This story is by Sridhar Shankar and was part of our 2018 Spring Writing Contest. You can find all the writing contest stories here.
The Medical Student
Amal Tarek, the third year medical student, glanced uneasily at the boy lying on the pallet on the far side of the hut. The boy’s name was Maher, and at fourteen, he was already a fearsome fighter. He lay still on his back on the thin padding, gingerly shifting to get more comfortable, but his face was pinched and his color sallow; his breath was rapid but shallow. He made no complaint and no sounds of agony issued from his lips. He was a warrior, and warriors didn’t cry. Nevertheless, it was clear that the boy had appendicitis. And he, Amal, was expected to deal with it.
They had brought the boy into his hut three days after the medical bus had been ambushed en-route to the city for supplies, and the rebels had abducted the Professor and three of his colleagues. The city was under siege, the roads impassable. They had been in war-torn Afghanistan barely a month on their humanitarian mission, a mission to the land of his forefathers which was the main reason Amal had come along. He would have been on that trip to the city too, but a bout of diarrhea had laid him low. In retrospect, Amal supposed the malady had saved his life. Only to be dropped into this.
The fierce-eyed, bearded lieutenant had been explicit when he and a couple of others had brought the boy to his hut. They did not distinguish between someone who was a mere third-year medical student and a seasoned super-specialist surgeon. Amal was the guy in the white coat, and they expected him to deal with it; only, Maher was the chief’s son, and failure would not be looked upon kindly. In rapid-fire Dari, broken English, grunts and gestures, the lieutenant had made it abundantly clear that failure was not an option. A finger drawn across the throat did not leave much room for interpretation. It was no comfort to him that even his Professor, Harvard graduate though he was could probably not have helped—the man was an internist.
Amal examined the boy and found that he was still burning up. Rapid, thready pulse, like the fluttering of a tiny bird. His belly was hard, but was it “board-like-rigid” like in the textbooks? He was scared to push harder lest he hurt the patient more. Everything seemed to line up with what the textbooks said; even the history he had been able to elicit from the boy and the men who had accompanied him supported the diagnosis. Abdominal pain that started around his navel and then settled in his right lower belly.
The only question was if the appendix had ruptured or not. The former connoted a dismal prognosis regardless of intervention. A full-fledged hospital would be mandatory for that kind of complication, and Amal couldn’t decide if that was indeed the case.
“Peritonitis?” he mumbled, thumbing through the few books he had brought. His small field manual covered only basic surgical procedures under primitive conditions. He looked about his tent. These certainly qualified.
A new thought occurred to Amal. His life depended on Maher’s survival. And Maher’s survival depended on urgent intervention. Could he treat the boy conservatively? Give him antibiotics and suppress the infection? Certainly, something to be considered provided he had the resources, but all he had were a few doses of Ampicillin. That would not be enough. He would have to operate. His whole body shook at the idea. He was planning to go into Radiology, not surgery. Nevertheless, he would have to operate to save the boy’s life, and the boy would—if his diagnosis was correct—in all likelihood die anyway, and Amal would follow soon. Faisal was in charge here.
What if the boy lived? What would he end up accomplishing?
Amal struggled to remember the details of the operation. A right lower quadrant, grid-iron incision. It was an uncommon procedure nowadays. Today, most surgeons took out the appendix using laparoscopy, and the teaching had accordingly changed. Surgeons went in for an open operation only if there were complications.
He rose and went to the boy. Amal had kept him NPO—nothing per oral—for the last several hours, a standard pre-surgery preparation. No anesthetic or anesthesiologist, but then he had a good supply of morphine and several strong men to hold the boy down. He re-examined the boy, nodded and stepped out of the tent. There was no more time to lose, and he did not have the luxury of being scared.
The balance of power had shifted, but Amal knew it was only temporary.
Maher lay on the raised pallet, his eyes onyx pools of pain. His hand gripped Amal’s arm like a vise, and said something in Dari. Faisal translated with a grim look: “Save me or kill me. No in-between.”
Amal injected the morphine, and the boy’s breathing slowed. He’d waved off any restraints, although three strong men stood ready to control the boy if necessary.
Yellow light from five hurricane lanterns had transformed the formerly shadowy tent. The smell of dust, camel dung, cordite dominated the olfactory palette. Flies buzzed around his head. He ignored them.
Faisal, pale as camel’s milk, stood on the left side of the patient as the assistant while Amal prepped. Both wore gloves, no mask.
Stay calm, breathe.
With a ballpoint pen, he drew a line from the umbilicus to the highest point of the right hip bone where it protruded under the skin. He divided that into thirds and marked McBurney’s point, cleaned the area with iodine, twice. There was no alcohol, so he skipped that step. He injected the little bit of novocaine along the proposed incision line. Halfway, the novocaine ran out. Amal tossed the syringe and held his hand out for the scalpel.
A grunt as the knife went in, but other than a tensing of the muscles, no movement.
After Amal had split the muscle fibers, something he had only done on cadavers in this medical school, a thousand years ago, he incised the sac holding the guts —the peritoneum—as carefully as he could, and as the membrane parted, the large intestine popped out. He inserted his finger and rooted around, hooked it around something and there it was.
Hello there, buddy.
The organ was purplish-red and looked about as enraged as he could imagine an organ to look. But it had not burst. Not peritonitis after all. There was a chance. Relief washed over him.
Amal once overheard a conversation between two surgeons about how quick each was on an appy, and one of them had remarked, “Fifteen minutes, skin to skin.”
Amal took an hour and forty minutes, and he didn’t remember breathing during the time. As he stepped back from the table after tying off the last suture, he realized his clothes were saturated. If sweat had rolled off his face and fallen into the patient, Amal hadn’t noticed. He glanced across at Faisal and saw new respect in his eyes. Not that it would prevent the man from slitting his throat if things went south.
The men had not been required to restrain the boy. Despite the excruciating pain, the boy had not moved.
Stoic like hell.
There must’ve been pain despite the morphine and Amal could see it in the boy’s eyes. The drug had dulled the sheen of his dark eyes, but the fight endured.
Now all that remained in Amal’s hands was to administer the three doses of Ampicillin, and he loaded these into the intravenous fluid that dripped into the boy’s veins. Added more morphine. Nothing to do now but wait. Finally, Maher slept.
Later, Faisal returned to the tent with raised eyebrows. The unspoken question was if Maher would live, but Amal did not have the answer. The operation was only half the battle. The rest was up to Maher’s immune system. He shook his head in frustration. The language barrier was difficult to surmount. Faisal’s eyes hardened. Eyebrows raised, he tapped the dagger stuck in his belt and stalked out.
That was when gunfire erupted. The Professor had gotten through to the NATO forces despite the ambush. He was saved!
It had been six years since the rescue by the NATO soldiers. Dr. Tarek was now a busy trauma surgeon. In a rare free moment, he checked his email. There was one from an unknown address, and contrary to his usual habit, he opened it. Arabic script. Clicking opened a box from the translation software.
Dear Dr. Tarek,
Salaam. I never thank you for save my life. Shukran Jazilan, Baaraka Allahu fik (Thank you, may God bless you).
As you know from news, fighting go on many years after you leave. My father dies in fighting, Faisal also. Me leader since two year. I make peace plan, cease-fire. All safe now. Please visit if you can.