Читать книгу For Justice, Understanding and Humanity - Helmut Lauschke - Страница 7

I incised the skin on the right upper arm close under the shoulder breadth in the shape of a fish mouth. I ligated and cut the big arm vessels, shortened the arm nerves up to the armpit and cut the muscles after separation from the attachments to the most upper part of the bone shaft which was finally cut a few centimetres below the humerus head. “God, have merci and give the girl a life with some joy. Forgive what I do to the girl!” With this silent prayer, I cut the right arm off and laid it on the paper spread out on the floor. I sutured the skin-muscle flaps over the short stump together and got tears in my eyes when I dressed the wound and put on the bandage on the short stump. The girl was on the trolley when she searched with the left hand for her right arm and could not find the arm. Dr Lizette and a nurse carried her on the trolley to the recovery room, while she was still searching for the right arm. The instrumenting nurse opened the laces and pulled off the coat from me. The green shirt was drenched with sweat when I wiped the tears from my eyes and the sweat from my face. I looked with sadness on the amputated arm on the paper on the floor and removed with the bone nibbler a piece from the tumour and put it in a small plastic container with formalin for the histological examination. A nurse wrapped up the cut-off arm with the paper and sealed it with some plaster straps.

I was depressed when I left the theatre and went to the dressing room where I wiped off the sweat from the head, neck and chest and put on a dry green shirt. I felt exhausted when I filled a cup of tea and took a seat in the small tea room. Dr Lizette sat opposite to him with a sad face. She did not say a word. This kind of an ‘ugly’ operation had taken away her speech. Tabani left the theatre room 3 after a hernia repair. He entered the tea room and went to the small hatch and recognized the depressed atmosphere. He filled a cup of tea and asked how the operation had gone. “Terrible!”, shot this word from Lizette’s mouth that Tabani did not ask about the details. It became quiet in the tea room and everybody had his or her own thoughts, until a nurse stood in the door between corridor and dressing room and called me to help in theatre 1 where Dr Ruth did a gynaecological operation.

I understood this call as a ‘vibration’ to get out of the depression and followed the nurse without finishing the tea. The problem in theatre 1 was a deep-situated colon cancer on the sigma loop. The bowel with the tumour were cut out and an end-to-end connection [anastomosis] between the descending and the rectal colon were sutured. Dr Ruth thanked for the spontaneous help and finished the operation by closing up the abdominal wall by suturing the various layers.

The Philippine colleague did an internal fixation on the medial tuber [malleolus] of an ankle joint in theatre 2. He was busy to insert the tension screw. The patient was a woman who had slipped over a rolling stone, while she carried a bucket with water on her head. I changed the clothes in the dressing room and went to the outpatient department to see after the waiting patients in consulting room 4. A mother put her six-year-old girl on the chair on whom a monstrous deformity was cut off from the right hand [macrodactyly] that was twice as big as her foot. The operation was done a couple of weeks ago and the mother brought the girl for the follow-up. The girl looked happy to be freed from this ugly monster and that her hand got for the first time a functional meaning as she could grasp and keep small objects like a pencil between the thumb and the small finger. She demonstrated her skills and scribbled some lines on a piece of paper. I felt the satisfaction that I could improve the aesthetics of the hand shape and gave this hand a function and the girl a better quality of life. The mother was happy. She told that she will send her daughter to school what was impossible with the hand monster that had to be carried by her left hand. Doctor, patient and mother had a smile of relief and gratitude on their faces and the date for the next follow-up were noted in the health passport.

