A tale

I feel lost in a story that seems to fly by. It's moving, intense, captivating, exhausting...and each page is turned so fast I can only catch enough glimpses to get the general idea of the what's going on...yet, each page once turned is permanently turned...you can't go back.

A woman in labor for 2 days. Seen last night by a retired health care worker. Sent to us this morning. Her baby's too big. The head is all molded and almost sticking out...but it's just skin on his head that has been squeezed out...the skull won't fit through.

I have been called from my egg and rice breakfast. I run to the OR. I grab a syringe, anesthetic, an instrument box, a scalpel, a urinary catheter and some gauze and gloves. I rush back. I shave, prep, and slice down to her pubic bone. I start to cut through the cartilage. The scalpel breaks inside. I can't find it. I yell for a flashlight and another scalpel. I mop up the blood with the gauze. I call for Lona and Rachel. They each grab a leg. I cut deeper, going by feel. I tell Lona and Rachel to pull her legs apart. I hear a crack and feel her pelvis widen at the front.

The baby slides out in a slippery bath of brownish green fluid. He's huge, has a slow heartbeat and a little muscle tone. He never breaths. Despite CPR and resuscitation for 10 minutes he never cries. He's dead.

Meanwhile Lona has delivered the placenta and casually says she's bleeding. As I'm pressing the baby's chest between my fingers and two thumbs to pump his blood I look and see that Lona has draped a gauze over the perineum which is soaked with strings of coagulated blood dripping down into the green basin as the entire area is bright red. I leave the baby. I pull off the gauze...the entire birth canal is filled with blood and a piece of tissue hanging out. I yell for more gauze...they run to get it. I cram gauze inside and pull them out so I can see what's going on. Nathan holds a flashlight over my shoulder.

It appears the cervix has completely torn itself off circumferentially and is literally hanging by a thread. I clamp the base. Then, I soak up the blood in the wound where I cut her pelvis and with the flashlight try to find the piece of broken off scalpel. No where to be seen. I fish around with a needle driver and bang against something. I dab up blood and look again. I see it and pull it out. Then I wash out and suture up. I then suture up a tear around her urethra and a small posterior perineal tear. I cut off the dangling strip of cervix, take off the clamps, see there's no bleeding and an hour and a half after starting head off for rounds.

What part do I have to play? Why am I even in this story called H�pital Adventiste de Béré? My character being in the tale, much less one of the protagonists, is as odd as Crush the turtle showing up in Blair Witch Project. I get this feeling sometimes of the other players whispering behind their backs, when they think I'm not looking, asking how did he get a part? And, doesn't he realize that his lines are totally out of place and poorly acted?

I'm called over to the TB ward. Someone's not doing well. I see one of our long-timers is in bad shape. He'd come from Kelo...had started to improve and put on weight. He has a congenitally deformed left arm where the hand faces the wrong way and the whole thing is too short. Yesterday, his cousin told me he had a fever...probably malaria. Sure enough the smear is positive. I write for Quinine and Fandsidar and forget about it.

Now, he's death warmed over. He's unconscious, gray, has a slow heart beat, his cheeks are sunken and his breathing is more like an occasional deep sigh out of reflex rather than a serious effort at obtaining oxygen. I expect him to die in front of me. I sit there and stare at him for ten minutes. If I'd only gone to see him yesterday maybe I'd have seen he was bad and been more aggressive with treatment. It's so easy to ignore the TB patients...there just there taking pills. I'm so busy, maybe I'll see them tomorrow...at least once a week...or now and then...

A little girl, also hospitalized with TB, is sitting at the foot of the bed weeping. She is the cutest, cheeriest, most helpful girl. She always yells, "James-uh", and waves as she passes by carrying laundry or water on her head. She's helped us this week trim the mango trees wanting to saw as much as she can even if it doesn't really do much. Now, as easily as she laughs, she cries for someone she wouldn't know except for their common disease...I feel useless...I want to cry too...I want to run home and hide...I want to be a little kid again...but I just stand and stare and then walk lamely off with a blank expression...

Yet, somehow, it works. Beyond all rational thought, the play goes on...the plot thickens...the suspense builds...the rivals grow to respect each other...love is found in the most unexpected of places...laughter pops up randomly...joy is found...

I see all three "James-uhs" today. I've had three kids born here since I've been here who are named for me. The first one is the Chaplain's grandson. He's also been treated for Malaria a couple times and just wandered in with his mom looking healthy. James-uh 2 was brought in when 3 days old with a strangulated umbilical hernia that we operated on urgently. He recovered, then developed a wound infection and came in daily for a while for antibiotic shots and dressing changes. He sees me today as one of the sutures has poked through the skin and is sticking out. He is a round, chubby, dark baby with a serious afro going on and a vigorous cry and kick as I cut the suture and pull it out.

