Becoming Trauma

I’ve experienced a lot in Mekelle. Most good and some bad, but what I experienced last night will haunt me for some time.

My friends from home often ask if its safe here and my response has always been something along the lines of, “any city is dangerous, but at least its safer than the US right now.” And when I am alone on the streets here, I am hypervigilant, always analyzing my surroundings and thinking about the worst-case scenario. I always thought that hypervigilance would be enough to keep me safe. And finally, last night, I was proven wrong.

As most typical Friday nights we were invited to a friends house for dinner. This happened to be the residence of a Filipina doctor who always makes amazing food. This Friday was no exception. Joined by some of my closest friends here, we ate well and wished many people of the group a safe journey in the weeks to come. Judith is about to leave on vacation for a month, some visitors from the states were leaving the next day and my good friend Erin was about to finish her 7-week stay here to go back to the states. After stuffing ourselves, I nervously watch about a dozen rounds of karaoke, doing my best to pretend that I was busy playing with the dogs. Joseph drove us home and Erin decided to stay at chat for a bit.

It was really my last opportunity to hang out and say bye to her, but once it was getting late, it was time for her to go home. Although she insisted on walking home alone, I reminded her that “I wouldn’t be able to live with myself if I knew something happened to you if I let you walk home alone. Besides, the walk will be good for me.” So, we traveled together in the iconic star-lit sky and bathed in a cool, but comfortable breeze. With a flashlight in hand, we walked the route I had done so many times before, to Judith’s house. Down a very dimly lit, long cobblestone street to the main road, right turn, another 200 meters and then a left down another dark cobblestone. The 5 minute walk was relaxing and after returning Erin safely home, I reversed the trek.

As I mentioned before, I’m always hypervigilant on these walks. So, when I made the left turn to walk back up the long cobblestone hill to my house, I couldn’t help notice that a Bajaj that made the same turn, suddenly turned 180 degrees and descended the hill again. I heard the click of the clunky blue metallic passenger door open and I turned to see it slightly agar as I continued to ascend. The Bajaj turned the corner to the right and 2 passengers got out. People getting out on this corner isn’t abnormal, but the way they did caught my attention.

Crossing from the left side of the cobblestone to the right, I could hear their slightly rushed footsteps in the far distance. Looking over my shoulder, they had also crossed the cobblestone and were a good 60 meters away. A car that turned to come up the cobblestone created an elongated silhouette of our relative proximity. Because of the angle of the light, our shadows were 100 feet long and I couldn’t judge their distance from me. Something felt wrong and I decided to cross the street one last time to interrogate their motives.

As I did so, another care turned up the cobblestone and their shadows mirrored my movement across the street. As the blinding headlights of the car passed, I turned and clicked on my flashlight into the eyes of the two mimicking my movements. They startled, studdered stepped, and turned away as if the path up the cobblestone no longer existed. They were no more than 10 meters from me at that point.

I unclicked my flashlight in relief and thought to myself, “that’s right, fuc…”

In mid-thought, I feel a heavy thud against my back and a vice around my neck. Someone was strangulating me. I hurl my body forward and flip him completely over me as he falls on his back onto the hard cobblestone street. He still has a hold of my jacket and as I make the assumption that this is a 3^rd person of the previous stalking duo, I glance to assess the other’s proximity.

It was too late. As one tackles me to the cobblestone the other hits me in the head with something extremely hard. Stunned, but still conscious the scuffle continued. As I’m recounting this, its funny to me how ridiculously clear my thoughts were at the time. I thought, “I think this asshole just hit me with a cobblestone.” As a talking point in a number of my previous posts, I’ve always been fearful of these weapons.

It couldn’t have been more than 60 seconds of me trying to break free when, while on the ground, one had placed me in a tight headlock while the others struck my torso and held my arms. I hope none of you reading this has ever experienced being strangulated, but it’s a terrifying feeling. Combining that with my knowledge of head and neck anatomy and my clear thoughts, I could visualize my trachea compressed under the pressure of his arm. My jugular veins unable to return blood to my heart and my carotids kinked, unable to provide my brain with the oxygen it needed to maintain these vivid images. I couldn’t phonate, but my brain screamed “JUST TAKE MY STUFF, BUT DON’T KILL ME”

What was happening to the rest of my body became unimportant and although I saw one striking my body and the other digging in my pockets, I couldn’t feel it.

