Snakebite

The sound of a load diesel motor and the sudden appearance of headlights outside the fence sucks me quickly out of a deep sleep into the darkness of a moonless Chadian night. The truck stops in front of the hospital. I have a feeling I might as well get up already.

Sure enough, within minutes, the all-too-familiar knock, knock, knock on the sheet metal door confirms my suspicions.

"Oui?" I mumble as I roll out of bed trying not to disturb Sarah.

"It's me." Sounds out from through the screen door and across the porch into the bedroom. It sounds like the night nurse, Augustin. I pull on some shorts, grab my glasses and fumble through the dark of the living room which is lit eerily by a blue bug lamp.

"They've just brought in a Fulani boy with a snake bite."

I arrive at the door and take the blue carnet from Augustin's outstretched arm.

"He's agitated and his leg is swollen."

"How long has it been."

"About two hours. They're camped out over by Lai and he went to get some water or something and was bit on the foot."

"How did they find a car at this hour?"

"They ran to Lai and found someone."

"Ok, give him a vial of anti-venom in 500cc of Ringer's. Let it run in over 30 minutes. There's not much else really to do. Either it'll work or it won't...oh, give him some Diazepam to calm him down."

"Ok." And Augustin disappears into the night.

I walk inside and pour some water into a canning jar which serves as my guide to make sure I drink at least 5 liters of water a day. As I stare out into the shadows of the yard my thoughts wander to the boy.

Should I go up to the hospital? Would it make a difference? Won't he just probably die anyway?

Then I start to think, of the two forces in this world, good and evil, which would want me to go up to the hospital and which would recommend I go back to sleep. It's a no brainer, so I put on scrubs, grab my keys and head up to the ER.

On the way I send up a quick prayer. "Whatever happens, make sure You get the glory. If I can pray with them, give me the chance so they'll recognize You as the One who heals."

I arrive in the ER and pull back the green and yellow curtain. Writhing on the bed in agony, looking like death warmed over is a slender, wiry nomad boy with dreads, traditional scarring on his face, leather fetish bags around his neck, string bracelets on his wrists and wild colored pants blood stained on the right leg. His right ankle is covered with blood-soaked gauze and the entire leg is swollen and already blistering.

He is moaning and non-responsive with gingival bleeding thrashing his legs and arms around from time to time.

A shaven headed man in a dark gray pant-suit and traditional tattoos and the obligatory leather pouches around the neck is remarkable amongst his people for the lack of dreads and the presence of a cell phone on a string around his neck and sticking out of his shirt pocket. He stands at the head of the bed. Squatting all around the ER are more men and several women with the crazy dreads and black, charcoal based lined tattoos on the face, arms and chest. Plastic shoes are standard. Another family member stands in a corner, the bottom of his left foot pushed against his inner right thigh as he balances on one foot like a flamingo.

Augustin arrives with the IV and we hold the boy's left arm still while the IV perfusion gets running.

"Give him an ampoule of Pentazocine sub-cue since obviously the Diazepam isn't enough."

As Augustin leaves to get the Pentazocine I motion to the Fulani men and speak to them in my broken Arabic.

"We pray to Allah. Allah give him health. Allah only. Ok?"

Heads nod vigorously in agreement as arms outstretch in the Muslim prayer position.

"Rabbina Allah! Give this boy health. Give this boy life. In the name of Isa al-Masih, Amin!"

As the simple prayer finishes our hands move to our faces to take in Allah's blessing as murmurs of "Shukran" and "Alhamdullilah" whisper around the sleeping, snake-bit boy. The bald man points to the sky and pronounces solemnly, "Allah only gives health and life. Allah only."

Augustin arrives and gives the Pentazocine.

I go to the OR and get a 60cc syringe. I draw up 20cc of Ringers and combine it with the 10cc of anti-venom and give it slow IV push over 10 minutes. Within minutes of starting the anti-venom, the gingival bleeding stops and the ankle bleeding slows down.

