Surgery in the Mountains
Dafoe rose early the next morning to the sound of distant gunfire in the mountains. It underscored the sense of urgency he had felt since seeing the hospital in Mihajlovici, and he assembled the medical unit shortly after breakfast.
Miki seemed to know the layout of the village rather well. Fetching the commissar of the hospital on their arrival, he introduced him to Dafoe. His name was Marko Ivic. A thin-lipped man with a lantern jaw, he struck Dafoe from the outset as a forceful individual. Of only moderate height, Ivic had a commanding presence. "I took an immediate liking to Marko and felt that in him would be a reliable friend," Dafoe said. He was rarely wrong in his judgment of men.
Marko's first job was to escort Dafoe to a stretch of land at the edge of the village where he suggested they establish a campsite. "It was a good site in a small orchard at the edge of a grain field," Dafoe recalled. He liked the spot mainly for the view it afforded of the river Drinjaca from a crescent of land walled by limestone bluffs. Moreover, it was secluded. "Just far enough away from the village for some privacy, yet within easy reach of our work."
Opposite the site was the valley, dotted with peasant farms and more villages until finally, rising sharply, it merged with the forest and cliffs. "Far in the distance into the blue haze were more of the limestone cliffs, rising to great heights, and evidence of one or two villages. On the right the semi-circle also rose quickly, hiding the landscape beyond." On top of the crescent was the area reserved for patients with typhus and other infectious diseases.
Marko had already organized several workmen to prepare the medical unit's new camp. Two Italian tents were erected, then boarded at the sides and ends. A fire pit was dug to one side. Two young girls were appointed to fetch food and water for the unit. That night, they ate better than usual as they sat around a fire and sipped tea, smoked, and chatted amiably.
The next day Dafoe held a brief conference with Marko and "the Old Colonel," as he fondly referred to Dr Baboselac. That morning, the latter was to perform an emergency operation on a very pale Partisan wearing a black fur cap. He had a leg wound and some internal complications. Dafoe was surprised by the number of spectators jammed into the theatre, "all crowding around the patient, coughing and talking into the ground." The Old Colonel was forced to elbow his way around the table as he fought desperately to stop some haemorrhaging in the patient's bowel artery. He used very little anaesthetic during the operation, Dafoe noted. The patient was so badly shocked and ashen that Dafoe wondered if he would survive the ordeal. Meanwhile the Old Colonel shouted orders to one of the female assistants and an instrument was handed to him, "not efficiently or quickly," Dafoe observed. Later Baboselac asked him if he would care to take over the operation, but Dafoe declined.
The remainder of the morning was occupied with further improvements to the campsite. Marko promised to have the carpenters build some tables and benches. That afternoon, the medical unit left with Marko and the Old Colonel to find the underground magazine where some of the supplies were still hidden.
Dr Baboselac had a dignified, even magisterial air on horseback. Horses had been provided for the medical unit and for a while Dafoe rode across the open fields and into the woods of towering oak and birch. Some thirty minutes had passed when they entered a cup-shaped hollow layered with downfall. Here Marko hesitated. Miki asked Dafoe if he noticed anything unusual.
"Not really," he replied. He glanced around and inhaled the warm spring air mixed with the soft aroma of fresh earth. Then suddenly he realized that the ground underfoot was somehow unnatural; he was standing on the hidden magazine. Dafoe looked around for some sort of access until "a tall, fierce-looking peasant" materialized and scraped away the leaves to reveal a trap door. Miki invited Dafoe inside.
Dafoe negotiated his way into the narrow opening and was astonished to find an immense storage space carved out of the earth, estimating its size at six by eight metres. Heavy blackened planks lined the walls, through which water seemed to drip incessantly. Dafoe hunched slightly to clear the low ceiling. A musty, oppressive dampness pervaded the place.
