ALONE

I sit on the stool in the prep room. My whole body slumps. I stare at the concrete floor. The odor of sweat, blood and chlorine wafts gently towards me. I'm vaguely aware of Simeon and Abel moving past, taking a patient out; moving another in. I don't know if I can get off the stool. I just did a hernia and I don't remember much. My mind was elsewhere. I think I did it well. I hope so, it's one of our employees.

That morning started off alright. I woke up early, took the horses out to graze. I played a few songs on my much neglected guitar. I ate leftover garbanzos and rice. I guess things fell apart when I went to do rounds...

I walk into the courtyard and see two heavily turbaned men walking out with one of our patients' sons. I have a hunch. I call them over and ask them to return to whichever patient they were visiting. See we have a policy that only two family members can stay with each patient except during visiting hours from 3pm to 6pm. We've tried everything to enforce it but it's been a seven year battle. Our most recent strategy is to charge the extra family or friends a $2 overnight fee or fine. It's worked pretty well. Not on these guys though. The argument starts up almost immediately in Arabic.

"You are five with the patient, you are only allowed two."

"Yeah, we just came to visit we're on our way out."

"Do you know when visiting hours are?"

"We just came this morning. We're leaving."

"Now you have to pay a fine because visiting hours aren't until the afternoon."

"We have no money, we're just going now."

"How did you get in?"

"The gatekeeper let us in."

"Did you tell him you were visitors?"

"The other one maybe, not me."

"Yes, they told me they were sick and wanted to get consulted," adds the gatekeeper who's standing right there.

"I don't know, pardon, excuse us...we're going."

"Ok, I forgive you, now go pay the fine."

And on and on in never-ending circles goes the conversation.

Finally, I'm called to see a sick kid in the ER. I tell the gatekeeper not to let anyone in or out until we solve this problem. If they pay the fine, they can go. Five minutes later I come out of the ER in time to see about 20 people flowing in the open gate and the two men claiming to have no money hopping on their new motorcycle and taking off. In my head I can hear them mocking me the whole way home.

It seems silly, but somehow it's symbolic to me. I've been going round and round with this for seven years of staff members telling me it's good to have order in the hospital and respect the rules but no one enforcing except me occasionally creating unnecessary conflicts that drain my spirits. Yet I somehow feel compelled to keep trying. Today, as I do the hernia, though, I can think of nothing but despair and darkness as I think of the hopelessness of anything changing in this twisted world.

So, I sit on the stool. I don't know if I can get off it. Simeon comes up.

"We're ready for the next case."

Somehow, I lift my heavy limbs off the chair and shuffle in. The woman has a large tumor at the end of a pendulous breast reaching to her belly button. I'm not in the mood for careful dissection and a long, drawn out procedure. I stretch the breast out straight off the chest, attach two allis clamps at either end and N'Dilbe stretches the clamps out. I slash through, taking off the breast and mass in 4 or 5 strokes of the scalpel as large arteries squirt out blood everywhere including a major one that smacks me in the forehead and spatters my OR glasses. N'Dilbe holds compresses on the wound as I reach for clamps and clamp off all the blood vessels as the drape gets soaked with blood. It's over in a few seconds. Then I tie them all off and suture it closed. I'm in automatic mode.

My ankle is killing me. I got a rope burn on the opposite side of the ankle where I had the almost year long tropical ulcer that wouldn't heal. I fear it's twin has shown up. My ankle has been swelling up off and on over the last two weeks with red, painful skin all around. When I'm on my feet to long, especially in the OR, I can hardly walk for the pain. I limp home, throw a pillow on the concrete floor and lie there with my leg elevated on the couch. I stare at the ceiling as sweat makes my back stick to the cement.

I forget what drags me back up to see some of the patients. Somehow 2pm arrives and Samedi reminds me I've called a committee meeting. Great, just what I need. I somehow get through it without letting my anger and frustration show too much. I go back to a house empty except for two cats. I lie down all evening but can't get comfortable as my thin frame rests on the hard concrete. My neck hurts. I take some pain killers, brush my teeth and crawl into bed.

Outside the window, on the street by the fence a group of kids is yelling, screaming and laughing harshly and forced. Most parents let their kids run around wild like little goat kids. There's a bright moon and the under 10 party is happening a few meters away. I slip on some cut off scrubs, put my sore ankle into a worn out Croc, grab a stick and a head lamp and head to the gate. I slip out and dark little shapes are milling around me. I start swinging the stick indiscriminately and feel several resounding "thwacks" followed by small yelps as the crowd runs off quickly.

After yelling a little at all the teenagers and adults just sitting around watching, doing nothing I stumble back into the darkness of my house lit only by a bug lamp. I can't feel anything. Deep down I have a sense that at this moment I'm not the model missionary, but after seven years of seeing and participating in extreme suffering and poverty and ignorance I really could care less. I try to pray and read something uplifting but I still feel empty.

I'll probably feel better tomorrow...