The boy is asleep now, thanks to the meds. In fact, he's gurgling. I show the Fulani man with the bald head how to do a jaw thrust to open his airway and the boy starts breathing easier. I keep reminding him to keep the airway open as he keeps getting distracted. Finally, he buckles down and gets it.

I tell Augustin to get some IV Chlorpheniramine ready in case he has an allergic reaction. He comes back to say that the pharmacy is out.

Just then, I notice some welts showing up on the boys arms and abdomen. I rush to the OR and come back with Adrenaline and Benadryl. We give him the shots. It seems to stop spreading. His heart is racing but he's still knocked out.

I go back to the OR into the stock room and find the Hydrocortisone we'd just finally found last week at the pharmacy in Lai. Augustin adds 100mg to the perfusion.

I stay by the boy's side often placing my hand on his chest to feel his heart beat and see if he has a fever. He's breathing is slow and shallow and without the constant pressure of his Fulani uncle's hands thrusting his lower jaw forward he would drown in his own saliva.

What I wouldn't give for an old foot powered suction pump!

The bleeding has all but stopped and the hives aren't spreading and, maybe it's my imagination, but they seem to be receding a little.

The Fulani faces around me seem to relax a little. They sense that he might live.

"Alhamdullilah!" I say and point skyward, "Allah only!"

I go home.

The next morning, the boy starts to wake up. We find he has malaria, after 3 more days of malaria treatment, he is eating, sitting up, moving around and the swelling in his leg has started to go down.

I bid them farewell after thanking God again one more time for saving his life.

James

Horses

It's a gray Saturday morning. 6:30 am and a cool breeze is blowing in a cloudy sky bringing out the deepness of the green starting to push up through the desert soil. The transformation of desert into lush grasslands has begun with the first rains. Stefan and I are going for a ride. Pepper and Bob are standing near the stables but Libby is nowhere to be found. I search the compound and finally find her standing under a tree staring blankly through the chain link fence across the soccer field into the horizon. I grab her halter. She resists briefly with her head pulled back before resigning herself to her fate.

I tie Bob up to the tree right outside the stables and grab the new, synthetic saddle someone just gave Sarah and cinch it up as tight as I can across Bob's ever increasing girth. He's getting so strong I'll use the bit today. I slide the beautifully worked leather and silver harness and bit into his mouth and squeeze it over his ears and attach it under his chin. I attach the saddle bags over Libby's rump and fill it with water bottles, and a French Bible and Nangere songbook. I place my left purpose into Bob's stirrup and swing up and into place.

We saunter up to the gate and out into the street. Most people are just waking up huddled around smoky leaf fires warming themselves up after a long "cold" night. Some are gathered around a pot of bouillie anticipating the temporary assuaging of the ever present hunger of the end of the dry season. We cross Bere and approach Bendele. Gary and Wendy's empty house stares at us from the left, it's gate locked with a padlock and it's windows barred. A heavy silence reigns.

A few meters up Noel's children wave and flash huge grins as they shout out the obligatory "lapia! James-uh! Stef-ahn!

Passing Noel's house takes us out of the village into the bush. The main road is packed with a steady procession of people on their way to market. Women in brightly colored wraps saunter along their arms swinging in rhyme keeping in balance on their heads the large basins filled with sweet potatoes, sugar, millet, rice, corn, bean leaves and other marketable items. An ox cart plods slowly by loaded with sacks of grain, a few young kids piled on top and one lazily sitting across the pulling bar with a stick in hand to swat the two long-horned cows into the right direction. More women pass, long piles of twisted sticks cut into six feet lengths, tied and bundled onto their heads. Old and young mix in a never ending procession heading for the biggest event of the week, the Bere market.

Further up, we enter a small village where some of the travelers have stopped under a mango tree gathering around a large pot of freshly prepared rice wine to fill their bellies for the exhausting trip to Bere on foot and to prepare themselves for the social scene and eventually a staggering stumble home, dead drunk. They wave wildly their faces lighting up with white, toothy grins as we pass and call out our greetings.

