Old Lovers Don't Die

by Anderson, Paul G

  Christian picked up the magazine and noticed that it was complete with maps detailing mineral extraction and points of conflict. Chantal placed the coffee plunger and three cups on the table as he placed the magazine next to him. The aroma from the Rwandan coffee briefly took him back again to Mike and Sian’s house in Cape Town. It was where he had first experienced the strong aroma and the smooth taste of Rwandan coffee. Emmanuel poured the coffee and Christian learnt that Chantal was a teacher at the local primary school. One of her passions was in developing African art, the placemats she told him being one of her classes’ projects. The major problem was the lack of materials and often she would have to take the children outside for their art lesson and they would draw with a stick in the dirt. Then they would use the same stick to draw characters and scenes, leaving them to be admired by the other children at playtime.

  Chapter 14

  Christian and Emmanuel walked out through the front gate, going up the short alleyway to the main road. Despite the fact that it was 7:15 AM in the morning, there was already a constant stream of people, two to three deep in places, heading to and from the Congolese border. It was a reminder that Rwanda, with twelve million people, is the most densely populated country in Africa. The major export crops of coffee and tea provided work for some; however for the vast majority, there was no work. The Congo with its numerous mines and employment provided the potential to stave off starvation irrespective of the atavistic violence they had to endure.

  “Here’s hoping we don’t get too many of those people back tonight in our emergency room or operating theatre.” Emmanuel said as they walked on the opposite side of the road to the mainstream of people heading towards the Congolese border town of Goma.

  “I found Sister Teresa an interesting person yesterday. But she’s not going to be assisting me today?”

  “She gave you the thumbs up as well, which is important since she runs theatre. She usually assists Dr. Nikita but they’re both going to do an outpatient clinic at the orphanage that you passed on the way down here.”

  “I met an American girl who was due to work there for three months. She travelled on the bus with me from Kigali.”

  “We visit there every two weeks and I’m sure that we can arrange for you to go and do a clinic with Sister Teresa. I am sure Dr. Nikita would be delighted not have to travel up there. We do have some concerns as the orphanage is run by a Chinese foundation. While they provide buildings for the children, we are concerned about links to the Chinese government and corporate interests in the Congo. They have a manager Kim Yao, who gives the impression of caring deeply for the children. However, there have been some irregularities with some of the older boys disappearing from the orphanage. There are also unconfirmed reports of her having been seen near the Chinese mine at Bisie across the border.”

  “So theatre this morning without Dr. Nikita or Teresa, that will be a challenge I assume.”

  “Sister Margarita is very different to Teresa. She is much more outspoken for she has been with us for twenty-two years. Watch out or she will close the wound for you!”

  “Thank you for the warning.”

  Christian found a similar crowd outside Accident and Emergency as the previous day. Fortunately, there did not appear to be anyone who needed to bypass Accident and Emergency and go directly to the morgue. As he walked in with Emanuel, the greeting was in contrast with the previous day. The three nurses all looked up from their patients and smiled, the young man filling in the paperwork behind the wooden desk greeted him with a ‘good morning, Dr. Chris’. Emmanuel looked at him and winked.

  “Word travels fast here if you cut the mustard,” he said.

  Christian knew from the previous day that theatre would start at 8 AM and he had half an hour to sort out who else needed to be operated on. There was one young man who had a badly lacerated scalp from a machete attack. The bandage that had been applied to his head was soaked in blood, which was now trickling down and into his left eye. He would need suturing earlier rather than later. Another young man had fallen off the back of a motorbike and had an open fracture of his forearm. A two-year-old boy whose mother had brought him in with an infected spider bite on his lower leg needed cleaning and debriding. Hopefully it wasn’t a Buruli ulcer, which could consume the whole leg and need a skin graft. He told Sister Masuli he would start with the badly lacerated head and then reduce the fracture.

  Sister Margarita was in the changing room when he arrived. He had forgotten that the protocol was to allow twenty minutes for the female staff to change. He should have arrived at 8:10 AM. Margarita had only the top half of her surgical overalls on. They were fortunately sufficiently large that they reached down to her mid-thigh. She was unconcerned by Christian’s appearance, standing and looking at him before calmly reaching for the surgical trousers and pulling them on in front of him. Christian turned his back to provide some privacy and heard Margarita from behind him say.

  “Good morning, Dr. Chris. I am obviously Sister Margarita. You can come in and get changed and don’t feel embarrassed. I have brought up four boys, and I’m sure you’re not worried about how an older granny like me looks half dressed!”

  Christian smiled to himself. He still did not turn around, waiting until he heard Margarita walk through from the changing room into the theatre.

  “You can turn around now,” she said laughingly as she disappeared through the second door into theatre.

  Christian took about five minutes to change. By the time that he had done his compulsory three-minute wash-up in the red bowl, the patient with the lacerated scalp was on the table, with an intravenous line running. They had the same anaesthetic woman from the day before. Teresa had quietly informed him that her name was Satilde.

  “Good morning, Satilde,” he said as he pulled on the surgical gloves, watching as she applied pressure to the dressing which was oozing considerable blood underneath her gloved hand.

