EMERGENCY NGO - Surgical Centre for Victims of War, Kabul
July 2021

Photos and text by Emma Francis. Support EMERGENCY's work here.

I didn't see him come in but I did see him take his last breaths. I never saw his eye get amputated or the pieces of his brain put back inside his skull but I did see his mouth and the only hand he had left. We come from the day but never leaving the work across the street. It doesn't matter how loud the music is, the radios are louder. One of the first things I noticed was how everyone sat in silence. There was no obligation to talk. It was a painful waiting game. The silence held so much, things I won't ever comprehend or know. Things each person carries alone. Same place, unique experiences.There never feels like a moment in between.

It's either beeping of machines, cries, soft voices reading charts, or heavy silences. The wheels of hospital beds rolling down the pavement. Nodding. Hands over hearts. Eating. Smoking. Lot's of smoking. When I was younger I remember seeing a doctor in scrubs sit on the steps outside a hospital smoking and I told my dad that I thought it was ironic to see a doctor smoking. I feel like I understand why now. when I went in the ICU on my last day, it was two boys. They weren't conscious. I had photographed one in the surgery unit and as I came to take off my scrubs I peered through the windowed doors and saw a doctor and a nurse over the other boy. He was 12. He was unlucky. He was in his house. He was unlucky. The shrapnel from the shelling hit his brain. He was unlucky.

He came in the middle of the night and was stabilized. Bandages wrapped around almost every part of his body. His uncle asked how much it would cost to transport the body but there was no body to transport. He was alive. He couldn't breathe on his own. He was in a coma. There was still shrapnel in his brain. His hand was amputated. His right eye was gone. His face was destroyed. But there was no body to transport. It was early in the morning but the room felt dark. It felt too clean and cold. The doctor stood there pinching the skin of his tiny chest, testing for a reaction to the pain but there was none. She explained each step of what she was doing and why. Increase Co2. Give him morphine so he doesn't feel like he's suffocating. Check his heart rate. Pinch again just to double check. Sanitize. Start removing the tubes that are keeping him alive and see if he can breathe on his own. One minute goes by and he can't. I'm going to miss lunch. She has a choice and she makes it. Remove the tubes altogether. I see green and red numbers go in opposite directions. You can see his heart rate increase trying to save his weak body but there is nothing to save. He is lifeless and there is no recovery or future only stabilizing this state forever. Oxygen levels slowly drop and it's just the three of us at the end of the bed. No family. Just machine beeps growing tired. "Have you ever seen someone die before?"

I try to observe and learn but I feel frozen. I just watch the doctor's reaction. I keep watching the heart rate drop and I see the number 22 show up and I think, "Not long now." It shoots dramatically back up and I think, "It's ok to let go." I remember hearing people talk about their near death experiences and everyone always says how they float above their body and see the whole room. I wanted to wave and say goodbye, but he doesn't know me. So I just stand there watching his chest slowly stop puffing. Both numbers hit zero and we all look at each other and sort of shrug. She checks his heartbeat once more. sanitizes. No more pinching. All tubes are taken out and it's business as usual. Follow protocol. Radio commands are given and someone comes in with sheets and a bed.

I think back to when I was kid and we played dead for a game. How funny it was to drag each other's bodies across a field. Letting our limbs be heavy and easily manipulated like a doll. I watch the nurses do the same with him except it's not play time now. I keep thinking he'll wake up. That it was all a joke and he'll burst with laughter like me and my friends. The line between life and death isn't as big as I thought it was. Is it time for lunch? They take off the pile of sheets from his body because he isn't suffering from hypothermia anymore. Im still at the end of his bed and watch them tie his delicate big toes together in a small bow. A pale lavender sheet is unfolded and placed over him. I still see his toes. Take a picture of the toes, Emma. But I don't. I watch. The toes disappear and they twist the ends of the sheets together and tie them too. He looks like a piece of candy wrapped up. And they wheel him away. He was unlucky. Time for lunch.

Photos and text by Emma Francis.