Friday, August 31, 2012

‘Hot and Compassionate.’

There was once a time when I was very attractive to mothers and grandmothers of girls my age. I had served in the mission field, I was on my way to medical school, I came from a great family, etc. I had a lot going for me. For whatever reasons, their daughters/granddaughters were never quite as attracted to me, but I was a hit with the older generation.

So it was that I was frequently asked, ‘What are you looking for in a girl?’ (ie, Why haven’t you asked out my daughter/granddaughter, other than the obvious reason that she’s not interested in you?)

I eventually simplified my answer to a recited knee-jerk response of ‘Hot and Compassionate.’

I figured that if I was physically attracted to them, and they were a compassionate person (and they were attracted to me equally), then all the rest would fall into place. Yes, it was an oversimplified view of things, but at age 22/23, it made sense to me.

So in October of 2003, I found myself sitting in a room full of my medical school colleagues. A girl got up front and started talking about six weeks she had spent in Ethiopia. I could tell that she was really excited about serving the Lord in Africa. And from the back of the room, she looked pretty hot. (Some people look good from far, but far from good. She actually turned out to look even better close up!) I figured that in the few minutes of listening to her, I was now fully capable of judging her to be Hot and Compassionate.

And so, I turned to my friend sitting beside me and said, ‘I’m going to marry that girl.’ That girl turned out to be Danae.

(In the interest of full disclosure, I need to admit that this was not the first time I had said, ‘I’m going to marry that girl,’ the first time I ever saw a girl. In fact, I got the idea from my friend’s father, who had said the same thing about his future wife. I thought it was cool and decided that I would someday say the same thing the moment I laid eyes on my future wife. However, just to cover my bases, whenever I saw a girl who I thought had the potential to be my future wife, I had to tell whoever was standing/sitting next to me that ‘I’m going to marry that girl.’ As you can imagine, this led to many awkward moments, from shaking hands with a girl for the first time to meeting people in the check-out line at Wal-mart, there were many uncomfortable moments.)

Three years after hearing Danae speak for the first time, we exchanged our I-dos and I had my Hot and Compassionate. She had her... well, I’m not really sure what she had, but she had me. I got the better end of the deal, but she’s still making a go of it, bless her heart.

Then I slowly started to learn what the Compassionate part of the deal really meant. Compassionate meant working long hours to make sure all her patients were getting the best care possible. Compassionate meant making sure all her coworkers were ok. Compassionate meant I had to share my wife with others.

Then we came to Africa. It was here where I learned what Compassionate really entails.

Compassionate means that Danae’s hospital bill last time was $2400, paying for the medical care of countless women who wouldn’t otherwise be able to pay for treatments. Compassionate means that Danae is spending as much on her hospital bill as she earns. Compassionate means that I’d be financially almost as well off if Danae DIDN’T work, because then she wouldn’t see the need and wouldn’t agree to pay for all these women.

And then Compassionate hit a climax last Sabbath. We were walking the road to Kassere, to see the destruction the flooding had caused there. We had walked roughly three or four kilometers, mostly through thigh-deep water, when we came to a rise in the road, a spot where the road actually rose about the water and was dry for a few meters. There on the dry spot was a corpse. The body of a young woman in Arab garb, her face covered as they usually do after death. And there wasn’t a soul around with the body. On closer inspection, the corpse was breathing. Danae leaned over and pulled the cloth off her face and started to talk to her in French. She didn’t speak any French, so Danae tried a few words in Arabic. The corpse was able to breathe and talk, but was too weak to sit up.

Danae asked what I thought the problem was. I could see from across the road that her hands and fingernails were extremely pale, so I told her I was guessing severe anemia, most likely from malaria. Danae pulled down her conjunctiva and saw how pale she was and agreed. This girl needed a blood transfusion and IV quinine. But we were several kilometers of underwater road away from the hospital.