I've switched to Libbly now, as Stefan was having some troubles controlling her. We've been trotting for a while when an open stretch of road heading to Dabague opens up before us. I give a cluck and a kick with my heels and Libby is off on a fast gallop. She's our newest addition to the stables and like Pepper and Bob came to us at a good price thanks to her malnourishment. When Sarah walked her back from the Arab village where we bought her, she could barely do 5 kilometers at a slow walk. Now that she's put on some weight and become one of the friendliest horses around I want to see if she can run and if she's at all competitive.

I'm in front for a while before Bob catches up and barely passes us. Libby picks up speed a little but seems content to stay with Bob and not pass him. Alternately walking, trotting and galloping the 18 kilometers to Delbian pass quickly accompanied by a thousand "Lapias" and "As-salaam alekums".

We tie up Libby and Bob near some grass while a short man with a limp brings a bucket, fills it at the local water pump and gives the horses a much needed drink. We take off the saddle bags and saddles and hang them over mango tree branches out of the reach of curious little hands. I get to tell the story of David and Goliath to a group of kids where practically every other boy his carrying his own sling and sheep are grazing in the background. The story of a shepherd boy killing a giant with a stone and sling has never seemed more real.

I then am told by Noel that I'll be preaching so I pull out of my past the sermon I borrowed from the Pineapple Story guy about God loving impossibilities in using Gideon and 300 men to fight off an army of 135,000; Elijah taking on 400 prophets of Baal on a mountain and God burning up the wet wood, bull, stone and earth with fire from the sky; and Daniel's three friends being saved from a fiery furnace heated up seven times hotter.

In a surprising lack of African hospitality, Stefan and I are allowed to escape the usually obligatory millet paste and slime sauce meal and head back to Bere. Just outside of Dabegue, we come across three young boys bareback on tiny ponies herding cattle. As we trot past, one of them turns and starts running alongside heading towards the road. He wants to race! I cluck loudly and give a big kick to Libby's flanks and she almost shoots out from under me as she pushes to catch the pony. Within seconds we pull even and leave the surprisingly fast pony in the dust. Entering Dabegue we tear around puddles of water, under trees and around people scampering to get out of the way. I'd seen Stefan gunning Bob and was sure he'd catch us by now. I quickly over my shoulder and he's nowhere to be found. A commanding "whoa", a sharp pull on the reins and a lean back with all my force and Libby stops dead in her tracks.

Stefan finally catches up explaining that he lost his hat as Bob sprung forward to enter the race. We continue trotting and walking until we are about 5 kilometers from Bere.

"Let's race Bob and Libby. I want to really see what she can do. See that tree to the left just beyond that puddle? It'll be a walk up start. As soon as we enter the shadow of the tree, the race starts."

I feel my heart beat pick up as the tree approaches and we try to keep the horses even. It's a slow walk up. We're only a few feet away. The horses start to sense our excitement...and...we're there. Libby seems to have been expecting it as she rockets forward almost pulling my feet out of the stirrups. I'm holding on for dear life. We're ahead! I then see Bob cut around a little to the left where a side path goes around some bushes. He's picking up speed. At the same time I feel Libby fading, she's just not in shape and running out of energy. Bob leaves us way behind as we continue a slow gallop to the entrance to Bere and do a cool-down walk the rest of the way home.

As i finally pull myself out of the saddle, I can't believe how tired I am. I'm so wobbly I cna barely stay a foot. I'm covered with sweat and fine dust. The horses slurp up bucketfuls of water and then go for a roll as soon as their saddles are off. I take a quick shower and fall into a deep sleep before being awakened shortly by the nurse on duty.

"There's a woman with high blood pressure and seizures. She's seven months pregnant. The cervix is completely dilated."

