Thursday, February 13, 2020

Bunny Man

Bunny Man

I had counseled my patient before his surgery; he may need an amputation of his right foot. He accepted the risk.  A few cuts into my diabetic foot debridement, it was clear. His foot needed to come off.  His infection was bad, life-threatening.  The gangrene was worse than I expected.  Slicing into the necrotic skin over his foot, the air in the tissue escaped and seemed to be happy to be free and dancing its tentacles of stench through my surgical mask and deep into my nostrils.  The nasty juice under the skin spilled onto the floor.  I palpated up into his lower leg and could tell the infection traveled a significant distance.

I wasn’t sterile yet, so I took off my gloves and grabbed some yummy-smelling hand sanitizer a previous volunteer had left.  I break it out on special occasions such as this.  I squirted a tiny bit of it in each of our masks to cover up the putrid smell of dead flesh (but not enough to get drunk!).  Now we were good to go!  

Mark was providing anesthesia care, and the patient had significant hypotension following his spinal.  Mark was treating it perfectly.  The patient was still lucid.  

I hadn’t talked to the family about the amputation (I had only talked to the patient on rounds), so I decided to bring his wife in to show her how badly he needed an amputation.  Yes, into the operating room.  He was my last case of the day, and it was Friday afternoon.  

The wife looked at his wound and started to panic.  I escorted her out and talked to the men.  They started to get upset. I would do an amputation?!?!?!  So I brought two men in to show them the wound too.  They did not want an amputation.  

I wasn’t sure at what point the patient himself decided he also did not want an amputation, but he then started saying he did not want an amputation.  

Wait, what?  No, you already told me you were okay if you needed an amputation.  We had discussed that I would try to save your foot, but if the infection was too bad, I would have to take it off.  You had agreed.  

“I would rather die, than have my foot cut off!”  

Oh boy.  

Okay, bring a proper translator, get the family on my side, etc, etc.  

“Ok, well sir, you are actually dying, and I need to take off your infected foot.”

His blood pressure was dipping into the 50’s systolic.  Maybe I can claim he doesn’t know what he’s talking about.  

Mark had repeated a few doses of epinephrine, and we were pouring fluids into him.  We also started a blood transfusion.  

I had some questions translated into Arabic.  “What year is it?” 

“2019, no it’s 2020”.  

Okay, well he still knew what he was talking about.  Sort of.  

I exchanged family members.  I explained the gravity of the situation to the new family members, and finally they all agreed with me.  Two of them came in and tried to talk some sense into my patient, who was laying on the table, ready to have his leg amputated or ready to die.  One of which was going to happen that same day.  

My patient still absolutely refused amputation.  

I was using his early-20’s grandson as a translator, at this point in tears, unable to get it into his grandpa’s head; this needs to happen!  

No way.  “I’ve been injured several times in the military.  I was always fine.  God took care of me.  He will this time too.  If it’s my time to go, then I accept.”  He went on to explain his past injuries.

At this point, Mark, Philippe, Andrew and I were just standing back in the OR while different family members came in to plead with the patient to accept.  They told me to just cut it off and don’t listen to him.  

I explained to them I had to respect his wishes.  I would not simply lop off the leg of an unwilling patient.  He had to tell me to. 

Mean while it had been about 30 minutes of begging and pleading with this man, who would clearly die without an amputation, and maybe would die with an amputation.  

It was sad.  I tried my best to explain things to him.  I was worried he would get too hypotensive and not be able to talk to us anymore.  

God gives us choices to make.  We should respect those choices in others too.  Even if they are making the wrong one.  

There was one moment from this night I will never forget.  I was allowing different family members to come in, trying to talk some sense into this man.  

I saw two scenes unfold before me.  Andrew, turning calmly, quietly, non-intrusively away from the action, hands folded in prayer.  And the grandson explaining to me, the patient accepts.  They come simultaneously.  A life saved.  

I couldn’t believe my ears!  It actually brought tears to my eyes (which doesn’t happen very often anymore).  What a struggle.  What a relief. We can now help this man.  What an answer to my prayer, Andrew is the right surgeon for Bere.  He may not feel completely ready to do the gamut of cases that exist here, but he is ready to be used by God.  And God is clearly using him.  

We invited the other 6-7 men into the room.  Yes, into the operating room!  The head of the family lifted his face toward the sky and led them in prayer, all with palms facing up, better positioned to receive Allah’s blessings from heaven.  It certainly was a sight to see, especially if you are not used to family members in an operating room! 

They soon left.  We continued our case.  We cut off his leg and I sliced up the sides of his leg and removed all of the dead tissue I could.  We packed his wounds open.  

Two days later, I had to cut his leg off even higher.  He made no remarks about not wanting it.  He said, do whatever I felt best.  

After a few days of redressing his wound from his infected amputation, he told me through translation that he had a present for me.  

What!?  A present?  

