Old Lovers Don't Die (15 page)

“This used to be a back lounge but when our two children were growing up, we divided it to give each their own room. When you’re ready come through into the kitchen, I know that supper won’t be too far away.”

Chantal’s kitchen was a testament to her love of cooking. Approximately ten to twelve cookbooks sat in a neat rack at the end of the bench. Most had French titles, although the one that was open on the central island was in English. Garlic hung in bunches from the wall and small herbs grew in pots along the windowsill.

Chantal’s figure was still slim suggesting that she controlled the desire of all good chefs to sample what they created. Her long black hair was gathered up, and held on top of her head, a small thin wooden clip straining against the thick hair. It exposed a long thin neck, fine cheekbones, and aquiline nose that Christian had come to associate with the Tutsis. At nearly six foot tall, Chantal also had elegance about the way that she moved. Christian sat on one of the stools and watched as vegetables were quickly chopped and disappeared into the curry base.

“It will be ready in half an hour,” she said, looking up and smiling at Christian.

“It smells delicious, Mrs. Sudani.”

“That’s very polite. But if you call me Chantal, I will stop calling you Doctor Christian!”

“That sounds like a very good deal,” said Christian laughing.

Emmanuel walked back into the kitchen and motioned to Christian to follow him. The lounge which he led Christian to had a green leather three seater sofa and two reclining comfortable chairs, all facing the front window. Despite the fine curtain, Christian could still see the constant pedestrian traffic heading towards the border and the shores of the lake in the background.

“The lake looks inviting, doesn’t it? You would not know just looking at it that it could be the source of so many medical problems for us in the hospital.”

“Looks like some children are getting ready to go for a swim.”

“Unfortunately we cannot educate them all. Let me just quickly tell you a little about the hospital and then we can settle back and enjoy Chantal’s cooking. We usually do ward rounds at 8 AM. That is for both surgery and medicine. Patients accepted into our emergency department remain there until we see them. Some of those may not have been seen if we have been deluged by emergencies from the border and will need to be triaged. Given your surgical experience, we thought we would put you in with the surgical team. Currently we have no full-time surgeon, just one of our graduates who has done a bit of surgery. In many things, you might well be more experienced than he is, but our doctors here have to do everything from gynaecology through to urology and orthopaedics. You said in your letter that you had done some rotations in gynaecology and orthopaedics?”

“Yes that is right. I did a rotation in gynaecology in outback Australia. I have done about thirty caesarean sections and then a rotation at Alice Springs in orthopaedics. So I should be able to help with most things other than the really complicated orthopaedics.”

“That’s good. I will introduce you to Doctor Theodore Nikita. He will show you around the theatres and explain to you how everything works as well as outpatients. We do not have any real anaesthetists as you know them, just anaesthetic technicians. Anaesthesia in Garanyi is basically monitoring the patient and supplying oxygen, and a sedative drug of choice. I usually walk up to the hospital. That takes about twenty minutes and it’s quite safe although one of the staff will come back with you if it’s late at night.”

“Come on you two, food is ready and you can continue the discussion over supper.” Chantal’s voice drifted down the hallway and into the lounge where they were sitting.

The Accident and Emergency ward was attached to the side of the old hospital. It had been added on, jutting out from the main medical and surgical wards, like an inadequate afterthought. The hospital itself had an H shape accommodating 300 beds. Each side of the H had 150 beds. Medical and surgical wards were on one side of the H, Gynaecology and Paediatrics wards on the other side. The Accident and Emergency mutated from the middle of the H bringing it conveniently closer to the dirt roadway, which ran round the outside of the hospital. That meant the ambulance then could stop outside the entrance and quickly transfer patients.

The front door leading from the roadway consisted of two halves, which opened internally to allow stretchers and wheelchairs through. When Christian arrived with Emmanuel the following morning, both doors were tied back. Patients who could not be accommodated inside were sitting in the dirt at the front door, wounds crudely bandaged. One patient, Christian noticed, had a stick tied roughly with string, acting as a stabilizer of the obvious fracture. Another elderly man next to him seemed to be asleep, but Christian could detect no respiratory effort and he wondered whether he was dead.

Emmanuel carefully stepped over the patients sitting on the ground before stopping at the old man. He bent down and felt for a carotid pulse. After a few seconds he stood up, looked at Christian and shook his head; the old man was dead. Inside the front doors were six beds. Corrugated iron beds were painted white to hide their age, each with thick, dark, red blood-stained plastic mattresses. There were no sheets on any of the beds which were surrounded by grey floor tiles. Dried blood created Dali like art on the floor tiles.

There were two patients on each bed; if there were two males, they were head to toe. One bed strained under the impact of two woman and two children. Under four of the six beds, Christian could see patients with intravenous lines, the bags of saline which ran through them attached to the window catch. Others patients sat on the floor in between the beds apparently uninjured and were therefore most probably family.