I give some instructions and go back down to lay down, but then think better of it and get up, put on scrubs and head to the hospital.

The woman is thrashing around on the bed moaning and whining. The cervix is only at three centimeters. We start an oxytocin drip to give her better contractions and I go to see some other patients. The nurse runs to get me.

"She's having a crisis again!"

I enter the labor and delivery room. The husband is at the bed side and the woman is hysterical. It's not a seizure, though, and she quickly calms down when the husband leaves. I order some pain medication and then she has a grand mal seizure. We hurry her to the OR. Luckily Simeon is there and Samedi lives right next door. The woman is combative and agitated and difficult to get on the OR table. We tie her arms and legs down good, prep the abdomen, scrub and gown and drape.

We pray and Simeon gives one milliliter of Ketamine and I slice down to fascia, rip the fascia and muscles open, lift up a bladder flap, slice into the uterus, poke into the amniotic sac and squeeze out a full term baby boy who after a little rubbing and slapping starts to give a healthy cry. I suture up the uterus and skin and head home to finally rest.

James

Only God Knows

I've just started rounds on surgery. The young girl operated on for perforated bowel secondary to Typhoid Fever is doing much better. She still has a drain in and we're doing dressing changes on the open wound on her skin incision but she's eating, drinking, walking, pooping and peeing so we are otherwise happy. Suddenly, Carson comes in and in his slow drawl tells me they need me to help find an IV on a kid...it's kind of urgent.

I walk through the open screen door, across the porch covered with convalescing patients and family members lying on colorful mats, across the well-swept courtyard and over to the sidewalk where a small crowd has gathered around a mother with a brightly colored head wrap holding a limp child sitting on a wooden chair facing away from me and towards the white coated nurse bent closely over the child trying to start an IV. It's the new nurse, Tchiptchang. Standing to the side, muscles bulging out of his scrubs, Abel holds a bottle of 5% glucose attached to an IV line waiting for the chance to attach it to a venous access.

I'm quickly filled in as I stride up.

"Really low blood sugar. Sick for a week. Treated at home with market meds and who knows what else. Just came in. Unconscious. We can't get an IV."

The kid's eyes are rolled back in his head. His hands and face are pale. His body is like a rag doll. I listen and he has a faint heart beat. He's barely breathing.

"Let's get him to the OR!"

We rush off around the corner and into the brightly lit OR prep room. We place the child on a gurney and I start doing chest compressions. Abel and Tchiptchang are trying to find a scalp vein. Carson is holding the IV which we have placed subcutaneously on his abdomen which is swelling up. He remains unconscious. I suggest they try and external jugular vein on his neck. Augustin arrives and tries as well. No success. I try a femoral vein on both sides while Abel and Carson take turns doing CPR. I fail on both sides.

The nurses keep trying on the scalp and neck. No luck. I call for another hemoglobin as I can't believe the first one is really 10. He looks too pale. His heart is still beating, though barely. We keep on CPR. He's about 2 1/2 years old. His mom stands in the background, a helpless and hopeless expression on her face. She's probably thinking of all the other small boys she's seen buried in her life and thinking about probably burying hers today.

I'm thinking back to the 4 year old I was just doing similar, unsuccessful, resuscitation efforts on last week. I'm about ready to stop. The hemoglobin comes back 8. We keep on CPR. The nurses keep trying to find an IV. I finally try the right femoral vein again.

I stretch out the skin on his inner thigh. I feel for a pulse but find nothing. I poke blindly with a 22G IV catheter attached to a syringe I aspirate from. I get some dark blood back. I can't really thread the catheter. I take out the needle. No blood. I slowly pull it back until the blood starts to ooze out. I call for the IV tubing and attach the 5% glucose solution and hold the IV to let it run in fast. We tape it down but someone has to hold it just so in order for it to work. Within 30 seconds, the boy's eyes open. A few seconds later he's looking around and starting to move his limbs. He has a strong heart beat and is breathing!

