Lies

The knock on the door is all too familiar. The case is not. A well built young man in his mid twenties lies on the ER bed with his legs curled up in obvious pain. He as all the symptoms of acute appendicitis. What is unusual is that he's only been sick for three days and the excruciating pain localizing to his right lower quadrant started at 4:00 am this morning. It's just a little after 6:00 am on a Sunday. He actually came in to the hospital almost right away. He didn't wait!

I open him up with a McBurney incision and find an appendix with the last two centimeters flaming red but non-perforated. I think this is probably the first non-perforated appendicitis I've operated on in 7 years here in Chad. Unlike the others, he should have an uncomplicated recovery and go home in a couple days. As I close up the skin incision I notice through the glass block windows of the OR that outside has turned dark and I can hear the rain pounding on the tin roof. This year, the rain started early and has been consistent and heavy. I head outside to do rounds as the cool wind and rain forces everyone under shelter.

The surgery ward is saturated with complicated wounds and post-op cases or patients who've come from far away and with the rains having destroyed all roads into Bere, it is unthinkable to send them home and have them come back in a week for suture removal. We'll just have to keep them until they can go home definitively.

On the medicine ward I find a not too uncommon sight. An elderly woman is sitting on the hospital bed with an IV hanging off her arm attached to an empty bag of IV fluids that once had Quinine in it. On the floor next to her bed is a half folded mat with a baby asleep on it surrounded by two young women and a young man eating a traditional meal. They break off a piece of millet paste and dip it into the slimy, green leafy sauce using two fingers and the thumb of the right hand. The man gets up when we approach while the women continue dipping and eating.

"Ca va?"

"Oui, ca va."

"Do you know the hospital rules?"

"Yes."

"Ok, how many family members can stay with the patient?"

"Two."

"How many of you are there?"

"Two."

"Do I look stupid? I can count. How many of you are there?"

"Three but one of them is outside."

"Where are we, inside or outside?"

"Inside."

"Do I look stupid? Where is the woman, inside or outside?"

"Inside, but she just arrived this morning."

"Really? Who let her in?" I go to the door and call the gatekeeper who is standing in the rain swallowed up in his army green poncho.

"Jean-Jacques, did you let this person in this morning?"

"No, she must have been in here already."

I turn to the family member and ask him, "When did she come?"

"Ask her."

Seraphim, one of our nurses' aides asks the woman in Nangjere when she got here.

"Nanga," she replies and even I understand that doesn't mean today, that means yesterday.

"My friend," I ask the man. "How many more lies are you going to tell today that are so easy to verify as false? Are you going to tell us you're the president of Chad? Or maybe Barack Obama?"

But I can tell by the look on his face that my attempt at humor has escaped him.

I finish rounds just in time to be called to labor and delivery where a woman has been in prolonged labor at the health center and was referred since 2 am. She arrives at 10am. I examine her and find that the baby is trying to come out face first and it just isn't working. We do a see section and pull out what looks like a little alien with his eyes bugging out, forehead swollen and molded by the pelvis and his face edematous and red. But he does start crying and moving with some vigorous efforts at reanimation by Sarah and Anatole and looks like he'll be fine. I wonder how long it'll take him before the culture teaches him that lying is ok as long as it's used to give excuses for not doing what you should be doing and to protect yourself from something that might turn out to be shameful.

But for right now, he's just like any other newborn, he just wants oxygen followed by a good breast feeding.