It’s Friday night, my third day on the job as a missionary physician in Tchad. The nurse grabs me. ‘This baby doesn’t look good.’
Lyol’s in my arms, but I know what baby he’s talking about, so I go and take Lyol with me. Danae had just done a C-section on a lady earlier in the day.
I walk into the room and I see a baby. Looks dead. I put my hand on the chest. It’s dead. Wait. No, there’s a pulse. I don’t take the time to measure it, but I’ve felt enough pulses to know this is between 40 and 50. I look for an ambu-bag to ventilate and breathe for the baby. There is none. I start chest compressions with my right hand index and middle fingers on the sternum. Lyol is sitting on my left arm. This won’t work. I show the nurse what I’m doing.
‘We need to continue doing these compressions, find a bag and start ventilating, check a blood sugar and give 0.1mg of Atropine.’ I catch myself. I’m in Tchad. ‘Do this, give half an amp of dextrose and atropine.’ I know it’s more than a one-day-old should receive, but I also know they won’t understand doses any smaller. I realize I can’t help if I have Lyol.
Running out of the room, I’m in a corridor with maternity patients at one end and surgical patients at the other. I run to the operating room. Danae will still be operating for a while yet. I run back to our apartment, put my 22-month-old son inside the door and padlock him shut inside.
He’s screaming for me while I run back to the hospital. The neighbors yell at me that I’m crazy for locking him inside.
I burst back into the room with the infant and... nothing is happening. I check the pulse, still 40-50. I start my little compressions again and have the nurse follow me to the prep room outside the operating room. I continue compressions while he tries a line. He gets an IV and the lab man walks in with his glucometer. Of course, I forgot. They had to call him in from home. We can’t check any labs after noon or on Sabbath without calling somebody in.
The glucose comes back high. That’s when I realize that an ‘amp’ here is actually 100cc of D50. By now he’s got half the bottle. Way too much. ‘Half an amp,’ I mutter to myself and disconnect it and squeeze out the rest on the floor in frustration. I’d hate to see what the atropine bottle looks like, but there’s no atropine around yet. Instead my nurse is now giving quinine. I suppose when your only tool is a hammer, everything looks like a nail. They figure everything here is a symptom of malaria and give everybody and their neighbor’s dog quinine. Of course, they’re usually right.
Finally an ambu-bag shows up, but by now he’s lost his pulse. Oh my goodness. I forgot they give the quinine in D10. More sugar! I stop the quinine with sugar and start to bag/compressions. I know it’s futile deep down inside, but I’ve started CPR on a one-day-old. Everything in me fights the knowledge that I should stop.
I go through my mental checklist of things I can fix and things I can’t. Congenital heart disease. Ductal-dependent lesions. Electrolytes. Brain bleed. Thrombosis Embolism. Now I’m getting to some pretty unlikely things and I can’t do anything about them anyways out here in the bush of Tchad.
I’m still doing CPR. Alone now. My nurse left me long ago. Pretty much right after starting the quinine. With the sugar.
What have I already addressed? Definitely no longer hypoglycemic, if he every was in the first place. No more respiratory issue now that I’m bagging, although that may have been the original problem.
‘What are you doing here?’ Oh no. The voices have started again. It was exactly one week ago they tormented me, demanding to know much the same thing. ‘Who do you think you are?’ ‘What problems do you think you can solve?’ ‘Look at these people. Everybody has already given up. They know it’s futile. Even if you could do something, you couldn’t get these people to buy into devoting so much care and time to this one little one-day-old. Not in a place where one in eight children die at birth anyway.’ ‘What are you doing here?’ ‘What are you doing in Tchad?’ ‘You can’t make any difference.’ ‘Look at you. First week on the job and killing newborns already.’ ‘What do you think you’re doing here?’ ‘What are you doing here?’ ‘You locked up your own healthy son, screaming his eyes out for his Daddy, to come to try to save a one-day-old nobody even cares about.’ ‘What are you doing here?’ ‘A good Daddy would have stayed with his son.’ ‘What are you doing here?’ ‘Who do you think you are?’ ‘You can’t make a difference.’ ‘You can’t change this place.’ ‘Who do you think you are?’ ‘What are you doing here?’ ‘Go home. Take your wife and your son and go back where you belong. Where your family is. Where the money is.’ ‘What do you think you’re doing here?’ ‘Who do you think you are?’
I’m still doing CPR. It’s been forty minutes. Abel, one of our best nurses, come out of the operating room. He calmly puts new batteries in an O2 sat monitor, turns it on and puts it on the baby. Despite my bagging and compressions, I can’t get the sat monitor to register. Abel’s deaf, but he shakes his head slowly and puts his hands on my shoulders. I turn and throw something non-breakable against the wall. Abel wraps up the baby neatly in a colorful, decorative cloth, traditional to all women here. The baby’s face is covered. It’s not right. Abel walks calmly and slowly back into the operating room.
I sit on the bed with my forehead pressed against my knees. Completely alone in the bush of Tchad, sitting beside a dead one-day-old, I feel the saline run down my cheeks.
What am I doing here?