sparkle gives you faith in this world, one who had always wanted this sort of work. She was from South Africa’s Free State and had that matter-of-fact way about her that defines people. But these gunshots, this was new to her. Back home, back in Bloemfontein, a place of long pastoral lands and the languid time of rural life, it was all stab wounds and car accidents. Not like here in the Cape Flats.
We were in the controlled section of the hospital. Only the staff and the dying and those clinging to life went back here: an unseen world the gun helped create. A world of sterile swabbed pain. We had walked through clanging doors and down long lines of scuffed corridors that glowed in the off-white light and turned into a windowless room. There we sat at a metal desk surrounded by blood pressure gauges and ventilators, IV lines and machines whose purpose you didn’t want to know. Drugs lay in quick-grasp handfuls in cabinets that hung upon the scrubbed walls. Adrenaline, Etomidate, Furosemide, Atropine – alien and painful-sounding words. There were ugly things that caused pain. Scissors. Scalpels. Large-bore catheter needles, sixteen gauge. They spoke of one thing: that the pain caused by guns does not end with the pulling of the trigger. That’s just the start.
Her patient population was predominantly, almost exclusively, young black and coloured men. And the gunshot wounds were predominantly low-velocity and multiple. No AK47 rounds here; rather, small handguns and bang, bang, bang. People getting shot four, five times even.
‘One guy was shot thirty times,’ she said. ‘Mostly flesh wounds, but he survived.’ She tapped the desk. She was frustrated with the lack of resources. She wanted to help so badly, but things were never just about desire here. ‘In the US you have full body scans. Full diagnostics, all on hand for you there. All in fifteen minutes. But here – we see so much violence and we’ve only just got an ultrasound.’
Computerised tomography scans and X-rays here can take twenty-four hours to get back, and this made for hard decisions. The other day a patient came in – shot in the abdomen. They put forty units of blood and blood products back into him, but by then he had suffered renal failure, so he went on a ventilator and then into an intensive care unit for four weeks. This meant others were refused intensive care, there just weren’t enough beds – and by others she meant children with acute appendicitis or cancer. One life saved here, even if it’s the life of a killer, means another life lost.
This is the stark reality of trauma surgery in a land of scarce resources. The ratio of public doctors to patients can be as low as 3 for every 100,000 in the South African health system.11 Such state medics care for about 85 per cent of the nation’s trauma cases and these men and women in white clearly don’t have enough resources to cope.
The gun has hardened her, she said. No longer does she want to be told about the background of her patients. ‘I am not interested in knowing anything more than that they were shot. I don’t need to know that one guy, a guy we’ve spent a long time helping and given lots of resources to, that he then brags about how many women he has raped. That’s too hard to hear. I don’t want to know, because, you know, lots of them have raped and killed.’
Her voice slipped a little in the white room. I noticed an edge of anger. I suspected that she, her heart so full of care, couldn’t comprehend how others did not feel the same desire to change matters, to help. But the thing she found the hardest was that those whose lives were marked by violence – the gangsters, the young thugs – often survived the terrible wounds caused by guns. It was the passer-by – the innocent caught in the crossfire who never expected this – who died with a look of surprise on their face, unprepared for the sudden descent. That bothered her.
She had seen a change in her personality. Now she is more clinical, dispassionate. ‘Don’t come and cry on me.’ This was what this brave doctor said to people. And she looked a little guilty at what this had done to her relationship with her patient boyfriend, an engineer and a man who never had to hold a dying teenager or an infant with a gaping gun wound in his back. Other things slip, too. After days of bloody surgery, everyday chores like tax forms and bill payments and driving licence renewals just fade out. Death captures her attention like a demanding child.
‘There are days when nothing happens. Then a whole number of gun-trauma victims come in at the same time. It’s 0 per cent to 100 per cent. In those days when nothing is happening, you pace the corridors; you get bored. You find yourself only functioning when something happens – when you are on adrenaline,’ she said.
She had been soaked in blood, head to toe, several times in the last year alone. So I asked her about HIV in this land where about 10 per cent of the population are infected, and her answer was as brutally logical as her other answers. She didn’t think about it – she took the necessary precautions with double gloves and all the rest. But it’s not possible to avoid blood. If there was cause for concern, she would take antiretroviral drugs and to hell with it.
‘They aren’t good. They make you tired, give you diarrhoea. You vomit. So you ask yourself – what are the chances of getting an infection? You treat all patients with caution but you can’t discriminate.’
Blood was nothing to her. But, then again, she couldn’t watch horror films. She was scared of the dark.
I ask about what would be the worst type of gunshot, and she was quick with her answer. ‘The head. If the head is involved and the bullet has gone through – well, it’s a very poor prognosis. If vasculature is involved, if you get shot in the neck, chest, abdomen and it is close to a vessel – all of these have poor outcomes.’
‘In fact,’ she said, ‘we don’t get to see a lot of large vessel abdominal injuries because those shot there just die.’
If you are shot in the limbs, she went on, you can get devastating trauma to nerves, or you get complex fractures, and then young men lose their legs. But what is most horrific is a spinal injury: C3 fractures, quadriplegics, tetraplegics. They end up in care homes and lie there, and no one turns them. No one cares for them, until their own foreshortened death.
She descended into talking about sepsis and perianal wounds and genital trauma. But her mind drifted back to those she felt most powerless about. It was the bleeders that stuck in her mind, those shot in the portal vein, the retrohepatic inferior vena cava, the aorta. They die there on the table, and you ask yourself: ‘Did I do the best I could?’ Holding these nameless men as they slip into unconsciousness and beyond has meant she has begun to take sleeping tablets to help her sleep. Or she turns off her phone and goes for a run and just, well, just tries to live a life of the living.
‘In the end,’ she said, patient and calm and answering my questions as best she could, ‘you really just want people to survive.’
The man’s face had the look of wax; his eyes were glazed and unfocused. He had sustained a vicious beating, and it was unlikely he would survive the night. His leg moved in small, grotesque, primal jerks. The man beside him was breathing in short, sharp gasps. That one making urgent noises with a bloody drip coiled up and away from his chest had been stabbed with a screwdriver.
The night after my conversation with Dr Taylor, I had driven back through the streets of Cape Town, through patches of contained light cast upon the empty dark roads, to witness what a weekend night brought to this hospital. To see people on the edge of surviving and to see which way they’d fall.
On this midnight watch, the waiting area outside Tygerburg’s trauma unit was filling up. A small boy lay silent, supine in his mother’s arms. His thumb had been ripped off, and the nurse was telling the mother they would not be able to save it. Later, the mother was to ask me if I was able to help him, because I was white and she assumed I was a doctor.
The
