Dr Gopee

Fatal road accidents on the decline?

 

Dr R Neerunjun Gopee

 

There were 31 fewer people who died in road accidents last year than in 2008, according to an officer of the Traffic Branch who was being interviewed on the radio the other morning. He added that their objective was to reduce the number of fatal accidents even further, and said something which had a ring of truism, namely ‘ce n’est pas la route qui tue, mais c’est l’homme qui tue.’ Perhaps he should have added ‘qui se tue – ou essaie de se tuer’ I reflected, as I recalled one of the so many victims of road accidents that I have come across as a doctor.

 

That was in the UK when I was training to be a surgeon, and the subject was a 17-year old who was admitted after a motorcycle accident. He had been partying with friends in a pub after work, and he was speeding back on one of those huge monsters that dare-do youngsters like to show off on. Within minutes he had crashed, and he was brought to hospital in an unconscious state, with multiple injuries.

 

 

He had fractured his leg, sustained a tear of the bowel, punctured his lung, and had a head injury too. Medical and health personnel are of course used to such things, and they set to work patching him up. Several days later when I was doing my ward round, there he was sitting up in his bed, smiling and quite comfortable, with little pain if any at all, and I had the opportunity to have a longer chat with him. And why he is one of the most memorable cases in my career was what he was intending to do once he was well and was discharged: he was already planning to buy himself a more powerful motorcycle! – and showed me the model in a magazine that he was reading.

 

I could not believe my ears! For his present accident was the second one in his short span of life, and it was almost to the day one year after his first accident which took place under exactly the same circumstances! He had gone to the same pub after work, and had crashed similarly because of speeding, and again not very far from the pub and the hospital too, for the pub was just down the road about half a mile away. And he had once more sustained multiple injuries. When I asked him whether two accidents with such serious injuries were not sufficient to deter him, and admonished that he might not be third time lucky, ‘so wha?’ he said, in the vernacular typical of West Yorskhire, ‘’a luv me bike…’

 

Motorcycle accidents are the dread of doctors in general, and orthopaedic surgeons in particular. They are known to be associated with the most extreme types of injuries, and mostly involve young people in the prime of their life and often at the peak of their productivity at work. And they are often fatal; if not, they frequently result in severe disability. One of the most feared calls that an orthopaedic surgeon can get is when the junior resident phones to say that he has a youngster who has come in after a motorcycle accident and he can’t move his upper limb on one side or the other. The first thing that comes to the surgeon’s mind is ‘brachial plexus injury!’

 

The brachial plexus is a bunch of cord-like nerves that pass from the lower part of the neck, coming from the spinal cord, and course under the collar bone towards the arm (brachium – hence brachial), and thence divide and subdivide into branches that go all the way to the hand. Nerves are like electrical cables that transmit electricity from the central station to the periphery. Cut the cables, and no electricity flows: life is paralysed.

Exactly similar is injury to the brachial plexus: it is so badly damaged that the signals (which are in fact of electrical nature too) from the brain via the spinal cord to the upper limb cannot be transmitted, and the limb is therefore paralysed. More often than not this is irreversible, and repairing the brachial plexus and attempting to make the limb regain some function is one of the most daunting challenges in orthopaedics. And even if function comes back, it is never complete, there is always a persistent weakness and deficiency.

In the worst case scenario, the damage cannot be repaired, the limb remains paralysed, and is such a burden that many a patient prefers to have it amputated, especially if it is associated with pain and odd sensations which damaged nerves generate.

 

My Yorkshire patient fortunately did not have a brachial plexus lesion – as it is, he had enough of injuries already! I do not know what happened to him later on, but I do hope that he was luckier with his new, bigger bike! And that is why the observation of the officer from the Traffic Branch rang a bell in my mind – at the origin of it all is human behaviour. Which, analysed and understood objectively, can be largely controlled by a directed effort of the will. This then allows us to exercise the choice of which we are rationally capable. Alas, mostly we allow ourselves to be ruled by passion and emotions, and then we reap the consequences.

 

Of course, passion and emotions have their place in the human being’s life. Without them we would be robots, and act reflexly without thinking. We want to love and to be loved; we want to be moved by the sight of sunrise and sunset; to admire the beautiful rose with the morning dew on it, and lift it to our nostril to be lost momentarily in the aroma of the perfume with our eyes closed… All this we value – and yet at times, we consciously make decisions that endanger our lives.

 

Such as drunk driving and speeding, or riding without a helmet. Or exhibit road rage for simple matters. The list is long indeed, but we are all aware of the precautions that we should take so as not to be victims or to produce victims.

 

It is right therefore that the arm of the law should be strong enough to force us to behave for our own safety. The Global Status Report on Road Safety by the World Health Organisation is clear that it is ‘the low level of enforcement of simple road safety measures, like prohibition and monitoring of drunken driving, wearing of seatbelts and child restraints, and checks on speeding, that leads to a majority of deaths.’ Studies worldwide have confirmed, for example, that merely enforcing sobriety checks and carrying out random breath-testing can bring down dramatically alcohol-related crashes. Ditto for reduction of injuries and fatalities by the use of seat-belts and crash-helmets.

 

So kudos to the Traffic Branch, and I wish them bon courage in the pursuit of their noble objective.

 

RN Gopee