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.
The paramedics, in their rush to get the victims to hospital, had not cut any of the victim’s clothes off. Christian reached for the scissors on the emergency trolley as well as the surgical gloves. He was about to cut through the shirt when Sister Maxwell walked past and, with a look of feigned horror, handed him the protective glasses from the trolley.
He attempted to quickly cut through the blood-soaked shirt, but the scissors were old and blunt, and kept catching and locking on the matted blood and denim. Christian discarded them and ripped the blood-soaked shirt so that he could see most of the upper body.
Underneath the shirt was black hair that any primate would have been proud of. It covered most of the torso, making any identification of a potential wound difficult. The lower abdomen by contrast was covered in a myriad of tattoos. Swastikas, tridents, tattooed words venerating the Hells Angels, death, and the devil. Some words were indiscriminately tattooed where there was available skin: Touch Me I Will Kill You/Death To All Spades and one tattoo which was centred on his belly button, Fuck All Pigs. As Christian scanned for a possible bleeding site, he remembered what Bolt had always said about tattoos. The number of tattoos on any body was inversely proportional to the intelligence of the tattooed. The more tattoos that you had, the less intelligent you were. Bolt would often quote many a sports star known to be covered in tattoos, as hard evidence that this was a not theory but scientific fact. He also constantly reminded medical students that one in five of any tattoos that they saw would possibly be hepatitis C positive; such was the lack of sterile control in tattoo parlours. Christian looked at the bikie and his tattoos, thinking the first part of Bolt’s theory would remain unproven unless the bikie regained consciousness.
Checking to see whether he could see a small stab wound beneath one of the ribs, he glanced up to see a growing pool of blood gathering beneath the beard.
“Sister, we going to need to remove that beard. Can you give me the electric shaver?”
“We may need a scrub cutter to deal with that piece of undergrowth.”
“No Sister,” said Christian looking up and smiling. “I'm sure the battery-operated razor will be fine.”
Christian positioned himself so that he could remove a significant part of the beard from the right neck and jaw. As he applied the battery razor to the beard, it was no match for the congealed blood and quickly seized. Christian tugged at it trying to dislodge both hair and clotted blood. Clumps of blood and hair came away with the razor as he pulled, which caused two immediate reactions.
A gush of bright red arterial blood, powerful enough to reach his eyes, splashed on his protective glasses. Thank you, Sister Maxwell, he quietly said to himself. He quickly put his gloved finger onto the spurting vessel, which stopped the flow. Then he looked round for an intern to continue the pressure while he finished the examination. Whether it was the pressure that he applied to stop the bleeding or tearing of the blood-soaked beard, the bikie suddenly opened his eyes. Coal black, chillingly dispassionate eyes turned and fixated on Christian. Without warning, his massive hand reached up with the speed of a giant cobra and grabbed Christian roughly around the throat.
“You cut off my beard and I will fucking kill you. I know your fucki
ng name now, dipshit, shave that off and you will die.”
Christian was startled but immediately pulled back breaking the grip and looked at the bikie, feeling evil and hatred emanating in a continuous deathly stare. It was like confronting some alien life form. How someone be that close to death, weakened by significant blood loss and yet could retain such physical power, defied basic physiology. Such power seemed to have some kind of evil supernatural component. Christian briefly wondered whether this was what he had trained eight years for, and whether the world would be a better place if he released his finger from the carotid artery. Despite the attractiveness of the thought, his training was to preserve life, irrespective of whom the life belonged to and no matter how evil they seemed.
“Let's go with another litre of Haemacell, Sister. Cross match blood and notify theatre that we need to do an exploration of his neck.”
As Christian looked up, he noticed Bolt standing behind him. He had obviously heard the threats from the bikie.
“Have you done your second examination yet?” Bolt asked. “And he won't remember your name. Hypnovel, which he will get in theatre, takes away the memory. He won't remember your name if he wakes up.”