The next day on rounds, I heard something moving in a box under his bed.  I suspected it might be an animal because all of the nurses know I love animals.  He told me, open the box.  I opened it and there were two teenage bunnies inside!  My patient raises bunnies for a living and wanted to give me something special.  


I love our new bunnies.  The kids are already playing with them daily.  

The Test

The Test

This is only a test. Do not panic. This is only a test.

Do not mind the darkness. Do not mind the lack of running water. Do not mind the dead batteries in your phone, in your flashlight, in your… everything. This is only a test.

If this were a real emergency, it would seem… well, just about exactly like this. Except I wouldn’t be telling you, ‘This is only a test.’

Dad did it. Dad got remarried. So now we have Donna in the family.

She’s alright. You know, as far as wicked stepmothers go. (Kidding, kidding.)

Donna has traveled the world, including the third world and including Africa.

However, her stories from the third world seem to involve scenes witnessed from a luxury cruise ship or panoramas absorbed from the veranda of a luxury safari lodges or… well, you get the picture.

One problem: Our family is NOT the luxury type. 

Sure, just like anybody else, we can enjoy the finer things in life. We can go all out and order sour cream on our Taco Bell burrito every once in a while (but we prefer carrying in our own store brand tub of the white, creamy goodness and dolloping it on ourselves). We can drink Perrier (so long as it’s sat out a few days and gone flat and we didn’t actually pay for it and somebody holds our nose for us). We can stay in a hotel that’s rated with stars (plural!). We can buy non-pre-owned clothes occasionally!!! (There’s another name for that, but I can’t remember what it is off the top of my head… oh right!… ‘new’.) We fancy. Boogie. Wait, no. That’s a dance. Bougie. Poverty chic.

Donna’s just plain chic, which until recently, we merely presumed to be alternative spelling for soy chicken.

So when Donna assumed herself to be tough enough to hack it in Chad, we chortled. But vows were taking, visas were attained, flights were booked and paid for, and, seeing as how they were non-refundable (the tickets, not the vows), and seeing as how we aren’t the family to even let a lukewarm month-old strangely-bubbling piece of quiche (see, we’re fancy) go to waste if it’s free, we figured she might as well come.

We gave her a day here before we pulled the plug. We decided enough was enough and we shut off the generator.

‘It’s broken,’ we lied. It was freaking hi-lar-i-ous. As if all three generators could ever possibly die at the exact same time. But she bought it.

So for a week, Donna was here with only rare electricity and running water. Shower in the drips when they run. Rush to plug in everything when the lights go on. Then groan when the lights go off the moment you plug something in. Sleep without a fan. No blow dryer or curling iron for you, sister!

How do you like Chad, now!

What? You like it here? What’s wrong with you, woman?!

Hmmm… we may need to turn up the pressure…

Oh, dear! You don’t have water to drink, Donna? I’m so sorry. Well, when in Chad…

What? You already stocked some water?

What? You’re ok without your phone?

But… Hmmm… 

Huh? You cleaned out that stank fridge? Hmmm…

You’re just fine with eating in candlelight? Hmmm…

You don’t need the fan at night? Hmmm…

Well, I give up. I’m out of ideas.

Night before Dad and Donna head home, the ‘mechanic’ comes to fix the generator. (Read: the actor we hired to pretend to be a mechanic.) Within a few hours, the generator is magically purring away, allowing Donna to charge her phone for the loooooooong journey home.

Now that Donna’s gone, we can finally leave on our generator and bask in our constant running water.

Now what’s the stereotype?… Was it wicked stepmother or wicked stepson?

(Only kidding, we actually did have genuine generator issues the ENTIRE time they were visiting, more so than we’ve had in all 9+ years here. We were so spoiled with Jamie and then Rollin to keep things humming. The generators seem to be on the mend now, although we still had to shut down for a few hours this morning. And when the generators are out, out water goes out too.)


(As a second aside to the story, the mechanic came in at night and worked until 11pm fixing two generators, or at least patching them to workable for the moment, although we still needed two solenoids, now installed, and two more pieces, which are arriving from America next week. He also diagnosed a third generator and is working on it at home and bringing it back next weekend. At 11pm, he decided to work on the Prado, which he had diagnosed by midnight and decided he would need to take that one home too. At 6am, he got Rollin’s car running for the first time in almost a year. Then pulled the starter from the pickup to take home and work on. Then he had our old beastie running again for the first time in years, although not adequately. It will also need to go to Moundou if it’s ever to run again. He worked fast and we kept him busy with seven engines! When a previous mechanic had heard this guy was coming, the old mechanic told the new mechanic he was also a witch doctor and had previously paralyzed two mechanics to cross his turf and he’d kill him. Apparently, our mechanic wasn’t impressed, because he came anyway. Never boring here…)

The Toilet Seat

The TOILET SEAT

‘What is WRONG with these people?!?!?!’

