Monday, November 20, 6:07pm.
‘Can anybody help me? Can anybody leverage an entire embassy?’
These were the final two sentences of a desperate plea put out to over 15,000 emergency physicians in a Facebook group. I had tried everything I could. I had had a very deep bag of tricks and plans, but it was down to this.
I had three options:
1. Convince the American embassy in Chad to release two vials, its entire stock, which the embassy had been refusing to do for two days.
2. Pay $41,000 to fly a private jet from Kenya to Chad, meaning we quit our mission in Africa and return to America to pay it off afterward.
3. Accept the risk and play the lottery, hoping I will never be forced to watch my children die the worst death imaginable.
This was the only thing in my head. I must find immunoglobulin. And I must find it tonight.
The previous Thursday, November 16, 3pm.
‘Lucy scratched up Addison really badly, and bit her ear. She won’t let anybody in or out of the house. She’s guarding the door. I yelled at Lyol and Zane to climb up the tree. I’ve got Juniper and Addison inside and I’ve barricaded the door. The kitty door. Can you come home?’
Rabies? No, it’s not rabies. ‘Yup, I’m on my way.’
Rabies? No, it’s not rabies. Walking home, I think about Lyol’s right forearm, scratched to smithereens. I remember the howl at 5am earlier that day, waking me up, then Lyol running inside holding his arm up as the blood flowed freely down the arm, and the tears freely down the cheeks. We washed it well with soap and water. He wanted bandaids, but I pointed out to him his entire forearm was used as a scratching post and his palm as a fang-sharpener. You can’t cover the whole thing with a bandaid.
Walking up to work that morning, I saw Lucy stalking a tomcat, who was eyeing her warily. I approached Lucy, who growled, swiped, and missed. I noticed all the cat fur stuck in her claws and the fur in her mouth. Poor tomcat. Messed with the wrong cat.
Lucy then darted under the car. Other cats like hiding under the cars. Lucy usually doesn’t. I sauntered over to the car, bent over and reached out to her. She swiped again, and missed. I stretched out my iPad. She attacked it, scratching and biting it repeatedly.
Lucy’s always been a bit feral, scratching a biting. Not many truly domesticated and tame cats around here. And when she’s pregnant, she’s always a bit extra crotchety. Her belly looked about to pop.
Entering the gate, I hear Dolores holler. ‘Careful! She’s by the front door!’
‘Hi, Daddy!’ Lyol and Zane chorus from up in the tree. ‘We’re up here so Lucy won’t get us.’
I open the front porch door and Lucy is there hissing at me. I corral her into the back porch and shut the door. Crisis averted. She’ll cool off once she has her kittens. But just in case…
I go into the back porch where Lucy is. She’s hissing and meowing up a storm. I force her up onto the counter. I block the door to the kids’ room. Then I place a huge bucket of paint against the office door. I ask the boys for a bowl of milk and I give it to Lucy. She drinks it up. Dolores brings a makeshift litter box. I put in a second bowl of milk and then walk out through the kids’ bedroom, the hardest door to open onto the back porch.
I round up the kids and make certain we are all on the same page.
‘Ok, guys. Lucy is being even meaner than she normally is. Lyol and Addison have both been scratched and bitten today. We will quarantine her to the back until she has her kittens and cools off.’ I pause. ‘And she could be sick. We need to watch her for the next ten days to make sure she doesn’t get crazier than normal. Absolutely nobody besides Daddy is allowed to go back there. If you see your baby sister trying to go back there, you are allowed to do anything necessary to make sure she can’t go back there. Do you understand?’
‘Yes, but why, Daddy?’
‘There’s a tiny chance Lucy’s craziness is from rabies, and since she bit you, if she has rabies, you can die without a fancy shot. But don’t worry, she’s just fine. Just mean ol’ Lucy.’
‘I don’t want a shot. I hate shots.’
‘I know you do. Don’t worry. You won’t need any. Lucy is fine.’
Saturday, November 18, 5pm.
‘Daddy! Lucy had her kittens! Can I go back there and get them?’
Remember, there’s a tiny chance Lucy is sick. I’m the only person allowed back there.’
‘Daddy, can you go get her kittens.’
Sure. Hopefully having her litter will finally calm her down. I go back and find three kittens spread all across the back porch. One is by the kids' bedroom, with what looks like a bite to the back and a horrible scratch to its leg. One is in the middle of the porch. It's dead. The third one is over by Lucy, meowing on the floor. Lucy remains up on the countertop. The kittens have not been cleaned. Lucy seems oblivious to them. She’s done this before with past litters too. This is no big deal.
Sunday, November 19, 6am.
This might be a big deal. I hear a fourth kitten. Somehow it got into the cooking charcoal. How did it get there? The other three are dead. Lucy hasn’t touched the bowl of milk I put out yesterday. I start conversing with an awesome rabies specialist in America.
Sunday, November 19, 2pm.