At the end of the ward was a small wooden table, at which a young man in a white, neatly pressed shirt sat writing vigorously. Four patients were crowded onto the bench next to him waiting to have their details recorded. Standing behind him in a white coat, with a stethoscope around his neck, was Dr. Theodore Nikita. Broad shouldered with shiny black leather shoes, he did not look up as they entered, continuing to scrutinize patient notes, while intermittently asking questions of the young man at the desk.

“Dr. Nikita.” Emmanuel said, stopping next to him.

“Good morning, Doctor Sudani. As you can see, another busy night. Most of these came from across the border in the Congo after militia burnt down another village. Well, I should correct that - some of the ones who survived came here.”

“I see there is one outside the front door who didn’t survive.”

“Yes, we couldn’t deal with anymore at about 2 AM and I had to close the front doors. I found him this morning and he had no pulse. We are going to get him taken to the morgue.”

Emmanuel nodded. “This is Doctor Christopher de Villiers. He has come to work with us for three months from Australia. You might remember me telling you about him and that he had some surgical experience that we could do with.”

Christian stepped from behind Emmanuel to shake Doctor Nikita’s hand. Before he could do so, Nikita turned from both of them reached up and took a white coat from a peg on the wall. Then he turned and thrust it in Christian’s direction, avoiding a handshake.

“Let’s see what you know and how useful it’s going to be. They don’t have malaria in Australia, do they?”

“Thank you,” said Christian taking the white coat and slipping his stethoscope into the pocket. “We do have cases of malaria in Australia, but those are usually patients who have been to Southeast Asia. So there’s a great awareness about its presentation in medical schools.”

The greeting, or lack of greeting, Christian could understand. Doctor Nikita had been up most of the night, still had many patients to see, and did not need a medical tourist. He had always assumed that he would have to earn his stripes.

“I’ll leave you two to it. Christian, you can find me in the office. Theodore will explain how surgery and the theatre work. I will see you later.”

Theodore Nikita put down the folder that he had been reading and picked up a new folder from the desk. Without saying anything to Christian, he headed towards the patients on the right of the wooden desk. One woman got off the bed as he approached. The other woman who remained on the bed was partly covered by a bloodstained blanket. Her
long black hair was matted with blood, her face partly hidden by the blanket, contorted in pain. In her right arm was an intravenous line, the bag of saline to which it was connected almost empty. Nikita bent over her and felt for her pulse before pushing the blanket down to listen to her chest with his stethoscope. He touched her abdomen and she winced and cried out several times.

“She needs to be first on the theatre list,” he said, straightening up and talking to a sister in a tight ill-fitting uniform.

Christian was surprised that he had not removed the blanket from the lower half of the woman. The gentle touch on the abdomen, which caused a painful reaction, indicated peritoneal irritation to the extent that she required urgent surgery. Something was seriously wrong inside her abdomen.

“What do you know about recto-vaginal fistulae?” Nikita said without turning to face him.

“In the western world, they are usually the result of obstetric difficulties. Poorly applied forceps at the time of delivering the child can cause a tear in the uterus and the rectum resulting in a communication between the vagina and rectum resulting in faecal discharge out the vagina.”

“How do you repair them?” Nikita continued, still not looking at Christian.

“If the bowel contents have discharged into the abdominal cavity, we would at the time of surgery repair the hole in the vagina and the bowel and leave the patient with a colostomy.”

“Have you done any?”

“Not recto vagina fistulae repair, but obviously laparotomies and colostomies.”

“You can assist me this morning then,” Nikita said finally turning to look at Christian. The scrutinization from Nikita, Christian assumed, was a well-practiced look, designed not only to assess but to inform.

“This was not the result of obstetric accident. Congolese militia raped this young girl, repeatedly. Not content with that, they then brutalized. It would not be fair to say that she is lucky that she is alive but in the extreme inhumanity, which you encounter here, she is. If you’re going to work here and make a contribution, you will need to be familiar with this kind of injury and how to deal with it.”

Nikita pulled back the blanket far enough that Christian could see a large broken stick protruding from the young woman’s vagina. Nikita watched while Christian tried to take in the gross brutality. The image repulsed him; it assailed every decent sense he had built up over twenty-seven years. Waves of disgust rushed at him. He could not imagine how any one human being could brutalize another in such a fashion. He could not control the shock that appeared on his face. He knew Nikita had wanted to shock him, to see whether he was capable of dealing with the brutality that he was going to encounter. Christian looked at the young woman whom he estimated to be almost the same age as he was, crying and grimacing with pain. She had no family beside her, no support group, no one to turn to. Christian reached down and pulled the blanket up before walking to the far side of the bed opposite Nikita. He sat down on the bed, took the young woman’s hand, and as he did so, her eyes opened, fear and the pain openly transmitted. Christian bent over and, struggling to remember his high school French, said:

“Nous allons prendre soin de vous et de vous faire une meilleure,” which he hoped translated into a reassurance that indicated she would be well looked after and recover. The girl squeezed his hand, and closed her eyes. “Tres bien, a good start, you may turn out to be better than the other five medical voyeurs that we’ve had here,” Nikita said dismissively before he turned towards a middle-aged plumpish woman in a white coat, who had just walked through the front door.

