Futbol

Why did I choose to wear shoes? I thought it would protect my ankle which had been smashed by Jason last week forming a superficial blood clot leaving my left inner ankle and foot swollen and different shades of purple and green.

Now as I send the ball skimming back across the grass, in the general direction of where I want it to go, I feel some burning pains on the sides of both small toes.

As Bond, Gabriel, Klevin and Stephan continue to play with some of the neighborhood kids I step behind the two broken bricks marking the goal posts and take off my shoes. Sure enough, blisters have already burst leaving raw flesh where the side of the toes should be. I jump back up from the ground and join back in the game. As I look up past the other goal defended so well by Bond things sort of go into movie mode as four well muscled, lean teenage Chadians stroll up slowly from past the end of the fence. I almost feel like things should go in slow motion with sinister music from some gang flick plays in the background. The brief moment is burst, however, as they flash large smiles and I recognize Koumakoy and Frederick's "little" brother along with some of the normal neighborhood soccer thugs.



We quickly divide into "us" versus "them" as they are intent on preserving the national Chadian football honor on this warm, Friday afternoon. In fact, warm is an understatement as the humidity from last night’s downpour hangs like a suffocating blanket over the ratty field as a cloudless sky lets a merciless African sun slowly broil us alive.

Needless to say, a few minutes into the match and my scrub bottoms are already soaking with sweat from the waist down and the top has long since been discarded. Along with our great Brazilian hope, Klevin, we are the only barefoot ones on our team. Stephan is our version of a gangbanger with his recently shaved-head-except-for-monstrous-sideburns look intimidating the opposition almost as much as his bare bear chest and cleats. Gabriel and Bond also are wearing scrubs and tennis shoes. Our opposition is lean and mean wearing only shirts and the occasional t-shirt along with bare feet and/or flip flops of various sorts.

We score first, a beautiful pass from Klevin after some footwork only a Brazilian could imagine setting up Stephan for a nifty tap in. Second blood is a breakdown in passing on my part setting up an easily intercepted ball across the middle and an easy angle shot off the bricks. From there on out it's back-and-forth with the Chadians controlling the ball the majority of the time before losing it through too much dribbling and not enough passing. We on the other hand make the most of our few opportunities and are soon up 3 to 1.

A loud thunder from the East makes me look up to see angry clouds forming quickly casting a slight shadow over the millet jungle that Bere has become and sending a cool breeze across our sweaty bodies. A perfect rainbow encircles the encroaching storm and as brilliant footwork and sometimes stellar passes continue beneath the now menacing sky, small pellets of water began to drop into the dry dust of the road making up the Western part of our playing field.

I quickly run over and put my Bible and songbook into the open doors of the church just to the Southeast, then grab my shoes and barely get them in before the downpour starts. We have not yet begun to play.

The game goes on.


We are drenched within minutes and passes start to get sloppy and slow down as the earth turns boggy. The rainbow has disappeared but there is still clear sky to the West where the sun is almost changing color into sunset. The rain is coming down almost parallel to the ground drilling into our welcoming flesh from the East.

The western part of the field (formerly the road) is now almost unplayable as any pass hazarding into its slimy clutches is instantly stopped in a puddle of water and muddy sand. The Chadians with flip flops are starting to slip and slide dangerously while the barefooted ones continue with no loss of traction. A huge grin splays across my face as Bond looks on from the eaves of the church having retreated there with the first of the downpour.



I haven't had this much fun in a long time.

Eventually, the Chadians say they are done. Down now 5 to 1 I don't blame them. They rub their tummies and give mournful looks as they say they haven't eaten since the morning...no strength. I mock them comparing our sagging bodies to their chiseled frames but they just laugh and insist. We finally agree to meet again sunday, slap hands all around and I head back over to the church as the torrent continues.

The noise inside the tin-roofed church is deafening. The only people who've made it for Friday evening prayer meeting are Lazare and a few kids who come around me as I sit in front of Lazare and say we should sing or something.

Shouting out loudly as we belt out songs in Nangjere I can tell that the kids are loving it, especially one-armed-boy. Finally after a few rounds of "Ka Ama Kouma Kwani Teri" and "Kela ka dane ma ei kera...dul kang ddi, Jesus, Jesus-Christi". I tell them the story of David and Goliath using Lazare to translate from French into Nangjere.

