Just Here Trying to Save a Few Lives: Tales of Life and Death from the ER (2 page)

The father took my scribbled note and ran off to the pharmacy. We squatted there watching the baby seize, watching minutes tick by. Finally the father returned, triumphant, with the ampules. Simon broke them open and I drew up what we needed. I injected the baby slowly with phenobarbital, 5 mg, 10 mg and on. This should have stopped the seizure. Nothing. She kept twitching, seizing. I tried to get an idea from the family how long this had been going on. If it hadn't been long, the baby had a chance. A seizure lasting over an hour or more, though, meant there was not much use in even trying. I tried to ask, but either I couldn't make myself understood to Simon or Simon couldn't make himself understood to the parents, because I never did get any information.

We drew up more phenobarb and gave it slowly through the IV. Still, the baby seized. I had nothing more, no oxygen, no monitor. No other medication. If this didn't work, the baby was dead. After a few minutes I drew up another 20 mg and injected it slowly. Nothing else I could do. As I sat there brooding about this, the baby's spasms slowed a bit and became almost hiccup-like. Then, suddenly, the spasms were gone; the baby sighed deeply and was still.

We gave her ampicillin, oily chloramphenicol, and paracetamol for her fever. The nurses found a place for her between another young child with mild meningitis and a woman who had been desperately sick but now was doing much better, even walking a little today. “I'll be back later,” I told the nursing students. “Don't anyone touch that IV.”

So now I'm back. It's quiet at the hospital and dead black. The night-shift nurses are dozing at the two tables wedged between the tents and the verandah. A single candle lights up one table. I jostle Chuckie, Mark and Amos to wake them up. It's funny to think that I get on French nerves as much as they can get on mine. My first act in coming to the hospital was to award each nursing student an “American” name, a modification of whatever their name was in Hausa. My righthand man, Siminu, became Simon. Umar became Omar, Chafu became Chucky, et cetera. The French hate this. “That is so colonialist!” Pierre would tell me—but the nursing students love it. They laugh and clap each other on the back. “Now I shall go to America,” one tells me dreamily, and I know that feeling—everyone has it when they are young—and sometimes I think I've never lost it: that feeling that somewhere in the world—not here but somewhere—there is a place one can find oneself…where someone could be who he or she really is. In Nigeria it is America. Oh, America.

I poke at the students. “The baby that was seizing,” I whisper. “I've come back to check on her.”

They all yawn and stretch, looking around. They seem as puzzled and astonished to find themselves here as I feel sometimes. Someone scrambles for another candle for us to round with. Silently, or as silently as we can, we creep through the verandah and on to the tent. I am holding the candle high, not sure where we deposited that family. There are no beds at all in the tents. Each patient has a mat—brought in by the family—that serves as a sickbed. At the foot of each mat a family member sits—or, as now, dozes. The family member serves as the patient's caretaker—making dinner, feeding, washing. The hospital merely supplies and administers the drugs. If a patient requires any drug beyond that which our meager pharmacy supplies, the patient's family must get it from an outside pharmacy and bring it for us to administer.

I walk cautiously through the tent, past the sleeping figures. Bags of saline are randomly tied to the tent cross beams; we have no IV poles. Tubing snakes down here and there to a patient, who stirs restlessly or lies still as death as my little entourage and I pass by.

The baby is there, sleeping comfortably. The sign I made is still in place. For some reason the night nurses regarded it as one of their duties to remove all the IVs sometime during the course of the night. No matter how much I begged, pleaded, bargained, requested, the IVs were always gone in the morning. Finally, I scrounged up a single roll of tape, which I used to tape a sign over the IVs. The sign reads:

I, Dr. Grim,

will kill you if

you touch this IV.

I also added a homemade skull and crossbones, a sign universal enough, apparently, so that even Nigerian nursing students understand what it means.

My seizing patient still has her IV in place. She is sleeping peacefully in her mother's arms. The mother is sitting there pretty much as I left her, bolt upright and wide awake. She looks transfixed by the saline bag and the loop of IV tubing that dangles from it, dripping precious Western medicine into her child's vein. I flick open the baby's eyes, and she shakes herself restlessly, sighs and sleeps on. Normal respiratory pattern, heart rate, pulse. I hold the candle up to her face. It is not the face of the dying child I left, but the face of a sleeping angel.

I turn to look up at the nursing students. “Well, we've saved another life here,” I tell them. Someone translates this into Hausa and there is a nervous murmur of confirmation. They are all so proud of their work.

I hold the candle up and look around. Shadows dance everywhere in its light. I can see the baby's IV tubing more clearly now and see that it is covered with flies. There are flies almost everywhere you look. During the day the constant fanning of the relatives keeps the tent somewhat clear of them, but now, at night, they range free. The woman on the next mat over, unconscious and with no relatives, has a dozen of them feasting at the edges of her closed eyes.

