Just Sick

The house is asleep. I am awake. It’s midnight. And it’s my shift. I can’t sleep. I don’t want to.

Four children, two dogs and one wife. All peacefully sleeping. (Well, the wife isn’t sleeping peacefully. She’s just taking a break.)

I’m at the dining room table and six feet to my right is Juniper, sleeping like… well, like a baby.

But there’s the all-too-familiar green board strapped to her arm. Zane has worn it often. Now Juniper.

She’s just three months old for crying out loud. And it’s dry season. Couldn’t we have waited a bit longer?

Nope. 

This afternoon she puked. Not baby spit up. She doesn’t do that anymore. Real puke. Soaked everything. And she felt hot. Danae noticed it too. 101.4. Fever. Puked again. And again. And again. A lot. And shot it several feet.

Sabine came over and poked her right hand. Then her left. Then her left foot. Then her right foot. Then her left hand again. And again.

Sabine is amazing. Her patience and hands blow me away. She found the slightest thread of a vein in the wrist and the ever-familiar sugar solution is dripping into Juniper’s tiny, but still chubby, arm.

I look at her. Did she twitch? Is she breathing enough? Is she breathing too fast? Is that a respiratory alkalosis to compensate for a metabolic acidosis? Is she breathing at all now?

We’ve been down this road enough. It’s tiring. It wears on you. Nerves, shot. We have no right to be immune. We live in the same place as the other Tchadians who lose 21% of their children before age 5. But misery doesn’t love company in this case.

The last two Adventist missionary families trying to raise kids under the age of 12 here, some of my best friends in the world, some of the people I respect the most… lost a kid each. Can’t we be different? Can’t we be the exception?

And the all-too-familiar flashbacks start…

I cannot forget them. Doing CPR on one of my best friend’s children, born the same day as my son. His skin turning cold right under my palms. Turning over the care of my own son to the same friend who happened to be in the room when my son started seizing. The certainty he was dead before he finally took another breath. The blue skin.

I look back at my daughter? Is she getting ready to vomit? Is it the light or does she look pale? Could she have malaria-induced hemolytic anemia? Am I sure this is malaria?

There are new flashbacks to process for the first time…

I lost my nurse on Wednesday, five days ago. He was younger than me. He left behind his wife and five children. Is there any good reason I am alive and he isn’t? Did he suffer from some disease that could never attack me? Thursday, I was asked to speak for five minutes at his funeral. What do you say? I barely made it through. We then drove him to his village and buried him.

Yesterday, we lost another patient. But it was a success. We started a postpartum patient on quinine. Her heart stopped. Danae and Stephen jumped on it and started chest compressions and sent Ndilbe to get me. By the time I got there, she had received epinephrine and her heart was beating again. I gave her a little magnesium. We don’t have calcium. Her brain had gone a bit without oxygen. Danae had JUST been at her bedside talking to her. Five minutes later, Danae noticed she wasn’t breathing. If she hadn’t been there…

I look right again. Juniper is still breathing. She’s getting the same medicine. The same medicine the lady had just started when her heart stopped. The same quinine that prolongs the QTc interval and leads to torsades de point which leads to cardiac arrest.

I just gave her some IV Tylenol and threw a wet cloth over her and stuck her under the fan. She’s not as hot to the touch now.

Why should we be the exceptions? Why should we escape unscathed? Can we… Can we?

A nurse just knocked on the door. A pregnant lady just came in and died. She came in with a hemoglobin of 3. Danae had gotten a bag from our blood bank to give to her. Abre just came to tell me she died. Abre was on the verge of tears. I was surprised. Typically, nurses don’t get us to tell us patients died. Abre is good. And he cares. He’s rare. And he’s one of my favorites for it. It’s so easy for us to lose our humanity and the value of each life. Each soul. Death is so commonplace here. How long can we keep on caring? Do we need the hard shell to protect ourselves? Calloused? Calloused missionary?

I just looked right and didn’t see her breathing. I ran over and put my hand on her chest. She of course startled. She’s fine. For now. Just sleeping.