I end with teaching them "Only a Boy Named David" in Nangjere (Kware kusi ne David) by holding the songbook up to the last rays of light coming in the slit that serves as a window on the church. Then, one of the boys prays, Lazare locks up and I walk back slowly home through the mud and the mist.

Fracture update

I feel like an idiot. What was I thinking! Of course, the wound would get infected. I was too optimistic when I wrote that the wound looked great three days later and maybe a miracle would happen. The fracture got infected the next day. I tried to clean it out again and cover the bone with some muscle. That got infected. I tried to cast it in various ways, the bone didn't stay in place and kept pushing out through the wound, seeking the outside air like a drowning man. Nothing seemed to work. I thought maybe we'd have to amputate. Finally, we just left the whole thing open and let diluted bleach dressings do their trick. Slowly the wound cleaned up and granulation tissue formed. We kept asking if anyone could send us an external fixator, no one could find one. Finally, the wound was clean but the fracture was still only partially stabilized and the bone was still exposed.

Luckily, I am temporarily not alone. Dr. Bond and Dr. Jason Shives are with me in Bere. We talk about the open tibia fracture and what to do. Finally, we come up with a brilliant plan straight out of the MacGyver archives. Abel and Simeon prepare the patient while I head over to the house. I find a long piece of two and a half inch pipe that seems pretty strong. I grab a saw from the tool box and we cut two pieces off, roughly the length of a certain man's tibia.

Meanwhile, Jason and Abel have brought out the small generator and the cast saw and have been spewing plaster powder all over the ward in an attempt to take of the full leg cast.

We rejoin Bond in the OR where we try out Bond's regional spinal anesthetic technique by having our patient lie on his left side, the side of the fracture, while we put in the spinal lidocaine and let him sit on that side so only his left leg will be numb. When it's settled in, we turn him back onto his back and I hand the leg off to Gabriel to hold while Abel preps the leg with Betadine.

Jason and I scrub while Bond directs and advises. I first pull out some pieces of infected sequestrum and chip off some of the bone sticking too far out with a rongeur. We twist the leg into a more anatomical position and Gabriel holds it steady. I follow Bond's suggestion and make four tiny incisions, two above the wound and two below. Then I take a regular, unsterile cordless drill with my right hand and insert a sterile, threaded Steinman pin into the drill with my still clean left hand. I insert the still sterile end of the pin in one of the incisions and push it against the bone. I then squeeze the trigger and thread the pin in and through the tibia till it pokes the skin on the other side. Jason makes a small cut with the scalpel over the pin and I drill it the rest of the way through till it's sticking out the same amount on both sides. I repeat the processes for the remaining three pins.

Then, while Jason holds the PVC pipe steady against the pins, I mark where they should go through and then drill holes through the pipe. I then force the pipe over the pins till the pins hit the other side of the pipe. I then try to estimate where I should drill the second holes and mark the pipe again. I drill again and this time get each pin to go through it's second hole with the help of a little hammering. I repeat the process on the other side.

Gabriel lets go his stabilizing hold on the leg and we confirm that the fracture is now stabilized. Jason wraps gauze with Betadine around the pins while I dress the fracture wound with diluted bleach and we take him back out to the ward. It's once again in God's hands.

Eclampsia

Boom! Boom! Boom! The pounding on our cheap, metal front door jolts me out of a deep sleep. I glance quickly at my watch. 4:13am.

"James! Are you awake?!" I hear Dr. Bond's son, Gabriel, calling me, out of breath.

I pull on some shorts and fumble my way through the darkness out the bedroom door, past the bookshelf on the left, through the curtains covering the exit, out the living room door and onto the porch.

"What's up?" I mumble, trying to clear the cobwebs.

"Doudjé's wife just came in with seizures and we need some Magnesium from the pharmacy." I notice the shadowy form of Dr. Bond behind Gabriel in the moonless night.

"I'm coming," I reply and head back in to pull on some scrubs, grab my keys and a head lamp and back outside where I hear the voices of Gabriel and Bond fading around the corner of the container across the yard.

I push through the wet leaves of the bushes forming a hedge between our house and Lazare's little hut just outside the main house and stumble over his wire cooking "gounan". I make my way over to the fence, unlock the gate and head towards the dim light coming from the ER. I hear screams and wails and the sounds of a struggle coming from within that grow louder as I approach at a fast walk.

