I couldn't believe my ears. It was surreal. I didn't really feel any panic or anything, but I felt a calm, cold-blooded realization of what I needed to do.
My vacation was about to be cut short.
Ok, so you couldn't really call it a vacation, Sarah and I had come to the Koza Hospital as part of an exchange with Drs. Greg and Audrey who were now in Bere. We had now been in Northern Cameroun for just a day over two weeks but compared to Bere, it was a definite, much-needed break.
In those two weeks, I did 6 surgeries at Koza. Greg did 37 at Bere. I sat around all afternoon reading and watching movies while sipping cold drinks and eating homemade ice cream with a fan and a swampcooler as my constant companions while Greg and Audrey hardly saw the light of day and came home to Kerosene lamps and lukewarm tapwater.
This morning, I'd been woken out of my electric fan-cooled sleep by the nurse and ended up doing a crash c-section to save a distressed baby's life. Now, Greg's calm voice is speaking through my cell phone (yeah, even here in the African bush) telling me that one of our student missionaries (who we call Esther because there's just to many Sarah's) has severe abdominal pain and has vomited several times. Greg goes on to say that she has peritoneal signs and a positive Typhoid Fever test. She's been on IV fluids, antibiotics and morphine since yesterday. He doesn't know if she should be evacuated or what.
Fortunately, thanks to Gary Roberts' airplane, I have the luxury of saying, "I'll be right over, let me just quickly pack my bags and I'll see you in a few hours."
It's a Saturday morning and it's going to be a long day.
I quickly go over to the church right across from the house and find Yves, the administrator, to inform him of the situation. He is sitting on one of the front rows, so I drag him outside to break the news. He is understanding and wishes us bon voyage. After saying good-bye to Jacques and Calda, Sarah and I pack our bags and about 30 minutes after the phone call, Gary's wife, Wendy, is driving us out to the grass airstrip.
We take down the string "fence" Gary has guarded the plane with, detach the moorings, load up the barrels of fuel and our small backpacks, strap ourselves in and Gary fires up the single prop, we taxi (bump) across the grass and are soon banking sharply right en route to Garoua. An uneventful landing, flight plan and missed immigration agents (lucky for us since we didn't have visas) and we are heading to Moundou. Less than three hours from Koza and we land in Moundou where we have a little friendly discussion (heated argument) with customs ending in the usual way (laughs and hand pumping).
20 minutes, and a little flying lesson for James later we are circling Bere International watching Rich race down the airstrip on his motorcycle looking for goats, cows and soccer goal posts which could make our landing a little more bumpy.
"See that second path over the strip right before the little mound halfway down? That's where we'll try to put down in order to miss that little bump. We could circle around again, but this is faster..."
Gary says as my stomach gets left somewhere over to the right as be bank sharply left and downward towards the swath cut from the Chadian bush. Seconds later we are taxiing up to the quickly gathered crowd of mostly kids awaiting our arrival.
After the plane is unloaded, draped and secured and the watchmen posted, Anne kindly drives us over to the hospital in their Land Cruiser.
Greg is waiting for us dressed casually in jean shorts and a scrub top and large sandals. We go inside where the back room has been transformed into an intensive care of sorts with one patient, three doctors and three nurses, and multiple auxiliary staff (the other student missionaries) crowding around to help in any little way possible.
I slowly enter with my Sarah at my side. Esther (the other Sarah) gives us a weak, Morphine-influenced smile and says "hi". I ask her a few questions.
Apparently, her pain started yesterday morning early but she thought maybe it was just part of her monthly cramps. So she got on a motorcycle and took a little jaunt over to Kelo with a couple of the other volunteers. Curiously, the bumpy, bouncy ride did little to alleviate her pain. On her return, she had a typhoid test done which was sort of positive (they're sometimes hard to interpret and often have both false positives and false negatives). She was started on antibiotics and then IV fluids after she vomited. She had no urinary symptoms and bowel function was normal. She ate a little something at night. Her pain was equal on both sides of her pelvis. The pain increased with movement, tapping on the lower belly and "rebound tenderness".
Greg, Audrey, Sarah and I go to the next room to discuss what to do. She has evacuation insurance and with Gary's plane we could have her in N'Djamena maybe in time for the midnight, once-a-day flight to Paris. There is no hospital in Tchad I would prefer her to go to over ours (especially with Greg, a board-certified general surgeon there). We agree it could be typhoid fever, but that would usually have a longer course. While there are some atypical features I ask, "what if it is appendicitis"? In that case, she should be operated on ASAP, and an evacuation won't be fast enough to keep her from perforating with all the life-threatening complications. We continue to discuss, finally, I ask Greg, "If she was not a foreigner, would you operate on her." After a few moments, he says, "yes, I definitely would." So we are decided that if she chooses to stay in Bere, we'll open her up.
Now, Greg spends a long time explaining to Esther the options and she wisely calls her parents. With the time change, we at first only able to get through to her mom who wisely tells her that the decision is hers. Esther doesn't take long to say that here in Bere she is surrounded by friends and people she knows and the thought of flying to Europe (even accompanied by another of our volunteers who works in France and is leaving next week anyway) and being operated far away from anyone she knows, that thought scares her and she'd rather be operated on her in Chad.
So, the decision is made. Hans, Sonya and Christina go to prepare the OR and make sure everything is as clean and arranged as possible. Liz, Christina and Sarah prepare Esther for her operation.
Greg, Audrey and I wait just in the outer room of the operating block. Once the decision is made, I am anxious to get started. Greg calms me down. We'd already waited an hour or so for her to be able to talk to her father. At about 10pm we are finally ready to start.
I sit Esther up, wipe Betadine across her back, put on sterile gloves and inject a spinal anesthetic. We lay her down and Greg and I leave to respect her privacy while Audrey and the other girls prep the operating site and Audrey drapes her in sterile fashion. Greg and I scrub and when the all clear is given, enter the operating room. Contemporary Christian praise music is going in the background as Greg and I put on our gowns and gloves and Greg moves to the left side and asks for the scalpel.
We then pray officially once again (one of many continual prayers going up since our arrival) and we check to see if the anesthesia has taken effect. It isn't working completely, just giving her some warm tingling feelings in her legs, so Sarah gives her some Ketamine to go on top of her Diazepam and Greg slices from her pubis to just below her belly button.
As we enter the peritoneum, we get a small surge of liquidy pus from the pelvis. We know now, we've made the right decision. It just remains to be seen exactly what's the source. We irrigate and suction out the pus. As I retract, Greg examines the left tube and ovary, the uterus and then the right tube and ovary. Everything is completely normal. He moves over to the cecum and as his fingers work some inflamed tissue free, out pops a very angry appendix right about to burst. With a couple quick clamps, the vessels are clamped, cut and tied. The base of the appendix is then clamped and stick tied twice and sliced off. A lot more irrigation and suction and we close the fascia and skin. It's taken less than an hour, the anesthesia was completely uncomplicated and we take her home to the "ICU" 30 minutes praising God all the way!
If she had been evacuated, she would certainly have perforated either in Gary's plane or in the Air France plane. Amazingly enough, the best care available for her in the world at that moment in her life was found at the Bere Adventist Hospital.
(Story told with the permission of Sarah "Esther")
