ADAM

The moon has gone down. I walk in the dark with only the stars and the promises of yore to light my way. I make my way past the silent benches that all day held crowds singing in French and Nangjere as the drums pounded out their mournful beat. My body is as limp as the pillow I carry. Every last tear has been wrung from my eyes. I make my quiet pilgrimage to the site of my greatest sorrow. I enter the room that holds so many memories. As I open the rickety lock I remember locking that same door from inside as I cared for two little African babies struggling for their lives while outside men fought to end each others. The faint odor of bat guano greets my nostrils and makes me think of the time the winged mammal hit the fan and landed on the face of the baby fighting for breathe in the clutches of an asthma attack. I shine my light on the IV slowly dripping into the arm of my sweet little daughter, Miriam, as she tosses and turns in a fitful slumber. Sarah lies by her side in the mosquito net softly comforting her one remaining child. It seems like an eternity already since the morning when two babies wiggled and squirmed and flipped and grinned and giggled and squealed together in that same tent.

Sarah woke me up less than 24 hours ago. "The twins are really active and I'm
having a hard time. Can you come over?" I arrived to see Adam staring at me
with a silly grin right before flipping off the mattress between it and the net
and letting off a howl of frustration.

"You should have seen them. They both woke up, looked across the mat, grinned
and tried desperately to crawl to each other," said Sarah.

We'd arrived in Bere the day before. Thursday night, Adam had a fever of 104.
We were in N'Djamena and I bought a rapid malaria test. It was negative. I wasn't convinced. I opened a capsule of Artemesia, poured it on his mashed sweet potatoes and fed him despite his obvious preference for medicine-less food. The next morning, I fed him another dose and we loaded up the scalded dog and were on our way to Bere by 6:30am. By 2:30pm, both Adam and Miriam had been diagnosed with Falciparum malaria and started on IV Quinine. Through the night, they each got two of the every 8 hour doses.

I start Miriam's next IV perfusion and turn to Adam. I let 150 mL of 10%
glucose solution run from the IV bottle into the pediatric reservoir on his IV
tubing. The tubing has special air traps to avoid any accidental entry of air
into Adam's veins. I pull out 0.5mL to flush his IV and then carefully measur
90mg (0.3mL) of quinine and inject it into the top of the reservoir of 150mL. I
open up the IV, see that it was running well and slow it down to a drip.

I turn to look at Miriam and talk to Sarah.

"Is that a seizure?" Sarah interrupts our conversation and we turn to look at
Adam. He's not breathing. We start CPR. I run and get some 50% glucose
solution, afraid of low blood sugar. I text Olen who is there in minutes.
Still no breathing. Olen confirms a heartbeat, slow and irregular, but there.
Olen gets a bag valve mask and starts breathing for him while I do chest
compressions and Sarah continues to give glucose. Anatole arrives and checks
the blood sugar. It's high from all the glucose we've been giving him. We try
Adrenaline in ever increasing doses. His heartbeat never picks up. Every once
in a while he grimaces, groans, struggles for a couple breathes, giving us hope.
We work on him for over an hour. His heartbeat disappears. His pupils are
fixed and dilated. I'm praying desperately for a miracle. We stop.

Deja vu.

How many years ago did the same thing happen to my friend Gary and his little
boy Caleb?

It's 8:00 am and my life has suddenly changed for the worse. Sarah and I hold
Adam's still warm body. I desperately kiss his neck, my tears know no bounds.
My cries echo across the campus to join the thousands of others I've heard over
the years in this corner of Africa. Will I never again see his tongue half
hanging out of his silly grin? Will he never again wrap his legs around my
arms, brining my fingers to his mouth as he softly coos? Will he never again
thrash his arms in legs while staring at me with a look of pride and joy? Will
he never again take up the airplane position looking around for confirmation of
his abilities? Not in this life.

A day long ritual of African mourning begins as the news spreads like wildfire
through the village. People come to offer their condolences. Miriam becomes
agitated with all the visitors. I wrap Adam's body in my green and black
checked Arabic head scarf and carry him over to the house where friends have
arranged to let the mourners come in and visit. All day long the songs sung in
rhythmic Nangjere drift in as people make their way to where I am sitting on a
thin Nigerian mattress. So many people, so much collective pain and loss.
Salomon comes in and hugs me. A flood of tears bursts forth as I remember him
holding Adam so many times as we ate together in Moundou, enjoying one of his
famous sauces. Frederic kneels down and holds my hand long and hard in an
undulating shake of sympathy. Just last year I was at his house as he held his
son who had just died. The mother of the boy across the street who fell down a
well and died crouches and holds my hand as we share tears of sorrow and she
offers words of comfort and hope.

The steady stream of people brings me a steady stream of tears as I shake and
hold the black calloused hands of so many people who's lives have been filled
with loss. The strength of the grip and the power of the muscular arms of both
men and women combined with their roughened feet tell a thousand tales of woe.
Their is no awkwardness. They've done this before a thousand times. Tears come
from faces I've never seen before. But we now have a common bond of tragedy.
The only ones who seem uncomfortable are some of the westerners, but their warm
embraces make up for the lack of familiarity with death.

Gary and Wendy fly in from Zakouma just in time for the English portion of the
day long wake. Hymns of hope sung gently and powerfully by the many musicians
in our group of Nasaras warm my soul as Sarah holds Adam's now cold and
stiffening body.

"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." The rollicking song brings bursts of
tears from Gary, Wendy, Sarah and I as we remember Caleb's favorite song and the
other little foreigner buried in Bere what seems like ages ago. Now it's time
for last good byes. Sarah and I bring Adam's long little body into the house
and place it gently in the casket made by Jamie just this morning. I kiss his
cold brow one last time and we put on the lid.

The pathfinders are outside to carry the body to the grave site. Under a little
tree in front of our old house in Bere lies a volcanic stone with a little
plaque that says "Dinah Bindesboll Appel". Next to it is a deep, rectangular
hole waiting for our second child to return to the African dust. Noel gives a
stirring eulogy reminding us of the day when God will say "Viens" to both death
and the devil and both will be done away with forever. Then God will turn to
Sarah and James and say, "Here's Adam." And to Gary and Wendy, "Here's Caleb."
And the innocents will be restored to their rightful place.

But for now, we miss him terribly...

RIP Adam David Bindesboll Appel, June 25-December 31, 2011