It is difficult for me to tell this story, but i find my experience as a doctor incomplete if i don’t.
A Prof once told me that in the back of every doctors mind you will find a list of names, that haunt them until they die. I never believed him until that fateful day, because that was the day I found the very first name on my list in my graveyard.
She was petitely built with a round face and honey coloured eyes. Her skin was coal coloured, beautifully reflecting against her eyes. She had taken the great trek to south Africa all the way from Ethiopia, to join a student camp. Little did she know, it would be her last.
I met her in an unfamiliarly expensive environment, with the spinning of the helicopter wings deafening the sounds around me. You see it’s so unusual for a patient to be airlifted in the resource-exhausted setting like ours. The time energy and funds needed to mobilize a chopper and a team is far beyond the system we are in.
“How are You feeling?” Ten of us shouted at once, trying to score her GCS points.
All she said was “No English, Amarhic, Ethiopia” in a hoarse voice. We looked at each other confused. A language barrier was the last thing we needed and yet there it was.
How were we to explain her condition, although her eyes told me she knew. How would we consent her for the operation? How would we console her? Google translate took us only so far. Beyond that,a tight squeeze of the hand and a gentle nod would have to suffice.
the chopper was arranged with good reason indeed. Her injuries were debilitating and her frail body looked torn.The student camp had arranged to participate in outdoor activities like hiking, rock climbing and swimming. As dangerous as these may sound, it was the trip alone that killed her. The bakkie hit a boulder and overturned before smashing directly into the behind of a mountain. The driver was declared deceased on scene leaving behind the group of 10 students of whom this patient was most critically injured.
The moment I saw her my heart fell into a crevice of hopelessness. She didn’t cry she didn’t scream, instead she lay quiet between the headblocks that attempted to keep her C-spine from slipping. Her face was oddly calm. My eyes scanned her abdomen and I knew there was trouble. Aside from the worrisome abdomen her right femur was sticking out like a sore thumb causing her to leak her blood volume.
The orthopods joined us soon after, once they got a whiff of the broken bone and were visibly excited. One must know that very little can excite an orthopod, they are calm creatures by nature. The orthopod consultant was my favourite. He towered above me and spoke with the voice of revelation “We need to fix the femur before she bleeds to death or worse, throws a fat embolism”.
I guess my surgical registrar was not familiar with sharing his heroic limelight so he looked slightly perturbed. “Yes we also need to find out whats shattered in the abdomen, there’s obviously a blunt abdominal trauma, you can join us in theatre” he said.
The orthopod was unphased and began stabilising the femur. I doubt anyone of us had ever seen such a mangled limb before, entagled in tissue shards and nerve plexi, it was horrific. I imagine the orthopod began immediately calculating the screws and bolts and nails he was going to use while we lingered over her distended , tense abdomen.
Theatre was unsually cold that day, maybe in preparation for the life that was about to be lost. The familiar banter between the anaethetist and the surgeon and orthopod was absent. Each discipline worked heads down trying to piece together her body.
The abdomen was split wide open valiantly to find a shattered spleen and a bowel injury. My surgical registrar began rinsing the blood which never seemed to end, buying some time to think.
The orthopod began his drilling and screwing until we heard a snap from a bone below. “Whats that sound?” The anaethetist was on edge.
The instability of the fracture had become so tough to repair, he eventually abandoned the repair and performed an above knee amputation. We watched as the leg was tossed in the red waste bin, the most unnatural thing i’d seen.
The abdomen was failing us too. The splenectomy seemed to be useless as she poured from her kidney and liver. Damage control was done and sweat dampened my body. 6 hours of unending misery and we were no better than we had started.
She was wheeled off to ICU silently. I think we all knew the outcome and yet no one had spoke of it. No one had succumbed to the fate she had to eventually face. When the surgery was over, we pushed the bed to ICU.
A surgeon, an anaethetist, and an orthopod found themselves hanging over her bed, hoping for a miracle. Eyes fixated on the areas they each had attempted to repair. I watched as they fiddled with machinery and adjusted analgesic doses while darting back to the file to scribe their futile plans.
I sat beside her head and imagined how she may have felt, alone in a foreign country with no family around staring death right in the face. I imagined all the hopes and dreams she may have had, as any 16 year old would. My mind slipped dangerously into the “why her?” territories. I began doing something I often tried to avoid, questioning God.
If murderers and rapists are roaming the streets as free as a bird, why must a 16 year old girl be fighting for her life in vain? I wept out of anger as I felt my hands become damp. I knew better than to question the plans of the Almighty so I did something I hadn’t done in a while; I prayed out loud for the helpless girl who was chopped and prodded by us. Waiting for her to slip away, into her inevitable fate which she met in the morning.
It wasnt until the weekend was over that I could contact the social worker and hospital admin to get a hold of her family. They left word that they would like to speak to a doctor, and seeing as I was the one who requested the contact, I felt it should be me.
Nothing could have prepared me for the words I was to receive. I had thought out a well balanced professional and emotional response and wrote it on a serviette as I prepared myself. The phone rang and I waited in anticipation.
Her mother answered the phone with nothing more than a single sob. In that single sob I heard the shatter of an entire world, the loss she felt was palpable across time and space. I struggled to introduce myself, my voice cracking at the brim.
She expressed her gratitude and pride in the efforts we made to save her life and thanked me on behalf of the family. I looked down at the serviette and I couldn’t read the words between my fuzzy tear filled eyes.
I told her how brave and strong she had been and how calm and composed she was. I mentioned how the injuries were severe but she didnt suffer for long.
Her mother said ” I’m glad she had found peace, after all her name was Joy”
The name engraved on my list, forever to be remembered…Joy.