And then Compassionate did what Compassionate does. Danae simply bent over, picked the 12-year-old girl up (almost 70 pounds), slung her over her back, wrapped an African cloth around her like the women here carry their infants, and started trudging back to the hospital, through the deep water. In her mind, there was no other option of what to do.

Compassionate meant that we had to cut our walk short. Compassionate meant that Danae also escorted the girl all the way to the emergency room to make certain that she was seen by a nurse. Compassionate meant that Danae stayed to make sure she got the right treatment. And Compassionate meant that Danae went to our hospital blood bank and got a unit of blood to transfuse her emergently while waiting for the family to donate a bag of blood. Compassionate kept Danae and the hospital long enough to learn the girl’s blood type and to find out that her hemoglobin was 2. (Your hemoglobin is probably around 14.)

Nine years after I saw her for the first time, she’s still Hot. And she’s still Compassionate. And I’m still pretty lucky.

Thursday, August 30, 2012


What does your main highway look like in front of the hospital where you work? Well, normally it’s dirt.  It’s filled with people walking or maybe driving a moto, or quite possibly an ox or donkey.  

This past week, however, it’s been a waterway.  Ya, that’s right, the rains are taking their toll on our method of transportation.  But not just us....our patients’ transportation too.  Or rather, lack of.  If you are too sick to wade through the water, chances are you could easily die at home here.  

I know it seems like there is always something dramatic here, but hey, we don’t make this stuff up.  

Last week we had heard that the waters were getting closer and closer to the hospital property.  Kassere, a village about 5 km’s away from us has been flooded for about a week and a half now.  About 2000 people have had to leave their homes and come to live in the schools in the town of Bere.  Local churches have been donating food to help sustain them.  

Last thursday we took a look for ourselves.  The water was about 200 meters from our hospital entrance, so we did not have to go far.  However, once we started walking through all of the water, it was quite an adventure.  There is no other way to go, so everyone has to walk through the water, unless of course you are Gary and can just fly over!  

People thought it was so hilarious to see Lyol and our dogs having so much fun playing in the water.  Zane was thankfully content staying on Mommy’s back out of the water.  

It seems like we are turning into Venice, Italy.  Although a bit less romantic I think.  And a few less tourists and ice cream!  Oh for ice cream.  

Simeon, who’s in his mid 30’s, says he’s never seen anything like this here.  Samedi says he remembers a flood like this in the 1970’s.  

Aside from the obvious problems of people stuck without their homes and now living in crowded school buildings, there are foreseeable problems also that will arise.  Even if these mud houses do survive, they are obviously weakened from being soaking in water for several days.  People are left without their gardens and fields too.  This is prime rice season, which thankfully thrives in this, unless the top of the rice is covered too.    

There are also sanitation problems.  Where does everyone poop?  Even if they did all go in one designated spot, the waters have risen and the holes are overflowing.  This makes all of the water around contaminated.  

This is high risk for cholera, hepatitis A, and various other parasites.  We’ll just all get dewormed, etc when we come home in 2 months.  It’s easier than worrying every second where you walk.  

Janna organized a collection to buy one bar of soap for every family that is living in the schools in Bere.  She plans to give it out with our church soon.  

The surrounding water has put a damper on the number of elective surgeries we are doing this month.  We still have the urgent cases from c-sections, ectopic pregnancies, appendectomies, perforations, and trauma related stuff.  I’m thankful because Dad’s not here and I’ve gotten spoiled with him here because I really dislike hernias still.  Thankfully there’s always Samedi too, but he’s working in Urgence now.  

Olen has recovered from his malaria.  He finished 3 days of IV quinine and 4 days of oral quinine.  Zane has malaria now again, but is taking his pills like a champ.   Rainy season is certainly tough for many reasons.  The cooler weather and green scenery are quite nice though.   

Wednesday, August 22, 2012


We see some pretty interesting stuff here.  Some of the stuff we see are things that you have only read about in books.  Medical books that is.  And sometimes you have never even read about this stuff.  

