with the plactic-reconstructive challenge to improve function and aesthetics of the hand. It was a long operation due to the particular challenge which required patience and skills from the surgeon. The fingers were dressed and the hand got bandaged in fist position. The operation took two hours.
Lizette praised the art work during the small tea break. She asked after the outcome of these operations and I was able to give good news. In the same break Lizette mentioned the young colleague and writer of the story of the forbidden love of the racially mixed couple. She said that this colleague was an interesting person what I fully agreed with and called him an extraordinary person in terms of commitment and gift, since this colleague was devoted to his work as a medical doctor who critically reflected on the burning points of apartheid. “He had put his finger on the small-mindedness of the ruling system. If this colleague keeps up his strength of protest and got his fingers not broken that points on the evil of the moral seediness, we can expect something extraordinary from him.” Lizette said that she spoke with her husband about the colleague who regretted of not having met this doctor.
“How is your husband?”, I asked. “He comes back quite often exhausted. Then he sits in the armchair and is sunken in the world of thoughts”, Lizette answered. I had no problem to imagine the psychologist sunken in his thoughts, because it was psychologically a dubious enterprise to encourage young soldiers without experience to shoot human beings dead, if the young soldier was of a higher level of education and had the pensive character with the fine sense regarding life and its values including the Commandments. Lizette and I had faces of concern about the madness of killings what was against human reason and reasonableness, and an arrogant imposition against the clear conscience. The blades of purpose and reservation did not pair to one scissors where the problem stood between the gaping blades with the axiomatic antagonism of sharpness and cutting properties. The gap between those blades was psychologically not to fill and to close in the understanding of the common sense and in such stronger terms irreconcilable with the human conscience.
I left the tea room to continue with the operations. A young man lay on the operating table with a ruptured left shoulder edge joint and the stand-out position of the lateral end of the collarbone. The anatomic disorder was called ‘the piano key phenomenon’ when the lateral end of the collarbone should be pushed down to get its anatomic position, but came up again when the pushing finger was taken off. After a curved skin incision, the shoulder edge joint were exposed and the lateral end of the collarbone were pushed down into anatomic position and fixed in this position with two wires inserted from the lateral aspect through the shoulder blade spine into the collarbone. The bones were tightened together by the tension wiring in the figure-of-eight shape.
The correction osteotomy [bone cut and internal fixation] on the thigh bone of a fourteen-year-old boy was the next operation. The shaft fracture had healed with a malalignment in valgus position [kink with outward deviation of the leg]. Therefore, the bone shaft was cut through the kink with the oscillating saw and the shaft parts were brought in anatomic alignment and stabilized by a long nail put into the medullary cavity. The layers of the soft tissue were closed with sutures. A dressing and bandage has finished the operation.
Humane psychology versus war psychology
Dr Lizette said during the tea break, while the nurses cleaned the theatre room that her husband would not do long this work with the war psychology, because the demands were simply too high which exceeded the normal physical and mental capacity by far. “What is normal in a war?”, I asked and said: “Also we doctors are over-challenged and over-burdened, but war does not care about human issues and needs, because war is the destroyer of civilization and mankind. War is the devil who swallows the people and its children with the ruthlessness of the laws of likelihood.” Lizette said that war has its own psychology which differs by far from the psychology of her husband. I had the picture of a canyon in mind with the steep faces of the war psychology on one side and of the other psychology on the other side. I said: “I’m not a psychologist, but as far as I understand psychology, it is directed toward the human being to achieve the internal balance and freedom and the internal peace and rejects any destructive attempts that the war brings to a large extent.”
“The war psychology is not more than a grimace of disgust and destruction that has nothing in common with a psychology of human reasonableness with the great and fundamental values of mankind. It is the schizophrenia in the sick brains of our time and particularly in the moral-diverted brains of the loudmouthed politicians who don’t know what the psychology stands for. They connect the one with the other, the psychology in the human-educated way of civilization with the grimace of disgust and destruction. The ugly face of war psychology belongs in the devil’s pot of the pathology of ‘human’ sciences.”
I felt the agitation of Dr Lizette who stood in front of me. I stopped the elaboration about psychology and its pathology with the ugly face of the war psychology when both doctors went back to theatre 2 for the last operation. An old woman lay on the operating table who had a skin lesion on the right forearm with the clinical signs of malignancy. I washed hands and forearms and was with my thoughts far away to ask and discuss with colleagues the dubiousness and manipulative susceptibility of the psychology and its pathology.
A nurse pulled the operating coat over me and tied the laces over my back. The instumenting nurse held the scalpel in her right hand when I entered the theatre room and pulled over the gloves and approached the operating table. I cut out the lesion and marked with a stitch the proximal end of the excision for the topographic orientation of the histological findings and covered the large defect with a skin graft taken from the right thigh and fixed it with thin stitches. The operation had been finished after the dressings and bandages were put on. The patient were brought on the trolley and carried to the recovery room. I thanked Dr Lizette and the nurses for the good cooperation and left the theatre room for the dressing room where I pulled off the sweaty green shirt and green trousers and dried the skin on head, neck and chest and put on the civilian clothes. I left the theatre building and took the passage to the outpatient department to see the patients in consulting room 4 where the Philippine colleague had started working two hours ago.
When I passed the waiting hall I had seen the ten-year-old girl with the swollen right upper arm in company with an old woman. Both say on the third bench in front of the consulting room. I took my seat at the table and asked the nurse to call the old woman with her ten-year-old grandchild. They entered the room and the old woman took a seat on the chair. A second chair on which the back was broken off was put for the girl left to the chair with the grandmother. I showed the X-ray of the grandchild’s right upper arm to the grandmother by going with the pen’s tip around the bony lesion.
The grandmother kept her eyes on the X-ray and followed with great concern the marking with the pen. The girl with the beautiful face looked with innocent eyes at me to get the glimmer of hope that the doctor can help her. Her eyes expressed the full trust in the doctor, while the desperation drilled a hole into my heart. I told the grandmother that the bone lesion is a highly malignant one that threatened the life of her grandchild. Fortunately, there were no secondary tumours [metastases] in the lungs and on the ribs on the X-ray of the chest visible, but only the amputation of the arm can save her life. I had the greatest difficulty to speak out the sentence with the amputation. It caused the impact of a ‘grenade’ on the grandmother who gave the grandchild a hug with her left arm.
The girl’s eyes lost the hope and became deeply sad. It moved desperately my heart that I became speechless for a moment. Grandmother stroke with her left hand over the grandchild’s head and hugged her again with her left arm. It took minutes of silent thinking and silent despair when the grandmother agreed with the operation and gave her consent and signed the operation form. She stroke over the head of her grandchild who became stunned with tears in her eyes. I put her name on the preliminary operating list. I got speechless because of the mutilation as the result of