The cat is rabid. She will not drink. She is shaking. She can barely walk. Her back legs are not working properly. This is now officially a big deal. The rabies specialist agrees. This is what rabies looks like. Classic.
Rabies is a completely unique disease, unlike any other. One animal will bite another, and the rabies virus is transmitted via saliva into the wound. It doesn’t take much. The bite of a bat, a bite so small you cannot feel it or see a wound, is enough to transmit the virus. Once in the wound, the virus seeks out a nerve. The more highly innervated the part of the body is, the quicker it is for that virus to find the nerve and hop inside of it. The virus then travels up the nerve. To the brain. The shorter the physical distance between the wound and the brain, the quicker the virus can find its ultimate home. Once in the brain, the animal starts showing the first symptoms. Once symptoms appear, death is inevitable. You cannot wait for symptoms to show. If you do, it’s too late.
The treatment for rabies is always after exposure. If the animal can be quarantined, you observe the animal for ten days or until rabies symptoms appear, whichever is shorter. If the animal is normal for ten days, the patient is unlikely to develop rabies, as there was unlikely to be rabies virus in the saliva. If the animal displays rabies symptoms, treatment is indicated for the patient.
The treatment is simple. Rabies immunoglobulin, 20 international units per kilogram, injected into the wound site. If there’s too much volume, dump the rest into a big muscle nearby. Then a series of 4-5 shots, on Day 0, Day 3, Day 7, Day 14 +/- Day 28, preferably injected into a big muscle far away from the immunoglobulin, so the two don’t cancel each other out.
The immunoglobulin binds up the virus, so it can’t do anything. The vaccine is beat-up and ineffective virus bits, which stimulate and teach the immune system what the rabies virus looks like, so the immune system can go on the offensive.
This is the classic treatment for rabies. And given early enough, this treatment is 100% effective. Once rabies developments, 99.999% of patients will die, and the 0.001% who survive will never be normal again.
The rabies specialist tells me some patients have started to manifest symptoms within 3-4 days of exposure, although that’s very rare. But considering Addison was bitten on the ear, a structure highly innervating and very near to the brain, immunoglobulin within six days maximum is of the essence. We are now at three days. Rare patients have started to show symptoms by now. Borrowed time starts at this moment.
From this minute, I am actively staring at my iPhone’s screen, using my phone, WhatsApp, iMessage, texts, email and Facebook, for approximately 22 of the next 27 hours. I rarely look up.
I call Doumpa and ask him to bring my some immunoglobulin and vaccine for the kids. He informs me we have none. And he informs me there’s no immunoglobulin in the country. Well that’s clearly just ridiculous. I’ve given it before.
I call the regional pharmacy. They have five vaccines. We will need 25. No problem, five will get us our first shots and buy us time until the next shots are due, three days later. They will not open, because it’s Sunday. We can come by at 9am tomorrow. I’m uncomfortable with this, but I accept. They also inform me there is no immunoglobulin in the country.
I call our hospital private supplier in N’Djamena. The man can find anything, frequently hopping across the border into Cameroon to get stuff. He also assures me there is no immunoglobulin in the country. The government stopped ordering it years ago. But he knows he can buy both immunoglobulin and vaccine in Kousseri.
I call our sister hospital in Cameroon, who don’t have the immunoglobulin, but a neighboring private health center stocks some. They will get it in the morning and send it to us.
Danae is in America. I update her. She loses it. She wants her babies shot. Now.
Sunday, November 19, 3pm.
I am uneasy with the plan. So I contact our medical evacuation company in America. I explain to them two of my children have approximately 30-40 scratches (saliva gets under the claws when the cats groom) and 3-4 bites each, from a cat who just proved herself to be rabid. We can find vaccines, but we need immunoglobulin. There is none in the country. The next flight in from Paris would arrive Tuesday night, around 11pm. That’s too late. We want immunoglobulin before then. If somebody could ship it in on a flight from Kenya, Cameroon, Egypt, Ethiopia, Morocco, etc… that would be great. They will work on it.
I call the American embassy. The tell me to contact the medical evacuation company. The embassy can’t give any more help or guidance beyond that.
I am still uneasy with the plan, so I call Ndilbe, one of the most responsible friends I’ve ever known, who’s in Maroua, Cameroon. Third-largest city in Cameroon. He calls some physicians who run pharmacies. They insist they have both immunoglobulin and vaccine. They will meet him at 5am the next day.
Danae is in full-on freak out mode. Something that will continue for the next 31 hours. She is calling everybody she knows. Somebody has threatened mama bear’s cubs.
Sunday, November 19, 4pm.
Danae has a friend in Kenya who is looking for the immunoglobulin. The first half dozen pharmacy physicians all say there’s none in the country and they have to import it from South Africa. Finally, he finds one vial. One vial is enough to be split between Addison and Lyol. He’s now looking for a way to get it to us.
Sunday, November 19, 5pm.
