TB-wards, it was occupied by a new patient not later than one day, while many more patients were waiting for admission.
The presentation of the topic was brain catching. In the following discussion, the black paediatrician ‘corrected’ the lecturer that there is something different in the TB of a child compared with the TB of an adult. It was something small with what the paediatrian tried to make himself big. Dr David of the higher intelligence brought the weird position back into the clear line by a logically stronger definition showing the intellectual power when it came to the accuracy in summarizing the basic principles. Other questions from the colleagues were plain and clear and were answered in a plain and clear manner.
David thanked for the attention and the constructive questions. He received the applause, he did deserve. He took his seat on a chair and kept control of his pleasant humbleness. This doctor was a specialist of internal medicine who did his postgraduate at Wits-University in Johannesburg. He was a motivated and committed doctor and did a marvellous work on his patients at Oshakati hospital. David was always on time when he started the round through the packed wards of internal medicine. He was an excellent teacher and did once per week an academic round with his junior doctors who had praised his knowledge, experience and didacticism. Under whom, they had learnt much in terms of discipline, analytic thinking and management. This doctor kept a high ethical standard in terms of humanity who was on top compared with other colleagues, followed by Dr Tabani and Dr Ruth and the two doctors in uniform of the SADF like Dr van der Merwe and the young colleague. They were hard working doctors to the patients and dedicated with a ‘human face’ that they gave their lasting impressions to the nursing staff and the rest of the medical staff.
The young colleague said in the dining room when we took lunch that he had never heard such a lively lecture at the university. I replied that the lecture in medicine becomes more lively the closer it comes to the patients. The hard working doctor is ready to learn and be receptive for the fundaments in theory and practice which go more or less under the skin. It is because the practice-related connection exists in an overabundance at Oshakati hospital, if one only opens the door. The young colleague repeated that it was the best lecture he had heard in all his study years. He agreed that the reason was the tight connection with the practical demands at the hospital.
“Then was your time at the hospital also academically worthwhile”, I said with a smile. The young colleague replied: “It was the most instructive time in my life. I learnt a lot and have many reason to be grateful that I could work here and build up my knowledge and my first practical experiences. I wrote the Oshakati diary in which I noted the events, the impressions and experiences with the people inside and outside the hospital and the achievements in your department. I will read these notes with great attention in future, since I see them as fundamental guidelines on the way I have to go. These notes should be my lessons I have to keep in mind.” I was impressed and summarized the comment of the young colleague with the word ‘wonderful’. I mentioned the book about the forbidden love and reminded the colleague to keep me on track with the ongoing story of the young family at Pallis Bay. “I have promised this and I will keep my promise especially because you gave some constructive suggestions for the story”, the colleague confirmed.
We left the dining room and walked the passage to the outpatient department. The pale-faced superintendent saw us coming and waited outside the secretary’s office. When we were about to pass, the superintendent asked me, if the operation for removal of the axillary lymph nodes on the young woman with the breast lump could be postponed one day, since he has to attend a meeting with the medical director. I told that the operation could be done after that meeting, if it does not take too long. The superintendent said he would inform me.
We continued walking the passage to the outpatient department and passed the seven benches in the waiting hall which were packed with patients, and entered the consulting room where the Philippine colleague had started working. A helicopter turned over the roof and square when we were in full swing of work on the patients. The rotor blades whirled up the sand on the square. After the helicopter had set down a sandy cloud veiled it for some minutes. The rotor ran out and the three blades twitched to the stop when two men in uniform pulled out a man on a stretcher from the helicopter’s bulge and hurried with the stretcher to the entrance of the outpatient department. A nurse came running to the consulting room and called me to see the man who lay on the stretcher put down on the floor. The right arm of the man was torn off and lay disconnected from the blood circulation, but still connected by a small skin-muscle bridge beside the body. A strong compression bandage [as a tourniquet] was applied around the short upper arm stump to avoid the bleeding to death from the arm vessels. The injured groaned in pain. The cold sweat of death was on his face. I took a blood sample for cross-match and asked the two men in uniform the carry the stretcher with the injurd to the theatre building, while I informed the colleagues in consulting room 2 and the theatre staff of the emergency and asked Dr Lizette to give the anaesthetics.
I followed hurriedly the men with the stretcher and changed the clothes in the dressing room and helped the nurses in carrying the injured from the theatre reception to theatre room 2 where we lifted the injured from the stretcher onto the operating table. A nurse brought some bags of blood of group ‘0’ and Dr Lizette hung up the first transfusion bag and started the anaesthesia. I dried the hands in the washing passage with some blotting paper and a young nurse helped me into the operating coat and tied the laces over my back. The instrumenting nurse cleaned the skin with the brown disinfectant solution and covered the patient with sterile green sheets.
I separated the arm from the injured’s body by cutting through the small skin-muscle bridge and put the arm on a spread-out paper on the floor. I ligated the vessels close to the armpit and cleaned the wound by cutting off some dirty and hanging tissue shreds and shortened the arm nerves and bone stump. I smoothed the edges of the short bone stump with the bone file and covered the wound with the skin-muscle flap kept in position by some stitches. The stump were dressed and bandaged. A nurse has wrapped the cut-off arm in a big paper to an arm parcel. The operation had been finished when Dr Lizette asked, if the helicopter did land often on the square to bring injured people. It was the second time what I remembered that it was exceptional. The patient was lifted from the operating table onto the trolley and carried to the recovery room with a dripping transfusion bag to a left arm vein.
I changed the clothes in the dressing room when somebody knocked hard against the door. Without waiting a response like ‘Kom in’, a koevoet officer entered the dressing room when I stood in underpants busy to put on the shirt. The officer did not apologize for his disturbance, but said that the injured was one of his people who had crushed his arm between two vehicles. I told that he had amputated the arm. The officer was not surprised and said that he had seen already on the spot that this arm did no longer belong to the soldier. The officer asked how long the patient would be admitted at the hospital, since there was an order that military and koevoet personnel had to be transferred to the military hospital in Ondangwa as soon as possible. I closed the fly and held the ends of the belt in my hands when I said that the admission would last at least two days until the patient is in a stable condition.
The officer disagreed with the two days. He said that problems would arise in view of the military order. He did neither listen to the medical arguments nor took into account the risk of a human life after operation. He simply said that a military ambulance will take the patient in this evening when he is conscious and transport him to the military hospital. When I realized that a military order was above any medical arguments, I said: “If that is your decision then I will not argue longer. Do what you think is right. I have told you my objection from the medical point of view.” I asked the officer, if he were interested in the amputated arm. The officer agreed that I asked the nurse to bring the arm parcel and hand it over to the officer. We left the dressing room and the theatre building when the amputee with the missing right arm were carried on the trolley to the intensive care unit. The officer followed with the parcel of the cut-off and wrapped-up arm of his man lying on the trolley.
I