  “Teresa, let’s have all the sutures ready before we take the bandage down. And I may need you to apply pressure to control the bleeding while I suture.”

  Christian quickly cleaned the area around the bandage with betadine and then with Teresa standing opposite, removed the bandage. Blood quickly spurted, staining his surgical top. Remember to bring glasses tomorrow, he reminded himself. While his tallness was a barrier to direct HIV contamination via the eye, it was not completely foolproof. As Teresa applied pressure, he reached across to her operating tray for a large suture. He ran it under the bleeding artery. The haemorrhage was controlled when he tied the knot in the suture. Teresa could remove her hand from the control point and he assessed the rest of the wound. It was 10 to 12 cm in length running just from above the right eye down to the left ear. He could see the protective covering of the bone. That did not appear to be breached. Christian cleaned the wound out with betadine before asking Margarita for a finer suture to close the wound. As he was just preparing to tie the final knot and wondering about the chance of infection, they heard a loud commotion coming from the small reception area. Margarita looked through the doorway to see if she could see who they belonged to as Christian started to take his gloves off. As he started to remove his surgical gown, John, the clerk from Accident and Emergency appeared in the doorway. Initially he stood there looking at Christian as if dumbstruck.

  “What is it, John?” Christian said.

  “Dr. Chris! Dr. Chris, you need to come quickly. A truck has driven through the front fence of the hospital and there are people trapped underneath.” He tugged at Christian’s surgical top trying to hurry him up.

  “Margarita, finish bandaging the patient and I may need you and Satilde at the front of the hospital.”

  Christian did not worry about taking off his overshoes and he followed John up the concrete pathway. As they approached the rear of the hospital, he could already hear the crying and children screaming. At the front of the hospital, a large section of the fence was missing. Hundreds of people had already gather
ed around a large truck which had crashed through the fence and ended on its side inside the hospital grounds. Its brakes having failed coming down the hill, the driver had swerved to avoid the stream of people and had hit one of the large potholes. This had flipped the truck onto its side, trapping those walking past the hospital underneath.

  There were a few plaintive cries coming from those who were still alive but trapped underneath. Christian knew if they were going to survive, it meant getting the truck off them as soon as possible. At the rear of the truck, he could see one young boy trapped; people were digging feverishly to try and free his leg. They were making little progress against the jagged volcanic rock.

  “John, can we get as many men as possible on the side of the truck closest to the hospital?”

  Christian thought it might be impossible, given the amount of screaming coming from those caught underneath the truck and their families. John, however, anticipated the problem and let out a loud and high-pitched whistle. There was a momentary pause in the wailing cacophony. Everyone for a second turned and looked at John.

  “Nous aurons besoin de tous les hommes sur le côté du camion,” John shouted.

  The response was swift; fifteen or so of the men quickly assembled next to Christian and John.

  “John, what we need to do is get them all along the side of the truck and we will try and lift it at once.”

  John quickly got the men into position and once everyone surrounding saw what Christian was trying to achieve, rapidly joined the men on the hospital side of the truck. With over thirty people in position, Christian shouted to John.

  “On the count of three, John.”

  “Une Deux Trois.” John shouted slowly and deliberately.

  Slowly the truck started to rise. At twenty cm off the ground, it teetered and threatened to collapse again on all those underneath. As all thirty strained to hold the truck, Christian could see out of the corner of his eye a woman reached in and pulled out the young boy at the end of the truck. For what seemed like an age, the truck hovered above those underneath. Then more hands and shoulders rushed to help. John shouted again and with one extraordinary effort, the truck was righted.

  Christian quickly surveyed the human carnage. In the back of his head he could hear Bolt’s voice.

  “Prioritize, Prioritize, Prioritize. Decide who is dead and who you can save quickly, otherwise those whom you might save will be your worst statistic,” he used to shout incessantly at the medical students in the trauma unit.

  Christian quickly worked his way amongst the bodies. He looked for fixed dilated pupils and checked for pulses. He heard a young boy crying and knew that he needed immediate evaluation in case he was bleeding. He looked up and saw Satilde standing next to John. He pointed her in the direction of the young boy and shouted that he would need intravenous fluids. Quickly he triaged the others who had been trapped. There were no other survivors, including the last woman and her newly born child; he counted six as dead. Despite the death and destruction, the stream of people going past the hospital had quickly re-established itself. Not many he noticed stopped to look at the dead bodies. Perhaps death was too common in Africa; it was never very far away, almost bromidic. Christian waved John over to where he was arranging the bodies.

  “John, can you organize for them to be taken to the morgue?” He deliberately avoided using the term bodies as most still looked like they were sleeping; rigor mortis was hours away.

  “Yes, Dr. Chris, and I think that young boy up there needs your help. He is in a lot of pain and his leg is broken.”

  Christian joined Satilde as Teresa arrived with intravenous fluids. Satilde quickly inserted an intravenous line and started the saline running. She had also brought a hypodermic syringe and a vial of morphine.