There are two options for getting the immunoglobulin from Nairobi to N’Djamena. Either Danae’s friend can fly it to N’Djamena as carry-on, hoping his cooler doesn’t get flagged, or we can charter a jet for $41,000. Danae’s friend also doesn’t have a visa for Tchad. We have actually been on flights out with other passengers turned away in the airport for lack of visa. In fact, most airlines won’t let you on the flight to N’Djamena if you don’t have a visa in your passport.
The evacuation company says they have it in N’Djamena. Then they say they don’t. Then I get a call from the evacuation company’s office in Niger, trying to set up evacuation.
I call the kids inside and clean up and shower.
Sunday, November 19, 6pm.
The evacuation company’s medical team puts out the following recommendation: Evac entire family to closest appropriate facility with Rabies Immunoglobulin availability. Go by quickest possible way — commercial if necessary. Now maybe they don’t have the immunoglobulin in N’Djamena?
I ask the evacuation company to call the American embassy and see if they have immunoglobulin. I’m sure they must. Maybe the evacuation company can leverage it out. Apparently the ambassador herself would need to sign off on this.
Surely our military bases have some. Can’t we call them?
I also know the evacuation company has a subsidiary they bought out with a clinic in N’Djamena. Perhaps they can ask them if they have some immunoglobulin.
Ok, they will have evacuation flight arrangements by tonight, or a good plan for bringing in the immunoglobulin tonight.
Ok, evacuation subsidiary says they’ll have it tomorrow. We should just drive up tomorrow. And if they don’t, they’ll fly us out.
The kids are eating at the table.
Sunday, November 19, 7pm.
Danae buys a ticket to fly her friend from Kenya to N’Djamena. He has now found four vials in Nairobi. Samaritan’s Purse is trying to get him an emergency visa. His ticket is one-way, which might raise more flags. And the plan he comes on continues to Morocco, the opposite direction from getting him back to Kenya.
The evacuation company informs us the embassy will not be able to offer us the immunoglobulin. I knew they had it.
I finally wrestle all four kids into bed.
Sunday, November 19, 10pm.
The evacuation company informs us their plan is for me to fly alone with four children, ages 8, 6, 4 and 2, to Nairobi, arriving Tuesday morning at 2am. From there, we will be taken to the hospital, where they don’t have immunoglobulin, but they will instead offer us ‘alternative treatment.’ Um. No. I will not be accepting ‘alternative treatment’ for a 100% lethal disease when the regular treatment has no side effects and offers 100% protection against the disease. What possible benefit could ‘alternative treatment’ have? Furthermore, I find out, once I’m in Nairobi, I will be responsible for finding and paying for my own hotel and my own way back home to Tchad… with four children ages 8 and under. What could go wrong?
I inform the evacuation company their plan is unacceptable, not to mention contradictory to their medical team recommendation. Thanks, but no thanks. We will figure it out ourselves. We offer to the evacuation company to work with Danae’s friend and the government of Tchad or the American embassy to ensure he will be allowed to travel to Tchad and his medicines will make it to us. The evacuation company declines politely, informing us they can’t work with third parties.
We decide to part ways with the evacuation company. We have Josh trying to come in from Kenya with a cooler and a one-way ticket, but no visa. We also have Ndilbe, Koza and our supplier in N’Djamena all ready to go on the hunt first thing in the morning. Ndilbe was promised the immunoglobulin in Maroua at 5am, so he thinks he can get to the border by 10am.
Monday, November 20, 1am.
I am neurotic. I keep going back and forth. I don’t know what the right decision is. I’m pacing the house in circles. Suitcases are all over, along with backpacks, computer bags, passports, cash, etc. I don’t know if I should be packing for Nairobi or Paris or a quick day trip. I’m feeling confident Ndilbe can find something, so I throw a few items in a small bag and go to sleep.
Danae tells Josh not to head to the airport.
Monday, November 20, 5am.
I forgot to set an alarm, but I’m up anyway. I had a nightmare one of my kids had rabies. There is no way I will allow myself to fall back asleep again.
The kids know something is going on. They are up and bundles of nervous energy as well. I go back and check on Lucy. Lucy is dead. Four days ago now, 96 hours ago, Lyol was bitten. Lucy is dead. Rabies killed my cat less than four days after she bit my son, about three and a half days after she bit my daughter. On the ear. Right next to the brain.
I see the virus making its way from the tissue into the nerve. I can see the virus creeping it’s way up the very short nerve from her ear to her brain. It’s less than an inch from ear to brain tissue.
I am calming Danae down.
I am freaking out.
I am seeing my daughter go rabid.
This is no fun.
I immediately know I made a mistake not taking the risk and asking Josh to fly the immunoglobulin to N’Djamena.
I message Ndilbe to see if he got the immunoglobulin. No response. I call. No answer.
Monday, November 20, 6am.
We hit the road. I trust Ndilbe got the immunoglobulin in Maroua and is headed for the border already to meet us.
Rollin is driving. I am on the phone. With everybody.