But this one I’d read about.  It’s something that’s always in the back of our minds as a possibility, but it is SOOOO RARE, that you never really give it a thought longer than a half of a second.  

It’s maybe something that that one old doctor’s colleague’s friend once saw a million years ago.  

But, no...this was not something for the books only.  This was a RARE case and it was a case for Bere Adventist Hospital.  

I had spent the last 2 or 3 hours doing consultations and helping with obstetric ultrasounds with Doudja, our radiology tech.  He also speaks a million languages (I’m sure at least 10) so I usually steal him to help translate for me too.  There were only about 3 ultrasounds left, so I went home and left the other 3 for him to finish up.  

About 10 minutes later Doudja called me.  “Doctor, I have something interesting for you.”

I finish eating my late lunch and then head back in.  Doudja calls the woman back and she walks over to the table.  She has had pain for over 3 weeks.  She has been seen at multiple health care centers and treated with various antibiotics to help her pelvic pain.  

But what Doudja found could never be treated with antibiotics.  He said he wasn’t sure of the diagnosis, but knew it wasn’t normal.  

I put the probe on her belly.  She was quite tender.  I found a 10 week sized embryo without a heartbeat.  This is termed missed abortion (baby died but hasn’t been expelled).  THAT was definitely IN the uterus.  I spanned the edges of the uterus and could see that the uterus with the 10 week miscarriage continued down to the cervix and vagina.  


Then I moved the probe UP.  It was another pregnancy.  A moving, kicking little fetus.  But WHERE was it?  Was there another horn of the uterus?  Was it really outside of the uterus?  Maybe she had 2 uteri.  I scanned more and determined that it looked like an ectopic pregnancy.  If this was not operated on and removed, the mother would lose her life.  The ectopic pregnancy measured 12 weeks.  So the intrauterine pregnancy must have died 2 weeks ago and the ectopic pregnancy continued to get the blood supply from the fallopian tube.  
This is a bad picture taken of the ultrasound machine.  In the upper left you see part of the bag of the ectopic pregnancy (pregnancy outside of the uterus), and on the right you see a part of the intrauterine pregnancy (pregnancy in the uterus).  It was hard to get them both in the same picture.  

I explained to the family that we had to operate.  Today.  It would be free, so not to worry about the money.  

They said they didn’t want any more children.  She had already had 9 pregnancies, including 2 sets of twins.  Of the thirteen fetuses she had gestated over the course of her life, only four were living.

I planned on doing a laparotomy with removal of the ectopic pregnancy, tubal ligation of the other tube, and would need to do a curettage to remove the intrauterine miscarriage.  

I called Dad over to help me, and then we opened her up.  There was a lot of blood.  The 12 week baby was indeed an ectopic pregnancy and was located in the left tube.  So I removed the entire left tube.  It was adherent to the intestines a little, so we carefully separated that.  The tube didn’t actually appear ruptured, but there was still a lot of blood in her abdomen.  This must have been because the pregnancy was demanding the surrounding vessels to contribute blood to it and some of these burst.  

Because there was so much blood, I aborted my thoughts of just doing a hysterectomy for a cool picture of the ectopic and intrauterine pregnancy in the same picture.  I do have a bad picture of the ultrasound image from before the operation.  

I finished the tubal of the other side, irrigated LOTS of fluid to get rid of the blood, closed her up, and then did the curettage from below.  

She is recovering well postop now.  

It would be cool to write a case report about this.  If any budding resident is interested, I can send you the details.  They are all carefully recorded in our charting system.  Ha.  

Saturday, August 18, 2012


The sickness here always continues. There is much pain and suffering here in Chad. I suppose that’s why we are here, to help fight this and show God’s love in the process. But now I guess I’m mostly concerned with my family.

Zachee, my cook, told me today that the locals believe the rainy weather brings sickness upon people. So naturally people don’t go and play in the rain like Lyol does, but in a way it is true. Rainy season definitely brings more mosquitos which brings more malaria. It seems to be a more potent malaria too. I’m not sure why. But people definitely get hit harder.