Orthostatic hypotension is a sudden decrease in blood flow to the brain caused by a rapid systemic change in blood pressure. As less oxygenated blood reaches the visual cortex in your brain, your vision blurs. I’ve experienced this often, but the same blurring that occurs during strangulation is incredibly different. Time slows, other senses dull and the dread of impending doom sets in. Now, I’ve never experienced a near-death experience before, but my life didn’t flash before my eyes like popular belief had lead me to believe. On the contrary, I continued to have well-processed thoughts that now focused on the futility of the situation. There was nothing I could do as what light managed to touch my retina faded away.

Suddenly I awoke to the loud deep voice yelling “police” from somewhere in the darkness. The grip around my neck released and the full capacity of my senses returned in a split second. I could see the men sprint away into the shadows and I could hear my loud inspiratory stridor as I gasped for air, but I couldn’t move. With a good amount of disequilibrium, all I could do was pivot in my semi-supine position.

The next thing I head was “Neh-eh, Neh-eh”, “come, come” in Tigrinya. With one shoe missing, I staggered to my feet and walked as fast as I could into the compound where the sounds were coming from. I collapsed again once in their compound, still attempting to regain my breath. The sound of the heavy metallic gate locking shut behind me signaled the end of my nightmare.

I can’t articulate what this type of relief felt like, but knowing that nothing in that moment could harm me, left me defenseless and numb. My anonymous saviors encouraged me to get up, but I couldn’t, paralyzed by the comfort of that cement walkway protected by that metallic gate.

They gently brought me inside into the light that allowed me to start assessing my injuries. Hematomas and abrasions, nothing serious. I was breathing without stridor now, but had a painful, hoarse dysphonia. Now that I could appreciate their faces, a son in his late teens and his mother spoke to each other, clearly deciding what in the world to do with me. They called the police who arrived about 15 mins later in a pick-up truck with the bed full of 10 men with their iconic AK-47s and military camo. The 3 of us met them outside, standing on the very cobblestone I had just been attacked on. I immediately found my flashlight and clicked it on. No phone, no wallet.

The police, son and mother exchanged a drawn-out series of interactions as people pointed in different directions and the men in camo stared at me. Finally, the one man dressed in civilian clothing approached me and said: “What do you want me to do about this?”

I mean, I knew that there was no chance in finding these guys. I barely saw their faces for a split second, everyone wears jeans and a sweatshirt here, and everyone pretty much has the same haircut. I couldn’t identify these guys even if they somehow found them. Even so, his question told me everything I needed to know about the usefulness of the Mekelle police. I politely asked for an escort up the remainder of the cobblestone. When I reached my house, the man in plain clothes said something to me in Tigrinya and all of the camo men with AK-47s laughed boisterously. I had no idea what was said, but I didn’t care. There was one more metallic gate between me and my safety and I was focused on opening it.

The familiar shadows of our tiled porch calmed me. As the police truck drove away, I was greeted with a peaceful quiet breeze. The same I had experienced when I started that walk 30 minutes earlier. Glancing up, the stars remained beautiful.

I walked upstairs and knocked on Alaine’s door and explained what happened. Her response was exactly what I needed. She was kind, caring, understanding and helpful. She made me tea and let me use her phone. Other than money, the only other thing in my wallet was my debit card. I used that excuse to call home on Alaine’s phone to explain what happened to my Mother and to get her to cancel the card. My Mom handled the information better than I had expected; perhaps she saw this as an inevitability, just as I had.

The remainder of the night I laid awake, plagued by the never-ending loop of those 5 minutes. Reliving the emotions, blaming myself for not being smarter, stronger, better. But I was lucky. I was alive. Similar robberies end differently every day.

The next morning I made my way to Ayder Hospital and sat down at my desk. Normalcy seemed important. And this reminded me that I suffered blunt laryngeal trauma. I had dysphonia and stridor at one point, but other than pain now, I was asymptomatic. As expressed in my lectures to my residents here, those with blunt injury to the larynx require a flexible laryngoscopy to evaluate for overt injury

So, I walked downstairs into the empty OPD, grabbed the flexible scope and scoped myself. Not the first time I’ve done this….Here the video of my larynx for your enjoyment. Mild bruising of the false cord on the left and an odd intraluminal left posterior cricoid shelf, but otherwise normal. I doubt theres a fracture just in that one spot, so I’ll ignore it.

All in all, my bruises will heal, my tetanus shot will keep me safe and my material possessions will be replaced. My journey here has once again changed my perspective on life and has given me something I can never forget. For now, its back to normalcy. Tomorrow, perhaps I’ll teach a temporal bone lab for the residents.