Who doesn’t have a toilet seat? Why would somebody not take the very simple measure to install a toilet seat, so they can enjoy a creature comfort?

So we ask Jessica, our first volunteer to really ‘belong’ to us and not our predecessor, to bring us a toilet seat from America, since they weren’t able to be acquired in-country.

A week or so later, we have a toilet seat!

As we luxuriate in our frivolity, we recall the toilet in the back of our house, the guest quarters, also lacks a toilet seat. So why not ask my aunt and uncle to bring another one with them, so they can also appreciate tushy-delight? They oblige.

This is just one example of the myriad scenarios that left us shaking our heads, wondering, ‘What were James and Sarah thinking???’

James and Sarah were here for seven years before our arrival. Before we came, even from America, I would hear stories of how they had changed Bere from a run-down chicken coop into a fully-functioning and nationally-renowned hospital. But all I saw was the busted stuff!

At one point, I stepped back and looked at old pictures and listened to the local stories about what Bere Adventist Hospital actually was ‘back in the day.’

It’s impressive.

New wards were built, people were trained, reputations were elevated, etc. But they clearly had been here too long. They were willing to accept toilets without seats!!!

Well, well, well. The times they were a-changin’. We installed toilet seats. We improved this place drastically. No more toleration for frozen fannies.

Never mind nurses didn’t show up for work, or work when they did show up for that matter. Never mind we ran a tiny freezer chest on a timer to keep it forty degrees. Never mind we had chicken wire poking up through our counter top. Never mind there was no tub or hot water. Never mind our water ran out and our generator was off frequently.

We had plush seats for our keisters. 

Fast forward nine years.

We have fresh meat. Six new people with which to share our blessings and challenges. Diana, Sarah, Gabriel, Staci, Megan, Andrew… we can even toss in Elijah and Adelaide. Gone are the days of the family business, with Rollin and Dolores. Even down at the airport, we’ve had a bit of a changing of the guard. Gary and Wendy are long gone. Keith and Tammy and team have arrived. Only Jonathan and Melody are of our vintage.

To us, of course, the old days don’t seem so long ago.

But I think this new team has identified some ‘toilet seats’ of their own.

I can see James and Sarah now, faces cradled in their palms and eyes rolling, as they marvel at our inability to function without a 2-inch wide resting place for our bums instead of the standard single inch.

It would seem our new team has some hangups. They are so needy and high-maintenance. They insist on things like ‘electricity’ and ‘water’ in order to provide adequate care to patients. They get all whiny every time they need to repair a perforated gastric ulcer by dying headlamp, or deliver a baby by candlelight, or go eight days without water for a shower, or don’t have water to drink in the African heat, or can’t bathe their baby and keep them mosquito free and comfortable, or can’t perform an ultrasound on a pelvic mass, or can’t get laboratory testing, or can’t order medications, or… you see where I’m going? This new generation is just plain soft.

They also seem genuinely befuddled on why I insist on push-starting our car every time. Having a busted starter is a fantastic anti-theft device! Or why another couple cars haven’t worked in months to years. Or motorcycles. Or…

We simply take public transit if we must. Or we set up the tent and hammock in the back yard and sleep out there. Or light candles. Why fix stuff? We remember the old days when we didn’t have a toilet seat!

We just went through a week and half with essentially no electricity. It was frankly dangerous for the patients, not to mention lost income and lost reputation for the hospital.

And it was the right thing to do for the newbies to get frustrated, even angry. It was an unfortunate series of events and oversights that led to all three generators breaking down at the same time, something that should never happen. But it did. And our newbies were capable of both rolling with the punches and surviving, but also getting downright righteously indignant that the scenario would come to pass, and resolute it would never happen again.

We have such a great team now, a team able to see all our missing toilet seats, amenities normal to any remotely-modern hospital, but lacking here, and things we have grown accustomed to living without. This is the team to take the hospital to the next level. This is the team that will put lovely seats on all the barren rims.


And from where I type, although I can assure you my literal bum is quite well supported at the moment and my legs are not numb at all… it’s my figurative bum getting all worked up over the figurative seats this team will put on all our figurative toilets. It will be awesome. 

Candlelight

Candlelight

When I think of candlelight, I think of a nice dinner with my husband.  No children.  A pretty white tablecloth.  A table with a view, overlooking water or city lights.  A wonderful aromatic hot dinner set before us.  Quiet.  Romantic.  

Or…

A very calming evening after a stressful day.  Tranquil classical music.  A hot bath drawn and soft warmth lighting the bathroom.  Relaxing.  

Candlelight.  That’s what I think of.  

But not this…

This is far from usual.  Surgery, albeit basic, by candlelight.  Not something I often think about, or quite frankly, ever want to think about again!  This is insane!  