We give him some oral sugar water and show the mom how to keep giving him that all day long.

We let the glucose run in. The nurses finally find a real IV and we start treatment for malaria. Why do some make it and some don't? Only God knows.

James

Coffin

When I first saw the coffin it was half-finished. Lying amidst a pile of saw dust, it was a crude little thing, but somehow appropriate. Hard, twisted redwood had somehow been fashioned into a 3 foot long box with bottom, back and sides just waiting for the front and top to be able to enclose a little boy's body.

As I walk up to the container where Jeremy and Jonathan are making the coffin, I am struck by the cold beauty of the surroundings. A steel blue sky with gray angry clouds releases a slight drizzle of rain onto the African plain watering the wet sand and scrub bushes. A smattering of mango and Shea butter trees break up the monotony of the flat expanse. A group of tired grave diggers rest against the trunk of a tree to the right. Straight ahead is the beginnings of Gary's airplane hangar with the two old 20 foot containers making up the end of the hangar. Around the half-open doors of one container is gathered a crowd of mostly children with a smattering of adults all peering intently at the two white men making a coffin.

The purr of a small Honda generator is broken intermittently by the harsh roar of a power saw and the shocking pounding of large nails into hard wood. A cool breeze tries to soften the atmosphere which is heavy with grief. I squeeze through the crowd just in time to help Jeremy and Jonathan lift up the coffin, measure around and make the final trimmings. The wood is so hard that holes have to be drilled before nailing or the nails will bend. We place the small head piece on and Jeremy hammers the nails home. The only thing left is to place a small boy, recently alive and well, into the interior and hammer it shut until resurrection day.

The Adventist Youth Society has arrived in their sharp olive and tan uniforms. Jeremy, Jonathan and a couple of local men pick up the heavy burial box and lug it over to Gary and Wendy's humble abode. They place the casket gently on a simple wooden bed on the porch and wait for the final step.

Cherise, Gary and Wendy's two and a half year old daughter, runs in with a smile proudly showing off the cartoonish horse and car that Sarah has drawn on the back of her hands with a green marker.

It's almost time. Neighbors and friends are gathering outside. The rain continues to sprinkle the event as lighting flashes occasionally in the background. Gary looks at me. We walk silently over to the coffin and pick it up. It's rough and twisted wood bites into my hands with the weight of it's import crushing me more than it's physical gravitational force.

Followed by Wendy and Cherise we enter the house, pass through the living room and into the bedroom to the left where Caleb awaits, cold and silent. He is peacefully lying on the floor next to the two mosquito net covered mattresses where he slept with his sister. A small, baby blanket covers most of his lifeless form. Gary and I gently set the coffin down next to him. Gary lifts him up while Wendy arranges the blanket and smoothes it out over his face. Gary picks him up gently in his arms, tears streaming from his red and swollen eyes.

"Let me hold him one more time." Wendy's voice is deep and broken as she hugs her first born son for the last time on this earth.

"Cherise, do you want to kiss Caleb one more time?"; Gary asks softly.

"Yeah, daddy..."; She approaches wiping away a stray strand of pure, blond hair from her cherubic face. She leans forward, lips puckered, and places a tiny kiss on the top of Caleb's pale head.

Gary covers Caleb up again and lays him in the coffin. He fits too well. This shouldn't be happening. I sob quietly, letting the tears flow freely.

We take the even heavier coffin out to the porch where Jeremy expertly pounds the last nails home with a devastating sound of finality. It's definitely time now.

The uniformed young people wait outside. Gary and I place the coffin on the shoulders of six young Chadian girls who will bear the honors.

"Left, left, left-right-left..."; The solemn march begins as we all fall in behind while the young people sing a mournfully echoing marching song about following Jesus no matter the cost. The procession winds out the gate, around the fence, past the water tower and out towards the airstrip.

