but lets go back to Friday night first.  Nobody (at least in a mining camp) throws a party like the procurement and supply chain people.  This fact might be useless to you, but to me on a remote island with severely limited options for nightly entertainment its like  The Stones showing up to play at your local bar.  It's a non-miss event and Friday's party didn't disappoint.  Massive heaps of Indonesian cooked Chinese food were prepared and a Filipino cover band was brought in from neighboring Lombok island.  They weren't The Stones, but they weren't bad.  Like a true Filipino band, they could cover absolutely every song we could yell out.  After a while it became a challenge to find a song they didn't know and we lost that challenge.  I  stood in the middle of the floor, hands held high in Devil's Horn gesture and shouted:


"FREEBIRRRRRRRRRRD!!!!!"


The band immediately broke into Sweet Home Alabama.  Not bad.  Not Freebird, but almost.  The bizarreness of that moment (remote island, middle of the China Sea, about as far from Alabama as one could get) was not wasted on me. Also it was the first time I ever heard the word "Birmingham" pronounced, Billlllllingham.  Asian pronunciation, but we all knew what they meant.  As I was still on call I couldn't join the rest of the guys as they tore into a few precious bottles of Jack Daniels (specifically squirreled away for this night).  I did stick around for moral support though.  At one point we took over the stage and did our own bad renditions of a few Bob Marley songs and a particularly horrifying Mustang Sally, but we were having a good time in the jungle.  I ultimately got home sometime around 1 AM.




Saturday morning comes too soon, but I made it to 7:30 AM Saturday morning hospital rounds, right on time.  If I could have done rounds in a mask and sunglasses I would have.  I tend to clean up well, but I hoped I didn't look half as bad as I felt.  I was half counting on the notion that, to my Indonesian staff, all white people pretty much always look the same.  Luckily it was a quiet morning.  As noon approached  I dreamed of getting on my couch after lunch and velcro-ing myself there for the rest of the day.  Then..........................


"Doc.  Bus accident."  It was said so matter-of-fact.

If you see this, something bad happened

The potential ramifications of those three words sent out  painful ripples in my brain.  This is a mining site with over five thousand employees.  We have buses of all sizes, the biggest of them carrying sixty or more people.  Extrapolate that to our little Jungle Clinic  which has three small emergency room bays and two patient rooms.  I wanted better recon information on the bus and the number of victims so that we could be prepared.  I wasn't going to have time to find out.  A gurney came barreling through the ER door hitting it hard and smacking it into the wall next to my office.


I don't know if I unconsciously said, "oh shit" or if I was just thinking it.  I grabbed a pair of gloves and headed into ER bay number one.  At that time I could see a lot of people start to filter into our waiting room. They were limping or walking on their own.  They could wait.  My staff  turned the waiting room into a MASH-type triage center.  It was happening fast.


I started getting a lot of information quickly.  A 30 person bus had lost it's brakes on the way down the gravel hill that heads into our townsite.  It scraped against the large plastic barriers on the side of the road and careened another half mile down the road before crashing into a drainage ditch by the mess-hall.  Two passengers had jumped from the bus while it was moving about forty kilometers per hour.  One of them was the guy in ER bay number one.  He was unconscious, possibly with a cracked skull.  The second was in the adjacent surgery room.  He was cut, scraped and bleeding, but at least he was awake.  Patient number one was definitely going to need to be air lifted out of here to another island.  He needed an MRI of his head and the sooner the better. The best we could do for him at our place was to stabilize him. I was hoping we could delay the second patients evacuation because we only had one helicopter available .  The second had crashed in the jungle two weeks ago (that is another story).


Our Jungle Clinic is not a bad set up for a jungle clinic.  It is probably the best equipped third world clinic  I've ever worked in.  But we are not a tertiary medical center.  We can plug up holes, deliver babies, put a few bones back together and sew things up that are not completely torn off.  If we have to.  We live in a potentially unstable environment with all kind of threats:  heavy equipment, Dengue Fever, Malaria, Dysentery and Tuberculosis.  Those are the anticipated problems.  Add to these earthquakes, tsunamis, poisonous snakes, civil unrest (twice in the last month) and bus crashes and you have defined Indonesia.  Both beautiful and dangerous.  The idea that we are going to be overwhelmed is never off my mind.  It is terrifying and exciting at the same time.


This time we were lucky.  Two people injured seriously, two people banged up pretty badly and thirteen people with cuts, bumps, bruises and various levels of emotional shock.  We got the first patient x-rayed and ready for evacuation.  The chopper landed in the field across the road from the clinic. He was off.  By six pm the last patient was seen.  The staff sat together behind the nurses station.  They were tired, hungry and giddy.  They discussed where they would go to eat and what they would do on their Sunday day off.  Not one of them is older than twenty-eight, but they showed a lot of maturity today.


I was spent.  I drove up the hill to my house.  The sun was going down and I stopped for a minute to watch a family of monkeys cross the road.  The biggest one hissed at me.  I hadn't the strength to hiss back.  When I walked into the house I got a text message:  "Party at Rantung Bar tonight. Live music.  Food.  Beer." All I wanted to do was lay down on the couch for the next day and a half. I was tired, but I was wired.  I changed my shirt and went back out to the car before the couch started to feel too good.


Rantung Bar was packed as only the only show in town could be.  There was a band from Sengigi Beach that had traveled from nearby Lombok Island.  They weren't like The Stones.  They were more like the REO Speedwagon of bar bands.  I stayed for a beer, but I just wasn't feeling it.  I got in my car and took the beach road home. I cannot party like I used to.