Does it Hurt to Die (4 page)

Resigned to dying, he looked along the pew in front of him in the vain hope that the terrorists might be moving to another part of the church. What he then saw petrified him. The four terrorists were now throwing grenades randomly. They were pulling the pins and tossing grenades as they walked amongst the remaining congregation.

Jannie watched as one of the terrorists looked in his direction, saw him move and then lobbed a grenade towards him. He watched it curling through the air, as if in slow motion, the nails stuck crudely to its casing clearly visible. It bounced just in front of where his feet were trapped, before making a vitus-like roll down the aisle of the church. The grenade bumped and lurched down the aisle until he lost sight of it. He curled himself up as tightly as he could, thinking that he would not see his son again, that this was where his life as he knew it would end. There was a muffled explosion, intense pain and then blackness.

‘
He’s alive,’ he heard someone shout.

Jannie then felt the pain, an immense burning type of pain coming from his left forearm, an excruciating pain, reaching knife-like into his shoulder. He looked down and saw his hand at a strange angle. He then tried to move his hand, but it did not move as it normally should. He could see the radius and ulna bones in his forearm protruding through the skin. Pieces of bone rested on the back of his hand, and every time he tried to move, the excruciating pain returned. He looked at his arm as his brain tried to work out whether the major nerve had been severed. If it was, he knew he might never operate again. Then he heard a familiar voice.

‘There’s blood gushing from your leg, Dr de Villiers,’ said Katrina, a young woman from the youth group who was now standing behind him.

‘
Well, put your hand on it and press,’ Jannie urged.

As Katrina took a scarf and applied pressure to his leg, he heard his heart loudly beating. Instinctively he counted for five seconds and then calculated that it was one hundred and twenty beats a minute. Tachycardia at that rate indicated he must have been losing significant blood. Unless it was stopped, he would quickly pass out. The pain started to come in waves again but then another voice he recognised spoke his name.

‘Dr de Villiers, you’re bleeding from your back and leg. I’ll need to take your shirt and trousers off.’ It was Willie Smith, his intern from Groote Schuur Hospital.

‘
Willie, I have a compound forearm fracture, but that’s not what’s bleeding. I can feel pain down my back and legs. Go ahead and rip off my shirt and trousers. Find out what’s bleeding.’

Willie removed Jannie’s shirt.

‘There are some shrapnel wounds, Dr de Villiers.’

‘
Tear off pieces of the shirt and plug them, Willie, and then look at my left ankle, it feels wet and it’s hurting like hell.’

‘
You have a large hole above the malleolus from a grenade fragment and it’s spurting blood.’

‘
Stuff the sock in there, Willie, and put some pressure on it. The shrapnel must have hit the artery.’

The pain flooded upwards as Willie stuffed the sock into the small crater created by the grenade exploding behind his ankle
. ‘It’s stopped,’ Willie said, after pushing hard against the sock for five minutes.

‘
Good. See if you can find a splint for my arm.’

‘
I’ll do that, Dr de Villiers,’ said Katrina.

He could feel Willie checking the rest of his back and plugging small holes with pieces of his torn shirt. As he counted his heart beats again one of the congregation had fixed the loudspeaker and was requesting any medical people who were present to come forward to help with the injuries. How ironic, Jannie thought. Here he was one of the people who could probably help most and he was the one needing help. When Katrina returned with a splint for his arm, she took over applying pressure to his ankle while Willie tore out one of the batons from the pew to reinforce it. When the ambulances arrived Willie supervised the transfer of Jannie on to a pew, and then they lifted him up, carrying him over the dead and dying to the nearest ambulance.

Either side of him he could see bodies with arms and legs at different angles. The carnage was like nothing that he had ever seen in his military service. Other members of the congregation who had survived were lying dying, with others comforting them. Intravenous lines were being put up as the paramedics arrived amongst the smoke and the smell of cordite. The smoke from exploded grenades hovered like a cross of death over those on the floor. Who would do such a thing? he thought. Who would commit such an outrage in a church, a place of peace and worship, of racial friendship? Perhaps his father had been right all along. The kind of barbarian who behaved like this had no right to rule the country.

‘
Jannie,’ said a voice. He looked to his right and level with his face was John, an old family friend. ‘How are you, Jannie?’

‘
My arm is badly broken and I’ve been shot through the side. Can you contact Renata and tell her to get Chris Kimble, the orthopaedic surgeon, and Digby Mornay; I may need a laparotomy, I have a puncture wound on my abdomen.’

‘
Which hospital?’ John shouted as they loaded Jannie into the ambulance.

‘
Constantiaberg—the private one,’ Jannie responded as the rear doors closed.

The doorbell rang and its sound reverberated down the hallway to where Renata was on the phone. She wondered who it could be late on a Sunday night.

‘Margie, hang on there’s someone at the front door,’ she said as she put the phone down and walked to the front door. Renata flicked the outside light on and peered through the security eyepiece. John and Mary were standing there. They were coloured people whose friendship Renata cherished, hoping that their kindness and sophistication would change some of Jannie’s Afrikaner prejudices. She punched in the security code and opened the door.