Gary's plane stares silently, it's windows covered with a tarp as if even it is too grief-stricken to observe the final steps of the young boy who loved so much to greet his daddy's return from mission flights or climb all over the cockpit dreaming of the day when he too would fly.

We march across the deep red laterite surface of the airstrip, cross a sandy path, pass through some low scrub brush and arrive at the six foot deep hole that will be Caleb's resting site until the end of the world. A pile of sandy clay with two hand made ropes strung across it lays to the side of the grave. The coffin is marched around the hole and deposited carefully on top of the ropes and dirt pile. A crowd has gathered. The wind blows. The rain falls. The universe mourns.

The service starts with a couple of French hymns that have never had much meaning for me until now.

"Jusqu'a la mort, c'est notre cri de guerre, le libre cri d'un peuple rachete, jusqu'a la mort nous te serons fideles..."; (Even unto death, it's our battle cry, the free cry of a redeemed people, even unto death we will be faithful...) Even song off tune the deep feeling of those singing it penetrates to the bottom of my heart. We are free, we are at war, their are casulties, but we don't mourn as those who have no hope...we will stay faithful...my heart wants to believe it.

"Et mon coeur n'a rien a craindre, puisque tu me conduiras. Je te suivrai sans me plaindre en m'appuyant sur ton bras." (And my heart has nothing to fear, because You are guiding me. I will follow You without complaint, leaning on your arm). A cold chill runs down my spine as I feel the presence of God. He is present. He weeps with us at this tragedy. We have nothing to fear.

After I give opening prayer, Andre exhorts us with a little eulogy reminding us that death is a sleep, that our hope is in the resurrection when Jesus comes again to reunite all of us who have abandoned our rebellion against him. Caleb's suffering is over, it's those of us left on earth who suffer, but Jesus is coming soon to wipe every tear from our eyes and destroy our last enemy, death.

Then, Gary talks about how much Caleb loved to talk about Jesus and his second coming and then he had us sing together Caleb's favorite song in English:

"When the trumpet of the Lord shall sound, and time shall be no more...when the roll is called up yonder I'll be there!";

Unfortunately, as the local gravediggers go to lay the coffin in the tomb they realize they've made the hole too small. As they rush to and fro quickly to dig the grave larger, the chorale saves the day with a some traditional, echo and repeat style African songs. Finally, the modifications are made and the coffin is slowly lowered into it's final resting place with the help of the rough ropes.

As the dirt starts to be shoveled on top of the coffin, Cherise seems to realize a little what's going on. Her heart-breaking cries and tears tear us all apart. Gary crouches down gently beside her.

"What is Caleb doing right now?";

"Sleeping, daddy."

"And when will he wake up."

"Oh yeah, when Jesus comes." Her face lights up a little and she wipes her eyes as Wendy picks her up and holds her close.

As the crowd starts spontaneously singing in Nangjere, the grave-diggers expertly create the funeral mound. A handmade hoe, a stick and the end of a shovel pound and stir the earth into place as two other men shovel the earth in and continually pick up what has fallen to the sides. Then with some final pounding with the flats of the shovels a perfectly oval mound arises as only those who've seen much death and assisted many funerals could make it.

We then turn to follow the Advent Youth as they lead us back singing the same marching songs. Arriving at the house, we follow local custom by seating Gary, Wendy and Cherise in lounge chairs along with the other participants in the memorial service while the mourners pass one by one to greet. The women curtsy and bow while solemnly shaking hands, often with two hands or the second hand touching the forearm of the right hand as they shake as a sign of respect. The men shuffle and nod somberly as they hold the hands for a long time and silently let you know they feel your loss (and they all have lost children so it means something). One crippled man on crutches hobbles in and hugs both parents while tears stream down his cheeks.

Finally, the kids file in for their respectful shaking of hands as the adults take a seat on mats spread out behind the choral which has been singing French hymns without ceasing. Annie and some of the local women serve Kool-Aid. People quietly converse. Occasional sobs burst forth. Laughter is sometimes heard. Gary and Wendy are periodically called away by phone calls from well-wishers around the world.

