Old Lovers Don't Die (2 page)

“De Villiers!”

Bolt shouted across the sanitised white Emergency Room at the Royal Adelaide hospital. Christian felt his name reverberate off the walls as interns and nurses turned to look at the source of the minatory guttural sound. The voice belonged to Dr. Adrian Bolt, the senior surgical registrar who had become the scourge of the trauma unit at the Royal Adelaide Hospital.

Adrian Bolt liked to give the impression the trauma unit was his own medical fiefdom. Within the confines of his personally constructed kingdom, judgement and commands were to be acted upon instantly. His word, he considered, was fundamental law and as with many short men, he had inherited the gene for belittling taller male individuals with acid sarcasm.

“De Villiers, stop trying to bloody chat up that nurse and get your stupid slack arse over here! We may have a gunshot trauma coming through that door; there is no time to be organising when you next get laid. I need you to be thinking resuscitation - not sex, and to be able to react instantly.”

Christian stopped talking and returned Bolt’s stare. Bolt was daring him to respond; the insecurity of his size desperate to manifest in a more belittling comment. Christian considered a cutting reply; this was his last week in the trauma unit before he went overseas for a year. It would almost be worth the vitriolic holocaust that would ensue to repay Bolt’s abuse in kind.

Adrian Bolt had passed his fellowship in surgery six months previously and was hoping to become a full consultant. That he had not yet been appointed clearly irked him. For most every other senior registrar, it was an automatic acclamation after graduation. The delay suggested to everyone that Bolt was either not good enough or not well enough liked. Christian had seen that he was a good surgeon. The only reason he could imagine that he had had not been appointed was that he had seriously pissed off the authorities in the Department of Surgery.

In contrast to his meticulous medical knowledge, Bolt cared little about his appearance. His black hair was receding on both sides; a few small tufts remained above each ear accompanied by unruly irregular strands crawling down his neck. Bolt allowed the hair uncontrolled growth for months. Periodically, he would sweep it out of the way with a carefully manicured hand, unconcernedly showering dandruff in every direction. This created a mini snowstorm, from which the medical students took sudden and evasive action. On a bad day, he had no shame and would take some of the lubricating jelly from the trolley on the ward and plaster his hair into place.

Medical students on ward rounds over the years had listed Bolt’s hair plastering as one of the ‘official’ causes of nausea. Ranked fifth on the list, it was a favourite answer at the annual quiz night, the answer which students had learned over the years and would shout out ‘Bolt’ at the appropriate time with great alacrity and laughter. Christian personally thought that the great tufts of unruly black primal hair emanating from his ears should have been added to the list. However, that was overruled when he had suggested it to the student committee; it was not considered truly nauseating, as they were difficult to see consistently if you were below average height. For someone who was so unconcerned about his personal appearance, Bolt’s approach to general and personal hygiene was also somewhat unusual. He insisted that on the ward all students and nurses fastidiously use the alcohol wash bottles.

“Do not bloody infect patients; wash your hands,” was one of his favourite invectives.

Yet his personal hygiene appeared to lack the same consistent rigor. His hands were clean from the constant use of the alcohol antiseptic bottles, but his body odour suggested that the rest of him needed a good bath. Stale sweat impregnated his blue surgical overalls; mixed with old blood and fast food, it created an olid reaction under the hot fluorescent lights of the Emergency Department. Another inexplicable peculiarity of Bolt’s was that he did not change his surgical overalls regularly; he seemed oblivious to the pungent smell which had started days before he decided to change them

The blue surgical overalls, which Bolt favoured in the emergency department, were a curiosity in themselves. All overalls for use in the department were delivered from the central sterile supply room neatly folded. Bolt’s overalls appeared on the ward with ironed creases. The strange thing was no one seemed to care about whether his or her overalls were ironed except Bolt. That created another favourite question on student quiz night for which no one knew the correct answer. He did not have a girlfriend and none of the nurses liked him, which ruled both out as surreptitious ironing women. There was a rumour that he sent them to his mother who lived in the small town of Whyalla. Small packages wrapped in brown paper, with a Whyalla postmark, turned up at the Emergency Department every two to three weeks addressed to Dr. Adrian Bolt. That however was just medical student speculation, for no one really knew, and no one dared ask.

