With bandages wrapped tightly around their abdomen, it seemed one of the Bondi stabbing victims was in a temporarily stable condition on arrival at hospital.
Conscious and speaking to emergency department staff, it was believed they'd been well enough for transport to a trauma unit further from Westfield Bondi, instead of nearby facilities where the worst cases went.
Major Daniel Chan, an on-call general surgery fellow, only learned about the Bondi attack when his wife messaged him on his way to work for an unrelated surgery.
He had almost finished this operation when called to the emergency room to assess the victim.
Major Chan introduced himself to the resuscitation team and patient, then assumed the surgical lead.
"Soon we realised the patient was putting on a brave face," Major Chan said.
Beneath the bandages was massive internal bleeding from multiple internal injuries.
An emergency bandage around the abdomen and blood transfusions meant they were relatively stable despite continuing massive internal bleeding.
Things became more obvious when they underwent general anesthetic.
"Even when you're lying down, you still have muscle tone in your abdominal wall," Major Chan said.
"Once those are paralysed, it no longer maintains that pressure, and so the bleeding accelerates."
'It's like trying to patch holes in a bucket that's leaking while someone's trying to pour water in.'
In the first few minutes their blood pressure dropped and they were quite close to needing CPR.
"As it turns out, I think the patient might've been actually more unwell than some of the patients transferred to other facilities," Major Chan said.
The operation began with an incision in the abdomen. Blood and clots were removed and large sponges packed.
Major Chan then raced to tie off and stitch bleeding blood vessels as the anaesthetists' team rapidly transfused the patient with multiple blood products.
"It's like trying to patch holes in a bucket that's leaking while someone's trying to pour water in," he said.
During the course of surgery, the patient lost more blood than their body normally held.
The team sweated under their gowns from theatre heating and the blood warmers heating blood for transfusion.
Finding and stopping internal bleeds wasn't the end, as Major Chan waited for the anaesthetist to confirm blood pressure and circulation were stable - so they knew nothing was missed.
Other major abdominal organs also had to be repaired.
The patient was finally stabilised and surgery completed after two hours.
Major Chan conducts between 400-500 surgeries a year, but the 5 per cent that are trauma cases stand out, as everything stops to conduct them.
"When a life-threatening case comes in, everyone else needing an emergency operation gets pushed down the line, as surgery is prioritised according to the urgency and is not a first-come, first-serve basis," Major Chan said.
"The rest of the day doesn't disappear; everything is shifted into the night."
Major Chan conducted another two or three operations that evening, finishing his shift at 3am.
'We send troops into harm's way and if they get hurt, they should get the best medical care we can provide, and that's an Australian healthcare team.'
While completing his undergraduate degree, Major Chan enlisted in the Army Reserve as an officer cadet and later transferred to become a medical officer after graduating in 2011.
He has since performed thousands of surgeries and was admitted as a Fellow of the Royal Australasian College of Surgeons in General Surgery in 2019, a qualification attained after years of specialist training.
Now posted to the 2nd Health Brigade, he has deployed to Iraq, Solomon Islands and the NSW bushfires.
In 2019, he also conducted the first surgery aboard a Navy landing helicopter dock. A soldier aboard was suffering appendicitis, and lacking the equipment for routine keyhole surgery, an Army-Navy surgical team undertook an older-style open operation.
The technique had been done safely for hundreds of years, but the ship had to be steered into the waves to avoid side roll and the engines were throttled back to reduce vibration.
Less than two days later, the soldier was walking around the ship.
"We send troops into harm's way and if they get hurt, they should get the best medical care we can provide, and that's an Australian healthcare team," Major Chan said.
