Old Lovers Don't Die (16 page)

The rest of the ward round became a bit of a blur for Christian. Out of the corner of his eye, he could see the young girl sipping away at the Coca-Cola. He felt certain his diagnosis was the correct one, but would that be enough Coca-Cola to dissolve the hair?

They saw another young boy who had water on his brain, and then a prisoner from the jail across the road who had been badly beaten by other prisoners, but whom Nikita didn’t think needed surgery. A young man was the final patient they reviewed. He had fallen off his motorbike and badly lacerated his head. Nikita told Christian that his job would be to suture the laceration after the major surgery was finished. They would review the prisoner later in the day.

Christian followed Nikita out through a side door. A smooth concrete pathway led twenty metres to a faded pale green wooden door, which had ‘Theatre’ in large red letters painted on it. Several trolleys for transporting patients were parked on either side of the pathway. In their original state, they were white. Now they had faded to a dirty cream with parts of the enamel chipped off exposing bare metal, which was mostly stained by splashes of blood. There were no mattresses on any of the trolleys. Just literally, they had the bare essentials on which to transport the patients from accident and emergency down the hill to theatre.

Nikita knocked on the door and waited. Christian stopped behind him thinking about the young girl with the gastric bezoar. If he was right and it resolved the obstruction, he was not sure still how Nikita would feel. Would he view it as a challenge to his authority rather than a good clinical outcome for the patient?

“Good morning, Dr. Nikita”, said the voice behind the door. “Come in. The anaesthetist is not yet here.”

Christian followed Nikita into a tired, grey-tiled reception area. A small wooden desk in one corner had patient notes scattered over it. Huddled in the other corner was a large used oxygen cylinder waiting to be refilled. Next to the cylinder, was a small portable sterilizer, the door of which was open revealing several broken shelves and the charred remains of internal wiring. Two opaque windows of the type frequently seen in public toilets provided some filtered light.

“That is the changing room,” Nikita said, pointing to the door which led off from the left-hand side of the room. “And the other door over there goes through into the theatre.”

Christian looked in the direction of the changing room. There was no door to the changing room and it was no bigger than a large broom cupboard with half a dozen large hooks on the wall for clothes. He could see a collection of male and female clothes. As if reading his mind, Dr. Nikita looked at him and smiled before saying,

“Not quite what you’re used to Australia, everyone in together?”

“No, we have separate changing rooms. To suggest that we all change together would produce a fierce outcry from the female staff. Although I do recall when I was working in South Africa, we had a very glamorous German medical student who insisted on changing in the male changing room. All the surgeons started their lists on time for the duration that she was there.”

It was the first time that Christian had seen Nikita smile. Not a full smile, just the hint of one which adumbrated, he hoped, greater acceptance.

“To preserve dignity here, we have an agreement that the female staff get changed first, twenty minutes before an operation, and then the male staff, ten minutes before surgery.”

In the corner of the changing room was a pile of neatly stacked blue surgical overalls. Christian found the large pair that Theresa had left for him, and put them on. Over shoes, he found next to the doorway. They were only one size and he struggled to get his size 12 shoes into them. The one on his left foot tore a little exposing his shoe and the dustiness of the outside world. He was searching for another to cover the torn defect when Nikita walked in.

“There are masks and hats in theatre,” he said without looking up. “What do you think we use for anaesthesia here?”

“Ketamine intravenous as a 75 mg standard dose.”

“You have done your reading. What do you need to look out for postoperatively?”

“Hallucinations. It’s one of the most distressing things for the patients, I believe. Otherwise it would be the perfect anaesthetic drug for developing countries, particularly as it doesn’t have a marked effect on respiration.”

“Well, at least that’s a better answer than the last German doctor we had here. He could only tell me that it was a date rape drug.”

Nikita pulled on blue surgical overalls followed by surgical gumboots. Originally white, the boots had faded with constant washing to a yellow cream colour. There were pink outlines where blood had etched itself into the waterproofing, resistant to constant washing. In places, the stains coalesced to give the appearance of an unmarked map of Africa. On the heel of the boots, Nikita’s name was written with ballpoint pen. Nikita pulled on his boots and stamped his feet into place before calling over his shoulder, in Christian’s direction, as he walked through the door,

“Come with me. I’ll introduce you to Sister Teresa. She has been the scrub nurse here for twelve years. She does minor surgery and likes to think that she could do major surgery. Despite that, she is invaluable and she will also be your assistant when you start your own surgical list.”

Sister Teresa looked formidable, dressed in similar blue surgical overalls. Christian had always wondered about the original selection of surgical overalls for surgery; they always seem to be badly fitted and more suited to those who needed to crawl underneath cars. Sister Theresa’s were no different. They were tight around her bottom and in front battling to constrain large breasts, which threatened to open all the buttons with any sudden movement. A mask hid most of her face, and a mass of tightly woven hair was held in place with a cloth cap with a Red Cross insignia emblazoned on the front. Her boots were similar to Nikita’s, although much less bloodstained; they had two red hearts drawn in ballpoint pen over the toes of each boot which he could never imagine on Nikita’s boots. Green surgical gloves completed the impression of an overweight sensitive plumber intent on clearing a drain rather than an experienced scrub nurse.

“Sister Teresa, this is Dr. Christian de Villiers from Australia who will be joining us for three months.”

Sister Teresa looked up from the surgical instruments that she was arranging, briefly looked at Christian, and said,

“Make sure you wash your hands for two minutes.”

Christian looked down in the direction where she had been looking, and saw a large red plastic bowl to wash his hands in and a single piece of soap; there was a well-used grey hand towel folded neatly alongside. The theatre itself was the size of a small bedroom. All of the walls were lined with grey enamelled tiles. From a central pivot in the ceiling was a large surgical light. On the operating table directly underneath lay the patient, the piece of wood protruding offensively from her vagina.