Dusk approaches. Noel rises and calls an end to the wake with a prayer. They graciously don't insist on their custom of singing, dancing and drumming all night long. Instead, everyone files solemnly out shaking our hands one last time. About this time, Rich and Anne, our friends from N'Djamena arrive.

The sun sets on a day that started out as any other day and quickly tumbled into an early morning ER call, a desperate last ditch effort and the laying to rest of a four year old boy in a crude, twisted coffin, resting peacefully in the African bush through the rest of this world's turmoil until the end of the world and the beginning of the next when God will wipe every tear from our eyes and our last enemy death will die as we all are reunited with those we have lost.

James

Tragedy

"Hurry to the ER! James! Run!" The familiar words come not in the usual African French but in the familiar English of our friends, Gary and Wendy Roberts as they whiz by the house on their motorcycle.

I'd just gotten up a little before 5:00am to write email when I heard the roar of the moto and the cries of the anguished parents.

I quickly pull on some scrubs and rush out the door where I run into Sarah who's just come to get me. She is just finishing up a night shift in the ER. It's about 6:00am.

The hospital is bathed with an early morning tranquility that would've been soothing on any other morning but this one.

I arrive at the ER and see Gary bent over his son, Caleb, giving him mouth to mouth as his pale, limp body wants to sink into the top of the desk he's lying on.

"He was still breathing as we were coming but he just stopped. He has no heart beat!"

I start giving chest compressions as I bark out orders to Sarah, Wendy, Koumabas, Hortance and Augustin who luckily happens to be there.

"Get some IV glucose and some IV tubing!"

"Someone look for an IV!"

"Call the lab for a hemoglobin and glucose check!"

"Get the pulse ox from the OR!"

As they rush off to find the material I look closer at Caleb. His body is flaccid, his face is pale and haggard, eyes closed, mouth half open, a mild gurgling coming out of his throat with each chest compression. He has no heart beat and his lungs sound filled with fluid. His belly is soft with an enlarged liver.

Gary takes over chest compressions as Hortance hands me the D5W attached to some IV tubing which I quickly insert under the skin of his stomach for a subcutaneous perfusion of glucose in case his blood sugar is low.

"Give him half an ampoule of IV furosemide IM.

Augustin is patiently searching for an IV on Caleb's small, white hands and arms. Sarah arrives with the pulse oximeter. We continue chest compressions. The O2 sat is 15%. I have Gary start rescue breathing again. The pulse ox stops working.

"Sarah, get some Adrenaline and Atropine from the OR!"

Still no IV.

"Koumabas, get me a blue IV catheter and a 5cc seringe!"

I keep doing compressions while Gary does two rescue breaths every 10 cardiac compressions.

Wendy has come back with an epi-pen and accidentally sticks her thumb with it instead of Caleb's leg.

Sarah gives Adrenaline and Atropine intramuscularly.

I listen and detect a faint, slow heart beat.

We continue CPR.

"Wendy, find me one of those small red, urine catheters in the OR so we can empty his bladder!"

Koumabas gives me the IV catheter with which I miraculously find his right femoral vein on the first try despite feeling no pulse and am able to thread the catheter in. I attach the IV glucose bottle and let it run in.

Meanwhile Mathieu has arrived and now has the results: hemoglobin a little low and blood sugar extremely low.

Wendy returns with the foley and Augustin drains Caleb's bladder. Calebs lungs are clearer. He still has a faint heartbeat.

"Sarah, inject the Adrenaline as rapidly as you can....now!" I quickly pump Caleb's heart has fast as I can with my external compressions to get the medicine to his heart.

"Sarah, take over chest compressions, I'm going to find some Magnesium in my office!"

The magnesium goes in the IV fluids and slowly trickles in.
Gary still does rescue breathing. Wendy offers to take over but Gary wants to keep going.

