The lamp in the ceiling of the ambulance is strong. The man who has been shot four times looks me in the eyes. Pain relief makes his eyes misty. A group of men stand around the back doors watching us as we do a final check of oxygen, the drip and the man's respiratory rate and pulse.
Three hours earlier, unidentified men fired several shots at him. A bullet penetrated his left thigh and his leg is now immobilized on the stretcher. A bullet ripped a hole in his right calf. Another bullet entered his back, between the second and third rib on the left side of his chest, and exited between the seventh and eighth on the other side. It must have missed his heart by a few millimetres.
The bullet I'm worried about is the one that has penetrated his abdomen below the navel and not come out. He has a tube through his nose, one through each side of his chest and one in his penis. Blood comes out through three of four tubes.
Without surgery, we can’t save his life. The bleeding in his abdomen must be stopped.
Once we have done what we can, I begin to arrange for ambulance transportation to Quetta, but my colleagues stop me. They tell me that he has no family here. I know unfortunately what this means, that no hospital would take him in Quetta. No hospital is willing to take responsibility for what might happen without the family's consent. The frustration is great for us all. We realise that he will die within hours. Our goal is to make his last hours of life free of pain and alleviate his suffering. I gave him pain relief with ketamine for two hours while his condition gets worse.
Suddenly, a man runs in, gasping for air. He turned out to be the cousin of the man and is able to go along in the ambulance. I quickly phone for an ambulance and made the patient ready.
That’s where we are now, in the light of the lamp in the ceiling. Now he has a chance, anyway, I think. We step out and his cousin jumps in and sits down next to him. I look at the two and the situation suddenly hits me. The nearly four-hour journey will be painful. The road bumps and the pain relief that will stop working.
I give the driver, who I have trained to give intramuscular injections, an ampoule of tramadol. He promises to stop the car by the road to give the injection, although it will not make much difference. I wish we could do more.
I remind myself that the care that we have to offer here is a dream to many people living in places where MSF works, and an even more distant dream in the places we do not have access to.
In the hours that follow, I am not present. In my mind, I find myself in the ambulance with him. On a bumpy road in darkness.