Chills

I close my office door. I feel cold and tired. My muscles and joints ache. I put my Old Navy sweatshirt on over my scrubs. I lie down on the exam table. It's not even my office. I'm in the Prenatal care office temporarily as the main building gets renovated. I'm sure it's just exhaustion. I don't really feel sick. It feels so good to lie down. Since Sarah left three days ago my life has been crazy again.

I drove her to the N'Djamena airport in our pickup. We walked across the courtyard and into the waiting area past huddled groups of Tchadians, many wearing the traditional robes and round hats or turbans. Sarah packs lightly so I had her backpack on and she had just a tiny carry on bag. Acting like we knew what we were doing we walked past the guards through the cage like entrance to the check in room. I held her hand. We loaded her bag onto the belt and I hugged her good bye. Apparently, people were watching in wonder to see someone actually show affection because when I let her go where only ticketed passengers can go a woman came up and told me to go with her. She said we could go up to the observatory to watch the plane come in. The woman checked her passport and then we walked up the steps to a huge glass window with open slats letting the cool N'Djaména night air blow in. We stood there laughing and talking watching a plane come in (not many come into N'Djaména). Finally, I knew I had to say goodbye. I felt weird, surreal. It hadn't sunk in that she was leaving and that I wouldn't see her again until a week before we got married. I had the strange sensation of wondering if I even knew this beautiful girl with wild red hair beside me and would I feel even weirder after a month apart. Then I walked down the stairs, past the passport checkpoints, out the guarded cage-like entrance and into the eerily dimly lit yellow N'Djaména night. Across the pavement, into the car, zombie like thinking how normal this all seemed and yet within a few hours one could be in Europe in a different universe.

Rahama knocks on the door and opens it. "Docteur, pardonnez-moi, mais il y a d'un urgence." And three sweaty, out-of-breath men come in carrying an elderly woman who's moaning but not responsive. Probably malaria. I examine her and order some tests and treatments and send her to the ward. I really start to feel chills. I head to the lab and have Matthieu poke my finger for a Goutte Epaisse (malaria smear). Then I go back and lie down, slipping quickly into that nebulous zone not awake, not asleep, not thinking, not dreaming just there kind of aware but not aware.

I arrive back at SIL, the Bible translator's compound in N'Djaména, and shoot the breeze with Nathan until well after midnight. At 6:30am I'm awake again with the truck ready to go. We'd spent all day yesterday getting it fixed after running around, buying and replacing several parts. Now I go pick up Joy and Michelle from Pasteur Job's house. They've come visiting from the Adventist Hospital in Koze, North Cameroun. They are student missionary nurses. All we had to do is go to the Camerounian embassy to renew their Camerounian visas. Simple right? Wait, I'm forgetting we're in French Africa. We're told that even though they have 45 day valid Tchadian visas they need to go buy Visa de Court Sejour (3 months) before the ambassador can give them new Camerounian visas. A technicality but we run back and forth all over N'Djamena several times before it's resolved. I'm driving as we've left the chauffeur in Béré due to lack of space in the car.

Finally, at 10:45 we leave N'Djaména. We race through the pothole filled roads to Guelengdeng dodging them mostly but feeling the severe jolt when we come on one suddenly. No flat tires this time, though, not like the trip to N'Djaména. Suddenly, in Guelengdeng the truck stalls when I brake and put in the clutch. The same problem we'd supposedly fixed in N'Djaména. Now, leaving Guelengdeng we also start to lose power. I'm not sure we'll make it to Bongor but I find that by pumping the gas pedal I'm able to keep a little power and the pickup limps in. We stop right where we normally eat chicken, drink pineapple milkshakes and buy soap. As soon as I open the hood, a group crowds around quickly hoping to benefit from "Nasara." Everyone's a mechanic, several are drunk and I don't trust any. All I need is to change to fuel filter I think. We have an extra with us. I ask for a number 12 wrench. They give me one that is worn and when I say it doesn't work they try to show me that I'm just stupid Nasara who needs their expert help by grabbing it and almost stripping the nut before I can wrestle it away from them. I spot a public transport van just ahead and go ask for a real wrench which I get and soon have the filter off. Then someone comes with a tire chain welded to a pipe which grips the filter allowing me to unscrew the head. Then, I hear my name (although they've all been calling me "Docteur" from the beginning, I guess I've been there enough times now), Docteur James and I recognize the mechanic/chauffeur from the health district of Béré. Just happens to have stopped there on his way to N'Djaména so he makes a few adjustments to the idle and we are on our way. Not before pipe/bike chain man demands to be paid. I give him 500 francs. He refuses saying he'll take nothing rather than that small amount. I say fine. I'm going. The passengers with us, the chaplain's daughter, adds 500 making it a 1000 francs ($2). He still refuses. They say I should give him more. I tell him I just spent time with the second best mechanic in N'Djaména who charges 4000 francs/hour and since he wants more than 1000 francs for 15 minutes he must think he's a better mechanic. He continues to refuse. I get in the car. His friend takes the 1000 francs. I say it's not for you. My tchadian passengers say that's the way it works in Africa. The "mechanic" tries to make me feel guilty by coming up to wish me "bon voyage" even though I'm robbing him because he's a good person (according to him). I say, "Ça va" and start up the car. Finally, he realizes he isn't going to get more so his attitude changes, he takes the 1000 francs, smiles, shakes my hand and wishes me a real "bon voyage" now. Having visited with 6 different mechanics here in Tchad in the span of 2 weeks with 2 different cars has kind of made me a "local" as far as knowing what's appropriate payment for services.