A man of around fifty years of age took the seat on the chair and held the leg prosthesis with his right hand. The bone stump was prominent and had thinned and inflamed the soft tissue coat. A revision with shortening of the bone shaft was needed that I admitted the patient and put his name on the preliminary operating list. An old woman supported by another woman walked with difficulty to the chair. She stood by holding the right hand on the backrest and pulled up with her left hand the long-hanging dress over her left knee. The old woman kept her head bowed and indicated with her left index finger the swollen knee which she could not bend. I helped the old woman for a seat on the chair and cleaned the skin over the knee with the disinfectant solution and put a needle into her joint. An amber-coloured fluid of a big amount ran through the needle into the kidney bowl. I had removed the needle when the old woman felt the relief and flexed the knee. She was one of the many old people who came to the hospital with advanced alterations [arthrosis] of the knee joint for release of the effusion. An artificial joint could help a number of patients, but this was not affordable for the poor people in the north and also not feasible at Oshakati hospital. I explained to the old woman that only a stiffening of the knee could take away her pain, but she rejected this kind of help. She said that she needed her knees. I prescribed the anti-inflammatory drug in her health passport. The old woman left accompanied by the younger woman the consulting room for the dispensary in the waiting hall to receive the small yellow plastic bag with the pre-packed tabs for no longer than one month or only two weeks, if a drug shortage was in sight.

A child with a broken right forearm sat on the knees of the mother. I went with mother and child to the plaster room and reduced the fracture in a short-lasting anaesthesia and immobilized the arm with a long cast in flexed position of the elbow. A young man had dislocated his left thumb. It were reduced in local anaesthesia and immobilized on a splint. The next patient was a woman who had cut off the tips of her left index, middle and ring finger with a panga. I put the patient on the operating table in the casualty theatre and anaesthetized the fingers and covered the defects over the stumps with flaps in V-Y-shapes. The nurse gave the anti-tetanus injection. A boy entered accompanied by the father the consulting room. He limped with the left foot wrapped in a rag. The boy had stepped in pieces of glass and had cut his toes. The father carried the son to the small theatre room and put him on the operating table. I cleaned the toes and the forefoot and gave the anaesthetics to the toes affected and removed some splinters and sutured the wounds. Dressings and bandage were applied and the nurse gave the booster injection against tetanus. A mother brought her baby on whom the sixth finger on both hands and the sixth toe on both feet were ligated to separate them from the blood supply. The surplus fingers and toes had fallen off that the hexadactyly [six fingers] were brought back to the normal pentadactyly [five fingers] with five fingers and five toes. Lunchtime had started thirty minutes ago when I left the consulting room. Three of the seven waiting benches were cleared up.

The kitchen man filled the plate with rice and put a lobe of meat and the two pumpkin halves on the plate and spread with a big kitchen spoon the sharp chilli sauce over the rice. Dr Nestor and the paediatrician sat at one table that I took the next table. The friendly kitchen man with the dark spots on the white kitchen clothes cleaned the table from the used plates, cups and cutlery. I ate the rice and the half of the meat and the flesh of the pumpkin. The ten-year-old girl was in my mind, I had cut off her right arm.

The paediatrician left the dining room and Nestor came to the table and took a seat. He saw the sadness in my eyes and asked for the reason. I told him the story: The father was torn in pieces by a landmine a few weeks ago and the mother was sick who had to look after the girl’s younger brothers and sisters. I had cut off the right arm on the ten-years-old girl because of a bone malignancy in the upper arm. Nestor got a serious face from one second to the other. He put his right arm on my left shoulder and looked at me with sad eyes. After a minute of a thoughtful silence he said that we as medical doctors have to do our work which is to help our patients. “More than saving the girl’s life, you cannot do”, he added and changed the subject knowing that nobody could give the poor girl the right arm back.

He asked in connection with the text of the advertisement in the German ‘Ärzteblatt’ for my opinion, particularly if German doctors would be interested to come to Oshakati. A small advertisement was commissioned for what Dr Witthuhn as the medical director was ready to pay from the small and restricted hospital budget. I was concerned, if the small size could catch the eyes of the readers, but I answered the question positively and said that a glut of doctors exists in West Germany that goes parallel with a reduction of the medical and nursing staff according to the reduction of the bed capacity in the hospitals together with the closings of small community or privately run hospitals.

