The Noble Maggots
It was July 1993, a warm summer night in the small Northern Nigerian town of Zaria. I was a resident in Trauma and Orthopedic Surgery at the local Teaching hospital and was on call that night. I had been born in Pakistan, but had grown up in this West African town as my dad taught at the local university.
I had gone to medical school here and started my training in Orthopedics. However after two years, I had become tired of dealing with the surgical lifestyle and had been accepted for further studies in the United States. It was my last night on call.
I received a message that a new patient had been brought in. It was a gunshot wound. This was very unusual. Guns were very rare in Zaria. I quickly went to see this patient. He was 24 years old. Apparently he was a member of a local gang. He had gotten into a confrontation with the police, and was shot in the leg. In the ensuing chaos, he managed to crawl into the bushes and lay there for two days until the police found him.
His leg was a mess. Gangrene had set in and it was infested with maggots. The dangerous signs of gas formation in the leg had started. I knew that gas gangrene was lethal and can kill rapidly. He needed an urgent amputation.
I spoke to his family and got the anesthetist on call to prepare for an emergent amputation. The police had handcuffed his good leg to the bed. The constable had to get permission from his senior Inspector to release the cuffs, and we got ready for Surgery.
Suddenly, I heard a commotion outside. A crowd of young men had gathered, maybe 10 to 15, some armed with machetes. They were his friends and fellow gang members. Apparently one of them had heard the Police Inspector telling another policeman that he will tell the doctor not to save the leg as he would prefer this gang leader to be handicapped. Of course no such conversation occurred, but the crowd was adamant that they will not allow the amputation. The Police constable had disappeared.
This was scary. I walked straight up to the crowd and told them that this was the only way to save his life, but since they objected, I will not do the surgery. I took off my gloves for good effect and walked out of the operating room, right through the crowd. It was the bravest thing I have ever done. Thankfully, the crowd parted and let me through. I had given orders for the patient to be put on strong antibiotics, but was not sure he would survive the night.
However, he did survive the night. The maggots in his leg probably saved his life. This was a fact known in the pre antibiotic era that wounds infected with maggots often did better as maggots would remove the dead tissue. He was still very sick, but alive the next morning.
It was at this point that his father came to me and asked me to please do the amputation and save his son’s life. He assured me that the gang members will not interfere. I called the anesthetist and we got ready for emergency surgery.
I did that amputation that day. It was quick and involved a lot of debridement of dead tissue. His wound was packed and antibiotics were continued.
The next day, I came to see him in the ward before leaving for the United States. He was sitting up and eating. The police had released him on bail. I had handed over his care to another colleague. This was the last Surgery I was involved in.
I came to the United States and started a new career in Infectious Diseases and Internal Medicine. I never entered an operating room as a surgeon again.
I have no doubt that his life was saved in part because of the maggots. It was interesting to see something I had only read about in history books.
I thought often about this patient and how his life would be with one leg. I hope he is doing well and has kept out of trouble from the Police.
It was July 1993, a warm summer night in the small Northern Nigerian town of Zaria. I was a resident in Trauma and Orthopedic Surgery at the local Teaching hospital and was on call that night. I had been born in Pakistan, but had grown up in this West African town as my dad taught at the local university.
I had gone to medical school here and started my training in Orthopedics. However after two years, I had become tired of dealing with the surgical lifestyle and had been accepted for further studies in the United States. It was my last night on call.
I received a message that a new patient had been brought in. It was a gunshot wound. This was very unusual. Guns were very rare in Zaria. I quickly went to see this patient. He was 24 years old. Apparently he was a member of a local gang. He had gotten into a confrontation with the police, and was shot in the leg. In the ensuing chaos, he managed to crawl into the bushes and lay there for two days until the police found him.
His leg was a mess. Gangrene had set in and it was infested with maggots. The dangerous signs of gas formation in the leg had started. I knew that gas gangrene was lethal and can kill rapidly. He needed an urgent amputation.
I spoke to his family and got the anesthetist on call to prepare for an emergent amputation. The police had handcuffed his good leg to the bed. The constable had to get permission from his senior Inspector to release the cuffs, and we got ready for Surgery.
Suddenly, I heard a commotion outside. A crowd of young men had gathered, maybe 10 to 15, some armed with machetes. They were his friends and fellow gang members. Apparently one of them had heard the Police Inspector telling another policeman that he will tell the doctor not to save the leg as he would prefer this gang leader to be handicapped. Of course no such conversation occurred, but the crowd was adamant that they will not allow the amputation. The Police constable had disappeared.
This was scary. I walked straight up to the crowd and told them that this was the only way to save his life, but since they objected, I will not do the surgery. I took off my gloves for good effect and walked out of the operating room, right through the crowd. It was the bravest thing I have ever done. Thankfully, the crowd parted and let me through. I had given orders for the patient to be put on strong antibiotics, but was not sure he would survive the night.
However, he did survive the night. The maggots in his leg probably saved his life. This was a fact known in the pre antibiotic era that wounds infected with maggots often did better as maggots would remove the dead tissue. He was still very sick, but alive the next morning.
It was at this point that his father came to me and asked me to please do the amputation and save his son’s life. He assured me that the gang members will not interfere. I called the anesthetist and we got ready for emergency surgery.
I did that amputation that day. It was quick and involved a lot of debridement of dead tissue. His wound was packed and antibiotics were continued.
The next day, I came to see him in the ward before leaving for the United States. He was sitting up and eating. The police had released him on bail. I had handed over his care to another colleague. This was the last Surgery I was involved in.
I came to the United States and started a new career in Infectious Diseases and Internal Medicine. I never entered an operating room as a surgeon again.
I have no doubt that his life was saved in part because of the maggots. It was interesting to see something I had only read about in history books.
I thought often about this patient and how his life would be with one leg. I hope he is doing well and has kept out of trouble from the Police.
Zaria, Nigeria, July 1993.
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