The other strange thing about Bolt’s surgical overalls was that they always seemed a size too small. The cuffs squatted a good five cm above his surgical clogs, suggesting they were two sizes too small. On closer inspection, this was due to the fact the overalls rode up under his crotch. Bolt took the trousers and rolled the top down before tying them tightly below his waist. As a result, the trousers pulled up into his crotch, displaying various parts of his anatomy not normally visible. Christian thought that not only did it look uncomfortable but also it must have made standing up to pee almost impossible. The medical student’s analysis was that in pulling his pants into his crotch, it made him feel taller than he was. Christian thought that was too simplistic an explanation and wondered whether there was something a bit more perverse, knowing Bolt the way that he did. In that strange mind of his, it was more likely Bolt was trying to demonstrate that not all of his anatomy derived from the same gene that had dictated his height.

Adrian Bolt’s only redeeming feature that Christian could see was that he was damn good at surgery. The unshakeable belief in his own knowledge ensured that he had a good base from which to teach. Coupled with the desire never to display weakness or fear meant that if you could tolerate the sarcasm, excellent medical and surgical learning was almost compulsory. Not that Christian was enthusiastic when the time came at the thought of doing another rotation with Bolt. He could easily recall with the embarrassment the first time when Bolt had picked on him as a medical student. The medical students and Bolt had been rehearsing positions for a potential trauma. Marked out on the floor in the trauma unit were positions for each of the assisting staff as well as the senior registrar or consultant. Footprints in different colours permanently glued to the floor indicating where everyone was to stand. This was to ensure rapid and effective deployment of medical staff. Christian could remember that in his haste to get to the yellow footprints as the third assistant, he had ended up standing at the first nurse’s station. Bolt at that time had taken great delight in pointing out his stupidity and making him kneel in his position as they went through the rehearsal.

“While you're down there, pray that you are not as stupid again. We are here to save lives, not to have you lose them.”

Christian could distinctly remember the look of disgust from Bolt at committing so basic an error, but also the pleasure he got from belittling him in front of the other students. Christian enjoyed neither. Opting to do six months as a surgical trainee meant possibly more of the same abuse. He had thought long and hard about whether he wanted to endure that again and then rationalised that despite Bolt being arrogance personified, he was the best teacher. Christian also knew he had learnt a lot from this first rotation despite the regular humiliations. He knew that to be a surgeon, he needed the exposure to significant trauma, which provided an excellent background to dealing with other surgical emergencies. Enduring six months of Bolt would, in the overall scheme of his training, be worth it.

“Can't you move any faster than that, de Villiers?”

Bolt’s voice sliced through the silence that had now descended upon the Emergency Room as Christian moved to take up his position where a potential trauma victim might be waiting.

“And don't just stand there like some lanky beanpole without a brain, make sure you have some large bore intravenous catheters and the peritoneal lavage set in your hands ready to go.”

Christian was again tempted to say something confronting. He fought the urge and reminded himself there would be learning in this exercise and he would shortly be going overseas. He thought about asking a question and then remembered that even asking a question was to invite a comment on one's stupidity. Bolt expected everyone to learn by watching what he did; seeking verbal clarification indicated that you were not concentrating sufficiently. There was some small consolation. Bolt dispensed his arrogance without favour to all who ranked below him: doctors, medical students, nurses, and orderlies. The only real exception was if you were significantly taller than Bolt, then you had to expect a greater dose of sarcasm.