Miki explained that patients were hidden in underground shelters such as this during enemy offensives. With the darkness, the damp, the shortage of food and potable water, the dismal sanitary conditions, and the mental strain, "no wonder the patients look pale and wan with a haunted expression on their faces," Dafoe concluded. "And what a strain on the nurses," he said as an afterthought.
Miki described the precarious nature of life in the shelters. He related the story of a nurse who was captured in Mihajlovici during the last offensive as she went out to collect some water. She was tortured to reveal the location of the magazine, and hanged when she refused to cooperate.
With a flashlight, Dafoe found some canisters and the unit's kitbags with some other supplies stacked in a corner of the magazine. He selected the equipment he thought essential, then helped Frank and Chris repack the canisters.
They started work in earnest the next day. Dafoe had risen early, shaved and washed in a nearby strewn just as he would every morning in Mihajlovici, before proceeding to the hospital. There he asked Marko to organize a work detail, first to clean up the grounds which resembled a barnyard and dig a latrine. Later he asked the commissar to have the men cut a ditch to redirect the small stream that was the cause of the pervasive mud that drew the wallowing pigs. Marko promised he would see to it at once. In the meantime, Dafoe and his assistants attacked the two surgical theatres.
"I'm afraid we treated the Old Colonel's instruments as a bunch of junk, although I dare say they saved many a Partisan's life," he admitted. In fact, only a few of the instruments were worth saving. Dafoe set aside several items to replace the materiel lost to the Cetniks the night of his arrival. Then, to the utter amazement of everyone in the hospital, he and his assistants scrubbed the walls and floors and cleaned the ceiling and its covering with Lysol and cold water. "They couldn't understand it when we refused to have the girls do it," he recalled. "Even Miki was dumbfounded."
Dafoe put his incredulous guard to work outside, where he wanted a stone platform constructed to cover a mud hole in front of the doorway. He thought it imperative to prevent the Partisans from tracking in any more filth. Later he would stress the need to preserve a sterile environment.
Now that the two theatres were well scrubbed, the canisters were moved inside and opened. Dafoe had to improvise to some extent, as he still lacked several items. Nevertheless, the Partisans crowded around him, eager to see his supplies. The doctors were puzzled by his sulpha drugs and plasma, which they had not encountered before. All had misgivings in the event they had to evacuate the hospital in an emergency. Impressed by the Canadian surgeon's supplies, they were equally fearful of losing them. But Dafoe was adamant: all of his equipment was vital if the medical unit was to function effectively.
The work in the two theatres was completed by mid-afternoon. Even the shelving for drugs and supplies, which he had asked one of the carpenters to construct, was ready. The Old Colonel told Dafoe the most seriously wounded patients would be ready for surgery the next day, as instructed.
The medical unit's first full day of surgery in the mountains got underway early the next morning. Chris had limited experience as an anaesthetist and would have to be watched carefully. Frank, however, was a trained operating-room orderly, and so would handle the instruments. The first patient was the pale fellow Dr Baboselac had operated on the day before. The man was almost moribund and his deathly pallor was accentuated by the black fur cap still on his head. The Old Colonel asked Dafoe to examine the man's leg wound, which was oozing pus.
Dafoe administered 1/4 cc of morphia and a gram of Luminal prior to anaesthetic. Once the man was unconscious, Dafoe quickly closed the wound and plastered the man's leg above the knee. Then he gave the patient a pint of plasma before releasing him. The Partisan doctors noted with alarm that Dafoe had not bothered to blood-type the patient first. "No need to," he assured them, as a second man was carried in. As moribund as the first, he had a severe gunshot wound to his body and a second large wound in the area of the faecal fistula. Dafoe suspected these wounds were many days old, and told the Partisan doctors hovering beside him that he doubted the man would survive, but he proceeded anyway and gave him plasma.
Throughout the morning, Dafoe treated several patients with fractured femurs. He extended the limbs appropriately and explained the procedure as best he could to the Partisan doctors. Shortly before lunch he checked on the progress of his first two cases. The man with the black fur cap had not yet come out of the anaesthetic and the second patient had died.
