Getting close

Kulluku,

Al-salam alekum...anina afe...al hamdu lillah...

It's kind of strange. I only really get close to patients if they have problems severe enough to keep them hospitalized for a long time. There's Marty, the fisherman bit by the hippo. We still keep in touch. It seems every time I go to swim at a certain spot I see him. Last Saturday, he stopped by to give Sarah and I some fish he'd caught. Apparently, he's back fishing the lake with the hippos. But that friendship was at the cost of excruciating daily dressing changes on a two-foot long, 6 inch deep wound on his derriere.

Gai, the tall, lanky young man with one lung also sees us often at another swimming hole we frequent. He's usually off hunting with his bush knife but stops to say hello. He stops by the hospital from time to time as well and we're always glad to see him. He became our friend because of living with a chest tube for weeks, undergoing a thoracotomy with second chest tube and being hooked up to a crude suction machine every night when the power came on.

Then there's Freddy whose father refused amputation, who we did deep dressing changes deep into his thigh on for months and who ended up dying but not before finding a place in our hearts.

The list could go on and on...people brought into our lives through painful circumstances and suffering who somehow change us and become part of us through the process.

Currently, there's Suzanne and Yvonne. After a year of virtually no wound infections we were faced with two consecutive c-sections that turned into catastrophic post-op pus nightmares. Suzanne came first. Hers was a simple routine c-section except that the child was difficult to resuscitate and died 2 days later. She had a normal post-op course but then came back a week later with a little pus coming out of her wound, diarrhea and a distended abdomen.

She was started on antibiotics by the nurse, found to have malaria, treated for malaria and started to improve. I saw her a day later and opened the wound up more as there appeared to be a little abscess inside. Overall, she was doing well, walking and eating.

15 minutes after I opened the wound her husband came running to find me and said she'd had a huge diarrheal episode. I came in to find her standing in a puddle of foul smelling fluid. When I asked her she said it'd come from her wound. I took off the dressing and saw some fluid coming out.

We went to the OR to explore and ended up having to open her up in the midline as we found her entire abdomen filled with pus and inflammatory debris. She was left with a huge inverted T-shaped wound with the skin open in the midline and the entire wound down to the uterus open at the base.

She's been here over 6 weeks and has recuperated nicely with only a small portion of her wound still to close. Unfortunately, she has developed a nasty bed sore on her sacrum. But she and I and her mom (named Sarah) and my Sarah have all become fast friends. They don't speak French and I don't speak Nangjere but our non-verbal communication is enough to show that we're happy to see each other and that she has grown as fond of us as we have of her. They joke that Sarah needs to give me more back rubs as I work to hard...both probably true.

Just a few days after Suzanne came in with her wound infection, Yvonne came in with almost exactly the same thing. You'll remember that she is the woman infected with HIV who gave birth to twins by c-section. Her wound wasn't as extensive so I put drains in and we're doing dressings on the existing wound.

We helped them get formula from the Catholics so they wouldn't get HIV from the mom's breast milk. They did fine for about a month and we grew quite fond of them. In fact, they named one James and when I told them my twin brother was named David they named the other one David. David was the stronger one. James developed some abscesses on his head and was treated with some antibiotics. He was smaller and frailer from the beginning.

Yvonne's 3 year old son has started hanging out with the kids at church and basically has made himself a regular on campus. Her ten year old daughter helped us cut tree limbs and cooks and cleans for Yvonne here at the hospital.

Yvonne had a couple of setbacks but has pulled through. She developed a partial bowel obstruction which was resolved with one day of antibiotics, IV fluids and a nasogastric tube. A second one was cured with watching, waiting and prayer. She came to church last week and gives God thanks that she's recovering. The past two days she was well enough to walk to the market and back.

Unfortunately, David and James developed diarrhea and got Malaria. In a strange parallel to my own life, David (the stronger one), died after two days while the weaker James pulled through and is doing fine. It has been truly a bizarre sort of d�j� vu all along with Yvonne, James and David...but it has been a joy as well. I guess now I have two twin Davids to look forward to seeing in heaven...

James