not really awake either. I'm in that gray zone between...the
netherworld. I reel the desperation rising within me. Images of the
day's surgeries well up as well as a nebulous, all-pervading fear that
gnaws deep down...a fear put into words earlier in the day by Dr. Warren.
"James, I don't know how you're going to be able to handle it when I'm
gone. It's just too much."
A retired surgeon, Warren arrived at the end of January to much
anticipation on my part. I was sure that I would have a break and be
able to catch up on so much other stuff I'd let slip by in January. I
had reached the breaking point with our 71 surgeries in the first month
of 2007, but now, with the arrival of a real surgeon, I was sure that
things were on the up swing. Maybe I'd have time for a little exercise.
Shoot some hoops, go to the river for a swim, ride the horses, jog a
little, you know, some leisurely activities having nothing to do with
I even hoped that while I was at work I'd have a chance to relax, really
follow the inpatients well, have some in depth outpatient visits. You
know, be a real, thorough doctor for once, not just someone scrambling
around to try and do the minimum possible to save as many of the masses
that came from all over the country to the one hospital still
functioning and still affordable.
I was wrong...dead wrong.
Warren arrived on Sunday. On Monday, he did two hernias, a
hysterectomie, and a nephrectomie. I saw 50 inpatients and 28
outpatients, and did 6 ultrasounds. Then, we all got called in at
midnight for a perforated duodenal ulcer that needed to be intubated and
resuscitated in a difficult anesthesia case. While Warren operated I
was bagging him and telling Paul what drugs to give to keep the man
alive. We managed to save his live for a few days before he succumbed.
Who knows exactly what since we have no electrolyte or chemistry
panels in our lab and no intensive care.
Then, things started to get really bad.
First, the big autoclave has been out for months waiting for parts.
Then, within the week prior to Warren's arrival, both small autoclaves
got fried. Then, the generator went out leaving us without water or
power. We had a small generator given us by the Shanks in Koza,
Cameroun that at least allowed us a little light, suction and a monitor
in the OR. However, Warren, at the age of 74, was forced to work
without air conditioning in the ever-increasing Chadian hot season.
And work he did. In three weeks, counting today, he's done 55
surgeries, many of them complicated like the man with a redundant small
bowel cyst and many hysterectomies and some osteomyelitis. Of course,
there's always the tons of hernias and hydroceles as well as a c-section
with 8 liters of ascites and an ovarian cyst the size of a soccer ball.
The lab then ran out of power. We hooked everything up in reverse
(since the small generator is 110V and the hospital is wired for 220V)
so the lab battery could charge and than they could run things off the
inverter. I thought we had it all set up but they managed to fry a
microscope bulb and the hematocrit machine leaving us without the
ability to even check the hemoglobin. Now, we rely entirely on the
color of the conjunctiva to decide if a person needs to be transfused.
Modern day medicine at it's best.
We adapted. We borrowed a 220V generator from the District to pump
water every few days and continued to operate with the small 110V one.
I continued to see about twice as many outpatients as normal as well as
the increased number of inpatients due to the increase in frequentation
and the increase in surgical cases. We borrowed a stand up autoclave (a
glorified pressure cooker) that takes 6 hours to sterilize with either a
petrol or propane stove stuck underneath trying to heat it up...we have
no adequate heating source.
Not to mention that our accountant is not working as we're giving him
time off to try and find money to pay off the $1200 he stole from the
hospital. Not to mention the fact that Andre's been in N'Djamena for
most of the month trying to get medicines from the central pharmacy as
we run out of even basic things like Bactrim and Flagyl. We haven't had
a new urine collection bag in months. We've been re-washing old ones
and using feeding tube bags. So, all the administrative decisions have
been falling back on me as well.
And, all the nurses are working themselves to the bone at the same time.
What would we do without our two student missionary nurses, Paul and
Israel? What about our half deaf new nurse, Abel, who's not above
getting down and dirty to assist on surgeries, clean up the blood and
guts, wash the instruments, and stay till sundown almost every day
except Saturday? What about the two new government nurses just assigned?
God always gives us just enough to get by.
But, now, today, with the bloody c-section for uterine rupture leading
to a hysterectomy with four blood transfusions and difficulty
controlling the bleeding rolling around in my head after a "relaxed"
Sunday spending over six hours in the OR (we had a case of osteomyelitis
of the tibia as well as an incarcerated hernia that came in during the
c-section), now, when I don't eat from a few hash browns for breakfast
until some cold pasta late in the evening, now, as the panic sets in as
Warren's departure approaches...How will I handle it? And more
importantly, what will happen to the hospital and health care in the
region when Sarah and I go on vacation March 11...and both Paul and
And more importantly, how will my body handle this stress if I can't
even sleep but spend my nights tossing and turning or begging God with
racking sobs to intervene? It's been too much for too long and it's
just getting heavier...Is God not listening or is someone else out there
who He's calling to come help not listening? All I know is that I'm not
going to last much longer with some kind of intervention.
Is there anybody out there?