The Obvious

A siren blasted away outside the casualty area. Nothing unusual for me but it was unusual for a hospital in a city with no ambulance service. I watched from inside as the crowd looked out from the open air waiting space in the direction of the noise. This was going to be interesting.
Two nurses wheeled a stretcher into the department with a man lying on his back with an arrow embedded in his right chest.
The arrow was pulsating.
About that time I realized I was the only physician around. Normally not a problem. In fact I knew what obviously needed to be done and NOT done. The man needed to go immediately to the operating theatre to have the arrow removed after his chest had been opened under controlled, visualized conditions.
He came with a set of x rays from a transferring district hospital which also included a picture of his dislocated left elbow. The blood and air in his left chest were adjacent to a barbed arrowhead. Should someone had attempted to remove that arrow, the man probably would have bled to death.
As it was, he had normal vital signs and was responsive though I did not attempt to speak with him. I wouldn't have understood him anyway.
I knew what needed to be done and began with the nurses help to prepare the man for immediate surgery. We however could not locate a surgeon.
BMC is a teaching hospital and is one of 5 consultant hospitals in the country. There is a thoracic surgeon on staff who happened to be out of town. At this time the surgery intern arrived and spoke to the man. He called his senior resident. The decision was made to place a chest tube and schedule an elective thoracotomy for when the thoracic surgeon returned. They were going to leave the arrow in.
Then the intern shared with me that the arrow had already been there two days. Their plan actually made sense.
What seemed so obvious to me doesn't seem so obvious anymore.