Africa is the continent where the sun triggers off the reflex of the exotic with the great distances, the width of the deserts, the clear night sky and the pristine habitats of the wild animals. Dr Nestor laughed and his fist knocked the hope for more doctors on the table. He got attracted by his imagination that the German doctors would respond, since from South Africa there was nothing to expect after it has withdrawn its doctors from the hospital. “The military does force us on our knees, but we will not give up”, Nestor said with an undertone of bitterness. I agreed and said that the few doctors left will stand as a unit with straightened knees. “We will pass the critical time and keep the hospital running and if we work sore our fingers.” It was a strong saying of an unconditional motivation when we left the dining room.

On his longer round in the children’s ward, I looked after the ten-year-old girl whom I hopefully did save her life, but took certainly away from her the quality of a normal and a cheerful life. The girl lay in bed with a tear-stained face. Her eyes were red which looked hopelessly. I gave a smile of deep sympathy and understanding what however remained unresponded. The girl kept the great sadness on her face that I was unable to ease. There was no point of light. I stroke her hair as her grandmother has done in the consulting room. The girl took it with running tears. She started weeping bitterly that my eyes got moist as well. It was the sad lesson that I couldn’t comfort the girl in her despair. I left her and left the children’s ward.

Outside the ward I wiped off the tears and went to the outpatient department to continue the work in consulting room 4. The Philippine colleague was busy in the plaster room to reduce a lower leg fracture on a child and to put on a long leg cast. I took the seat at the table, while a mother put her three-year-old girl on the knee and held up the girl’s right lower leg which had the clubfoot deformity. I explained the operation to the mother who agreed and gave the consent for the operation that I admitted the girl and wrote her name on the preliminary operating list. An old man who was accompanied by his son entered the consulting room and took the seat. The man had a spotted grey cataract and was blind. He showed his right hand which had a bayonet deformity on the wrist. The son told that the father had fallen. I took father and son to the plaster room where I put the father on the examination couch and gave the pain injection into the fracture gap. The son held the thin upper arm of the father and I pulled with one hand the old man’s thumb and pushed with his other hand the radial knot into place. I put on a forearm cast, while the son held the father’s hand up by pulling his thumb.

“Is that all?”, the old man asked his son and the son asked the doctor. I removed the plaster spots from his hands and made some notes and prescribed the pain killer in the health passport and gave the passport to the son who helped his father to sit up. The father thanked for the work and that it was painlessly done and left the plaster room guided by his son. A young woman sat on the chair. She put the tip of her right index finger on her right thigh where a needle was inside. I palpated the resistance and removed the needle in local anaesthesia by a small skin incision in the casualty theatre. I made a few stitches to close the incision and put the dressing on the wound, while the nurse injected the tetanus antitoxin. A twelve-year-old boy were carried on a trolley to the consulting room with a broken right ankle. He had fallen from a tree. The X-ray revealed an inner and outer malleolar fracture. The boy was brought to the plaster room and got a short-lasting anaesthesia. The fractures were reduced and the foot with ankle got immobilized in anatomic position by a short leg cast.

It was around six o’clock in the evening when the last patient was seen and treated. The seven cleared-up benches were reserved for those patients who were brought back by the hospital bus from Windhoek. It was a large crowd of people who entered the waiting hall and started occupying the benches with their bags and some with their children and with sheets and other things. More people left the bus and filled the semicircle around the bus to get their bags and luggage from the driver who cleared up the big luggage hold under the passenger area. The shutters of the luggage hold were opened on both sides that one could look through. The driver went around the bus and took the luggage out from both sides of the hold and put it on the square in front of the people in the semicircle. The bigger bags were piled up in the reception hall next to the entrance to the outpatient waiting hall.

