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As a doctor one really has no choice over the patients we see. In that regard, one can often find themselves in the same room as some unsavoury characters with no where to run.

The thrill of not knowing who and what may walk through the door is exhilarating, Is it a granny or a 5 year old? Is it piles or an appendicitis? Or.. you may find something hugely unfamiliar walk through the door with chains and handcuffs draped in orange, followed by 2 police officers with rifles.

It was difficult to hide my astonishment as they proceeded in like the most natural thing in the world. I was in the same room as a convict. A chilling thought. His gaze hung over me like a wet blanket.

My mind darted- what did he do? Did he rob a cash in transit? Was he a murderer? Did he sneak into ordinary peoples homes and demand money?

The answer was more bone chilling than all of the above. In retrospect I wish I had never asked.

I tried my utmost best to proceed with the history taking and examination as usual.

The main complaint was a small mass on the abdomen just above the umbilicus, a lipoma, barely visible, imbedded deep under the layers of adiposity, but causing this criminal a great deal of pain.

He smiled a flashy smile, just enough white amongst the gold teeth, his lips stained blue with fading tattoo ink and more piercings then I could count, a gang member I imagined.

He smelled of old cigarettes and terror. He grinned. “Doll, you see i have this lump in my stomach, it’s paining for years now, couldnt take it so i tuned the prison i need to see a doctor”.

‘I’m not a “doll”‘, i replied sternly. Address me by my name or nothing at all. I squinted my eyes and pursed my lips trying to instill an ounce of fear into him.

I commenced with the clinical examination and listened to his lungs snort, which told tales of a lifetime choked by smoke. I suspected he had chronic obstructive pulmonary disease or COPD, common in smokers. Every cigarette eating away at His lung tissue until all that remained was a mass of moth eaten rot.

His gaze peering over my head, ignorant of his condition. I felt no need to entertain his health condition when clearly he had no regard for his own life. I stared blankly at the wall and explained he needed surgery to remove the lipoma.

“Doll, you mean to tell me all this pain is caused by a ball of fat? It’s unbelievable”

My irritation levels had risen. You know what’s unbelievable? The fact that I need to sit here and listen to you undermine my qualifications and waste time on your small lipoma whilst people who really need help are out there waiting, i thought. I kept silent.

“What did you do?” I spat out. He looked at me square in the eye. The police officer gripped his rifle a little tighter and straightened up.

“He ran a network of human trafficking for 10 years amongst other things” he casually announced.

I froze.

“I need to discuss your lipoma with the consultant” I ran out.

I stepped out and shut the door with an oomph. I ripped my phone out and punched in this criminals name in and waited as vodacoms network slacked once again.

I read the first heading on Google as my hands trembled. I stopped dead in my tracks as I felt my heart gallop.

I picked the phone up and called the consultant. “Er doc there’s a prisoner here with a lipoma. Needs excision”.

“Oh. another one of those. What did this fellow do now, steal chappies from spar? Unfortunately we try and get these fellows out as quick as possible. If it were up to me I’d send him back with a spade up his ass”

My mouth went dry. I read the news article of my phone verbatim..” He trafficked thousands of women all around south africa for 10 years. He has been involved in house robberies and embezzlement. He has raped, murdered and been charged with fraud….” My voice trailed off.

“Oh, a real criminal , the little ass#*@, thinks he can come here and traffick our ladies , I’ll show him. Ill meet you there now”

I was confused. I hoped the consultant wasn’t about to do anything rash, like attempt to murder a criminal in SOPD. Would i be an accomplice? I’m relatively young I thought, I won’t survive in prison. Before I had time to figure out the details of my escape plan, the consultant came barging in.

“Show me where this man is” he demanded.

We entered the room and I watched the consultant adorn his professional vice. “Good day, sir how are you. I heard you have a worrisome lipoma. Let me have a look at it please” he cheerfully retorted.

The criminal was overjoyed to be escalated to the consultant. He began chirping about mutton curry in the good old days and indigestion. The consultant sniggered at his verbal diarrhoea.

The consultant raised his left eyebrow in dismay.

“Sir, this lipoma, as small as it looks needs to be removed immediately. The pressure its causing on the nerve plexus around your abdomen is causing the pain. Incidentally, I suspect it’s also causing pressure on the stomach causing the gastritis and your mutton curry woes”

The criminal looked worried. His forehead frowns deepened. The smug grin wiped off in an instant.

“Good news, I will clear my schedule for you tonight, Dr Moosa and i will operate and remove it today after she prepares you for theatre” the consultant said.

The criminal was sniggering once more. The ugly goldtooth shimmer was blinding. The police officers were overjoyed. That meant Less time babysitting for them.

I began the preparation procedure and began to draw bloods. I noticed the tattoo on his cubital fossa branded his former gangs name.

“Doll, I’m scared of needles” he nervously spoke. Really!?!? I thought, gazing at his numerous tattoos and piercings.

“But I once knew a girl who looked just like you. Round face, long hair…” I didnt let him continue for fear of what he may say. The fact that he mentioned her in the past tense made me shiver. I finished up the pre-OP procedures and retreated to the outside bench to think. I was dreading the theatre time.

The consultant was unsually chirpy pre-op. He chatted too enthusiastically with the anaethetist. I was worried. Why is no one as affected as me?

When the patient was on the table he began explaining the procedure and the anaethetist gazed over him, arms folded, watching his every move like a newly found specimen.

“Instead of a general anaesthesia where you are fast asleep, we have decided to go with a spinal anaesthesia due to the fact that your lungs are almost non- existent.” He happily announced.

The criminal sat up. “You mean ill be awake? Will I feel anything?”

“Only THIS injection going into your SPINE” said the anaethetist holding up the biggest baddest needle he could find. He neglected to let him know he would be numb from the waist down.

I finally realised what the cheerfulness was about. I laughed internally. The scrub sister chipped in “hi im Karma, nice to meet you.”

The criminal was wet with a mixture of fear and sweat. He panted with anxiety. He lost his intimidating touch and embodied a helpless, lost man. In that moment, and for one moment only, I actually pitied him.

The anaethtist began the procedure with extra vigor. He looked at his assistant with a nod. “I cannot use a local anaesthetic due to your tatooed back” he said gravely.

The criminal was now hunched forward with 3 people holding him in place. He squeeled as if anyone would listen. The spinal needle went in and we felt him shuffle beneath our grip. I saw tears escape his lacrimal glands.

Once we scrubbed up and were in place the surgeon turned to the criminal, ” Since we are using a spinal anaesthetic which only works up until the belly button, you may feel some pain once we start cutting above it”

The theatre sisters burst out into laughter. I think by now the criminal was accepting of the situation. He nodded gracefully and let the surgeon be.

The entire operation was met with the surgeon cutting, me retracting, and the criminal crying. The anaethetist turned the radio off and enjoyed the sound of the nurses chanting “Payback the money” in a synchronized tone.

I peered over the screen separating us from the criminal and I looked him in the fear filled eye and said “oh and im not your doll” while the surgeon cut through raw flesh.

Post op the surgeon omitted to write up any morphine or analgesia as we usually do. He pranced around the theatre quite satisfied with how he handled the situation.

In retrospect i think the criminal deserved the minute amount of pain he was made to feel ,failing in comparison to the people’s lives he had ended and families he had destroyed. After all You do know what they say about payback…

Disclaimer: no criminals were harmed during this procedure. Patient survived and continues to serve his 15 life sentences.