I ask Benjamin to buy the five vaccines in Lai. Zane and Juniper can be vaccinated this evening.
Monday, November 20, 7am.
Ndilbe has been stood up. The guy never showed. Ndilbe does what he does best. This man works harder than anybody I know. He starts calling and going to all hospitals and pharmacies in the town.
Monday, November 20, 10am.
We arrive at the Cameroon border and wait for Ndilbe. Ndilbe is still getting the wild goose chase. He calls a pharmacy. They all say they have it. He goes to the pharmacy. When they show it to him, he sees it’s the vaccine, not the immunoglobulin. Ndilbe works hard with Hamed from Koza to find it. He can’t. He goes to the regional government pharmacy. They say there is none. Ndilbe keeps trying over and over again.
I go to the regional hospital in Bongor, the border town. They obviously have no immunoglobulin. They inform me the government stopped stocking it years ago. Too expensive. They just give the vaccine and pray.
But at the regional pharmacy in Bongor, I find the vaccine and buy fifty of them. Then in the pickup, parked right in front of the regional pharmacy, Rollin injects me, Addison and Lyol. Addison and Lyol both screamed bloody murder, then were injected and said, well that didn’t hurt! Oh, the anticipation.
The kids ate watermelon and played tic-tac-toe in the dirt for the next five hours while I coordinated on my phone all the goings-on.
Monday, November 20, 2pm.
My supplier in N’Djamena bought me the immunoglobulin across the border in Cameroon! I ask for a picture of it. It’s vaccine.
Hamed finds the immunoglobulin and sends it to Ndilbe in Maroua! I ask for a picture of it. It’s vaccine.
Ndilbe has now been to thirty pharmacies in Maroua. Nothing. We call a doctor in Garoua, farther south. I debate trying to cross the border without a visa. But I can’t find the immunoglobulin, so what’s the point.
This whole time, I’ve been assuring Danae we will have the immunoglobulin at any moment. It never works out.
I ask the evacuation company to contact the embassy again. They ask. Embassy says no. I ask them to ask for just one piddly little vial. They ask. Embassy says no.
So I call the embassy again. Embassy tells me I need to contact the evacuation company’s local subsidiary. I do that. Subsidiary says I need a membership. Fine. I’ll become a member. Subsidiary tells me to call the embassy. Back and forth, back and forth!
Monday, November 20, 3pm.
Now the evacuation company sends me an email saying they are working with the embassy and will be getting the immunoglobulin.
We load the kids in the car, gas it up and head north to the capital and the immunoglobulin!
Monday, November 20, 5pm.
Ndilbe and Hamed are still searching in Cameroon.
An email comes in: ‘The US Embassy in N’Djamena confirms that they cannot provide the immunoglobulin.’
The email continues: The subsidiary clinic found one vial in their refrigerator, but it’s a smaller vial. And it will cost $3500 for the vial alone.
I contact the subsidiary. I don’t have that kind of cash on me. I can get it tomorrow. I’ll be arriving in N’Djamena about 9pm. Can you just give it to me and I’ll pay you tomorrow?
The subsidiary says no. I email the parent evacuation company, copied to everybody I know. My father lives in the next town over from the headquarters of the evacuation company. He can have cash in their office in an hour. Adventist Risk Management writes back immediately guaranteeing payment. The Health Ministries department of the church writes back immediately guaranteeing payment. The evacuation company informs the subsidiary payment will be made, don’t ask me for anything.
This is a huge relief. We will get the immunoglobulin tonight.
Wait. I do the math. The size of this small vial… it means… there’s only enough dose for one of my children…
I look in the back seat. My children have been absolute angels today. I has been a long, hard, boring, stressful, hot day, in a car in 100 degree heat with no air conditioning and a father who won’t let them put down their windows.
I can’t control my mind. It wanders as I stare at my children. I imagine them sick. What will be their first symptom?
I have a couple patients die of rabies every year in my hospital. It is tops on my list of worst ways to day. Miserable. Uncomfortable. Painful. No dignity. Drawn out. Tetanus is pretty bad. Rabies is worse. Burning, drowning, all that stuff is bad. But it doesn’t go on for days. I had a boy with rabies just a couple weeks ago. I had a man with rabies from a cat bite last year. They all die. Benzodiazepines like Valium do nothing. I just give the patients massive doses of ketamine until they drift off into oblivion. It’s not euthanasia. But it’s a means of stopping their suffering while their body goes through the process of figuring out how to die a lousy death. It’s what I would want for me.
Now… which kid do I save? Which one do I give the immunoglobulin to?
You’ve gotta be kidding me. This is a decision I will actually need to make? This is not real. This is not happening. This is like those horrific situations in movies that would never really ever come to fruition.
I look in the back seat. I imagine both kids dying from rabies. I imagine one, then the other, suffering from this horrible scourge. I can’t take this. I need to think logically and practically.
I decide Addison gets the immunoglobulin. Her bite wound is closer to the brain. I believe she will develop rabies symptoms earlier. Simple as that.