After the patients have taken their luggage, the boxes with the drugs and infusion bags were taken from the luggage hold and carried on the trolley to the waiting hall. Finally, the bus driver took the big freezer box with the transfusion bags from the co-driver’s place which were carried on the trolley to the hall. The returned patients had to be seen by the doctor who was on outpatient call. This doctor had to decide, if the patient could be discharged or had to be admitted. The doctor on call was Dr Ruth who started the screening work. I went through the wards and looked after the operated patients of the day. The ten-year-old girl after amputation of the right arm was sleeping. The nurse had given her the pain injection. I looked at her sleeping face and saw the broad grieving rings around her closed eyes with the spots of dried-up tears. I read from her face that she had a fight in her troublesome sleep against the attempt to get reminded of what was done on her.

I left the hospital and crossed the square when I looked back to the outpatient reception where people and mothers with children prepared their sleeping places for the night. Cardboards and papers were spread out on the front passage surrounded with bags, tops and bottles. Young women breastfed their babies and wrapped them in cloths and carried them on the back. Old women puffed on short pipes what had the sharp smells of herbal-tobacco mixtures. Old men fiddled clumsily on the long sticks. Old and young sat side by side. They stared over the square, rummaged in bags and pockets and put out spoons and tins and ate from tinplates and pots and drank water from plastic bottles. Spoons clattered in the pots. The people spoke hardly to each other.

It was sunset and the sun dived the sky for some minutes in a red-violet blaze of colour. I took the way back to the flat as a walk under the great light spectacle of a ‘dramatic’ transfiguration. I showed the permit to the guard at the checkpoint who had no objection. Dogs strayed around and the cats were hiding. I pulled off the sandals with the sweaty cork soles in the verandah and the sweaty shirt in the sun-heated sitting room. I went to the small kitchen and filled the kettle half with water and put it on the gas flame for a cup of rooibos tea. I stirred in two teaspoons of sugar and took the cup with for a seat on the step outside the verandah door where I lit up the cigarette. It was an evening as the countless evenings were when I returned tired and exhausted from the hospital to spend the rest of the day in loneliness. I looked at the sky and saw the first stars coming out in the early darkness.

The ten-year-old girl knocked in my mind. She was weeping about the loss of her right arm. It was a great tragedy which I compared with the tragedy of the fourteen-year-old Kristofina who was hit by lightning which had burnt the right lower leg and had charred her shin bone. Kristofina passed away a few hours after admission. The ‘lightning strike’ on the ten-year-old girl was the malignant bone tumour on her upper arm [humerus] why the girl had to sacrifice her right arm. I saw still the amputated arm on the spread-out paper on the floor where the dark blood ran out from the cut-off end and formed a small lake of blood that clotted and stuck the arm to the paper. The question was: which kind of life could this girl expect. It was a question which I could only hypothetically answer.

The traumatic impact was inconceivable in respect to the psychological trauma. The girl was a right-hander and understood the world from this side. The change from right to left would be the greatest break and the learning process had to start right from the scratch. The prominent right shoulder board with the extremely short arm stump had lost any functional meaning. The girl’s body with the broken-off anatomy had an aesthetic deficit of a significant degree for the rest of her life. The stroke of fate and the surgery had crippled her human shape so much that loneliness and sadness would accompany the girl through the years to come.

The night sky stood in full splendour. I stubbed out the cigarette in the sand and emptied the cup of tea. I stood up, put the cup on the sink and took a seat at the verandah table in the sitting room and started to write down some of my reflections:

With ten you were a child

when you were hit with your beautiful face

what more frequently hit older and injured people.

Your dreams became inevitably shocked

when they hurried ahead and have seen

what came from the darkness without any light.

You called for your father

loud and then soft, so you have called

who saw you and was on the way

when he got torn loudly to pieces.

You have squatted down

with your hands against your eyes.

You were afraid and you were right

and has learnt to shed your tears

which could not stop.

The arm was the next without being pertly

it was taken from you for some reason

that you couldn’t find in your dream

because there was a corner in the darkness

without brightening by a single spark of light.

What should I say?

There was something hidden in the arm’s bone

that did not look good, because it was bad.

That is that I cut off the bad from you

what was in your right arm.