Danae just got called up to do a Cesarean section. I’m now alone-er.

I just learned this morning that while I was on vacation, the hospital signed a statement we had received 15.000.000 CFA worth of free medications from the government. The only problem was that we accepted a 10.000.000 CFA check in lieu of the medications. The supplier gets to bill the government 15.000.000 and keep his 5.000.000. We get 10.000.000 and if we don’t play along, we get zero. The authorities called me in to explain to me as much. I told them we would never sign a false statement.

Well, I was wrong. We did. When I found out, I was so livid. I threw a child’s proper temper tantrum and stormed out. So sick of the corruption. If the hospital does it, can I blame my staff for trying to steal an extra buck, or for falsely signing they gave medications? If the hospital’s stamp doesn’t mean something is true, what good is it? If we are being like all the other hospitals, if our integrity is for sale, what are we doing here?

We actually sat on the floor of our bedroom, looked at each other, and asked, ‘Is it time?’

Is it time? Is it time to go home? When you’re just so tired of everything. Tired of all the corruption. Tired of the same old problems. Tired of the heat. Tired of the constant sickness. Tired of rice and beans, beans and rice. Tired of the dirt. When you’re this irritable, is it time to get off the battlefield? Can you still help people? Is this what burnout feels like? Can you burn out when you love so many employees, the Abres, the Sabines, the Ndilbes, so many friends, so many patients, so deeply?

For the moment, if you need anything, you know where to find me. I’ll be right here. Awake. Beside my baby. Glancing nervously. Afraid to sleep. Afraid to miss the subtlest sign. Afraid to miss a moment with my daughter. Never knowing…

I look right. Her leg shook. Again. What that rhythmic? Is she seizing? Are her breaths coming erratically? Sweet Juniper. So precious. Leave her alone. I’m tired of this. Sick of it. Just sick.

(This was written about four weeks ago. Juniper finished her quinine, but was still vomiting with fever, so we extended her treatment several extra days. She also had intense diarrhea and went days without urinating. Two days after she finished quinine, Lyol got malaria. Before Lyol finished his quinine, Zane got malaria. Before Zane finished his quinine, I got malaria. Less than a week after I started treatment on myself, Danae got malaria. Five of the six of us had malaria the month of March. Addison alone escaped unscathed. Juniper still has fevers on and off, which we blame on the heat, but no more of the lethargy and vomiting and diarrhea. So yes, we are sick of being sick.)

(As a second aside, yesterday it was discovered that two teachers at the school had stolen tuition. One stole four months’ worth of salary. The other stole three years’ worth of salary. Now there is no money to pay the other teachers their salaries for March, let alone the rest of the year until kids pay tuition for the next year. They purchased a fake receipt book to issue the students their receipts, so this was clearly premeditated. And yet, they tried to justify themselves. These were the same teachers who publicly accused me of stealing their money last year and called me a colonialist, despite the evidence that for the first time in history the cash drawer had 100% of tuition for all students at the school. And these same teachers insist they can’t repay a dime for their colleagues’ salaries. Some members of the church committee were leaning toward letting them off the hook, but it was finally decided to fire them last night, although we have still granted them a month to come up with the missing money before we bring them to the justice.)

(As a final aside, we do have our ups. Remember, we are only inspired to write during our downs. So our blog is a pretty depressing blog to read. If it were all downs, we wouldn’t still be here. We will try to do a better job of sharing our ups. But days like yesterday, you really do wonder what you’re doing here working at things you are untrained to do 24/7 for missionary salary when teachers like these just go about ruining all our hard work. It’s often tempting to go home, work my ER shifts and make a ton of money. Eventually, we will return home, either for our kids’ education or for our own sanity. But for the moment, we stay for the Abres, the Sabines, the Ndilbes and the others, the local people laboring right along beside us. They sweat the same sweat. The bleed the same blood. They cry the same tears. They suffer the same malaria. They make their own sacrifices. They too could make more money. They too could live closer to family. They share the same joys, the same successes, the same frustrations and the same failures. They are our friends, and they are our family. And so, for the moment, we stay.)