Panic

I wake up in a panic...did I ever really sleep? I'm not sure. Yet, I'm not really awake either. I'm in that gray zone between...the netherworld. I reel the desperation rising within me. Images of the day'ssurgeries well up as well as a nebulous, all-pervadingfear that gnaws deep down...a fear put into wordsearlier in the day by Dr. Warren.

"James, I don't know how you're going to be able to handle it when I'm gone. It's just too much."

A retired surgeon, Warren arrived at the end of January to much anticipation on my part. I was surethat I would have a break and be able to catch up onso much other stuff I'd let slip by in January. I had reached the breaking point with our 71 surgeries in the first month of 2007, but now, with the arrival of a real surgeon, I was sure that things were on the upswing. Maybe I'd have time for a little exercise. Shoot some hoops, go to the river for a swim, ride the horses, jog a little, you know, some leisurely activities having nothing to do with the hospital.

I even hoped that while I was at work I'd have a chance to relax, really follow the inpatients well, have some in depth outpatient visits. You know, be areal, thorough doctor for once, not just someone scrambling around to try and do the minimum possible to save as many of the masses that came from all overthe country to the one hospital still functioning and still affordable.
I was wrong...dead wrong.

Warren arrived on Sunday. On Monday, he did two hernias, a hysterectomie, and a nephrectomie. I saw 50 inpatients and 28 outpatients, and did 6 ultrasounds. Then, we all got called in at midnight for a perforated duodenal ulcer that needed to be intubated and resuscitated in a difficult anesthesiacase. While Warren operated I was bagging him and telling Paul what drugs to give to keep the man alive.We managed to save his live for a few days before he succumbed. Who knows exactly what since we have noelectrolyte or chemistry panels in our lab and nointensive care.

Then, things started to get really bad.

First, the big autoclave has been out for monthswaiting for parts. Then, within the week prior to Warren's arrival, both small autoclaves got fried. Then, the generator went out leaving us without wateror power. We had a small generator given us by the Shanks in Koza, Cameroun that at least allowed us alittle light, suction and a monitor in the OR. However, Warren, at the age of 74, was forced to workwithout air conditioning in the ever-increasing Chadian hot season.

And work he did. In three weeks, counting today, he's done 55 surgeries, many of them complicated like the man with a redundant small bowel cyst and many hysterectomies and some osteomyelitis. Of course, there's always the tons of hernias and hydroceles aswell as a c-section with 8 liters of ascites and anovarian cyst the size of a soccer ball.

The lab then ran out of power. We hooked everything up in reverse (since the small generator is 110V and the hospital is wired for 220V) so the lab battery could charge and than they could run things off the inverter. I thought we had it all set up but they managed to fry a microscope bulb and the hematocrit machine leaving us without the ability to even check the hemoglobin. Now, we rely entirely on the color of the conjunctiva to decide if a person needs to be transfused. Modern day medicine at it's best.

We adapted. We borrowed a 220V generator from the District to pump water every few days and continued to operate with the small 110V one. I continued to see about twice as many outpatients as normal as well as the increased number of inpatients due to the increase in frequentation and the increase in surgical cases. We borrowed a stand up autoclave (a glorified pressurecooker) that takes 6 hours to sterilize with either apetrol or propane stove stuck underneath trying toheat it up...we have no adequate heating source.

Not to mention that our accountant is not working as we're giving him time off to try and find money to payoff the $1200 he stole from the hospital. Not to mention the fact that Andre's been in N'Djamena formost of the month trying to get medicines from the central pharmacy as we run out of even basic thingslike Bactrim and Flagyl. We haven't had a new urine collection bag in months. We've been re-washing oldones and using feeding tube bags. So, all the administrative decisions have been falling back on meas well.

And, all the nurses are working themselves to the bone at the same time. What would we do without our two student missionary nurses, Paul and Israel? What about our half deaf new nurse, Abel, who's not above getting down and dirty to assist on surgeries, cleanup the blood and guts, wash the instruments, and staytill sundown almost every day except Saturday? Whatabout the two new government nurses just assigned?

God always gives us just enough to get by.

But, now, today, with the bloody c-section for uterinerupture leading to a hysterectomy with four blood transfusions and difficulty controlling the bleeding rolling around in my head after a "relaxed" Sunday spending over six hours in the OR (we had a case ofosteomyelitis of the tibia as well as an incarcerated hernia that came in during the c-section), now, when I don't eat from a few hash browns for breakfast until some cold pasta late in the evening, now, as the panic sets in as Warren's departure approaches...How will I handle it? And more importantly, what will happen to the hospital and health care in the region when Sarah and I go on vacation March 11...and both Paul and Israel leave?

And more importantly, how will my body handle this stress if I can't even sleep but spend my nights tossing and turning or begging God with racking sobs to intervene? It's been too much for too long and it's just getting heavier...Is God not listening or is someone else out there who He's calling to come help not listening? All I know is that I'm not going to last much longer with out some kind of intervention.

Is there anybody out there?

James