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