It is a case if one likes to help

but is unable to do so without a compromise.

When you come back from your dream

and will remember where it was

you will be sad what I didn’t want to be

maybe, you will be angry with me

what I can understand.

You were a young and beautiful girl

to whom it had happened with the arm

which you have used to play and write

to carry the container with water

or put the bucket with water on your head

or gave the goat a smack.

Now the arm is cut off

and you will never get it again.

Poor little girl, what will be

when you wake up?

I put the picture of the girl into my mind as she was trying to fly with the left wing, but dropped as a falling angel and was about to break the flapping wing. It was the picture of the pity and sadness when she raised up the left arm, but where the right arm had to be, there was not more than a short and ugly stub.

I left the table and took again a seat on the step outside of the verandah door and lit up a cigarette. The convoy of the five Elands with the long ninety-millimetre barrels took the sharp left curve in front of the flat to leave the village for the nightly field patrol. The heavy vehicles left a sandy cloud behind and the nose smelt the dry-bitter stuff what was tasted on the tongue as well. The moon was nearly round like a baker’s face and the round face kept silent as it had lost its speech. I looked at the Southern Cross and understood the deadly silence in that ‘rural’ area of an unknown light years’ distance. After this night observation and night reflection I pulled off the clothes and went to bed. I wished that the ten-year-old girl didn’t meet me in my dream.

I woke up bathed in sweat when the cocks crowed the morning of the new day. A missile whizzed through the dream and tore off my right arm. The cold sweat was related to the ‘fact’ that I could not continue the work as a surgeon. I felt myself useless and saw the fundament of my existence falling to pieces. It were the crowing cocks which saved my life and gave me the existence back by pulling me out of the dream what was a hard battle. It brought me back the right arm what I was unable to do to the girl. I stood under the shower when I asked myself the question, if I had tried in this dream to put a new arm on the girl. I felt ashamed that I didn’t try it. I was in the expectation of the new day and drank the cup of instant coffee with the chicory supplement and two teaspoons of sugar to fight the tiredness after the dramatic missile dream. I put on the sandals in the verandah and left the flat without looking at the paper with the writings of the previous evening.

There were no dogs straying around and no cats jumping in the roadside ditches. On my walk to the hospital I looked at the small shelters packed and surrounded with layers of sandbags on the sides of the houses, but no dog lay in front of the shelter entrances and no cat lay on top of the sandbag hills. I showed my permit to the guard at the checkpoint who responded with a long yawn. The gatekeeper put the whole egg into his mouth and rubbed the shells into the sand. His mouth was full that he was unable to say a word of greeting when I passed the hospital gate and did greet him. There were two new patients in the intensive care unit who were operated in the night by Dr Tabani, the one because of an intestinal obstruction and the other because of a spleen rupture after a traffic accident. Since the beds in the unit were occupied, Tabani had transferred two patients to the general wards, the man with the missing arm and missing leg to the orthopaedic male ward and the man after reconstructive surgery of the face to the surgical ward. The man after laparotomy with removal of the spleen and bowel resection was in stable condition. I removed the drains and completed the records and wished the nurses a good day and left the ward.

The girl in the children’s ward after the right arm amputation who gave me the dramatic missile dream at night, lay on the back and slept. The swollen eyelids and the salt crusts of her dried-up tears had taken away her innocence. The child’s face had become features of an adult and of sadness. The pain about the loss of freedom and a hopeful future had weighted heavily her life. Temperature and pulse had risen in correspondence with the increased adrenalin distribution what was triggered by the pain responding hypothalamic centre. I pulled the sheet from the right shoulder and saw the dark blood spot on the bandage. The girl’s heart beats knocked strongly against the chest under the grey hospital shirt that I understood these beats as her resistance to a life, she didn’t want. I stroke her hair and put the sheet back over her right shoulder and completed the record.