The abdomen and pelvic region had been liberally coated with the antiseptic betadine. Christian noted as he walked into theatre, that there was no ventilator, just a large oxygen bottle, similar to the one he had seen in the waiting room, connected via a mask to the patient. The operation would utilise only oxygen and ketamine. Christian knew from his reading that that would mean not only that there was not muscular paralysis, but the patient would be disconcertingly moving around on the table as they operated in a semi-conscious state, although unaware of pain.

“Would you take it out first or leave it in?” Nikita said as he washed his hands in the red plastic bowl.

“Leave it in until we have opened the abdomen so it’s possible to trace any damage to uterus/ bladder and bowel.”

Nikita dried his hands before walking through the open door into theatre. Christian noticed the anaesthetic person strapping the arms down as the patient started to move under the effects of ketamine. Nikita stood on the right side of the operating table. On the left-hand side were the instrument tray and the considerable size of Sister Teresa. There was little space for Christian. As he pulled his surgical gloves on, he wondered how he was going to be able to see into the abdomen to assist Dr. Nikita efficiently. He stood alongside Sister Teresa who provided him with no extra space. As Christian placed his hands on the part of the abdomen covered by the surgical drapes, he felt the patient move and heard the disconcerting moan that was part of the hallucinatory effect of the ketamine. Sister Teresa began talking very quickly in her national Kinyarwanda dialect as she handed Nikita the scalpel. Nikita looked up at Sister Teresa, before he made a cut in the abdomen with the scalpel, and said in English,

“No, you are not the assistant. This one is different than the last medical tourist. He has clinical knowledge. Move down and let him in.”

Christian moved opposite Nikita as Sister Teresa reluctantly made room for him. Nikita then made a lower midline incision as Christian placed his hands on the pelvis of the patient as she started to move on the table. Out of the corner of his eye, he glanced in the direction of the woman administering the oxygen and the ketamine. She had her head buried deep beneath the drapes listening to the woman’s breathing and checking her pulse.

“Penetration of the uterus and the bladder, but no bowel. That was lucky.”

Christian looked inside the abdomen. Considerable force had been used to drive the broom through both the uterus and the bladder, the roundness of the tip the only thing that had saved the more mobile bowel from being ripped apart. After placing sutures to mark the penetration through the uterus and bladder, Nikita pushed the broom out through the pelvis.

“No colostomy will be needed.” Christian said as both a question and as personal relief for the patient.

“Despite western research suggesting that a colostomy is the surgical approach which works best, we clean the bowel and join it back together; no colostomy. In Africa colostomy bags fall off, and patients return with faeces discharging directly onto their abdomens. Close the abdomen with a nylon suture after I finish the washout.”

Nikita finished the washout within the abdomen, slid his hand between the woman’s thighs and removed totally the broken broom. Christian moved around to the patient’s right-hand side and took the Rutherford forceps Teresa had handed to him. He placed them on the edge of the fascia and handed them to Teresa to hold. He could feel her eyes watching him, judging, unbelieving of his competence.

“Could I have the one nylon suture please, Teresa?”

Teresa took the suture from its packet, straightened the nylon out, and gave it to him on a needle holder.

“Thank you, Teresa,” he said as he began suturing the layers of the abdomen while she retracted the skin. The abdominal wall closed neatly and he could sense Teresa’s appreciation of his skill. It wasn’t anything that she said, just a diminution in the hostility of her look. Christian decided to chance his arm, as there was something that he had wanted to know about the brutality of this particular woman.

“Teresa,” he said as he placed the final suture in the abdominal fascia and looked over his mask, engaging her eyes.

“Yes, Doctor de Villiers.”

“Why do you think these women get brutalized in this way?”

Teresa held his gaze during a long pause. He had the feeling that she was trying to make up her mind whether replying would concede acceptance of him on that side of the table as the surgeon.

“Raping a woman is not about sex. Whether it is in the western world or here, it is about power and degradation. It is a return to the animal kingdom where the male dominates, and the strongest male dominates in any way that he enjoys. Only here, there is not just the urge to dominate but to physically destroy and mutilate any who do not comply with their commands. It is unbridled evilness, in which one group tries to outdo the other. It is like the primeval blood thirst that drove the genocide. They are worse than animals and they know no one cares and no one will stop them as long as the world gets its share of resources.”

Christian looked at Teresa over his mask. There were several things which had surprised him about her reply. Firstly, that she had replied, or considered him worthy of her reply. Secondly that it was not just a passionate disgust that she was evoking, although that was implicit in her explanation: it was more the identification and understanding of the root cause of such mephitic depravity.

“Why do these militia groups continue to exist? I thought the United Nations had a peacekeeping force to control them.”

“Most foreigners think that. In addition, they think that this is still an ethnic conflict, which should therefore be left to the locals to sort out. That Kariba’s militia are exiled Hutus and the group named M 23 are Tutsi from Rwanda who want to keep the exiled Hutu in the Congolese Bush.”

“And clearly that’s not the case,” Christian said as he surveyed the table Teresa was using for his surgical instruments and sutures, looking for a suture he could close the skin with. The patient for the first time had stopped moving as he was suturing and Christian wondered for a minute whether she was still alive. He glanced towards the anaesthetic technician who was showing no alarm. Perhaps without the significant stimulation of protecting the abdomen and cutting through the tissue, the ketamine was in a dominant phase.

“Could I have that 30 nylon, Teresa?”

Teresa handed him the nylon on a needle holder after first straightening the memory of the nylon before continuing her explanation of the brutalities.