‘
Hi, John, come on in, take your coats off. I’m on the phone. Won’t be a minute.’

She walked quickly back to where the phone was in the lounge.

‘Margie, I have to go. John and Mary have arrived. I’ll call you tomorrow.’

She put the phone down and turned to face John, thinking as she did that he did not look as relaxed as he normally did. She noticed that John also had not removed his coat, which was one of the first things that usually happened, now that they felt comfortable visiting her home. As she looked more closely at his face, there was not even the slightest hint of the smile that she loved. He always smiled—in fact, Renata could not remember him not smiling, ever.

‘What’s the matter, John?’

‘
We’ve got bad news about Jannie.’

‘
Is he dead?’

‘
No, but he’s badly injured and needs you to meet him at Constantiaberg Hospital with Chris Kimber.’

‘
Kimble,’ corrected Renata.

‘
Yes,’ continued John, ‘and Digby Mornay.’

Renata noticed Mary was crying and wondered at the back of her mind whether she would be OK to look after Christian.

‘John, was it a bad car crash?’

‘
No, no, Renata, it was a terrorist attack on St Andrew’s.’

Renata felt her face drain.

‘What kind of terrorist attack?’

‘
Four or five men with guns and grenades just shooting anywhere and everywhere.’

‘
Mary, can you look after Christian?’ Renata asked, suddenly assuming her medical persona.

‘
John, can you phone Chris Kimble and Digby, and explain what’s happened? Their numbers are on the pad next to the phone. Tell them to meet me at Constantiaberg straight away.’

‘
Don’t you need me to drive you?’ asked John, astounded at the sudden change from the shock they were all feeling, to the calmness and organisation that Renata was now displaying.

‘
No, John, I want to be there when he arrives, and if he dies, I want to be there with him.’

Renata grabbed her coat and peeked in on Christian. She could not see him, but his breathing reassured her that he was soundly asleep. As she opened the front door, she heard John on the phone asking for Dr Kimbler, not Kimble.

Chris Kimble would not be fazed, Renata thought. He had been called many things in his halcyon medical school days, but he now had a reputation as one of South Africa’s leading orthopaedic hand surgeons. Renata stopped in mid-thought. That is why Jannie wanted Chris, not because of their friendship but because he needed the best. He must have a serious arm injury, she thought. Trust Jannie to be thinking of what he best needed when he was shot and bleeding.

‘
Where’s Dr de Villiers?’ she asked as calmly as she could as she walked into the emergency room at Constantiaberg.

‘
He hasn’t arrived yet, Mrs de Villiers.’

Renata hid her annoyance. The sister knew she was a medical doctor, well known in her own right; but steeped in Afrikaner tradition, she always felt addressing her in the diminutive somehow preserved the past. A past of female subservience Renata had tirelessly fought against. She said nothing, partly because it had been ineffective in the past, and partly because it gave Corrine satisfaction.

‘No one’s arrived yet, Mrs de Villiers. There are not enough ambulances and they’re bringing some people here in cars, but because of the access to the church, they can’t get out quickly.’

Renata turned away, thinking what Jannie must be going through, willing him to get here, and knowing in her mind that with any trauma it is the first hour that is critical for survival
. ‘The golden hour,’ she remembered Van der Spuy calling it, the thought a flashback from her time in the trauma unit at Groote Schuur. She remembered thinking at the time that it seemed a terribly inappropriate term. It certainly was not going to be too golden if you were badly injured or if you died, but then again they could not have called it the ungolden hour either she thought. Her mind wandered again to Jannie, wondering how badly he was hurt. A hand on her shoulder interrupted her thoughts.

‘
Chris,’ she said, turning and grabbing his large frame while letting his big arms encircle her.

‘
It’s OK, Renata, he’s alive, and he’s on his way.’

‘
How do you know?’ she asked as she pushed herself away, composure rearranged and somehow strengthened from his embrace.

‘
We’ve been in contact with the ambulance by radio telephone. We could hear Jannie shouting at the ambulance driver to go to Constantiaberg, not Victoria, so we at least know he’s conscious.’

As staff hurriedly prepared extra stretchers, and other doctors Renata knew assembled, details of the attack came through.

‘Twenty dead and hundreds injured,’ said the first driver. ‘It’s absolute mayhem—bodies everywhere.’

‘
Two minutes,’ said Chris. ‘He’s two minutes away.’

‘
Where’s Digby, Chris? We need Digby,’ she exclaimed.

‘
Calm down, Renata, he’s in the emergency room making sure there’s Haemacell, saline and wide bore IV lines. He’s also organised theatre and called Roger for the anaesthetic.’

That’s typical of Digby, she thought. Although he was Jannie’s friend, it did not interfere with his training. Emotion was suppressed, and rational thought meant survival.

‘He’s here,’ Chris said. ‘Renata, tell Digby, and I’ll get Jannie through into the resuscitation room.’

Renata looked towards the doors and noted that she had been unaware of the growing number of people, mostly with minor injuries, she thought, from a quick glance. What did strike her was the shocked look on most of their faces, as if someone had phlebotomised their joy. She turned from the door and hurried to the second emergency room. She heard Digby’s voice as she entered.