I push aside the bright green and yellow flowered curtain blocking the entrance to the ER and my eyes are instantly drawn to a group of 8-10 people surrounding on of the beds. Cries and moans are coming from inside the circle of bodies, a bottle of IV fluids hangs from a wooden IV pole and a tube descends into the crowd. Arms and legs shoot out here and there and are instantly seized by several hands and pushed back inside.

I push the people aside and get my first look. It is certainly Doudjés wife (and Koumakoy and Frederic's sister) but she is barely recognizable. I nod to Frederic and his mom who are part of the crowd.

"Lapia ei?"

"Lapie, Jamsuh," responds the mom.

"Ca va" is the reply from Frederic.


Doudjé hasn't arrived yet but his wife is swollen up like a balloon with edema everywhere and is alternately thrashing and lying moaning on the exam table. Just then she makes a violent effort and pulls out her IV causing blood to splatter all over the bed and floor as a nursing student rushes to stop the bleeding with a cotton ball.

She seems to vaguely recognize me as she looks at me, or more like through me, and mumbles "Jamsuh, jamsuh, jamsuh" over and over.

Augustin, the night nurse, informs me that she came in convulsing and with a blood pressure of 140/90. No question about it, it's eclampsia. I had just done an ultrasound on her a few weeks ago and discovered she had twins. There is definitely no time to lose.

"I found both fetal heartbeats" reassures Dr. Bond as I start to bark out orders.

"Augustin, call Simeon and Abel! Gabriel, you and the nursing student go get the gurney and take her to the OR! David, go call Sarah, tell her we need her immediately! Bond, I'll go get the Magnesium from the pharmacy, here's the keys to the OR."

We all split as the family continues to hold her down.

I pull out 6 ampoules of Magnesium and meet the gurney in the OR just in time to see the next seizure.

As she rolls through the door her body stiffens, her eyes roll back in her head and then she starts shaking violently with her teeth clenched. She starts bleeding again from the old IV site. Then, after a few seconds, the seizure stops and she falls unconscious.

"Now's our chance since she's unconscious. Let's get her clothes off, get her in the OR, start an IV and get her ready for surgery."

Sarah and Abel have both arrived now so an IV, a foley catheter and antibiotics are quickly done and she is transferred to the OR table.

I sidle up to Bond and ask him quietly if he minds if I do the surgery. Since I've been following her during her pregnancy and it's a friend of mine and I myself was a twin born by c-section, I request the privilege of doing the life-saving surgery on her. Bond is generous and concedes me the case. We scrub together.

By this time Simeon has arrived and I tell him to prepare one millilter of Ketamine. Doudjé's wife is still somnolent. Bond and I scrub and don gowns and gloves. Abel has prepared the surgical field and we drape the lower abdomen.

We pause for prayer and then I take up the scalpel. Two slices later and I see the uterus. Bond stretches the peritoneal opening wider as I insert the bladder retractor. I make a small transverse incision and poke through with a hemostat. I then insert the index finger of both hands and pull out and up opening the uterine wound. There is the upper back and neck of a tiny baby. I insert my hand down into the uterus till I find the head and lift it up and into the uterine wound. Bond pushes the top of the uterus and the baby slides into the world with a gasp and a scream.

Here's where things go temporarily wrong. Bond has grabbed the clamps for the ombilical cord and tells me to go for the next baby. I see the bulging amniotic sac and try to break it with my fingers with no success. Then, for some strange reason, I do something I never do, I reach again for the scalpel and as I bring it up to the surgical wound, Bond reaches down to grap some scissors to cut the cord and the scalpel collides with his finger. I'm horrified but Bond signals me to keep going as he finishes cutting the cord and handing off the baby. I put the scalpel down, burst the sac with another instrument and deliver the second baby who also comes out with great tone and grimacing and crying. Bond calls for another glove and we suture closed the uterus, the fascia and the skin with no further complications.


By the end of the surgery, her blood pressure has already normalized. Bond goes off to wash out his wound. We call in the lab to do an HIV test which is negative and Bond starts on post-exposure prophylaxis. By the next day, the edemas have started to go down, the twins are breastfeeding and Doudjé is the happiest, proudest man in town giving praise to God for his blessings.