I made Dad get a malaria test today because he is just kind of worn out. It was negative. Wed and Thursday Dad stayed home. This morning he has been eating and drinking. His pain is much better. Today he refused to stay home. He came in to do some rounds and 2 surgical cases. I also did rounds with him and then on maternity. Our surgical wards are full of healing abscesses. It’s actually quite gross.

I saw some consults and came home for a lunch of rice and beans. Olen’s parents were here for 2 weeks and just left yesterday, so Lyol is readjusting to life without them again. He keeps repeating, “Lyol wants to go to America.” So I say, “We are going to America in 2 months.” And Olen says, “Lyol, we are going to America in 72 days.”

Olen had done rounds on peds and medicine, but was feeling a little sick, so decided to rest at home for the rest of the afternoon. He finished quinine pills 8 days ago, so at least we knew it’s wasn’t malaria. Our kids and Olen all have runny noses and a cough right now. This viral thing is going around. So I figured Olen just feels achy from that.

Dad also stayed home this afternoon because he’s still recovering from his kidney stone that he’s not sure if he’s passed or not.

I went back in to see some more consults and follow up on a few patients. I came home, but a nurse found me 5 minutes later to tell me that a man has an anal abscess and was referred here. Sounds like so much fun. I took Zachee and Louise (my laundry lady) over to the hospital to see all of the construction so that they are ‘in the know.’ We looked at the footprint for the new operating suites and for the private ward buildings. The work for the One Day Hospital has been coming along nicely. It changes every day, and I couldn’t believe how much had happened in 2 days (since I had last looked at it). After awing over the new building plans, I finally went to the bloc (OR) and stabbed the abscess that had been waiting for me. It wasn’t as gratifying as it sometimes can be, but still some pus came out.

I went home, played with the kids, bought some fruit and veggies from some produce ladies that come to my door. Aime had avocados, oranges, and green peppers that she had gotten from Kelo (You can’t get avocados or oranges here in Bere).

Another nurse came to the door. I refused to see a lady who had come in 3 months after breaking her hip. Her x-ray from Moundou 3 months ago showed the femur head completely severed from the femur. It’s friday evening and she’s had the same problem for 3 months, but my dad was nice enough to go lay eyes on her. He’s planning on surgery for Monday to replace the femur head.

Olen feels quite hot. I decide to poke his finger and do a home malaria test even though it doesn’t seem to work part of the time.

“No dear, this is a virus,” Olen says.

“I don’t care.”

Positive. The malaria test is definitely positive for falciparum.

Huh. That’s strange after finishing 1 week of oral quinine just 8 days ago. Well, he definitely has malaria. Maybe we should have treated him with fansidar and doxy last time along with the quinine pills.

Olen walks to the pharmacy to buy some more quinine pills and fansidar.

After eating dinner and putting the kids to bed I go in to check on a patient I was worried about having an intestinal obstruction. The NG tube put in a few hours ago wasn’t helping her distended abdomen and she felt rigid. Well, we’ve got to operate.

This poor lady. 5 months ago I had done a C-section and hysterectomy for a ruptured uterus with a term dead baby. Now she had to go through another surgery.

I go by my dad and mom’s apartment to see if dad would be willing to just sit in the operating room in case I needed his expert opinion. Samedi (who I used to call for backup in the OR) had gone somewhere far away today. Dad was sleeping at 8:30pm, since he’s still not feeling up to par, but he woke up when mom got the door. Of course dad said he would help.

Once in the bloc, Ndilbe gave our patient a spinal and Simeon and I scrubbed. Dad sat on the floor. I cut out the old scar and gently cut through the scar tissue. The air-filled intestines beneath were begging to push themselves out. The moment I entered the abdomen, there was a familiar smell. A bad smell. The smell of necrosis that only a dead bowel can give. Once you smell it, you remember it. I put my hand in to try to uncoil the tightly packed bowel and find the source of the problem.

“Dad, do you think you could scrub in?”