Bolt's comment took Christian by surprise; it was the first time that he had said anything to Christian that was not belittling.
“No, I have not done a second examination yet, so he may have another gunshot or stab wound; I was about to do that now.”
“Let's get to theatre. You can do the second examination in there while I'm scrubbing up. Sister Maxwell, make sure security knows, in case some of the other gang come looking to try to finish off what they started. Now where is that bloody intern when you need her? She can apply pressure to the neck.”
Bolt looked around, annoyed that that the intern was now helping another registrar with the third bikie to be wheeled in. Walking over to her, he tapped her on the shoulder, turned and pointed at Christian and said,
“That's where you need to be. And don't take your finger off that bloody neck until we get him into theatre.”
Christian signalled to the orderlies. Rupert, the older orderly with grey hair and a limp, quickly took control of the trolley and propelled the bikie towards the first emergency theatre. Christian walked ahead, guiding the head of the trolley and as they neared theatre, he pushed in the access code to open the double doors. Inside through the glass window, he could see Bolt scrubbing and beyond, Peter Jones the anaesthetist drawing up drugs.
“He has a small stab wound to his abdomen.” Christian said to Bolt as he walked into theatre
“I will do the neck first.” Said Bolt from the scrub bay. “Then you can open the abdomen, de Villiers.”
“Shit, he's losing pressure,” was the shout from Peter Jones as he struggled to get an arterial line positioned.
“I think you're going to have to do the abdomen first.”
“De Villiers, get scrubbed. I am going to open the abdomen and you can fix whatever is inside. What's the intern's name—Donna?”
“Yes,” replied Christian
Christian, from the scrub bay, could see the scrub sister rapidly applying a mix of alcohol and iodine skin preparation as an antiseptic to the abdomen. As it dried, it created a surreal yellow backdrop for the mosaic of tattoos, which now appeared two-dimensional. By the time drapes were flung into position, he was standing opposite Bolt.
“You guys better hurry. His pulse rate is up to 160 and his blood pressure is down to 80/40. He must be bleeding inside his abdomen.”
“Sister, give de Villiers the scalpel.”
Christian looked at the abdomen; it was now significantly distended and rapidly filling with blood. He had made incisions on the abdomen for trauma so he knew that once they entered the abdominal cavity, the bleeding would no longer be contained. Blood would flow all over the operating table and they would need to be able to quickly contain the bleeding. He would need to place a large number of abdominal packs inside the abdomen and very quickly stem the flow. As he looked down to see how far below the umbilicus he would make his incision, he saw the words tattooed just above the belly button. Fuck All Pigs, in old English script.
“How quaint is that.” Bolt said sarcastically looking at the Fuck All Pigs tattoo. “See whether you can curve your incision to go through the F.”
Christian made the incision starting high up on the abdomen and curving slightly through the F as requested by Bolt. It meant deviating from the midline, which was unusual, but he was not about to question Bolt at this point. On entering the abdominal cavity, fresh blood rushed up to greet them as predicted.
“Suction, Sister,” said Bolt as Christian placed one large abdominal pack after another into both sides of the abdomen. The bleeding finally slowed after the placement of seven large white abdominal packs. Bolt applied the suction and Christian could see there was a tear in one of the larger veins.
“You repair that and I'll retract for you.” Bolt said taking the metal retractor, which allowed Christian to see the bleeding vein.
Christian repaired the vein with fine sutures and then checked to see if whether there were any other bleeding sites. The stab wound had been quite lateral but there was no other bleeding from the entry wound.
“Well, that was an easy fix. We will have a quick look around, then we can close up his abdomen and fix his neck.”