James-uh 3 is weak and malnourished. He is the surviving twin of Yvonne, born of c-section to an HIV+ mom. David, his bro, died last week. He manages to barely hang on. We tried him on formula to protect him from mommy's HIV and almost killed him with the diarrhea and lactose-intolerance. He's somehow toughing it out and I see him stretch out his puny arms for mom's breast as I change her dressing. She pulls him close and he sucks vigorously as if his life depended on it...and it does...

Then, despite the time in the desert, thirsty, hot, baked, dried out, tongue sticking to the roof of the mouth, hot, unbearable...despite it coming to an end with refreshing rain and cool winds and pleasant evenings...the sleeplessness continues. The thoughts ramble. The feeling of hopelessness for change enters. The spirit isn't even willing and the flesh is very weak.

A well-groomed, stocky man walks into my office with jeans, a tucked-in flannel and alligator skin boots. He presents his dossier. He is the referring doctor for a patient I've just seen. I was surprised to get an official looking letter with a reference from a traditional healer that morning. He'd tried to treat her pelvic pain for 3 days without success and so now was referring to the hospital. How cool, I'd thought.

Now he's presenting me papers telling how he's met with other traditional healers from Benin and other African countries for an exchange of ideas and how they're researching traditional pharmaceuticals. I'm impressed. I ask him how he was trained. That's when things suddenly turned bizarre.

I notice he's holding a carved horn as if it was a newborn baby...tenderly and pressed against his chest. He calmly tells me that he was drowned as a child, 5 spirits entered him and revived him, and they now tell him which plants to use for which problems. I don't know what to say. We continue otherwise to chat as colleagues. I tell him we've found Shistosomes in his patient's urine and have prescribed treatment. He is gracious, polite, refined and the last way I'd expected to see my first witch doctor.

This is just the latest to confirm my suspicions of the heaviness of spiritual forces here. A few weeks ago, after morning report we somehow got on the topic and all the staff started recounting tales of the supernatural.

Rahama told of taking her husband into the bush to see a healer. He boiled water, made him stand in the vapor and then threw something at his eyes. Animal bones immediately flew out of her husband's eyes and fell to the ground. She was shocked but had presence of mind to gather them up. She showed them to me the next day.

Samedi once saw two men who came by to show their powers. One took a sharp bush knife, suddenly turned, and whacked off the head of his companion. They all saw it fall to the ground. Then he picked it up and set it back on his friend's shoulders and he started talking and moving normally.

Andr� has seen people put curses on things that if you touch them you become frozen in place till the person comes back and sees it was you who was going to steal it. The others all confirmed that this is common.

Someone told the tale of our swimming hole by the bridge where Sarah and I like to jump off the cliffs. Apparently, a healthy young man was accused of adultery and was forced to swim across...which he did fine. But on swimming back he suddenly cried, lifted his arms out, and disappeared under the surface never to be seen again.

Then, there are the simple things like, when Pastor Job from N'Djam�na was here and said he's never heard goats and animals make so much noise or be so bothersome. He said they must be possessed. I'd thought the same thing but was afraid of sounding silly or paranoid if I mentioned it. Why else would they poop on our porch exclusively, pee right out side our windows, bleat uncontrollably for no reason just as we fall asleep and basically do as much as possible to assure we get no rest.

Spiritual forces are palpable here. I believe that God will protect me...but how to battle for the others? I've seen many patients I'm convinced should've lived except there was always some "sorcellerie" going on, or as the patients say, "he's been poisoned" meaning had a spell cast on him. What can I do? I feel helpless and inadequate...

I wonder like Sam Gamgee as he wanders the wilds near Mordor if they will write about me in the tales or am I way too insignificant...do I have an important part to play in this cosmic story? Will I have made a difference when the credits roll?

Somehow, I know that in the end, as I sit around the campfires of heaven, I will have stories to tell. People will say, tell me more about Samedi, and Lona, and Anatole and especially, about Sarah...did you really?...Are you serious?...No way!...That's what keeps me going...even though, or especially because, a place like this is beyond my wildest nightmares...it begins to take on a mythic quality. I feel detached at times, looking at myself, wondering if this is reality or just another movie, a story, a tale, something someone made up...and just maybe Someone did and the ending will be beyond my fondest dreams...

To be continued...

James