If you’ve been reading our blog, you know that we’ve been having generator problems for a week and a half already.  This has been getting serious.  Our batteries are dying on our headlamps.  My cell phone is dead.  It gets charged up every now and then when we send it down to Bendele, but for the moment it has been dead.  

Staci and I joked that we would eventually be doing surgery by candlelight.  And now that time had come!  

A lady came in bleeding heavily with a term pregnancy.  She had stopped bleeding somewhat, but I went to help Staci in case we decided to do a c-section.  Staci is perfectly competent to do a c-section, but I am happy to help in the dark if need be.  Everything is harder in the dark!  We have already done several emergency abdominal cases this past week with just a headlamp in the operating room!  Everything is harder, trust me!  

I held the candle up to the woman’s clothes to see how much blood had leaked onto her clothes.  

Staci examined the woman, who was 4cm and not bleeding heavily anymore.  No heartbeat on doppler, but we needed to confirm it with an ultrasound.  

Hmm….how are we going to do this as the machine doesn’t hold a charge?  And the only small working generator is being used to try to repair the other big generators.  Finally a mechanic has come!  

Well, we’ll have to make do!  I quickly blew out the candle so that we could approach the generators and fuel source.  We made the rest of the way by moonlight.  

We brought the patient outside and had her lay on a piece of plastic, near where all of the men were working on the generators.  We carried the ultrasound cart out to be plugged into the working small generator.  OUTSIDE!  In the DARK!  

It fired up once being plugged in to the small generator.  

Sadly the baby had already died.  I always try to get these cases delivered vaginally.  The key is augmentation and early transfusions.  As the woman’s mother spoke French, but the patient didn’t, I regretfully had to use her own mother to inform the patient of the terrible news.

With a plan underway for this woman, we then stopped by urgence as a nurse had informed Staci that there was a trauma for her to see.  

We entered the room in urgence, dimly lit by a few people’s cell phones.  A young 20’s male was lying on the bed with no sheet, no shirt, blood covering his entire head.  It ran down his chest and saturated the bed. A student nurse was holding three compresses over the wound, but it clearly was still bleeding.

I held up my candle to see a little better. 

Staci went to the operating room to grab a razor, a couple sutures, and a staple gun.  Andrew soon arrived as he had been helping the men with the generators.  

There was no water, as there was no electricity, so Andrew ran to his house to get some more water so to irrigate the 5cm scalp laceration.  I got some more of the story while waiting and holding pressure on the bleeding wound.  I explained to the student nurse to fold your fingers up so they can put more direct pressure on the wound and not with a flat hand as the pressure was not directly over the wound.  We chatted about what had happened.  Someone had hit the patient’s head with a machete.  Who knows why. 

Staci and Andrew quickly made it back and we irrigated his wound.  We found a significant arterial bleeder and sutured both sides of it.  Irrigation again, and then Andrew stapled the skin shut.  Pressure dressing.  Done.  

The candle was still burning.  Thank goodness as it took quite a bit of scrubbing to get this man clean again!  

And then back home.  To candlelight.  And quietness.  It is actually quite nice to not have all of the stimulation of the cellphones and computer.   We even have the kids sleeping. 


And since I am writing this, we have electricity again.  But that’s for another story.  

Doctors without...

Doctors without Borders???… Doctors without Electricity

Huh, What?  No, that’s not us anymore.  We have three working generators.  Er, um, two working generators, Er, um, one working generator…

What?  We have no working generators?!!!  

This is NOT good.  

I could go into a whole other discussion as to how we should feel guilty since we are kind of the ones in charge here, but we’ll save that for another blog.  Simply stated, it is someone’s full-time job to make sure the generators are working, and they aren’t.  

Back to Doctors without electricity.  We are doctors, not mechanics.  But I should have paid attention more when my dad was working on cars at the farm in Oklahoma.  I failed in that area.  I’m pretty sure I could look it up on YouTube or something, but… I can’t charge my phone because you know what?  I have NO electricity!  

Back again to the doctoring side of things.  

Where to start?  There’s been nine days of spotty electricity, and now several days of zero electricity.  

It’s a terrible, terrible situation.  But it doesn’t really seem like a big deal anymore to me. 

I’ve become less demanding (Others might not agree with that, but it’s true).  For example, I used to use a knife handle with my scalpel. Several times they forgot to put the handle in, so I started using the scalpel by itself.  I figured it’s faster to just take scalpel and cut!  

I rarely use cautery, except for mastectomies or masses that bleed.  I don’t use suction for c-sections, but I do for big, dirty laparotomies.  

If you’ve lived in rural Africa long enough in the medical field, you get used to improvising.  You can get mad and angry, or simply do your best.  It’s possible that all three could occur.  

Recently, I’ve been doing many cases in the back closet.  I originally said I would only do simple cases like hernias and hydroceles back there, because the lighting is not ideal and the table doesn’t move.  The table, er, um, stretcher, is also pretty wide, so it’s hard to get to the middle of the patient.  