  Christian, looking at the young boy, thought he was about twelve years of age. He was dressed in a long flowing white gown. The lower part of the gown was soaked in blood, but he could still detect the boy’s right leg at an angle that indicated it was broken. He lifted the lower part of the boy’s robe; it was a closed fracture—there were no bones breaking the skin edge. Repairing it wouldn’t be difficult however, he needed to know whether there was any further injury. He tore the upper part of the boy’s gown so that he could examine his chest and abdomen. The abdomen was distended, so possibly two broken ribs on the left-hand side were indicating his spleen was bleeding. He was going to need to go to theatre urgently.

  “Satilde, Teresa, this young boy is going to need a laparotomy. I think he’s bleeding internally.”

  “He’s the son of the local Imam,” said Satilde. “Someone will need to tell him.”

  “He will be up at the mosque preparing for afternoon prayers, which is probably where his son Yusuf was heading,” Teresa said. “Mark, over there helping John, knows the Imam quite well. I’ll get him to go and get him urgently.”

  “Satilde, if you take off your white coat, we can use that as a stretcher and get him to theatre.”

  Satilde quickly took off the white coat and laid it on the ground next to Yusuf. Christian instructed several people as to what he wanted as Satilde translated into French. He could see the growing pain on Yusuf’s face as his abdomen was became increasingly distended. They would need to move him carefully so as not to cause greater pain with his fractured leg. They all then picked up a corner of the white coat as the crowd parted around them to let them through. Yusuf’s eyes by this time were closed, and Christian noticed that his heart rate had increased. They did not have much time if they were going to save his life. Teresa rejoined them after instructing Mark and proceeded ahead to clear a path through Accident and Emergency and down to the operating theatre.

  Fortunately, the operating table was cleaned from the previous operation and the next surgical pack was ready to be opened. Time was of the essence getting into Yusuf’s abdomen and normal sterility procedures had to take second place. Christian ripped open the surgical gown as he watched Teresa do the same. They did not wash their hands, quickly putting on surgical gloves as Satilde administered fentanyl and ketamine. At least for a short while Yusuf would have no pain.

  Christian was about to make the incision in the abdomen with the scalpel when the theatre door loudly crashed open followed by raised voices in the reception room. Then he heard John’s voice instructing the intruder that he could not go into theatre. As he looked over his left shoulder, he saw the ashen face of the local Imam, Yusuf’s father.

  “If I don’t operate on him, he’s going to die,” Christian said over his shoulder.

  “Let me pray for you both first.”

  “It will need to be a quick prayer.”

  “To Allah the Almighty God we belong, if it please Allah let his angel Izareel call his humble servant home and let the sun of the world continue to shine through Yusuf. May the wisdom of the prophet Mohammed guide the hands which care for him.”

  “And may the one true God look after us,” whispered Teresa.

  “Thank you,” Christian said smiling inwardly at the thought that, despite the crisis, it was still necessary for each to assert their religious belief. Turning back to make the incision, he said, “We will need many large packs, Teresa.”

  Christian made the incision in the skin down to Yusuf’s navel. As he did so, Satilde commented that Yusuf’s blood pressure was going down. That meant the bleeding inside the abdomen was getting critical. He could see Satilde squeezing the saline bag to encourage extra fluids into Yusuf. It was critical that he stop the bleeding. As he opened the fascia over the abdomen, blood gushed out over the surgical drapes and down onto the floor. Teresa quickly placed a retractor into the abdomen and handed him five large surgical packs. That would get rid of some of the blood, but he needed to isolate the splenic artery to stop the flow of blood. Reaching inside Yusuf’s abdomen, he could feel the lacerated spleen. Blindly he clamped the artery. The blood stopped welling up and, relieved, he put more packs in to dry up the blood. Satilde was busy pu
tting up another litre of saline as he introduced another clamp, divided the archery, and removed the badly lacerated spleen.

  “Don’t dispose of that until we have checked with the Imam.”

  “I think that’s only with death that the body parts have to be returned but you can ask them when we’re finished.”

  Christian washed out the abdomen with the saline before closing the abdomen with a nylon suture. He still had the leg fracture to set but at least now, he could take his time. As Therese placed the dressing over the incision, he looked at Yusuf’s right leg. There was no x-ray to be able to check the alignment, so it would have to be his best clinical judgment.

  “Teresa, do we have any plaster of Paris to make a cast?”

  “Yes, we do, but someone will have to get it from the pharmacy. I will see whether John is still out there.”

  Christian looked at the lower leg; the deviation was lateral approximately half way between the knee and the ankle. He put one hand on the inner side just around the knee and the other opposite to that just above the ankle. One short sharp push with his lower hand pulling down realigned the leg. Now all he needed was the plaster of Paris to keep it in position. He peeled off his gloves and gown and peered through the theatre door to the reception area where he could see the Imam. He was sitting on the ground in the corner looking anxiously towards the theatre door. Christian smiled reassuringly as he walked through and sat down next to him.

  “It’s going to be a difficult few days, but I think he will make it.”

  “Praise Allah. I am most grateful that he guided your hands.”

  “I had to remove his spleen, and although we can live without spleens in this environment, we going to need to see whether we can get him vaccinated. Do you know whether he has been vaccinated against TB or measles?”