situation to provide the wards with more hospital clothes, bed linen and sheets and washing bowls and spittoons, since the storeroom for clothes is empty and a few washing bowls and spittoons are left on the shelf that were defective and useless. The superintendent made a note and responded that new hospital clothes, bed linen and sheets and washing bowls and spittoons should be ordered. In terms of improving the washing and toilet facilities, I expressed the hope that the ‘Sekretaris’ will send soon people from the works department who should bring the defective things in order. The superintendent underlined the notes from the previous day.
The acting medical director gave notice that a medical student from Germany will come to do a part of her practical year at Oshakati hospital. He said that this student will collect her experiences in a short period of time and could assist the medical staff. The superintendent did welcome the news. He raised the hope that the advertisement in the German ‘Ärzteblatt’ should be effective that some German doctors would fill the gap at the hospital. The time was too short to speculate on the effectiveness of the advertisement which was sent to Germany. However, the first intercontinental thread from Oshakati to Germany was spun out which could get effective by the arrival of doctors from above the Mediterranean. The meeting had ended and the attendees left the superintendent’s office with a trace of optimism that the things what were discussed would become transformed into practice.
I went straight to the theatre building and changed the clothes in the dressing room. I entered the small tea room. Dr Tabani was not sitting there as usual and waiting for the anaesthetic doctor, since he had refused to attend the morning meetings with the speeches and comments which had never brought any practical results. He was probably busy with his ward round.
I put the ten-year-old girl into my mind on whom I had to cut off the right arm within the next hour. Psychologically, it would be a very difficult operation. Certainly it had its medical indication with respect to the high malignancy of the bone tumour, but it would humiliate and threaten the life of the girl at the same time. I looked at the chest X-rays again what I did several times before and could not see any sign of lung metastases. I hoped therefore that this operation could save the girl’s life, though it downgraded it to a pitiable being. The result of the operation was unthinkable for the girl that she had never imagined and wished before. Fate had badly crossed a thick black line through her life which was already heavily burdened by the death of her father and the sickness of her mother.
Dr Lizette entered the tea room and called the forthcoming operation a ‘terrible’ one, because also she could hardly imagine the whole impact of the loss of one arm on the girl. The operation had not started and I was still in the tea room when I stood in front of the question, if a short but integer life with both arms would not be preferable against a long life with a mutilated body, since with both arms the girl could laugh what she would never do full-heartedly with only one arm.
Dr Tabani had entered the tea room and looked at my face of concern. He asked me for the reason that I gave him the question about life and life quality. The colleague said after a while of thinking with his soft voice that individual life in its quality is maybe comparable with other lives, but cannot be predictable and measurable. “Any kind of generalization will fail”, Tabani said who was able to share my concern in regard to the young girl and the forthcoming operation. “You have to follow the medical ethics, everything else is beyond your power and capacity”, he added and I made a ‘note’ in my brain.
Dr Lizette left the tea room to prepare the anaesthetic tools in theatre 2 while I showed Tabani the chest X-ray with the question, if he could see a lung metastasis. He screened carefully the radiograph and gave it back with the comment that he couldn’t see such a sign. I thanked for his comment and left the tea room with the sad feeling that the operation had to be done following the rules of the medical ethics. Tabani wished me strength for this operation. The girl was on the operating table and I washed hands and forearms longer than normal because of the heaviness of the thoughtful reflections.
It was an oppressive silence over and around the girl what remembered of the silence of grief in the moment of a child’s burial. The lakes of tears were in the eyes of the parents and other family members and friends who follow speechlessly in the deepest shock the small coffin and say goodbye stunned with a speechless grief and the sounds of sobbing, while the coffin gets lowered down to the ground for the child’s eternal rest. And all this without the opportunity for a last goodbye kiss from the mother and the father. After the service and leaving the grave with the resting child bedded down into the soil, people would start remembering and reiterating their experiences of joy what this child had brought into the family and the family’s life.
To cut off the girl’s arm
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