Last month I started doing more advanced cases, as we had two ER physicians visiting who provided excellent anesthesia care.  Andrew operating in the big OR, and me operating in the closet.  Several times I said, absolutely no way was I going to do that case in the back, “Salle B.”  But then, due to time constraints and a multitude of patients, I ended up doing several emergency laparotomies in “Salle B,” the storage room.  We even moved a suction machine back there.  So I had an intubated patient and suction machine with my awesome headlamp that Dr. Dan left us.  We still couldn’t move the bed, but it was better than operating at midnight.  

Maybe God is evolving us to show we can do difficult cases with minimal things.  Or maybe we failed, letting all three generators break, even though it wasn’t exactly our fault.  It’s always our fault in the end.  And that gets tiring.  

So when Sarah and I did a third repeat cesarean in pitch black the other night, for twins no less… it wasn’t a big deal.  A little scary for her, since she had been gone four months, and it was her first surgery after being back.  But, she did a superb job!  

And when Andrew and I did an emergent laparotomy for gastric perforation last night, it wasn’t a huge deal.  It was not ideal, and we worried our headlamps might give out, and then what?… But God is sustaining us.  

Hopefully the generators are fixed soon.  And we have more responsible people take over soon.  

Monday, February 10, 2020

Seize the Day

Well I know a girl who was schooled in Manhattan.
She reads dusty books and learns phrases in Latin.
She is an author or maybe a poet,
A genius, but it’s just the world doesn’t know it.
She works on her novel most every day.
If you ask, she will say…

Seize the day.  Seize whatever you can,
‘Cause life slips away just like hourglass sand.
Seize the day.  Pray for grace from God’s hand,
And nothing will stand in your way.
Seize the day.  La di da di da, la di da di da di da

I know a doctor, a fine young physician,
left a six-figure job for a mission position.
He’s (She’s) healing the sick in an African clinic.
She works in the dirt and writes home to the cynics.
He says we work through the night almost everyday.
As we watch the sun rise we can say…

Seize the day…

I love this song.  I first heard it while vacationing in Tanzania as a student missionary.  A teenage missionary kid played it, and I was inspired by the song.  I wanted to become that young physician healing the sick in an African village.  

And through a series of miracles, God made it happen.  

Now we get to do just this.  And it’s the most rewarding thing.  Now as more and more colleagues join us, I get to help them do the same thing.  

One of them is a fine young physician, Staci.  She’s been here a little over a year already.  She’s taken over maternity and calls me with some of the harder cases. 

The other night, when she was getting called so frequently by maternity cases and not sleeping much, I thought of this song.  We had just been singing it with the SAME missionary kid.  Now Keith and his family have been living in Chad since July.  And we get to benefit from his fantastic guitar playing and praise song leading.  

This particular night, Staci was attempting to deliver a pregnant patient.  This is the patient’s fourth pregnancy.  She had two C-sections, one VBAC (vaginal birth after cesarean) in between the two cesareans, but only had one living child.  She opted to try delivering vaginally and had progressed normally.  

We’ve been having electric problems as our generators haven’t gotten the correct maintenance.  We have three, and they are all broken!  It seems you must micromanage everything or jobs don’t get done.  It’s so frustrating.  

So we had the patient in the operating room with nothing more than a cell phone light.  Even our headlamps were not charged.  Awesome.  

But you know what?  We were seizing the day!  Staci more than I, because she had been laboring with her most of the night, checking in on her.  It was 1am.  

I decided to do a trial of forceps.  It was not easy, but they worked!  

She then had a couple deep vaginal lacerations that weren’t bad, but it was difficult to see by cell phone light.  I might as well have been in a mud hut with dirt floor, because my OR wasn’t doing me much good without electricity.  We eventually got them repaired, and I packed her vagina.  

She did well, and her baby too.  


This job of ours always stays exciting.  But it’s fun to remember and look back at how God is allowing us to fulfill our dreams.  

I No Longer Can Hear Them

30 Jan 2020
‘Dear, can you go put Juniper back to sleep?’

Huh? Wha? Um, ok. I’m in a sleeping bag. On a mattress. On the ground. Outside. At the airport. Under the hammock. 

I remember. We came down to the airport to celebrate Caleb’s eighth birthday and decided to ‘camp out’ for the night. I hung up the hammock for Danae and tossed a mattress under her for myself. All ten kids are sleeping inside. And apparently Juniper is crying, although I don’t hear her.

‘I don’t hear her… Oh. Never mind.’

I walk into Keith and Tammy’s house, past sleeping Charles and Bernardine, through the pantry corridor and into the room of sleeping children. Juniper is sitting up and Keith and Tammy are doing a yeomen’s job trying to console her.

‘Juniper, lay down.’

She lays down and her crying turns to the hiccuping, gasping self-consoling that invariably happens when a toddler tries to switch from sobbing to peaceful breathing. I lay down next to her and press my forehead against hers. Her gasps become less and less frequent as the minutes pass until she is conked out once again and breathing rhythmically.

