Out of Africa

Randall N. Hyer, MD, PhD, MPH

Disclosures

Introduction

Wap, wap, wap... went the sound of the helicopter blades, sending herds of elephants, rhinos, and giraffes scurrying across the vast Kruger National Park.

We were on our way home to Sicily after spending 3 weeks on an airbase in northeastern South Africa near the Kruger, supporting the US military's flood relief mission in neighboring Mozambique. From my perch on the open cargo door, held only by a nylon belt, it looked like God had reached down and pushed half of Mozambique underwater.

Flooded Mozambique.

Of the 800 Americans deployed, there was 1 accidental death. A young airman fell off a waterfall near the Kruger while on liberty in South Africa. Scuba divers found his body the next morning. South African law required an autopsy be done before the remains were repatriated. United States law required an American physician be present. I received the call.

The escort officer for the deceased -- in this case his former boss -- and I drove the 3 hours to Johannesburg. He was very fond of the deceased. Listening to him was a little unsettling since I knew what task lay ahead. The next morning, the funeral director escorted me to the state morgue. On the way, he reflected on the epidemic of violence in South Africa and thoroughly warned me of the upcoming visual and olfactory sensations. Located near Soweto, this morgue handled 8000 deaths due to unnatural causes (eg, violence) last year. Johannesburg's other morgue was even busier. Between the two, that was at least 44 unnatural deaths each day.

I can return to the noise, smells, and sights of the morgue whenever the memory resurfaces. Voices echoing down corridors with rubber boots squishing and squeaking on the wet floor. The acrid smell of formaldehyde and putrid smell of death infiltrating my nostrils. Stacks of bodies on multi-tray carts crowding out the light. Gunshot wounds left little doubt about the cause of death. Lifeless and unmoving corpses of children seemed so strange. Their small bodies covered only half the tray -- a graphic reminder of how much life was lost.

The state forensic pathologist and I moved smartly through our task, collected the necessary samples, and completed the paperwork. The airman's brightly polished aluminum casket sharply contrasted with the bare metal trays of the locals. I pictured his upcoming military funeral with starched white uniforms, solemn faces, and the smoke drifting away from a 21-gun salute.

Driving to the mortuary, I wondered whether I would be next. People drive erratically and do not stop for pedestrians or other drivers in certain parts of Johannesburg. At the morgue I had seen the corpse of a US civilian banker who was in a car accident. Unbelted, he had fractured his thigh, ripped his femoral artery, and bled to death. He was about my age, well groomed, and in good shape. I could not help but identify with him. Death is one of the few things in life that is truly irreversible. I think of him when I've neglected to fasten my seat belt -- although I now wear it 99% of the time.

After meticulously examining the airman's teeth, I signed off his positive identification. It was as if the end of my pen was directly connected to a notification squad now knocking on the front door of his family's home. I pictured the messenger and chaplain standing on the doorstep, the children playing out back, the leaves rustling in the breeze, and the shock of the news hitting his mother.

Snapping out of my daydream, I realized I had but 1 hour to catch the flight to London. I wanted out. My senses were overloaded and my emotions were drained. At the gate, I was disappointed to discover that the 747-400 was completely full. After 3 weeks of intense work and the events of that day, I needed space.

I made my way down the aisle, weaving through an overstuffed airplane. I finally spotted my middle seat in the last row, right in front of the lavatory, next to 2 boys fighting over their GameBoy. Oh please. The Captain was apologizing on the loudspeaker for having to reseat everyone because of the stretcher patient. Hearing "stretcher patient" grabbed my attention and, looking up, I saw him. Since I had to walk around the stretcher to get to my seat and was searching for a diversion from my gloom, I stopped to say hi.

Asking the flight nurse to relay my offer of services to the patient, she quickly asked him if he wanted to talk with the doctor. Immediately, he gushed forth with a deluge of questions and a palpable need to connect with me. He was English and probably had some lucky grandchildren to bounce on his knees. His warmth and energy quickly brightened my spirits. Ignoring commands to take my seat, I stayed with him for a full 5 minutes as we talked about my life in Sicily and the Navy.

As I was being escorted to my seat, I finally asked him, "Why the stretcher?" In a matter-of-fact voice, but thinly disguising a deep well of emotion, he said he was carjacked in Johannesburg and shot in the neck. "I am paralyzed from the neck down, Doc." He caught my eye and we connected for an infinite moment. I gave him my heartfelt apologies and sympathy, barely holding back my tears. I squeezed his hand and told him I would be there for him. He did not squeeze back.

Rounding the lavatory, I took my seat. Suddenly, those rambunctious boys were not so bad. Life was good. I could feel my arms and legs. I had the best seat in the house and slept the whole way home.

Disclosure: The views and opinions are those of the author and do not purport to represent those of the United States Navy or United States Department of Defense.

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