"Mathieu, can we do a Potassium?"

"Oui!"

I draw a milliliter of dark blood from Caleb's femoral vein and Mathieu hurries off to the lab.

CPR continues. We've been going for 40 minutes.

I listen to Caleb's chest. No heartbeat.

We continue CPR.

"Sarah, more atropine."

Gary speaks up after his 2 rescue breaths. "Should we stop?"

"Let's go just a little more."

Atropine is in. We continue CPR 5 more minutes.

I listen to Caleb's heart...

Nothing.

We stop.

Gary and Wendy collapse weeping into each others arms as sobs explode from within my chest. I grab Gary from the side my arm draped across his neck. Sarah is on the other side hugging Wendy.

Gary solemnly wraps up the still, little body.

"Do you want to use the van? We can drive you back home."

Gary turns to Wendy, "No, let's just put him between us on the motorcycle and go home."

"Anything we can do?"

"No, we just want some alone time. Then in the afternoon we'll have a service." The trudge out to the motorcycle, the quiet bundle in Gary's arms.

Tears streaming down my face I walk slowly back home thinking back to September 3, 2001 when I also found myself stopping CPR on someone I loved and sadly giving them up temporarily into God's hands. Just like then when I told my twin brother, "I know where you'll be...I just better make sure I'm there as well," I think the same thing about little Caleb and can't wait to see him again, maybe even by my brother David's side, when things are finally finished down here.

But, meanwhile, I'm back home sobbing like a baby. Sarah walks in and kneels down in front of me. We embrace and cry together. Outside, the wind is blowing, whipping up a storm. It starts to rain. God is crying too.

Message from: James Appel

I feel a cold sweat creeping along the surface of my skin. A sensation of nausea rises to my throat. I desperately try to focus my eyes somewhere that will calm the waves of motion sickness but as the Cessna 172 lurges and plunges in the turbulence 7500 feet above the surface of a desert in a wall of dust and clouds there seems to be no escape.

"I think I might need one of those barf bags Sarah just brought you." I stoically mention to Gary.

"Here, you better start flying again, that often helps...gives you a little sense of control when it's turbulent."

I grab the controls and try to remember to make small adjustments back and forth and side to side as my gaze shifts rapidly between the horizon and the various instruments on the panel as I try to maintain altitude, direction, vertical speed, and bearings as the thermals rising from the hot sand below buffet us up and down and side to side.

My nausea slowly disappears.

An hour later we as we approach Bere I give the controls back to Gary for the landing. The two men in the back from the Chadian government who have come to evaluate our work at the hospital break the silence with a heartfelt "Dieu merci" as the plane touches down smoothly and taxis in to the waiting hospital van.

I greet Levi warmly and we pack up and head to the hospital.

What was starting to turn green with the early April rains has changed to a dreary brown.

"I guess I must have taken the rain with me to the US," I joke with Levi. "A week after arriving in Florida they had a two week long rain storm that ended their drought. Don't worry, though, I brought it back with me!"

We both laugh, but half hope it's true as people are already starting to talk about famine this year (although they do every year no matter how much rain we get.)

I get our visitors settled in the guest house and change into scrubs to take a quick tour of the hospitalized patients.

The arab man with the broken tibia and jaw is elated to see me and immediately asks to have the PVC pipe external fixator removed. The wiring on his jaw was taken off a few days ago and seems to be well healed. The leg looks good too, we'll have to send him to Moundou for an x-ray since ours has been broken for years.

Mathieu, our friend who spent a month collecting a seriously infected fracture with the local traditional bone setters before coming to us just in time to save his leg waves to me from across the room. I greet him and take a brief look at the wound which has closed up somewhat but is still quite deep into the gap left where we'd removed the infected bone.

All the other patients are new.

That evening I am woken up by a fierce wind followed by a scattered rain. The next few days we have several intense thunderstorms. The drought is over. It's good to be back.