Dad scrubs in and helps me with a foot-long bowel resection and reanastamosis. He lets me do it all though, so hopefully I’ll remember it next time when he’s on annual leave. We don’t have bowel staplers here, so I put in lots and lots stitches in the bowel, and it took a little time. In the states you could do this in a few minutes with a fancy stapler.

This patient’s terminal ileum (small intestine) had attached to the pelvic sidewall and then coiled over on itself and become obstructed. When the intestine gets obstructed from a mechanical cause like this, it loses blood flow. The part that doesn’t get blood flow dies.

We all go home, tired at 11:30pm.

I’m surprised to see the light on in the bathroom when I get home. Olen is vomiting. Oh, the night continues to only get more dramatic. He looks weak too. Okay, now I have to be the strong one. Please God, help me.

I run back to the hospital and buy IV fluids, IV quinine, iv nausea meds, IV dextrose in case olen gets hypoglycemic on me, and an IV. I ask one of the nurses if they could come over and find an IV (again on a nasara). Djo comes over and finds one on the first stick.

It’s 2 am now. Olen has finally stopped vomiting. He’s sleeping peacefully. So I watch the drip. And I’m not tired. My children are healthy and sleeping peacefully. The bug light zaps bugs loudly in the corner. If you weren’t used to it, it would scare you I promise. But I barely notice it now. Our electricity has been running quite well lately.

This place is seriously crazy at times. We always need your prayers.


olen and danae

Olen phone: +235 62 16 04 93

Danae phone: +235 62 17 04 80

Olen et Danae Netteburg

Hopital Adventiste de Bere

52 Boite Postale

Kelo, Tchad


Volunteers Welcome!!!


Ya ya’ve heard this before. I’m an OB doctor. I’m not a man’s doctor. Well, half of the time.

Writhing flank pain. Severe. Tinge of blood in his urine. Vomiting some. Abdomen soft. No chest pain.

The diagnosis is clear.

Give tons of iv fluids, order a non-contrast abdominal pelvic CT scan. Oh, wait....scratch that last one, ha! Back to giving tons of fluid.

Um...order consult from my ER husband.

Concur on diagnosis. My DAD has a kidney stone.

My dad is a worker. When he was little he walked up hill both ways in the snow to school like 20 miles each way. No seriously, he grew up on a farm in Missouri and then Oklahoma... Back when the boys were tough and milked cows every morning at 5am...just to get STARTED with their day.

And think college is tough now? He worked 40-60 hours per week in college. None of this study while you work job either....a real job. Tough work.

He’s been here since Feb and hasn’t taken a sick day off. He worked every day even when he had malaria. The OR team used to insist that we take a small break for lunch every day. I was fine with that. I need food. When my dad got here he refused to take a break and worked right through lunch, sometimes switching off with me, or sometimes not. He’s making his daughter look bad. (he he...just kidding).

He blows everything off. When I was growing up, we would have never thought of going to the emergency room. “ cut your finger off? Put a bandaid on it!” Maybe that’s every doctor’s kid’s experience. Unless you’re dying, you don’t seek urgent medical help. Unless you’re dying, you go to school. You go to work.

So when I found my dad writhing in pain laying in his bed, it was significant. He’s certainly no faker.

He hasn’t felt this bad since he had hepatitis and had to leave Nigeria, 41 years ago.

Tuesday he started feeling some twinges of pain. Of course he didn’t tell anyone. Jonathan took Mom and Dad to Moundou in the plane so Dad could help James with a hip surgery.

When they came back that evening he vomited, but was feeling better.

Wednesday Dad did a couple of cases in the OR. During the second case, a prostate, his pain became so severe, that he had to scrub out early. He quickly went home to bed, a 2 minute walk away.

Olen and I assessed him. We decided our plan of tons of fluids.

I asked the nurses who was going to put in my dad’s IV. (We are certainly keeping them busy this year with sick nasaras). Simeon came and got an IV on the first try.