‘Carol, are there two high flow IV sets ready? Have you got the O negative blood yet?’

‘
Yes, Doctor,’ she replied.

‘
The latest report on the RT was that he was…’

‘
Dead?’ cut in Renata.

Digby looked up
. ‘No, Renata. Unconscious.’

Digby did not look at her again, but she had the feeling there was more that he was not telling her.

Chris’s voice interrupted her building anxiety.

‘
Digby, IV line, stat. His pulse is one hundred and BP fifty.’

‘
What the hell is the matter with those paramedics; don’t they know how to put up an IV?’ Digby snapped.

Renata watched transfixed as Digby and Chris each grabbed a large bore twelve gauge needle. Jannie’s face was covered in blood, both fresh and clotted. Through that, she could still see how pale he was—pale and lifeless
, nothing moving other than his chest as he struggled to breathe. His arm was strapped to a simple piece of wood—the straightness of the wood demonstrating the angulated fracture of his forearm, the bones protruding four or five centimetres beyond the skin.

‘
Chris, have you got anything?’

Renata watched what was becoming feverish activity. Digby’s needle had obtained a negative venous return from the neck and Chris was having little success from the right arm.

‘No, go for the groin.’

Digby grabbed another needle, and Renata watched him feel for the femoral artery knowing the vein would be medial to it. How many times had she done this herself
? she thought. How many times had she not been able to feel a pulse and stabbed for the vein blindly? She wondered whether Digby could feel a pulse.

‘
Got it,’ shouted Digby.

‘
Haemacell, stat. Chris, you come and tape this. What’s happening to his pulse and BP?’

‘
Still the same,’ said one of the sisters, ‘one hundred systolic, fifty diastolic, pulse one hundred and thirty.’

Renata could feel the tension ease slightly. They had access; at least Jannie was not going to die solely from blood loss.

‘Digby, I’ve got another vein,’ announced Chris.

‘
Good, put the normal saline through there and put a pressure bag on it.’

Renata watched as a sister applied a pressure cuff around the litre of normal saline, increasing its flow into the IV line. She glanced at the monitor. His BP had risen slightly to seventy diastolic, and Renata knew his heart was responding to the fluid replacement.

She continued to watch the monitor, its unvarying waveform, its regular muted beep, now at a rate of one hundred and forty per minute, which meant he was still trying to compensate for his blood loss. She did not want to look at Jannie again; she could tell he still had not moved. One of the sisters cleaned his forehead. She could see how pale he looked and how lifeless he was. She wondered briefly whether she should be helping to clean him up, but she could not move. She just stared at the monitor, willing his blood pressure to rise and his pulse rate to start falling.

The phone rang and Renata listened as Jannie’s haemoglobin of five was called out. He would normally run at fifteen or sixteen, a drop of ten meant significant blood loss or ongoing bleeding.

‘Most of the blood loss from his head, back and legs is controlled,’ reported Chris.

‘
The concern is, if he doesn’t wake, we can’t assess his abdomen. All the shrapnel wounds in his back could have penetrated his abdomen and he may have a large vessel bleeding.’

It was Digby’s longest commentary so far, something Renata knew from experience that tended to happen when you felt you had more control over a situation.

Jannie’s moan startled them all. Their attention turned from the IV lines to him.

‘
Renata, come and try to talk to him. Sister, get X-ray in here, and let theatre know we’ll be there in half an hour,’ commanded Digby.

Renata bent over and whispered his name. Jannie opened his eyes, and then closed them quickly. It was partly the brightness of the lights in emergency, but greater than the brightness was the memory. It was overwhelming and nauseating. He did not want it as a memory, and he did not want to be on a stretcher, triaged in an emergency room he knew so well. He felt the blood pressure cuff inflate and squinting against the brightness tried to focus.

‘Jannie, you’re going to be OK.’

As Renata came into focus, he noticed that she had tears in her eyes and remembered that he had never seen her cry.

‘Jannie, you’re going to need to go to theatre. Your arm is fractured in two places, and your leg and back have started bleeding again. Digby’s worried that you have internal bleeding.’

‘
Tell him my abdomen is fine.’

Digby turned from the monitor
. ‘Jannie, we need to be certain.’

‘
Well, don’t put one of those damn long peritoneal lavage catheters in there to find out.’

‘
OK, OK, we’ll go clinically for now.’ Digby managed a wry smile, thinking that his friend could not be this combative if his abdomen was filling slowly with blood.

‘
Theatre’s ready, Dr Mornay,’ the voice over the intercom announced.

‘
Chris, we’ll do the back and legs first. See whether he stabilises haemodynamically and then proceed with his arm if he is.’

Jannie listened to the monitor being detached and placed on his stretcher when suddenly he remembered
. ‘Renata, the transplant…’

‘
Yes,’ Renata cut in, ‘I phoned Bill. He’s taken over and said not to worry when you asked.’ She smiled to herself thinking how typical it was for him to still be thinking about the transplant at a time like this. For the first time Renata was pleased to hear him talk about it. It was for him probably a better predictor of survival, she thought, than his haemoglobin or blood pressure.