"For a moment I lost heart," Dafoe recalled, "even though I knew they were both hopeless cases and had agreement with this opinion from the Yugoslav doctors. Still, it wasn't a very auspicious start. The chief nurse was certain that it was the plasma that killed them and asked the Old Colonel not to let me give any more patients that 'poison.' [He] got very angry and told her not to give me advice."
In fact, Dafoe had reservations regarding the skill of several nurses assigned to the theatre. They rarely helped during operations, although they watched carefully enough. One young woman seemed an exception. Dafoe guessed she was sixteen or seventeen. She had vivid colouring, dark hair, and velvety eyes and was "well-built for her age." He added that she was "very intelligent and quite capable" in the theatre.
Dafoe resumed work shortly after lunch undeterred by his earlier letdown. The Old Colonel sent the patients in according to the seriousness of the treatment required. Two stretcher-bearers were allotted that afternoon, and Miki saw that the patients kept coming at a steady rate. Dafoe used a lot of plaster that day. By the time the sunlight faded, he had operated on as many as fifteen serious surgical cases and he was exhausted. The whole unit had worked exceedingly hard to erase the morning's disappointment and Dafoe felt that they had achieved tangible results. Even Chris had performed well, handling the anaesthetics without difficulty.
That evening Marko was given a boisterous welcome at the unit's campsite when he arrived with a roasted lamb for dinner. Everyone sat around the fire enjoying pieces of the succulent meat and washing it down with some rum that had been removed from the supply canisters.
Still, Dafoe could not remove himself from the work at hand, as he and Marko discussed ways to improve the hospital. In particular he wanted additional cleaning details formed. Marko was more than willing to co-operate, but grumbled about the many lazy souls under his command. In the same breath he admitted that everyone was tired. Marko himself had worked non-stop for eighteen months and was ready to drop from exhaustion. Moreover, he frequently suffered debilitating migraines, a condition exacerbated by his many duties at the hospital. Nevertheless, Dafoe's great faith in the commissar was unshaken.
The medical unit's second day of surgery started shortly after dawn. Dafoe made his rounds, noting the condition of patients he had already treated. Their morale had risen appreciably. But it was a double-edged victory, as Dafoe was fully aware. "It was pathetic to have other patients showing me their wounds and begging me to do something," he recalled. Dafoe assured everyone he would help just as soon as he could. From Dafoe's notebook:
"The cases came on one after the other, GSW [gunshot wound] limbs, with and without fractures. Most of them severe and running with pus. I never believed that there was so much pus in the world, or that individuals could exist with so much pus literally buckets of it. Many of the fractures were so severely infected that I could not put POP [Plaster of Paris] on them as I wished, but only back-splints. I remember one woman of about 25 good-looking and intelligent. GSW of the knee...and femur. Full of pus."
On the third day of surgery, Dafoe had to amputate the woman's leg. "She was very brave about it all," he said afterwards. "In addition to the wound on the leg, she had smaller wounds higher up on the thighs and one across the mons veneris....On top of that she had scabies. What a mess for a woman to live with."
The Old Colonel demonstrated a German method of amputating a limb. Dafoe thought it had several advantages and he tried it successfully. Amputations were seldom performed by surgeons in the British Army, he claimed, no doubt owing to the advanced system of first aid in the field and early transport of patients to hospitals. He was grateful for the Old Colonel's advice.
Still more patients with fractured limbs and gunshot wounds were arriving. That afternoon, Dafoe did a chest resection on a burly Partisan. He noted that Miki stayed as far away from the theatre as he could during the operations, "as he disliked the blood and pus and was also very shy of women partly undressed". Whenever he did enter the room, it was usually backwards. Normally he remained outside, hard at work on the stone platform he was building. As a result, Dafoe sometimes found himself stranded without an interpreter at a critical moment. Then the Old Colonel, who stood by drawing sketches or speaking with the nurses in German, would react explosively.