“Matron Malasu, this patient needs an urgent laparotomy. Take her to theatre and arrange some large overalls for this tall Muzungu doctor.”

Christian smiled in the direction of Matron Malasu. She looked over the top of her glasses, perched precariously at the end of her nose, and said,

“Come and see me, tall Muzungu Doctor, when you are finished with Dr Nikita.”

Christian followed Doctor Nikita to the next bed. Lying on it with a distended belly was a twelve-year-old girl with long hair, a clump of which she was holding in her hand. Standing next to her, holding her other hand, was a woman in what Christian had come to recognize as traditional female dress: a blue-green floor-length skirt with a red sash draped over one shoulder hiding a T-shirt with a picture of Nelson Mandela. Her hair she had pushed up in a bun, decorated with beads and two pink ribbons. Christian assumed it was the mother of the young girl. Sitting under the bed were a young boy and girl playing with a wooden comb.

“She is a repeat offender,” Nikita said standing at the foot of the bed and looking down at the young girl. “She swallows things which block the bowel. She has had two major operations already and now looks like she needs a third. Examine her and tell me that I am right. We will operate on her after the previous patient.”

Christian looked at the young girl; to him she did not look dehydrated or distressed which was a good sign. He asked her to put out her tongue and noted that it was well hydrated, something that did not fit with a bowel obstruction. Surgery may not be as urgent as Doctor Nikita was thinking.

“Vous vomissez?”

“No, she hasn’t been vomiting,” the woman said who was standing next to her. “You can speak to her in English; she understands English well.”

Christian smiled at the woman, and explained that he was going to examine the young girl’s abdomen. He tapped her abdomen gently and noted that she did not react or wince in pain. That was another very good sign; it meant that the abdominal contents were not providing irritation. Taking his stethoscope, he placed it on her abdomen. There were low-pitched bowel sounds present, another good sign indicating that things were working relatively normally inside her abdomen. If there were no obstructions, she would not need surgery. He could feel Doctor Nikita watching him intently, willing him to confirm the diagnosis of obstructed bowel and the need for surgery. As he moved his stethoscope to the lower abdomen, he noticed a large clump of hair the young girl was clasping in her hand.

“Does she eat her hair?” Christian asked the mother.

“For as long as we have known her, she has done that. We adopted her when she was five. Both her parents were killed in the Congo by Kariba’s militia. “

Christian examined the young girl’s head and found many clumps of hair missing. Those clumps could be matted together in her stomach causing the distension of her stomach. It would be, he thought, a better explanation of the symptoms. However if he suggested matted lumps of hair as a diagnosis, it would conflict with Doctor Nikita’s management. Moreover, to contradict Nikita’s diagnosis would possibly compromise the rest of his stay in Garanyi. If he was right, the condition possibly could be treated without surgery from what he had recently read.

“So you agree with my diagnosis?”

Christian looked up from his examination. He did not reply immediately but put his ear on the young girl’s abdomen above the stomach. He then gently shook her side to side with Nikita watching.

“She has a succussion splash suggesting the outlet to her stomach is obstructed.”

“Well she still needs surgery.”

Christian stood up and looked around the ward. The article that he had read, just before coming to Africa, had been on exactly this girl’s condition—gastric bezoars or balls of hair in the stomach. The study had found that the obstruction could be overcome by getting the patient to drink Coca-Cola. The very acid nature of the drink dissolved clumps of hair and overcame the obstruction in many cases. In the far corner of the ward was a half-empty bottle of Coca-Cola. If he could persuade Nikita, it may well save the young girl from a further operation. Christian looked at Nikita who was now standing at the foot of the bed, arms folded, his body language suggesting Christian not challenge him. Christian briefly wrestled with the thought of not replying, however something within him would not allow him to deny his findings. If it meant damning his visit on the first day, so be it.

“I think we might be able to get away without surgery,” he said, straightening up from the side of the bed so that he could look Nikita straight in the eye.

“So you’re disagreeing with my diagnosis.”

“Yes. I think she’s got a gastric bezoar and from what I recently read, that half-finished bottle of Coca-Cola over there may relieve her obstruction.”

Nikita looked at Christian for thirty seconds before replying.

“If you’re not right, don’t come back tomorrow. Sister, give her that bottle of Coca-Cola and we will see her after surgery this evening.”