I’m doing the math and running the scenarios now. The next flight to a place with immunoglobulin is Paris tomorrow night, getting in Wednesday. There is officially no way to get Lyol immunoglobulin in less than six days from his bite.
Well, there is one way. There is still the jet. Josh has not returned the immunoglobulin. The jet can be ready in four hours and here four hours after that. There is the jet. $41,000 on a missionary salary is… significant.
How much is your child’s life worth? This question goes through my head over and over.
Danae and I are going back and forth on the matter. She has agreed to work in America until the $41,000 is paid off.
And we have backup plans. Lyol and I can fly to Paris and have Dr Kanor arrange for us to receive immunoglobulin first thing Wednesday morning. I can go to the embassy and threaten to make a scene until I’m arrested and create a public relations nightmare out of this. All these and a million more go through my head.
My son was bitten by a rapid cat who died less than four days later. The only way to get him the immunoglobulin in that six-day window… is $41,000 away.
We will do it.
Monday, November 20, 6:07pm.
‘Can anybody help me? Can anybody leverage an entire embassy?’
These are the final two sentences of a desperate plea put out to over 15,000 emergency physicians in a Facebook group. I tried everything I could. I had a very deep bag of tricks and plans, but it is down to this.
I have three options:
1. Convince the American embassy in Chad to release the immunoglobulin, which the embassy has been refusing to do for two days.
2. Pay $41,000 to fly a private jet from Kenya to Chad, meaning we quit our mission in Africa and return to America to pay it off afterward.
3. Accept the risk and play the lottery, hoping seven days won’t be too late to get Lyol the immunoglobulin in France
This remains the only thing in my head. I must find immunoglobulin. And I must find it tonight.
Monday, November 20, 7pm.
15,000 emergency physicians went into action, knowing the medical outcome of Lyol not receiving his immunoglobulin.
Many called senators and representatives from Minnesota (birth state), Oklahoma (Danae’s birth state), Massachusetts (residency training), Maryland (current permanent address) and even states we’ve never lived in. There were senators from states we have no relation with who were intervening!
Many called the White House.
Many tweeted the White House and Donald Trump and the embassy.
Many wrote on the Facebook pages of the White House and the President and the embassy.
Many found friends and contacts.
Many found immunoglobulin, albeit in places I couldn’t easily get to.
Many found alternative cheaper jets.
One contacted President Trump’s physician and another White House physician, both emergency doctors.
One had a friend who was the ambassador of another American embassy in a different African country. That ambassador called the ambassador here, telling her to release the vials.
Several were military doctors at various military bases in Africa. They called the ambassador. One even went so far as to promise to overnight their two vials of immunoglobulin to the embassy via DHL the next day, if they would release the immunoglobulin to us.
There are emergency physicians in the State Department, Department of Defense, Department of Justice who called the ambassador.
There were regional medical directors for the State Department giving me advice about the process.
There were several who called the CDC’s rabies department until the CDC called the ambassador to release the vial.
There were emergency physicians calling Fox News and CNN and other media outlets to try to push the story.
The American College of Emergency Physicians, the largest group of emergency physicians in America, started pulling strings from their head office and their DC office.
And then there were the phone calls. People called the embassy by the hundreds. This is not exaggeration. And I suspect it’s the low man on the totem pole who answers the calls. Reportedly, he was a bit flustered and everybody had to be put on hold as he tried to keep up with the flood of American emergency physicians trying to educate him on rabies and the need for immunoglobulin.
And then people gave. Somebody set up a GoFundMe for the $41,000 jet. They raised $14,000 in the first hour. It’s over $18,000 no. Others vowed to give if it was necessary. One vowed $10,000 if it became necessary. People I have never met in my life.
There were over 1000 comments on my Facebook post from people calling in to the embassy or pledging money for a jet or praying for us or finding a contact or doing whatever great or small thing they could do to help.
Less than one hour after begging for help from my emergency physician colleagues, the subsidiary let me know the embassy had released the immunoglobulin.
I cried in the car and tried to convey to my father-in-law the good news with a steady voice. I don’t think it worked.
I kept looking over my shoulder at my kids in the back seat. Half relieved. But half wondering if the gift would be pulled away again. So thankful our future, my future, was restored. Thankful my brain could wander down happy paths again. So happy I could imagine my children outliving me once again.
Monday, November 20, 8pm.
At a police checkpoint, they ask to see Rollin’s driver’s license. Technically, if you’ve lived in Tchad more than three months, you are supposed to have a Tchadian driver’s license. If you don’t, they can impound your car. I show them all our papers. I show him that I have a Tchadian driver’s license. He notices my name is spelled different on my Tchadian driver’s license than it is on my passport. He starts hinting at making trouble for us.