"Gde je Miki? Nama Miki!" he roared. Miki would appear at once.
Two new nurses were assigned to the theatre that day, contrary to the arrangements Dafoe had made with Marko. One of the girls proved maddeningly slow, although Dafoe realized they were both willing and eager to learn. Still, they were not much help at this stage except to hold a patient's leg still during an amputation or to fetch the water needed for mixing plaster. The latter was no mean job, as the water had to be carried some distance and the journey to the stream was not without an element of danger. The risk of ambush by enemy patrols was genuine.
These early days, although long and arduous for the medical unit, were often enlivened by stories of Partisan life. Moreover, Dafoe realized he had landed among an extraordinary cast of characters. The Old Colonel, for example, claimed to have performed at least 40,000 operations in his lifetime. He admitted it was probably more than enough for one man and unabashedly offered as evidence that his hands were growing unsteady and his eyesight dim as a result of age and a condition worsened by poor spectacles. Dafoe admired the Old Colonel for more than his candour. He enjoyed his company in the theatre even when he did not operate. A second opinion based on so many years of actual surgical work was invaluable. And someone had to sort out the patients before sending them into surgery. It was a job that required sound medical judgment and a trained eye.
Dafoe thought at first that the Old Colonel had a granddaughter named Natasan. Later Miki explained that she was the daughter of a Jewish couple from Austria who had been killed earlier in the war. The Old Colonel had "adopted" Natasan and the two were virtually inseparable, usually conversing in German. She seemed a bit peculiar to Dafoe. "Not very robust short and slight," he recalled. "Carrot-coloured hair done up in two braids at the back. Not a very good-looking face. Blue eyes, ruddy complexion, weak chin, and a rather cruel mouth. However, she smiled frequently and seemed quite pleasant and willing to help us, although she seldom came into the theatre."
It was probably just as well, for the medical unit was already outnumbered by the many curious Partisans who gathered around to watch the Canadian surgeon at work. Eventually, Dafoe asked Marko to issue orders forbidding anyone inside other than the Old Colonel, the nurses, and Miki.
With a bit more room in which to manoeuvre, Dafoe was better able to treat several fresh cases that arrived during the day. Among the new patients were two young peasants who had severely injured themselves with explosives. For one patient Dafoe had to disarticulate a hand at the wrist. The young man also had wounds to his legs and face and shrapnel had penetrated one eye. Dafoe was relieved to find that the lad's vision was only partially impaired. Still, he had difficulty preventing the eye from becoming infected.
The other peasant had sustained similar injuries, although he was not as fortunate in the operating room. Dafoe found it necessary to amputate one hand just above the wrist. It seemed such a terrible waste, especially when he learned that the accident had occurred during a foolhardy attempt to rig a homemade bomb. Given that the medical unit was already overextended in trying to deal with the many patients still languishing in the appalling conditions in the village, this type of carelessness seemed all the more deserving of Dafoe's anger.
Yet, to some extent Dafoe accepted all this as inevitable. He recognized in it a brutal truth of war that everything comes at you at once sometimes and you cope as best you can, regardless of the fact that it seldom makes any sense and that you will almost always fall short of achieving your best intentions. And here, he had discovered suffering on a scale he was unaccustomed to dealing with as a surgeon. He knew that it would require extraordinary dedication and stamina if he ever hoped to set it straight.
We do not know if Dafoe was unnerved at all by his first few days of surgery in the mountains, or if he saw in the faces and mutilated bodies of the many young men and women who passed through his surgical theatre some foreshadowing of the still more grievous days ahead.
If he ever sought a metaphor to describe that time, he would not have had to look much farther than his own hands in particular at the one that held the saw he used for amputations.
Copyright © Brian Jeffrey Street 1987,1998. All rights reserved.