The nurse with the heart for children changed the finger dressings on the right hand of the much younger girl after separation of the long fingers from the common skin bridges on the dorsal and the volar side due to the syndactyly. The skin grafts showed a good tendency to heal in and doctor and nurse put on the new dressings and a hand bandage. After all the children had been seen and the records were updated, I asked the nurse, if the children received the milk on a daily basis. The nurse looked astonished at me. When I asked about the condition of the toilets, the nurse smiled and asked, if I still believed in a miracle. I understood and said that I will bring up these points in the morning meeting, and left the children’s ward for a short round through the other wards.

I met on the way to the morning meeting the new black colleague who was a specialist surgeon and on the way to the superintendent’s office as well. The colleague said that he liked to have a conversation with me. I knew of the wish and waited for its realization. We entered the office and the black specialist took a seat on an upholstered chair next to the black paediatrician on the window side under the rattling air conditioners. I took my seat on a hard chair on the opposite side next to Dr Ruth, the hard-working black colleague in charge of the gynaecology department. The matrons arrived late and brought their chairs from the secretary’s office. The superintendent opened the meeting with ‘good morning!’ and introduced the new colleague to the attendees of the meeting. Dr Nestor said that the new colleague is the principal of the Lutheran mission hospital in Onandjokwe and will come twice per week to the Oshakati hospital to do the major surgical operations and should be in charge of the surgical wards.

The Superintendent expressed his hope that the presence of this new colleague would be a relief for the doctors of the surgical department. In this connection, he praised my restless commitment who had operated sore his fingers. The superintendent looked at my right hand with the dressed third and fourth finger and said he could not see Oshakati hospital without my great achievements. The new colleague who was the first black Namibian specialist surgeon did not say a word about his background and postgraduate training he had done in South Africa. The paediatrician whispered something into the colleague’s ear who did not show any reaction on his face. The superintendent asked the new colleague and me for a conversation after the meeting, and for comments from the forum.

The lean matron came up with the hospital clothes for the patients, the bed linen, washing bowls and spittoons what Dr David had complained about in one of the previous meetings. The matron confirmed that the shelves in the clothes’ storeroom were empty and the kept washing bowls and spittoons were defective and useless. These items had to be ordered, she said and the superintendent made a note and promised to work on this problem. Dr David thanked the matron for the immediate reaction. The pharmacist lady announced that the cardboards with the ordered drugs against malaria and TB and some other drugs had arrived. I brought the point of the nurse in the children’s ward that milk were only periodically provided for the children and then in little quantities. This had to be seen as a matter of urgency, since children need the protein to recover from their illnesses and to improve and accelerate the postoperative healing process.

Dr David emphasized the importance of milk as the basic nutritional element in treating the patients. He said that he cannot accept a hospital without the regular milk distribution to the patients and especially to those children who are malnourished as so often seen in this part of the world. The paediatrician did not say a word as he were not concerned about the poor nutritional status of the children. He looked at the yellowed asbestos mats in the ceiling as where there the answer for the protein enrichment of the nutrition.

The superintendent had the face of surprise as he was not aware of this serious problem. He made a note and framed it several times and instructed the matrons to look into this matter of urgency to make sure that the children and the TB-patients get the milk on a daily basis and in sufficient quantities. I mentioned the tiresome topic of the toilets and reiterated the question of the children’s nurse, if I still believe in a miracle. “I am inclined to believe in a miracle, especially in respect of the toilet conditions in the hospital”, I said. It caused a smile on some faces, while the matrons looked with faces of concern. The superintendent was aware of the unhygienic situation. He said that he had spoken to the ‘Sekretaris’ who promised to put things right, but was still waiting for the people of the works department to do the maintenance and repair. I imagined the ‘Sekretaris’ as he had turned up his nose because of the stench that he actually couldn’t smell through the phone. The superintendent made and framed a second note and reminded the forum that no patient could be sent to Windhoek the following two weeks for specialist treatment, since the specialists were on leave in South Africa. It was his final remark and Dr Nestor closed the meeting and asked the new colleague and me to stay.