I rise and return to my mattress outside. As I lay down and squirm into the sleeping bag, I hear them. I haven’t heard them in ages. I can’t remember the last time. The drumbeats.

It’s 3am. Somewhere in the village, somebody has died. The drum sounds it out.

The thump thump thump remains the heartbeat of the soul of Africa, pulsing an energy and an emotion for a radius of miles.

Where there is joy, there are drums. Where there is marriage, there are drums. Where there is worship, there are drums. Wherever celebration or gathering happens, the drums beat out an ethereal music across this dusty terrain.

And as sure as the sun rises in the east, wherever there is death, the drums ring the news.

I remember hearing the drums frequently when we first arrived. They would wake me at night. I would hear them, and I would know, often able to guess which hospitalized patient the drums called for. And I could imagine their pain. The mother who lost her baby. The son who lost his father. The father who lost his teenage daughter. The husband who lost his wife in childbirth. My brain wouldn’t be able to shut off, feeling compelled to sympathize my best.

But over the years, these drums, such an integral thread inextricably woven into the fabric of the tapestry of African life, moved from the soundtrack they deserved to a mere background music, adding flavor to the story, but no longer a central theme.

And now, just like the fan in my bedroom, these beautiful and soulful drums have become white noise. I no longer hear the drums. And I mourn the loss.

Tonight, this morning, whatever 3am constitutes, these drums are barely able to stir emotion within me. I feel something. For the first time in years perhaps, the drums have been able to stir me. But I am not moved to tears. I am not moved to curiosity. What I mourn is my loss of passion. If that’s what it is. Maybe it’s simply a fatigue.

To remain so passionate about a people, about a hospital, about a mission, about a future, about possibilities. And to be so tired.

I’m not tired of the work. I’m not tired of the patients, although it’s frustrating when they can’t/won’t pay for the treatment of their family members. I’m not tired of my nurses, although it’s frustrating when they don’t do their job. I not tired of the generator breaking down, although we’ve been without power, and therefore without water, for most of the last four days. I’m not tired of the poverty. I’m not tired of the dust. I’m not tired of my kids having malaria, although it’s always stressful. I’m not tired of the long trip. I’m not tired of… everything people assume I would be tired of.

I came to help. I can help. The suffering is real. Why won’t you simply let me help? There’s a shortage of physicians in Tchad. At least, a shortage of those willing to go off into a rural district hospital. We are eager to heal. There is a lack of education, and we are eager to train, so others may heal their neighbors. The need is palpable. The statistics place Tchad at or near the bottom of all health indicators. We want to identify the most promising and make them excellent nurses and physicians.

But we are tired of blatant opposition. We feel we have something to offer, but few takers. Sure, our patients are happy for our expertise. But things seem to get in the way and make life unnecessarily difficult. Employees go on strike. Military threaten. Authorities make efforts to accuse us, or to exert power over the hospital. Volunteers are harassed. Government bodies extort bribes as legitimate fees in order to allow us to help. Tchad has been named ‘Worst Country in the World to do Business’ and ‘World’s Most Corrupt Country,’ and ‘Worst Country in the World for Tourism’, despite National Geographic trying to promote Tchad as a place to visit in 2020. We can attest to these ‘worsts’. The level of suspicion and distrust and accusations is astounding. 

Everybody is certain we are stealing and that we are here for the money, which is laughable. Surprisingly, we’ve even had Americans think this. Anybody with any degree of interest in the truth could google what our average salary would be in America and realize it’s greater than the entire hospital income. And if they were to understand it, everybody would be certain we are off our rocker, unable to then understand the next step, which is why we choose to do this, if it isn’t for money. Last year, I even had to sit in the country-wide church meetings in which an elder publicly stated I was in Tchad for the money. A church elder incapable of believing the Gospel is sufficient reason for one to sacrifice financial gain. It explains far too much of the mentality we daily face.

And just like that, the drums are drowned out. White noise.

I strain to hear their message. There is death. I strain harder for empathy. I have nothing. The drums no longer emote. The drums fade. I roll over. I sleep like a baby.

1 Feb 2020
Now two days after waking to those 3am drums, I feel the same, but different. This morning I woke up at 1am to vomit. Then I went back to sleep. I went off into a remote village to teach people about Jesus, typically my favorite activity of any given week. I enjoyed it. My dad is visiting and told a great story about the Children of Israel and all the kids really got into it. Somebody came by with the biggest lizard I’ve ever seen. I helped the kids hold a baby eagle somebody had caught. All in all, a good day.