There are over 120 different distinct languages in Tchad. I start speaking to this guy in Nangere, one of those 120 languages. He was Nangere! So I ask him about his wife and his children and his health and tell him we are on our way from our home at the hospital in Bere up to N’Djamena for the children’s health… He is so amazed that I speak his language, however marginally, he just waves us through! The odds were not good I’d get a Nangere policeman!
Monday, November 20, 9pm.
We are sitting in the subsidiary clinic in N’Djamena. It is nice. There’s a water cooler, an air-conditioner, tiled floors, fancy chairs… where am I? Is this still Tchad? This is where the wealthy get treated!
The kids start to lose it. They’ve been such troopers today. They are so tired. And they know shots are coming. Tears start to flow freely as nothing can assuage their fears of the worst.
And I’ve never lied to my kids about pain. I tell them it will hurt when they ask if it will hurt. But just for a little bit. I don’t know if that last part is true, but I don’t know it to be false either.
We go into the treatment room. Addison gets the shots first. She gets several shots into her ear, where she was bitten. I know it’s gotta hurt. I have her face in my hands, looking into my eyes. She's crying. I wonder if she even notices that Daddy is crying too. Her tears may be tears of pain, and I may have the irony of tears of joy right in the face of my daughter’s tears of pain, but I’m no sadist. I’m feeling days’ worth of anxiety start to fade away, like water poured over my head, washing everything away and leaving me clean. I have finally won against the countdown clock. It really feels like the syringe should be massive and filled with green liquid and shoved directly into the heart right before something explodes. It feels that dramatic. I’ll never know what might or might not have happened. Because I got that immunoglobulin into her tiny body before she showed any symptoms. She may have had seconds, like the movies. Maybe she had days yet, or months or years or never. Nobody will ever be able to say.
But every time she cried from the needle going into her ear, or every time she screamed and flinched from the needle injecting the claw marks on her neck and back… every time… I rejoiced. I could see the immunoglobulin we had fought so hard to receive, I could just see it binding up those rabies viruses. And it felt so good.
Layers of relief began to shed off of me. We had made it.
Lyol was next. He had vomited while watching Addison get her shots. Poor boy was so worked up. Sobbing. He had to get shot in his palm several times and over and over and over again on his forearm. Addison then threw up while watching Lyol get shot. They were such hot messes. We were all hot messes. Happy, hot messes.
That feeling. Watching the kids get the immunoglobulin a thousand different people had worked and prayed for. It was too much. So many emotions, so deeply crammed into such a tiny wedge of time. It’s more than a heart and soul can process. I go numb. A happy numb.
Monday, November 20, 10pm.
We arrive at The Evangelical Alliance Mission, TEAM. I had sent them some afterthought texts while on the drive up, realizing we had nowhere to sleep. It was very late. But Stella came out to greet us and celebrate with us. She brought us into her home and fed us, even giving the children a special ice cream treat. I wasn’t hungry. But I ate. I knew I should. I hadn’t eaten much today, and absolutely nothing since morning. I’d been running on pure adrenaline, and I was sure I’d be hungry by morning.
Monday, November 20, 11pm.
I moved our vaccines from the cooler to the fridge. I showered the kids and tucked them in. We had a very special prayer that night. At least, it started special. But we had to cut the prayer short as Daddy couldn’t finish. It must have been all the dust and dry wind from the drive that caused my voice to break.
Tuesday, November 21, 3am.
I’ve showered. I’ve washed the kids’ clothes in the sink after stripping them naked. I want them to have clean clothes in the morning. I pick up my phone and collapse into bed.
There are over a thousand comments to my Facebook post. And about a hundred private messages. I had turned my phone on silent as soon as we got into the clinic and hadn’t turned the ringer back on since. I had forgotten to update people. I start to scroll through the comments. I start to sob again. People. People are so amazing. People care so much. My colleagues, most of whom I’d never met before… they went to such extreme lengths, stopping at nothing until my children were safe. Genuine worry. Genuine concern. Genuine care. Genuine love. I was overwhelmed. I’m still overwhelmed. I stare blankly at my phone. I scroll. I stare. I scroll some more. I want to process. I want to react emotionally. I want to respond. But my jumbled up emotions won’t allow me to do anything except send a general quick message. And drift away.
Tuesday, November 21, 4am.
After 23 hours of fighting, calling, texting, messaging, crying, hoping and praying without ceasing… I am gone. I am at rest. I can sleep the sleep of the just, the sleep of a man pure of conscious. I have done all I could for my family. They are safe now. They are loved. There is nothing more I can do. I can rest. I know nothing.
Tuesday, November 21, 6am.
Those dang kids. Who’s kids are they? Neither their mother nor I are morning people. Whatever did we do in a previous life to deserve this curse of children who love mornings?
Wait. My children are playing. Happily. I am so full. I want to get up with them. Hug them. Kiss them. Play with them. And stop imagining them dying. I want this moment.