Christian sutured up the first layer of the abdomen with a heavy nylon suture and was surprised when Bolt said he would do the skin layer. That was usually the junior surgeon’s job. He was also surprised when Bolt moved to his side of the operating table and rejected the skin stapler and insisted on a continuous suture. A continuous suture would take much longer than just stapling the skin together. Bolt, who was not renowned for his patience, made using the suture even more of an unusual request. Christian watched and assisted as Bolt slowly sutured the top half of the wound, then paused at the point of the tattoo where Christian had partly incised the F of the tattoo Fuck All Pigs. With a few small deft sutures, Bolt turned the F into an S. Then he completed the lower half of the wound, neatly tucking the suture in after tying his surgical knot. Looking over his surgical mask at Christian, he laughed and said.
“That should make for more interesting reading in the future.”
The next morning Christian took the lift up to the eighth floor where all post-operative patients were sent. The previous night they had not finished surgery until 2:30 am. Christian did not mind the tiredness this morning; it was his last ward round before he had a year off. He had successfully negotiated with the College of Surgeons to have a year off before starting formal training. He felt deep inside he needed to see some of the world to expand his medical and surgical horizons beyond Adelaide. There was also the other factor, which was the uncertainty in his love life. He had never been able to match the chemistry he had found with Isabella. Over the years, he had wondered whether it was impossible to recreate the chemistry with her. There had been a few other girlfriends but the intensity had not matched what he had had with Isabella. He needed to resolve that crisis with time away or possibly finding her again
As he walked out of the lift and down the corridor to S Ward, he was grateful that the bikie, whom he now knew as Anton Kauffman, had only a puncture wound to a vein, not an artery in his neck. That had been a relatively easy suture repair as well. Unfortunately, the other bikie had died on the operating table, a 9 mm bullet shredding his aorta and spinal cord. There was no way they could repair the aorta, despite the intervention of one of the best vascular surgeons in Adelaide, Rupert McKnee.
Christian punched in the code 911E for the last time and opened the door to the ward. Sally, whom he thought was the most attractive nurse on the ward, looked up and smiled at him from the nurses’ station as he walked in. Sally was a second-year nurse with an infectious amount of enthusiasm and a blonde ponytail, which she loved to twirl as she talked to you. He had been tempted to ask her out several times. Nevertheless, despite h
er obvious interest in him and her attractiveness, there was something missing which he could not quite define. He knew he needed to work out the Isabella legacy in his life; otherwise, he might never find someone to share his life with.
“Late night I hear,” Sally said, twirling her ponytail as Christian approached.
“Yes, it was and all a bit dramatic in the end.”
“We have moved Mr Kauffman into a private room. I have to warn you that there are four of his gang in there refusing to leave.”
“Probably ensuring that one of the rival Bandito’s gang doesn't come back to finish off. How come we have no police up here?”
“No one is saying anything; you know what it's like with gangs, if no one says anything, then charges can't be laid.”
Christian pulled the small table out from the side of the ward and retrieved Kauffman’s notes from the pigeonhole above. He read quickly through Sally's notes; there had been no change in Kauffman’s condition overnight, which was gratifying to see. He could report to Bolt that everything was stable and that would be his last action on the ward.
“Do you want me to change his dressings?” Sally interrupted his thoughts.
“No, you can leave that for forty-eight hours,” said Christian remembering Bolt’s handiwork and that any gratitude that might be coming, should be Bolt’s alone. As he closed the folder his mind turned to the discussion he had had with his mother about where he was going to spend the next year.
Chapter 2
“So Dr. de Villiers, now that you have done two years as a trainee surgeon, you are going to leave Adelaide and explore the world. Four more weeks to go, have you finalised all the possible destinations yet?” Renata enquired, standing in the doorway of Christian’s study.
Christian turned from the computer screen to see his mother standing in the doorway smiling. She had her hair pulled back into a tight bun with a nine-carat gold hair clip holding it tightly in place, her fine Flemish features freshly burnished with a cream that he remembered cost almost as much as his monthly iPhone plan. Most of his friends could not believe that she was forty-six years of age, as she looked so much younger. Perhaps there was something special about the Retinoic acid in the cream she used, a fact she would often refer to with no little hubris, whenever he teased her about the cost of the moisturising cream.
Old Lovers Don't Die Page 2