And then this evening, Andrew came to get me for a woman barely breathing according to the nurse, but apneic and pulseless by the time Andrew first saw her. He gave epinephrine and set the nurses to bagging and compressing before he came to the door. Walking up, I knew this wasn’t salvageable. I saw her, took off the bag, and noticed vomit pouring out her nostrils and inside the ambu-bag. So it was in her lungs too. No way this woman has a good outcome. I told Andrew we were not going to continue. And I could see the hurt. I could see he took it personally. That’s what I want in a colleague. I see it in Sarah. I see it in Staci. I still see the flicker, the spark in Danae too. And I used to have that.

I remember frequently throwing ambu-bags with all my strength against the wall on the far side of the room, frustrated by the dead baby before me, a baby who would live in America. I miss having that base anger. That tormenting knowledge that life is unfair. That I, ignorantly fortunate to be born a heterosexual white male American, should be unduly blessed with advantages not granted to the people around me. There’s no justice. There’s no explanation. It’s not fair. Life isn’t fair. I want to have that anger stirred within me once again. I want the tears I once shed for my lost patients. I want to feel the drumbeats.

And now, with this team of doctors, maybe we don’t need to accept what we once did. Maybe we can have an ICU and somebody to run it. Maybe we can put crash carts everywhere. And even stock them. Maybe we can intubate people and put them on ventilators. Maybe we can nurture our nursing students and cherry pick the cream of the crop and create an attitude that all these dying patients shouldn’t be dying. And maybe those drumbeats will resonate and reverberate in my chest once again.

But tonight, I just walked away from the sobbing family. I will sleep outside tonight, like I have for the last six nights. And the drums will sound. And they will be reduced to white noise.

I want to bring them back inside my soundtrack. The echo of joy, of lugubrious melancholy, of celebration, of emotion rising from deep within. I refuse to accept it is irrevocably lost.

So our solution to our predicament is a bit abnormal. We are leaving. We are going to spend time as a nuclear family without distraction of nurses, volunteers, other missionaries, patients, employees, church elders, and anybody else who can make it past our guards to knock incessantly on our door.

We are going to hike the Appalachian Trail. Yeah, it’s pretty unlikely that a four-year-old can actually do it. Or the rest of our family of six, for that matter. But we’re going to at least start hiking the 2200-mile long trail. We may quit after a week or two. Or an hour. But we will start. And whenever we quit the trail, then we will find some other way to pass our time. Or we won’t quit the trail. Who knows?

But our souls need to be reset, refreshed. And come November, we plan to be back in Tchad. And my prayer is that, unlike today… unlike the past couple years… I will be able to feel the drumbeats once again.

5 Feb 2020
I have changed, but I am the same. Am I starting to hear the drums? Please. Just a little. I need to hear them.

Last night, my friend’s 13-month-old daughter died.

‘Can you come to peds?’

‘Ummm… yeah. Gimme a couple minutes.’

‘It’s Abouna’s daughter.’

‘Ok, be right there.’

I had been… indisposed at home… at that moment. But I knew it was bad, or Staci wouldn’t be calling me at 8pm. I was in the pediatric nurse’s office a minute later.

I see people looking somber walking out of the office. I walk in and see a tiny, beautiful girl on the gynecological exam table we put in pediatrics. I see Abouna and his wife, Chantal. I see Abre, one of two nurses I had when I first arrived who still works here. I see Staci. Somebody steps to the side, and I see Staci hand squeezing the bag.

The mask covers the sweet girl’s face and her chest rises and falls rhythmically with Staci’s right hand compressing the air chamber to fill the girl’s lungs.

Staci tells me the story, a story I’ve heard literally hundreds of times before. She was called because the baby was doing poorly. She found her apneic. Moved her to the nurse’s office, where the bag was. Started breathing for her. Blood sugar fine. Hemoglobin fine. She had been playing earlier. She came into the hospital for fever and vomiting just a few hours earlier. Her dad had gone home only briefly and was back up. Her treatment had been perfect, early IV quinine, administered by a nurse who knows what he’s doing. I remind myself the girl has sickle cell disease and has been transfused myriad times in the past.

I dig my fingers up under her rib cage. Her heart is not beating.

I take over breathing from Staci while I consider our options.

But we are in Tchad. There are no good options. Staci has done everything right.

It doesn’t matter.

Abouna’s precious baby just died.

Chantal goes into hysterics, unsurprisingly, and the family carries her out.

Abouna asks me to pray, which I do.

Abouna begins to wrap up this lifeless form, so recently full of life.

Abre tells Abouna to step aside, he will handle it.

Her face is covered. The thin fabric cradles her, not carelessly, but not tightly either.

Abre carries her all the way to Abouna’s house.

Danae and Andrew join Staci and me on the pediatrics veranda, trying to decompress and process. I hired Abouna over four years ago. I interviewed and tested nearly a hundred candidates, and he smoked them all. Tests administered to anybody, he excels. Our staff meetings, his academic knowledge shines through. He has taught me many things. He volunteered to work in the operating theater, the hardest assignment in the hospital. He and Philippe work longer hours than anybody. He never complains. Always smiling, laughing, joking, practicing his English. He’s a favorite of anybody who visits. Able to muster seriousness when required. Never gives a reason to have his integrity questioned. And for any complicated surgery, Danae’s favorite assistant.

