was empty. The people who normally stayed overnight at this place should have moved to another place inside the premises. I thought that the people had expected koevoet with the Casspirs after this huge detonation which was not far away.
I entered the waiting hall and saw three trolleys with injured people. The first injured had a torn-open stomach with a prolapse of torn intestinal loops. On the second injured the right forearm and the left leg were missing. The upper arm and the leg stump were tied to stop the bleeding. The third injured had a torn face on which the left ear was missing. He could not see on his left eye due to a piece of metal that had injured the lens and stuck in the eyeball.
The nurse had taken the blood samples for cross-match and a young nurse had found the lab assistant and had given him the three samples. Infusion bags with physiological saline solution were put on each injured. I informed the anaesthetic doctor on call who was Dr Nestor, the new superintendent, and the theatre staff of the emergencies. One injured after the other were carried on the trolleys with squeaking rollers to the theatre building. The first operation was on the injured with the torn-open stomach. I had carried him to the theatre room 3 where I and two nurses put him from the trolley on the operating table. Dr Nestor appeared in operating clothes with a slight delay. The shock after the detonation was still in his face.
He pulled up the syringe for the induction and adjusted the levels of oxygen and nitrous oxide [laughing gas] on the anaesthetic machine. The instumenting nurse laid out the instruments on the instrument table, while I washed hands and forearms over the large zinc tub in the washing passge. The lab assistant brought four bags of blood for the patient and the first bag were connected for transfusion, while the other three bags were put in a thermostat to warm them up to body temperature. The patient was cleaned with the brown disinfectant solution and covered with sterile green sheets. I made a midline incision, while the nurse held the prolapsed bowel away. Blood were sucked from the abdominal cavity. The ruptured and bleeding spleen were removed and the bleeding mesenteric vessels were ligated. Intestinal loops with big tears were cut out and new bowel connections [anastomoses] were done. The urinary bladder was torn and were sutured. Other tears on the descending colon segment and the left kidney were sutured as well. Two wound drains were put in, one under the left diaphragm and the other to the deep abdominal pouch [of Douglas]. The closing of the abdominal wall was complicated by the torn tissue that had partly to be cut out. The operation went over two hours when the wound were dressed.
Dr Nestor had difficulties to bring up the blood pressure to a measurable level. All four blood units were given during the operation. The condition of the patient was critical and the operation were done in head-down position of the operating table. All hands took part to bring the patient on the trolley who were carried to the recovery room.
I went to the small tea room and filled two cups of tea, one for Nestor and one for me, and put the cups on the pen-scribbled wooden plate of the small club table. “Have you an idea where the detonation had occurred? It couldn’t be so far from the hospital”, I asked Nestor when he entered the tea room. “We can be grateful that the hospital wasn’t hit.” Nestor agreed, because nobody could imagine the extent of the catastrophe in such a case. “I hope the madness comes soon to an end. The damage is already big enough”, he said. I thought for a moment of the young colleague and writer on the book about the forbidden love who has predicted a speedy end of the system which was run-down morally and politically. He said that the end cannot take long, since the black masts were in sight.
The black superintendent understood the metaphor and got a smile what I interpreted as a smile of hope. He said that the time is overdue and he put his trust in the power of the united nations to bring the system of injustice and segregation definitely to an end. The picture of the two black specialists whirred through my mind who were talking to each other apparently on important future-related topics that they gave me not more than two minutes to greet the new colleague.
Dr Nestor and I left the tea room and went to theatre 2 and put the injured with the missing right forearm and the missing left leg from the trolley on the operating table. The lab assistant brought five bags of blood and Dr Nestor connected two bags for simultaneous transfusion to the injured. The operation consisted of ligation of the big vessels and of shortening of the big limb nerves and the long bone stumps which had to be covered with skin-muscle flaps. The flaps were prepared and kept in place by stitches. The wounds were dressed and bandaged over the stumps. The patient was carried to the recovery room where the first patient was still under observation with the oxygen mask on his face. The third injured needed plastic-reconstructive surgery on his torn face with the missing left ear. It was impossible to save the left eye. The metal had torn the lens and iris in pieces and stuck deep in the vitreous body [transparent jelly-like tissue filling the eyeball behind the lens].
The reconstruction of the eyelids took long, since the left inner eyelid corner [canthus] was torn up to the lacrimal point. Of the lost ear some skin-cartilage debris were left that I shaped a kind of ear which had less than half the size of the normal ear. The tip of the nose and the cartilage part of the nasal bridge were missing what made the reconstruction extremely difficult. The defect got covered by a rotation flap from the right cheek and the nose became flat with an angle at the end of the bony part of the nasal bridge. There were defects on the torn lips which were closed by shifting parts of the lips after mobilization. The operation lasted more than four hours and more operations were still needed on the face to a later stage. It was quarter past five when we left the theatre. I did not think of sleep and went under the shower in the dressing room where the first rays of the sunrise came through the window. I dried the skin and put on my civilian clothes. I went to the tea room and boiled water for a strong tea when I put two tea bags in the cup. Nestor had not fully recovered from the shock. He went home for a short rest and refreshment.
It was one of the sleepless nights of which there were so many to get through regardless of the physical and mental conditions. The workload was heavy, but the work had to be done. Fingers on both hands were dressed because of pressure sores, excoriations and cracks on the skin by frequent handwashings and the use of defective instruments in the huge number of operations. I left the theatre tea room to start the ward rounds earlier and looked after the operated patients in the intensive care unit. Two of the three patients of the night were in critical conditions with low blood pressure and high pulse rates. On the first patient with the prolapse of the intestinal bowel where some injured loops were resected and an anastomosis was done, the two abdominal drains produced blood in smaller amounts. The dressings on the shortened stumps of the second patient who lost his right forearm and his left leg, were bloody that new bandages were put on. New bags of blood were ordered from the lab in consideration of the possibility that all blood units were used during the operation and no more blood was available.
The face of the third patient after plastic-reconstructive surgery due to the extensive injury was widely covered with the head dressing except the right eye and the mouth with the reconstructed lips that were swollen. The circulatory system was stable and the patient was on infusion drip. Antibiotics were ordered for all three patients. The intensive care unit was overcrowded that those patients in stable condition were transferred to the general wards. I looked after the old man with the inoperable colon cancer in the surgical ward. The old man breathed with the longer intervals in between and was about to bring his life to an end.
I went to the female ward where the old woman after the above-knee amputation due to the femur malignancy showed a strong will to live. She waited for her discharge as early as possible to support morally her daughter with the two small grandchildren. The leg stump of the old woman looked satisfactory that I discharged the patient earlier after putting on a new dressing and bandage. I gave the necessary instructions which were translated by the nurse and agreed by the patient. I understood that the human aspect played the major role in the decision of the old woman.
The other old and emaciated woman after the below-knee amputation due to the forefoot gangrene had the great problem to find the inner peace.