At 195 cm, Christian had always been a prime target .He was also easily spotted and therefore frequently picked on. There was nowhere to hide on the big wide wards, even if he attempted to try to crouch behind some of the taller students. Bolt took great delight in finding him. There were days in this latest rotation, where Bolt’s comments had become so frequent, that Christian had longed to ignore the lessons of the past and respond in kind. Either that or one good punch to his short fat nose. He had managed to control that urge, knowing that any kind of response would see him shifted off the trauma unit; such was Bolt's influence. He picked up the peritoneal lavage catheter and took his place.

“Good work de Villiers. It may have taken six years but I can see that at least you can recognise a peritoneal lavage catheter. The next question is do you know where to put it.”

Christian did not look up but just briefly imagined plunging it into Bolt’s abdominal cavity. The catheter with a sharpened spike he had used to assess whether there was any ongoing bleeding inside the abdomen. A small incision was made in the abdomen, which allowed the catheter to be inserted. If blood came back up the catheter, that indicated bleeding inside the abdomen and mandatory surgery. Given speculation that Bolt only had ice in his veins, stabbing him with a catheter may have little value. They stood waiting for the next ascerbicism when the nurse manager pushed her way past Christian to stand next to Bolt.

Maureen Maxwell had spent fifteen years in the Emergency and Trauma Department; she owned it and was the one person of lesser rank that Bolt appeared to defer to. Maureen’s hair cut was extremely short in the style of a United States Marine; the efficiency of hairstyle complimented by her triathlete’s body suggested she was not a person to be messed with. Every finely sculpted inch of her body projected authority; you argued at your peril. Bolt and Maxwell together made a strange but hugely efficient team, with medical students often speculating as to what kind of children they would have in the unlikely event that Bolt was the only male left on the planet.

“There's been a bikie brawl in Hindley Street, four suspected gunshot victims, and two stabbings; they will be here in fifteen minutes.”

Maureen Maxwell spoke in a matter-of-fact way that belied not only the unfolding drama, but also her experience in dealing with emergencies. Nothing ruffled her, not even the eminent arrival of four gunshot victims.

Bolt turned and faced Christian.

“De Villiers, come with me. The rest of you stay the way you are and be ready. Sister Maxwell, alert the other teams that they will be needed stat and it will need all the theatres open and the anaesthetists on-call notified.”

Christian followed Bolt through into the front of the emergency department. Lines of trolleys were neatly parked next to each other, thirty in total he had once counted, anticipating a major catastrophe. Orderlies, in their grey overalls, gathered in one corner to help with the transfer of patients from arriving ambulances. Through the bulletproof glass, which lined the front of the emergency unit, Christian could see the flashing lights of the first ambulance approaching.

“So de Villiers, time to find out whether you have learnt anything. You are going to assess the first patient. Tell me what you do first. If you don't get this right, I’m sending you to drink coffee with the bloody nurses.”

“Check airway patency, check breathing, and check circulation. Stop any obvious haemorrhaging.”

Christian repeated the mantra that Bolt had taught them ad nauseam.

“Establish venous access; prioritise resuscitation of the patient. Identify injuries at a rapid first assessment; determine need for surgery before second assessment.” He continued before Bolt could say anything.

“Not bad for a lanky beanpole.’ conceded Bolt. ‘Let's see whether you are any good at putting that theory into action.”

Christian watched as the paramedics rushed the first bikie up the ramp and into the emergency assessment area. He took up position at the head of the trolley. The paramedics had already established venous access and that the bikie was breathing, but his eyes were closed and Christian was uncertain whether he was conscious. He made a mental note that a Glasgow coma score was automatically six, indicating possible major brain damage.

As Christian looked down at the bikie, he was confronted by a dishevelled beard matted in blood; there was no movement other than shallow breathing. Another mental note: he may be paralysed. Not therefore to be moved, without the placement of a spinal board. The first superficial examination quickly completed, Christian could see blood now soaking through the badly torn faded denim shirt. Fortunately, there was no obvious gushing of blood, which would indicate a major arterial puncture; a pulse rate of 120 bpm indicated that there had obviously been considerable blood loss somewhere.