And I just declared his baby girl dead. 

This sucks. But I’ve had a many children of staff die before. I’ve had several staff die in the hospital before. And die young. This place is terrible.

Danae and I are pragmatic. Staci is quiet. Andrew is about to lose it. A surgeon who’s lifelong goal is pediatrics. A heart for children. He has bonded with Abouna, as he bonds with everybody. He is a bundle of quivering facial muscles and cracking voice. He doesn’t understand. What am I saying? How is one supposed to understand? How is it I think I understand? What am I understanding?

About five minutes after Abouna headed home, we are on our way to his house as well. It’s nearing 9pm. His house isn’t hard to find. They are literally our next door neighbors. Even if they weren’t, it’s easy enough to follow the wails. This was so unexpected, but the wails are so intense already.

By the time we arrive, there is already a crowd. Not wanting to make this about me, I linger outside the door. Danae is inside with the women. Eventually, she comes to tell me Abouna is in an inner room alone.

I walk into the room and encounter an image that will never be erased. Inside this 10x10 mud-brick windowless room, a thin man kneels folded in two. As he has no electricity in his home, only a dying flashlight in the corner of the room gives a soft glow. I make out Abouna bent over his baby. He is sobbing. His heart is shattered. As any father would be, he is searching. In search of a girl who will awaken at any moment. In search of reason, meaning, purpose, explanation. In search of a solace he knows won’t be coming tonight. For this moment, his world has become very, very small, until it feels the entire universe is held in this single room, growing smaller by the second, until all existence will cease. And maybe this father would be ok with that.

I’ve never lost a child. All I have is my insufficient imagination. I’ve been in this situation often enough to know there are no words. There exists no reasoning. So I kneel beside him and wrap my arms around him in silence, all the while his soul continues its wandering and hopeless search for wholeness, as likely to find it tonight as a blind man could find an oasis in the desert.

And as I lift my head from my dear friend’s shoulder, I notice the dim light has cast the blurry outline of a third individual on the wall. No, nothing supernatural. He’s great, but Andrew is merely human. And he shows me both human and divine characteristics tonight. He has followed me into Abouna’s room. Not to be a spectator or a fly on the wall or a tourist or a NASCAR fan, seeking the carnage. Andrew is there because his heart is also broken. Andrew is sobbing. He takes every death so personally, just like I used to. Just like I wish I still could. Trying to comfort Abouna, Andrew frequently has to break off to the side alone as his own tears roll freely, mingling with Abouna’s on the already-damp sheets. Andrew wept. For a child was lost. And a friend suffered.

After a very long time of no words exchanged, somebody joined us and physically lifted Abouna up, letting him know it was time to come into the main room and join the others. Dutifully, Abouna did as culture dictated and sat against the wall with the wailing.

From the corner, the elders began singing. I sat beside Abouna and joined in the humble chorus.

songs…

Listening to this wrecked father singing horribly off-key and out of time, but singing of his faith in the God who gave him his daughter in the first place, I had to stop. I couldn’t carry on. I wasn’t worried my emotions would get the best of me. I simply couldn’t continue.

And I got mad. No, not at God. I just got mad at everything. I got livid with the random disparity of this planet. I got mad at myself. I haven’t brought this hospital up to a level where this child could have been saved. True, she would have died in any hospital in Tchad. But she would have lived in America. And so help me, I will make it so these babies don’t have to die.

I have the team. Andrew, Sarah, Staci, Megan, Stephen, Cherilyn. I have ICU equipment coming. I can get the crash carts and stock them. I have nurses, like Abouna, willing and eager to learn new skills. They can learn CPR, PALS, ACLS, ATLS. This is the team. This is the hospital. This is the year. We will establish and evolve our culture of excellence. We will have responsible nursing care able to identify these patients before they die. We will have the physicians and nurses capable of running an ICU. And dozens who would die, will live. 

Because I won’t let Abouna’s next baby die like this. We are better than this.

Or we will be. For the moment, I’m sitting in candlelight, because our generator hasn’t worked all day. It hasn’t worked properly for eight days now. You can’t very well run an ICU without electricity. But we won’t accept this level of incompetence anymore.

And as I sit in this darkness, from right over our back wall, I hear it. We sat with Abouna for hours last night and again for hours this evening. By now, the crowd has collected for the night. In his courtyard, under a bit of thatch held up by sticks pounded into the ground, there is a tiny table with homemade wooden benches and plastic chairs around it. Sweet tea will be served. A plastic mat will be spread on the ground. And people are singing.


And as they sing… I start to hear it. It’s been a long time, but my soul starts to hear it. Do you hear them too? This is happening.