I No Longer Can Hear Them

30 Jan 2020

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

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

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

‘I don’t hear her… Oh. Never mind.’

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

‘Juniper, lay down.’

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

1 Feb 2020

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

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

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

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

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

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

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

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

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

5 Feb 2020

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

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

‘Can you come to peds?’

‘Ummm… yeah. Gimme a couple minutes.’

‘It’s Abouna’s daughter.’

‘Ok, be right there.’

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

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

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

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

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

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

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

It doesn’t matter.

Abouna’s precious baby just died.

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

Abouna asks me to pray, which I do.

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

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

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

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

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

And I just declared his baby girl dead. 

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

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

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

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

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

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

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

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

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

songs…

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

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

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

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

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

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

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