images (25)The day I heard we would be getting medical students joining our surgical department, I was thoroughly overjoyed.  Apart from seeing the same faces day in and day out dealing with the same issues and the fact that we were ridiculously short staffed, it would be nice to have extra hands on deck.

New energy, new mindsets. Exactly what our tired old souls needed.

As Prof would say “Fresh meat” . Prof was a Cuban genius. The one thing that fascinated me Apart from his brilliant surgical mind, was of course his accent. Every time his vocal cords approximated and the words flowed, I was transported to a luxurious Cuban setting with electric soulful music as mocktails were being passed around and a faint tinge of Cigar odour in the air.

I welcomed the students who were unsurprisingly over eager to help and eased our ward work burden tremendously. Their enthusiasm reminded me of my internship days.. when the give of an IV line was felt and the backflow of blood excited me or the drops of pure CSF gold I’d see after a successful lumbar puncture.. A happiness I can’t fully express. Satisfaction at its rawest.

There was 1 student in particular that really amused me. A young chap with just enough stubble to be called a man, who followed us around like a stray puppy. He was constantly over keen to be in theatre. Always approaching the surgeon scheduled to be in theatre the next day begging for the permission to assist. He would wait outside the casualty doors scanning the crowds for acute surgical emergencies.

Thanks to the violent nature of south Africans, he certainly got his wish. “Moosa come quick there’s a stab neck in casualty and guess what there is a hematoma and guess what I cannot feel his radial pulses!” The excitement in his voice was deafening. The poor chap didn’t understand one important fact. We as a regional hospital had no access to vascular surgeons. The closest vascular unit was an hour away and unless you were willing to send a blood dried corpse and a blood filled ambulance all that way, it was a good idea to control the bleeding before referring.

So our mainstay makeshift vascular surgeon was a surgical consultant i called Houdini. Hardly seen except when summoned. Preferred to operate in the shadows. Astounding surgical skill but even he couldn’t compensate for lack of advanced equipment so these cases usually ended up in a bad way. Houdini was summoned for this stabbed neck and we waited.

The student was bouncing off the theatre walls so eager to be wearing the monotoned green theatre scrubs. I felt sorry for the poor chap. If only he knew what he was in for. I didn’t want to be the one to burst his overinflated bubble, so silent I remained.

“Have you ever seen anyone die?” I asked him. He looked confused by my morbid questioning and that was answer enough. “Nope i haven’t ,why?”

This made the situation even more difficult for me. I refused to taint his excitement with the prospect that the gentleman may not survive no matter what we did. I was hoping my questioning would hint toward it but he was obviously blinded by his adrenaline rush.

When Houdini walked in and saw the patient, scanned the stab wound, saw the way the knife had settled right on his pulsating vessels, neatly transsecting his neck muscles and exposing his trachea, you couldn’t miss the grim expression on his face. But of course, the student did.

“Lets get on with it then” Houdini muttered. Almost as a formality.

The student burst into an explosion of information spitting fire and hand gestures flying, about neck zonal injuries and vascular repair. Houdini looked utterly confused. “Whos this?” He looked at me. “Student I said” Houdini nodded in understanding and gave him a retractor to hold.

The student was really in his element now. I could hear his widened grin behind his face mask. His eyes gleemed with wonder. He looked at the retractor in awe. He was lost in its silvery reflection. Staring at his mirrored view of him in green scrubs. He was in love. Disillusioned.

If only he knew. What a broken man he would walk put of this theatre as. I wished i could have prepared him more, given him some divine interventional talk which would soften the blow. I remember the first time i saw someone die on the theatre table ,and it broke me into a million lifeless pieces.

The fun began. The stabbed neck was bleeding uncontrollably and the packing had failed to help. Houdini began his scavenger hunt for the bleeder whilst we retracted. The student quick realised it wasnt all fun and games. This is not greys anatomy. There is no producer or director. Theres you and your hands and I’d like to think , God.

The anaethetist was running around ordering more blood units to pump into the body even though it was seeping out like a bucket with a hole. The gentleman’s trachea was severed so the breathing  tube was fully visible making it a tricky intubation as air was leaking from the transsection.

His lungs were failing. His blood volume was depleting. Pretty soon he was bleeding out fresh normal saline from the drip. Houdini clamped and caught the 1st bleeder. The second was hidden deep beneath the sternum. “Flip i may have to crack this chest ” squealed Houdini.

I gulped. Opening the sternum was not a good sign. The sternum is the shield of the chest, carefully protecting its prized heart. Soon after this, the anaethetist was screaming his lungs out. “Start CPR we losing him”

The beginning of the end. The student was white as paper. The only blood flow noticeable was in his knuckles so tightly gripping the retractor he held. He stood back and watched as we desperately tried to bring him back to life. His organs were hypoxic and dry, deprived of blood which lay on the theatre floor.

After an hour Houdini stopped. “We did our best, call time of death”.

I looked at the student who sunk his shoulders and loosened his theatre gown. I was afraid this would happen. He was broken. The previous energy he exuded was gone. His eyes were glistening with tears.

I didnt see him for a while after that day. I evetually heard he opted to join a psychiatry rotation. I met him in passing on a Tuesday morning and i searched for the spark in his eye, the energetic vibe, and I found none. He was broken by death. As we all are.