As I approach the bridge five miles from Béré I have no thought as to all the
circumstances that would lead to my being in this exact spot at this exact time.
It is only later in looking back that I realize how many things worked together
to make it happen.

My father arrived in Chad over two weeks ago. He had wanted to see Adam's grave in Béré. But a container arrived, the scalded dog broke down and we had no good way to get there. But in the container was an old VW Vanagon Campmobile. Augustin the administrator from Béré, has adopted a daughter from one of his relatives. She has had a mass on her distal fibula for 2 years. They showed up a week ago with xrays showing a bone cyst. I plan to operate on her last Wednesday but it doesn't work out for me to be in Béré. We have two nurses in Béré who want to come work with us in Moundou. Our business manager, David, and I want to interview them in person.




All this and much more leads to us being in Béré today.

In Béré we interview the first candidate. I take Augustin's adopted daughter to
the OR and inject the cyst with a corticosteroid under local anesthesia. No big
deal. But the second applicant is in Kélo. It takes him a while to arrive. The interview drags on and on. I'm anxious to get back to Moundou before sundown. The nurse, Abba, seems like a good one, but his application is incomplete. The rest in in Kélo. I offer to take him to Kélo with us on our way back to Moundou. He agrees but doesn't have money for the return. He asks if we can go see his brother at the district medical office. I'm a little frustrated, but agree. We wait outside for what seems like hours. Finally, we're back on the red road to Kélo.

All this and much more makes us be at the bridge crossing the Tandjilé River at
this precise moment on this specific day.

The approach to the bridge is quite steep and sort of paved. It has sunk down
with time leaving a large bump where the actual bridge begins. I slow down in
anticipation. As I climb up the incline I see a crushed motorcycle lying on its
side against the railing on the other side of the road. A little farther on is
a twisted heap of a man in a uniform. He is completely still and around his
head is a deepening pool of blood. There is a man leaning over him. As I
approach slowly, the man looks up and waves us on. Instead, I stop and
Franklin, my dad and I get out and hurry over to what seems like a lifeless
form.

At first glance I notice the huge laceration on top of his head. He appears to
be breathing, however, and Franklin confirms quickly with his stethoscope. The blood around his head is fresh, bright red and just beginning to clot. I realize now why no crowd has gathered: the accident just happened and there are African killer bees buzzing around. The few people even close have pulled their shirts up to cover their heads. David shouts a warning which we ignore.

The man who had waved us on speaks up. "I'm a policeman off duty. Mark the
time, but I want nothing to do with this."

"That's ok. We'll take him to the hospital."

"C'est bon. Here, take his cell phone."

I take the phone and notice a broken cord dangling off to one side. Dad, Abba and some locals pick up the man as I go back to the car, rip off the plastic we'd used to cover up the broken back window of the Vanagon, and grab Franklin's turban.

"Franklin, do you mind? It'll get ruined..."

"No, go ahead!"

I tell Abba to compress the large laceration on the victim's skull to stop the
bleeding. We place him on the plastic. He appears to be somewhat conscious and starts trying to thrash around. Franklin and Abba stay with him. David decides to wait at the bridge and Dad and I climb in the front. I put the Vanagon in reverse and back down the bridge to where I can turn around. Then we fly back to Béré, the Vanagon's new springs making us almost float over what otherwise would have been a bouncy, bumpy ride.

I honk as we turn down the road to the hospital and the gatekeeper gets the gate open as we pull in.

"Get a gurney!" I shout to the nurses that gather around. We place the wounded man on the gurney and take him to the OR. Abba still holds pressure on his skull. I take off my bloody pants and put on some scrub pants.

After getting a large bore IV running at full speed I order antibiotics. The man is still agitated so we have to hold him on the gurney. I put on some gloves and examine the wound more thoroughly. His skull is crushed with a depressed fragment near the back and a piece of brain pushing through a rip in the dura.

We transfer the man to the operating table while Franklin gets the anesthesia going. I scrub and ask Ndilbe to scrub as well, but just then Abel arrives so I
have him join me instead. The patient is now under general anesthesia with
Ketamine (normally contraindicated in head injury, but since is skull is open it
can release the pressure inside).

I irrigate vigorously the wound, pull out the depressed skull fragment, put the
other pieces back in place and close the scalp in two layers after further irrigation. He doesn't appear to have any other injuries besides a laceration on his right arm. Olen confirms there is no serious intra-abdominal injury with an ultrasound. Franklin and I leave him in the capable hands of Olen and his father-in-law and head home.

We pick up David at the bridge. The wrecked bike has been removed.

"The locals told me the guy was fiddling with his phone right before the accident."

We continue on our way back to Moundou as I start to reflect on how we ended up in the right place at the right time to save a life. Al hamdullilah!