I check my phone. Danae reminds me we need immunoglobulin for the other two kids. They weren’t bitten, but the rabies experts are recommending it. She still has her Kenya friend on standby to fly to Ethiopia that afternoon. She wants me on the flight from N’Djamena to Addis Ababa. I will meet him in the airport. We will do a shady exchange of a cooler with immunoglobulin. Then we will spend the night and head back to our respective homes the next day.
This means Rollin either drives home alone with two kids in the car. Or hangs out with my kids for 24 hours alone in the capital. It also means we need to pay two round-trip airline tickets and find a hotel in Addis. But in the big scheme, it does seem like the cheapest, fastest and most reliable way of getting immunoglobulin into the other two kids. It would get the immunoglobulin into the last two kids about one week exactly from when Lucy went nuts-o and attacked Lyol and Addison. Not the ideal six days or less, but they are at much lower risk.
Hang on, Ndilbe thinks he found immunoglobulin in Maroua now. He can buy it, meet us at the border, and we can have the two others injected 24 hours earlier! We just need to wait until 8am.
Stella, who’s awesome, comes by and lets us know we can stay another night if we need to. This would create a huge inconvenience for her, but she is just that nice. She also refuses payment for the room. I love Stella.
Tuesday, November 21, 8am.
Ndilbe sends me the picture of the immunoglobulin. Nope, that’s vaccine. I give up. We will not find it in Cameroon. Ndilbe is incredible and dedicated and a dear friend. He’s willing to travel to the capital. But that would take a couple days. No, the most reliable is for me to fly to Ethiopia.
Danae has the itineraries reserved and is booking them.
Right before she books them, I get a text. From the subsidiary office that just injected the kids the night before. ‘There’s leftover immunoglobulin. Would you like to take it home to inject the other kids?’
I call Danae and she holds off on the tickets.
The subsidiary office won’t be available until 10am.
We run errands, swapping vehicles, picking up 300 Nangere Bibles, etc. Then we go and pick up the immunoglobulin. There is such freedom and release. Everything is done.
Tuesday, November 21, 11am.
I look across the table and my heart smiles, full to the brim and overflowing. We just had a prayer. Prayers have been awfully difficult to get through with a steady voice lately. I’m at the patisserie letting Addison and Lyol go hog wild. Hot chocolate, milkshakes, French fries, omelets, pastries. Whatever. Eat to your hearts’ content. They had traveled from 6am to 10pm. They had a shot at noon and a shot at 9pm. They had slept a very short night. They had eaten nothing. It’s now 11am. They deserve this. They earned it. They’ve been so good.
Tuesday, November 21, 2pm.
I’m laughing. Normally, I’d be spitting mad, stressed, cursing my luck. Not today. I just laugh.
The policeman is asking for my car papers and I’m discovering the glovebox to be barren. Yup, I’d normally be mad. The papers were removed before the car was given to the mechanic to be fixed. But nobody told me that. And nobody put the papers back. There is nothing in that glovebox.
But you know what? My kids just got shot up with immunoglobulin at nine o’clock last night. So I don’t care anymore. You can do anything you want. Impound the car. I’m happy. My kids are ok.
The police won’t let us drive farther, and they won’t let us return to N’Djamena. I call Koumakoi and he agrees to drive the two hours on motorcycle to bring us the papers.
Then the police chief asks me where I’m headed.
‘Are you the doctor at the hospital there?’
‘You’re a humanitarian?’
I guess so.
‘Please, go back to your patients and keep doing your good humanitarian work. Nobody else will bother you on the road. Have them send you the papers some more convenient way.’
Amazing. This doesn’t happen here.
Tuesday, November 21, 6pm.
We pull in to Bongor, the town where we spent five hours waiting for Ndilbe yesterday and where we vaccinated ourselves. Lyol had left his shoes there, and had been barefoot.
Amazingly, the guard had put his shoes into his guard shack. He was happy to see Lyol and give him his shoes back.
Driving away, Lyol ruminates out loud regarding the differences in his shots. ‘The vaccine wasn’t so bad. It barely hurt. But I don’t care for the Goblin Shot. That one hurt!’
Tuesday, November 21, 11pm.
I get out of the car, I walk in the door, I draw up the medicine. I pull Juniper out of her bed and give her the immunoglobulin before she’s fully awake. Then I do the same for Zane.
Four for four. All vaccinated. All immunoglobulined. All four tucked into their single bedroom. Crazy kids. Even in America, they don’t know what to do if they aren’t all four sleeping in the same room. Lyol and Addison kept mentioning how badly they missed playing with the others.
I smile so hard. I am so happy.
Wednesday, November 22, 1am.
Well, it’s back to normal life. Pediatric nurse got me at 11:30pm to tell me about a girl with a longstanding rash who came from far away. No recent change. No fever. Eating well. Not vomiting. I empathize, and tell him I think that can wait until morning.
At midnight, the urgence nurse calls to tell me there’s a finger lac he doesn’t know how to suture. I make a point to never get mad at a nurse for calling me when they shouldn’t. I’ll only get mad at them for not calling me when they should have. This nurse is actually really good. I’m surprised he doesn’t close this one himself, but whatever.