We arrive in Béré at 6pm.

I'm really starting to feel the chills. I have goose bumps all over and my hair is standing on end. My teeth are chattering and my legs shivering. I go to the house and climb in my zero degree down sleeping bag still chattering. The muscle aches are severe now and my head is pounding. I drift into a troubled snooze.

At 8:30pm I'm sitting on the porch ready for our evening prayer time with the missionaries. As a good missionary I've only waited 11 months to start having regular prayer with the other missionaries! I finish my opening prayer and am interrupted by Anatole. A case of intestinal obstruction. After struggling to place a nasogastric tube I go to place the urinary catheter in the patient before surgery. It gets blocked. Bloody tip. Try again. Finally, after 4 different types of catheters and no success we decide to just start the surgery. It's about 10pm. I scrub, Samedi preps with Betadine, and we gown and drape. After a prayer by Anatole, I grab the scalpel and slice quickly from sternum to pubis. Going through skin and subcutaneous fat I hit the fascia and slice through. The pressure inside the belly bulges out as I dissect carefully into the peritoneal cavity and then with my fingers protecting cut rapidly through the rest of the fascia till his belly is laid open from top to bottom. Black, foul-smelling small intestine pours out along with thick, dark red fluid. The Sigmoid colon is hugely dilated with the necrotic small intestine wrapped around it's base. I try to reduce the colon through the trap unsuccessfully. I poke a hole in the bowel wall letting out the gas and some nasty fluid then pull tight the purse string suture to close the hole and reduce the sigmoid freeing it. It is inflamed but still viable. The small intestine is dead just up to about 6-8 cm from the Cecum and halfway back to the duodenum. I clamp the bowel, poke/clamp/cut/tie across the blood supply to the dead part and heave it off onto the floor. Then I suture the two cut ends of good intestine back together in two layers. Then it's irrigation with cold fluids (I know they‚re supposed to be warm but how in the middle of the night in an emergency with no reliable source of power?) and suck out all the nastiness. I leave in two drains and stuff the colon and intestines back into their rightful place. I then close him up. By the end I can barely stand. I feel drained. It's 1am. Walking back I feel chills and have to warm up under the shower for half an hour before being able to sleep.

Matthieu comes to tell me my Malaria smear is positive for Falciparum (the worst kind). I take 5 Mefloquines and go back to the warmth of my sleeping bag.

Yesterday was no better. I come in to a hospital filled to the gills, mostly with nomadic arabs. I clear the place out by sending many home (as they should've been days ago). Then there's a girl with a post partum infection. She'd been to the Health Center on the 10th after 5 days of labor and was referred to the hospital. She shows up here two weeks later after delivering a dead baby at home with pus dripping out from down below. I take her to surgery, give her a spinal anesthetic and then try to clean up the damage. There is dead tissue in side that is easily pulled out. I then notice what looks like the inside of her bladder and I can‚t identify the cervix. It turns out her bladder has about an 8cm tear in it into the anterior vagina and her cervix was so shredded I can't even really find the opening into the uterus. I finally find it but it's at a weird angle, impossible to do a D&C. I have the mom by a urinary catheter and a suture and I proceed to repair her bladder injury. It seems to be working so far. Pray is all I can say.

That evening we celebrated Thanksgiving with mashed potatoes and gravy and Fri-chik Nathan got in a package from his mom. I just wasn't that hungry. I went to sleep early.

After worship today, I'd told the staff we would like them to celebrate Thanksgiving with us today even though it's a day late. After taking my Mefloquine and sleeping a few hours the chills and fever have worn off so I weakly join them in the courtyard under the trees where we have three coffee tables full of boiled chicken and rice. This is the first meal as a hospital staff together. I explain the rules and we all say what we're thankful for and then "Papa" Sam (Samedi) prays and we dig in and enjoy an hour of pleasant conversation. Everyone totally loved it. We finish and I head back to bed to sleep off my malaria and hope for no more terrible bouts of severe chills.

This evening I'm lying on the couch listening to Avalon's "We Are the Reason" and "Adonai" and I get chills for a different reason and I start to cry (I don't know if it's just the Mefloquine making me emotionally labile or not--I don't care). It's tears of joy though and overwhelming thanks to "my Adonai" who has brought me here to Béré.

Malaria's giving me a headache and a few chills now--gotta go.

James