Olen and I searched our medicine stashes for any strong pain killer that we could find. Hmmm...”Here’s one that says Adam Hernandez, Hydrocodone.” Yes, we believe in sharing medicines here, but it is definitely against all policies in the US.

Hydrocodone will work. So thanks Adam!

Our hospital has NO IV pain medications. This has been for months and months. It’s nothing new. We don’t have any oral narcotics either. We never have since we’ve been here. We give ibuprofen and tylenol pills for huge laparotomies and, well everything that hurts.

Got run over by a car? Tylenol. (No ibuprofen for fear of bleeding in your head)

Femur bone broken in two? Tylenol and ibuprofen.

Huge incision in your belly from your pubic bone to your sternum? Tylenol and ibuprofen.

Hey, it’s simple here. We are basic.

Some time goes by. Still Dad has severe pain. Olen scrounges up some morphine from some hidden place and gives dad 10mg in an IV perfusion. Finally dad gets a little relief.

He’s missed 2 days of work just laying in bed....writhing.



olen and danae

Olen phone: +235 62 16 04 93

Danae phone: +235 62 17 04 80

Olen et Danae Netteburg

Hopital Adventiste de Bere

52 Boite Postale

Kelo, Tchad


Volunteers Welcome!!!

Tuesday, August 7, 2012


I haven’t run a code this long in years. In fact, not since residency. I’m shocked at how smoothly it’s gone. Of course, the outcome is the same as most codes. I’ve known it was futile, barring a miracle, since the outset. But I’ve run the code now for an hour, entirely for the benefit of the care providers. And for myself. With all my heart I want to believe that there’s some small chance this will work. I’m now an Emergency Physician. This is something I’ve done dozens of times and can do flawlessly in my sleep. This is a code.

It’s 12:43AM. I tell Janna to give one last milligram of epinephrine IV push and I tell Bronwyn to continue chest compressions for two more minutes, then we’ll stop. I spend the two minutes wondering what else I can do for the care providers surrounding the bed, admiring the chest compressions done out of a heartfelt mixture of desperation and love, and running through the events of the last hour in my head...

I got the call at 11:45PM. ‘Come now, desatting,’ was all Janna had to tell me. I already knew the outcome, but I also knew we had to try everything. ER doc mode kicked in. ‘Stop whatever you’re giving her and run D50 in one IV and mannitol in the other.’ I hung up. Mannitol was my when-all-else-fails treatment. I suppose we’re now there. Janna is the best nurse I’ve ever worked with, and I apologize to no one for saying that. I trusted her to watch my son’s IV quinine drip while I slept and I’d do it again. I knew she would do exactly what I asked. There was no need for further conversation. Besides, I was already grabbing shorts and shirt to run in. And I ran.

During the run to the hospital, I recapped the case. 43yoF PMH mitral valve prolapse seen for... You know what, I know the history as well as I know any history. A malaria test result of 0.75%. Henri, the chief of my lab, told me, ‘I can count the stars in the sky, but I can’t count all the malaria under this microscope.’ He had never seen blood so full of malaria. That was Thursday. We hospitalized her on IV quinine, but she still fell unconscious the next afternoon. We gave her an IM shot of Fansidar. We gave her dexamethasone (which has not been proven to help, but doesn’t hurt). We gave 1:1 nursing care. We gave her a nasogastric tube. We gave her a urinary catheter. We have her IV fluids. We gave her the best care humanly possible in this part of the world. The D50 is because both quinine and malaria make you hypoglycemic and the mannitol is to take the pressure off the brain. Mannitol has not been proven to work, but doesn’t hurt.

And yet, there I was at 11:48PM, walking into a room and being greeted by the sight of CPR already underway. The patient’s on the floor, as that’s the only way to get something solid behind her back for good CPR. Bronwyn is doing an impressive job, even though she’s not a nurse. Janna, the only nurse in the hospital who knows CPR, is also the only one who can draw up meds.