I was the base of the finger with bleach. I inject some lidocaine on both sides of the finger, numbing the nerves where they come out. Tendons, ligaments, bones, all intact. Just a simple laceration. I suture it just and head home.
I lay in bed. Happy. My life, which could have been thrown into a nightmare two days ago, is back to normal. I like normal. I like my life.
Thursday, November 23, 10pm.
Thanksgiving has always been my favorite holiday. The whole family comes together. We eat more than we should. We talk. We play games. My mother always had a way of making it big. And meaningful.
Well, Mom died in August. Danae is in America.
I worked, as usual, starting with staff meeting (dosage calculations this morning), rounding on medicine and pediatrics, fixing a printer, telling the masons how I want the toilet and bathroom to be arranged in the house of the new doctor arriving in January, scheduling a committee meeting, prepping the new lab to be moved into, helping do a couple ultrasounds, signing social security papers for the last few months payroll, telling a woman her husband has azoospermia, telling a man we can’t do anything for the cancerous mass growing across his pharynx and about to occlude his airway, telling another man we can’t help his insanely arthritic hips, etc.
The kids ate Thanksgiving lunch with their Nana before I got home. I came home and ate Thanksgiving lunch alone. Papa came home and ate his lunch after me.
I just got the house clean, kids showered and fed and into bed alone, as I have done every evening for the last few weeks.
And I realized something.
This was the worst Thanksgiving. Away from my wife, away from… without… didn’t…
And then I realized something.
I have never been more thankful.
In my mind, my children were dying. And in reality, they may have been dying. We don’t know how much virus was in them, how far it had traveled up the nerves, how close it was to taking root in their brains. In the worst-case scenario, it would have already set up shop.
Now, my children are alive again, with an unthreatened future. My family is intact. Being apart from my wife sucks, but it is temporary.
Nobody is more thankful than I am this year.
And I’m a bit torn, morally, about being thankful. There is so much injustice in this world. I was born American to a middle-class family. I got lucky all along the road and ended up with my dream wife and my dream job. And being an American physician, I had the option of appealing to the American embassy for immunoglobulin. Being an American physician, I had the option of shelling out $41,000 to save the life of my children.
But what happens to African kids? They don’t get that option. They don’t get that chance. They don’t have that luck. Am I more special? Am I more precious? Am I more… I could go on and on. But I won’t find the answers I’m looking for.
So I try to make a difference. I try to level the playing field by elevating those who are a bit down.
1. So today, I am thankful for that blue passport. I’m thankful for the dumb luck I was born American. God apparently knew I wasn’t strong enough to hack it as a Chadian or a… take your pick. So He gave me the easy road.
2. Today, I am thankful for the American embassy. Yes, they farted around. Yes, had things gone extremely poorly, they could have been responsible for the deaths of my children. But I don’t hold anything against them. On the contrary, I’m grateful they listened to the voices of reason. The poor folks answering the phones aren’t doctors. They aren’t the decision-makers. The ambassador, she isn’t medical. How should she be expected to be able to make an informed decision. I get it, they have protocols. The immunoglobulin is expensive and is for their staff, not for all Americans. They have a budget. They need to justify expenses. They are under-funded. They can’t be expected to handle medical care for all Americans in Tchad. I get this. But they can’t really expect all travelers to Tchad to carry around a cooler of immunoglobulin with them wherever they go. It’s not like we didn’t do our due diligence. There was none in the country, or Cameroon, or the hospital the evacuation company wanted to send us to in Kenya. I am just so thankful to the people answering the phones, who passed the messages up the chain. I am so thankful to the ambassador, who gave the order to release the vials. Thank you.
3. Today, I am thankful for the emergency physician community. Dr Moody created a community. Dr Ly is amazing and inspires people to tune in. Dr Sabry-Elnaggar created another community of physicians. Aggie and many others helped organize efforts to help us. Alison raised nearly $20,000 in a couple hours, in the off chance we had to charter a private jet. Dr Parker convinced the largest professional body of American emergency physicians to use the leverage of their DC office to get this moving in the political world. I am thankful for the CDC, for the representatives and senators, for the… I could keep going down the list. It wouldn’t end.
4. Today, I am thankful for Mark Zuckerberg. He created Facebook to pick up chicks, but it turned out to have potentially saved my children’s lives. I don’t think MySpace could have pulled this off.
5. Today, I am thankful for my father-in-law. In addition to many other things, he drove up on Monday, allowing me to spend the entire drive on my phone, when the potholes allowed it.
6. Today, I am thankful for my children. You bring me so much joy. You are priceless. Irreplaceable. $41,000 could be $410,000. You are worth it.
7. Today, I am thankful for my wife. Making you proud is my greatest motivation for getting out of bed each morning.
8. Today, I am thankful for an all-loving and omnipotent God. He has saved my children dozens of times I know of, and countless more unknown.