Timing

Bad timing. Just when I really needed it, the van refuses to start. So much for the "scalded dog." I really need to go to N'Djamena to get the two new doctors from Congo their work permits. The local Police Commissioner has volunteered to help (for a small per diem of $80/day) and we can't refuse. His brother is second in command at the Police Headquarters in the capital that hands these things out. If he goes with us, we get the visas easily. If we refuse his help, he calls up his brother to slow the whole process down or even refuse.

I send them on ahead. I'm sure the van can be easily fixed. It was running perfectly when I parked it last Friday. Besides, Jamie's back and knows this car backwards and forwards.

All Monday passes and Jamie and I can't figure out why it won't run. We check everything we can think of. There's good compression, spark, fuel getting to the carburetor, etc but it doesn't want to start.

"I have a feeling I wasn't supposed to travel today, Jamie." I say with a touch of frustration. "Maybe one day we'll realize why. It must not be the right time."

I go home and go to sleep early. I must have fallen deeply asleep because when I finally hear the banging on the door I am totally disoriented in the dark room, barely lit by a pale blue bug lamp.

"Yeah, hallo." I shout groggily out the window in the general direction of the screened in porch's door. "C'est qui?"

"Hey, it's me, Cory." I recognize Jamie's son's voice. "Brichelle, is really sick in a lot of pain in her stomach and she's been vomiting. We tried to bring her to you first but no one answered our knock. She's at the hospital, can you come quickly.




I sense the urgency in Cory's voice and as I slip on the slightly used scrubs hanging over the end of the bed I wonder how I could've missed the knock. I must be getting out of my light sleeper mode. For seven years I've been woken up at all hours of the day and night for emergencies here in Chad and never not heard the call. At least until recently. This is the second time now in the last few weeks that I've slept through someone banging on my door.

I walk into the ER and Tchibtchang points me to the cubicle where Brichelle, Jamie's young teenage daughter lies in obvious discomfort. The signs and symptoms are classic for acute appendicitis. Even in my groggy state of trying to wake up, I recognize that. But the words come out kind of heavy. I must not have been very convincing because Tammy laughs loudly and hollowly, desperately hoping she misheard.

"Are you kidding? Appendicitis!?" I definitely would've woken up to that voice. "James, what does that mean...?"

"Well, I'm serious. She has acute appendicitis and the only treatment is an operation."

I can see Tammy is taking this hard, but Brichelle is calm and seems to just be glad that something is going to be done immediately for her severe pain. I call in Samedi, Simeon and Abel as we take Brichelle to the OR. Tammy accompanies us inside and makes sure that things are kept modest. Samedi arrives first and sits to start an IV on her right arm. I take the left and am happy to see she has great veins. I don't want to mess this one up. But I do, twice missing fat veins right in front of my face. Meanwhile, Samedi has the other IV up and running so I motion him over and he quickly finds the second IV and starts to give the antibiotics. Abel and Simeon are there but now there's the problem of the urinary catheter. Tammy has promised Brichelle privacy but there are only male nurses and doctors. We send Cory to the other side of town to get Wendy.

Meanwhile, we've prepped the OR, prepared the instruments and Samedi has scrubbed. Brichelle is on the OR table and we've given her Diazepam to relax her. We can't wait for the catheter. Then I remember, Lucie's on duty. She's not one of our best nurses, but I'm pretty sure she can put in a foley catheter. Besides, I'll be there to supervise. Lucie comes immediately and gets the urinary catheter in quickly, just as Wendy arrives.

I scrub and Samedi helps me on with gown and gloves. We drape the abdomen. It feels weird to have white skin under the drape. As I make my small incision in her right lower quadrant, I notice how even though the surface looks so different, just millimeters in under the slight pressure of a sharp scalpel and the blood, fat, muscle, and other tissues is exactly the same on black and white. I've made my incision a little high so I have to dig down to find where small and large bowel join until finally an inflamed appendix pops into view. I quickly clamp and tie the vessels and the stump after amputating that weird little intestinal appendage. I sew up the fascia, subcutaneous tissues and skin and apply some dermabond over the subcuticular suture.

The next morning, I go to see her at the hospital before getting on the public bus for N'Djamena. If not for the bad timing of having the car not start I wouldn't have been there to operate on Brichelle. That evening she goes home and rapidly recovers.

A week later, Jamie and Gary having exhausted their vast reserve of mechanical knowledge without success, the van still isn't running. It's a big mystery. Saturday morning I get a call from the vice-president of Chad's constitutional advisors. I met him a couple weeks ago. He is Muslim and a true believer. We talked about God for over an hour as he invited us to come to his village near the Sudanese border and look into helping his people in the area of health care. He tells me he's talked to the sultan who is excited to meet us. Can I come sometime this week?

So, I need a way to get to N'Djamena quickly as our meeting is tomorrow at noon. Jamie calls Maccabé, a local mechanic from Kelo who's helped him before. We go over the engine from top to bottom again. He's found a few things he thinks are wrong and assures me the car will start. We get it all put back together, and no change. Just as I'm about to throw in the towel, Maccabé reaches for the distributor.

"Have they checked this out?" Before I can reply that "Yes, of course we have..." Maccabé has reached under with a wrench and loosened it up. He puts the key in the ignition and starts up the car. With a little twist of the distributor, the engine roars to life. It looks like the timing of the spark plug firing was a little off. A few more adjustments and the vehicle is ready to go for my early departure tomorrow.

Imagine that, it was all about timing...=