11:49PM. I want chest compression continuous, but I also want respirations. Janna starts attempting to bag the patient, but runs into some difficulty. The bag won’t seal, even after we take out the nasogastric tube. I take the bag from Janna and start bagging the patient. We have good respirations. Bronwyn is doing good chest compressions. I ask Janna for one milligram of atropine IV push, which she gives.

I have a chance to regroup. I’m at the patient’s head controlling her breathing. I can see all of the patient and what medications she’s getting and what everybody’s doing. Typically, I run these from the feet of the patient, but I guess this will work just fine.

11:51PM. I ask Janna to give one milligram of IV push epinephrine, which she does.

11:53PM. The patient has a pulse. I ask Bronwyn to continue two more minutes of chest compressions. While I breathe for the patient, I ask Julie to call Danae to the OR and set up suction. I can already feel the liquid building up and can see her stomach bulging. She’s been putting out amazing amounts of bile from her nasogastric tube and I’m sure she’s a set up to aspirate. Unfortunately, I can’t intubate her here. I give Janna my keys and ask her to bring me a stretcher from the OR.

11:55PM. I do my best to bag her up and we hoist her up into the stretcher. I breathe for her for a while there too. Then we sprint the thirty yards to the OR. Once inside, I resume breathing again. We get her over to the OR table and I suction out her mouth. She’s now vomited and aspirated huge amounts. She can’t even protect her own airway. She’s lost an IV so Janna starts a second one within seconds. By now Jamie and Tammy have arrived. And a hoard of curious Tchadians are standing outside, with nothing better to do at midnight.

A chance to relax and see what our options are. She has a pulse. She’s not breathing, I’m doing that for her. Her sat is in the toilet, hovering in the 30s-40s, I’ve sucked out as much as I can, but she’s already aspirated a ton. She’s received enough D50 that she’s definitely not hypoglycemic and she’s receiving a second bottle of mannitol. There’s no point in giving any more of that. So we’re at a relatively stable point. I could intubate her, but I have no device to suction out her endotracheal tube. And Marci has also joined us in the room. We get the patient hooked up to a blood pressure cuff and she’s 80s/40s. Not ideal. Her atropine and epinephrine are wearing off. I put in a nasopharyngeal airway to make her breathing a little easier. I start an epi drip.

12:09AM. She loses her pulse again. We give atropine. We give epinephrine. The pulse comes back. She loses her pulse again. We give a third dose of atropine, a third dose of epinephrine, a fourth dose of epinephrine, a fifth, sixth, seventh, eight, ninth...

We continue ACLS. Everybody performs their part perfectly. Untrained people are giving great chest compressions. Gary shows up right as we’re dusting off the abandoned defibrillator, which show an unsurprising asystole. We don’t shock.

So here we are, back at 12:44AM. Fifty-nine minutes of coding. I look around the room and see so many faces. I see all my friends. There are nine expatriates doing a code in the middle of the night. I never witnessed this before. And then I look down once more at the patient. Minnie Amor Pardillo. My expatriate volunteer who has been here with me now over a year. My volunteer who started our public health project. We’ve buried children of volunteer missionaries, but never a volunteer him/herself.

And this is the great secret of Emergency Medicine. There is no rule saying that you should run a code for x number of minutes. You run the code until the physician deems it futile. While, that’s not always the reality. Often, codes are run in the first place or are run long for the sake of the family watching, just so they have the peace of mind and comfort that everything humanly possible was done. Often it’s for the staff, who might need that time. And when your staff and the family are one in the same, you run it even a bit longer still. And the staff has to know that we’d try just as hard for any one of them.

I run my H’s and T’s one more time in my head.

I watch the seconds tick to 12:45AM. I put my hand on Bronwyn’s hands and she stops her chest compressions. I stop breathing for her. There is still no pulse.

‘We’ve now been going for an hour. She was in asystole when we checked, she has received three doses of atropine...’ I summarize for all in the room what exactly has happened in the last hour in the space of ten seconds. ‘Unless anybody has any other ideas or any objections, we’re stopping.’ Somebody had to say it and it was my responsibility as the Emergency Physician. It would be cruel and unfair to expect anybody else to do it...

‘It’s now 12:45AM. Time of death.’

We clean her up, take out all the tubes. We place an open Bible on her chest.

I walk outside in the dark. Never alone, I have Africans all around me, but they won’t understand the following conversation. It will be in English.

‘Mr Pardillo, I’m so sorry to tell you that your sister Minnie has just died.’

We’re taught in medical school to use the word ‘died’. It leaves no room for interpretation, as opposed to ‘moved on’, ‘passed away’, or you could list any number of other euphemisms.

We're also taught in medical school to never be more sad than the family of the deceased is, otherwise the family will feel the burden to cheer us up. It's an undue, unnecessary and unfair burden to place on the family of the deceased.

This family is sad, it’s clear. But during the following hours, they showed more grace and faith than I have ever seen. More than I could ever conjure up in myself. I’m utterly humbled. And ashamed.

All prior deaths here have been buried here. But the family expresses that their first choice would be repatriation. Trying to honor her family’s wishes as best we can do is the least we could do to honor Minnie’s memory.

We are in a very warm place and it is rainy season here. These are not ideal factors for preservation. Minnie stayed in our OR and we turned on the generator and the AC. The girls went to Minnie’s hut and packed up her things. Gary and I set to getting everything lined up with the insurance company and preparing to fly Minnie to N’Djamena as soon as it was light out enough to take off. She would also need me to sign a death certificate. Not many people slept at all and those that did slept very little. At 4:45AM we were loading Minnie’s body into the LandCruiser and trying to explain to the Tchadians why we couldn’t spend the three day funeral typical here.

At the airport and ready to go, we realized that we had just spent the last five hours so busy that we hadn’t had time to digest and say goodbye. So we took the time to sing songs, read the Bible, pray and share thoughts about Minnie. Many local Tchadians came as well. There were many people missing Minnie dearly and many tears shed, both by the expatriate community and by the locals.

Minnie was one who worked quietly behind the scenes, and you never really knew what she was up to, but she made people like her. And because they liked her, they like us and our hospital. She worked to soothe many wounds that were opened between the hospital and the community villages. Wounds that existed long before she ever arrived. Wounds that nobody else had been able to salve. She spent so much time one-on-one with people, whether it was a Bible study, building relationships with village chiefs, talking to abused women, talking to suicidal patients, I've seen Minnie do it all. Even in the rush of our weekly dental clinic, she would ensure one-on-one time.

When you were in discussion with Minnie, you knew that you had her undivided attention, and that's a rare thing.

She will also be sorely missed by any volunteers who fall ill. When a volunteer got ill, Minnie saw it as part of her ministry to nurture them. (She would stay with them all night fanning them, encouraging them to eat and drink, holding their hair out of their face while they vomit, etc.) But she didn't stop there. She saw an opportunity to nurture even those not suffering physically.

When I think of Minnie, I will always think of her walking along to talk somebody, with a never-ending smile that still held sincerity, with a cheerful wave and a heartfelt 'GOD Bless' and of course, the ever-present backpack. I'm not sure I ever saw her without it. We used to joke with her as to what was in her mysterious backpack. Such a large backpack for such a tiny woman. That's a memory that can bring a smile to my face even in this difficult and grieving time.

When we were talking about Minnie just before loading her into the plane, Janna said, 'If I ever met a child of God, it was Minnie.'

A better eulogy was never written.

Until the trumpet sounds, Minnie, sleep well.

Saturday, August 4, 2012


If you ever prayed before, I would ask you to pray for us. If you've never prayed before, I'd ask you to start.

We have a expatriate volunteer who has been comatose and seizing for 24 hours with cerebral malaria. Prognosis is not good, but we've seen miracles before.


olen and danae

Olen phone: +235 62 16 04 93

Danae phone: +235 62 17 04 80