Across the tent I see the policeman's child. His father is chief of the local police bureau. He makes, according to Simon, $20 a month when the government remembers to pay him. This is much too little to be able to take his son to one of the private clinics. I get up and go over there to say hello to his mother. I gaze down at the child for a moment, remembering. He came in sick, very sick. We gave him chloramphenicol and he only got sicker. One evening during rounds I found him, blue-black, scarcely breathing, sweating, as close to death as I had ever seen anything that was still alive. Again I had no way to tell if this was meningitis or malaria or anything else. He had “failed” chloramphenicol, for whatever reason. I could only give him what medicine we had left, ampicillin and chloroquine. But first we had to get an IV in, which turned out to be impossible in this dehydrated, almost prune-like little boy. Simon tried and I tried, over and over. The child lay there dying, and his only hope was for us to get a butterfly needle threaded into one of his hair-sized veins. But we couldn't get anything. Finally one of the senior nurses came by, looked down his nose through his rimless spectacles, cluck-clucked, and knelt down beside me to examine the arm. He got it in, first try.

We gave the child IV ampicillin, and within a few hours his fever broke. Still, when morning came, the child looked deathly ill. His mother spooned teaspoons of water into his mouth, but he didn't move, didn't swallow. The water spilled out along the edges of his lips. Why didn't you just let him die? I thought to myself. Now he's just going to suffer longer.

Suffer. To suffer. Suffering.

That afternoon I stopped by again to see him, and he was making little sipping movements with his lips and actually swallowing the water. His mother sat there, cross-legged, her scarf covering her hair. Her son's head rested in her lap. She was always there, always awake, always watching her boy. A day or two ago he actually opened his eyes and could lift his hand weakly to touch his mother's arm. Earlier today I had come in and found him sitting upright, very precariously, with his stick limbs girdered to give him some balance.

His father, the policeman, had pulled me aside yesterday evening as I was rounding. He held his hands out, cupped, as if he were offering me water.

“Thank you,” he said to me. He was as formal as his freshly pressed uniform. “Thank you, thank you.” That was all, but what else could he say or do?

Tonight the mother is wide awake, with the child sleeping beside her. She sits in dignified silence watching her son. She nods to me as I kneel beside her. I pull my stethoscope out of my bush jacket and press the bell against the child's bare rib cage.

“Breathing good,” I tell her in Hausa. I know a total of four phrases in Hausa. The others are “Getting better, little by little,” “It was Allah's will” and “He's dead.”

Next to the child, though, is an empty space where there was a patient of mine when I left a few hours earlier. It was a young woman tended by her husband. We were treating her for both meningitis and malaria, but I'm not really sure she had either. The ampicillin and the chloramphenicol we poured into her seemed to do nothing. She wasn't very sick to begin with, but she got sicker as the days wore on. For the last two days it was clear she was dying. Her husband never left her. He nursed her with what he had, a little soup, a cool wet rag to her forehead. He would patiently wave away flies for hours at a time. He never asked us for anything; he never seemed to do more than to accept what fate doled out to him. When I tried to explain that I was going to try to treat his wife with IV chloroquine for malaria, he nodded and said nothing. What will be, will be.

I point to the empty space and look at Simon. He shrugs.

That woman was all that man had.

It's late. I check my watch again by candlelight but can't see more than a shadow. Outside, the night is as black as before. I look around for Pierre but he must still be at the measles ward, so I walk up to the pharmacy to try to find something to drink. There is no moon. The trees carry their giant canopy of leaves like great black clouds boiling overhead. The air is close; the wind has died down. There is a touch of dampness in the air. Perfect weather for an epidemic.

I fish out my key to unlock the pharmacy door. Everything here has to be locked up and guarded; the pilfering is unending. There are some Cokes hidden behind a stack of saline bags. I pull one out and root around, candle held high, for the bottle opener. How long has it been since I've used a bottle opener in America? I find it, go back out and sit on the front steps where it's cooler. The stars are all out, all brilliant. Out of habit I search for the Big Dipper, the Little Dipper, Cassiopeia, but nothing I see looks familiar.

Why am I in Nigeria? I wonder this for the hundredth time us I look up at the stars. There is the thin arc of a comet up above one of the trees. The answer is simple burnout. I am here
NO
I won't be there. So I won't be back at home and in the ER. A crisis of faith brought me here to Nigeria. I had been thinking more and more that I might not want to spend the rest of my medical career wide awake at three
A.M.
attending some screaming drunk shackled to the bed while someone in the next bed over vomits copiously into a metal basin. It was beginning to get to me in ways I really didn't understand. Or ways I understood too well. It didn't take a genius to figure it out. The fact is that I have just seen too many cases of child abuse, sexual abuse, assaults, bad mothers and worse fathers, disastrous car wrecks, people dying who shouldn't die, people alive only by some whim of God's. I was turning into someone I didn't recognize, someone I didn't particularly like.

I have, when I go back home, some career decisions before me—a potential for a whole new life. I have been offered a chance to do a completely different kind of medicine. It involves—don't laugh—hair transplants. A friend of mine, a family practice physician, has offered me a partnership in her practice. She specializes in what charitably may be described as boutique medicine. Hair transplants, electrolysis, skin peels, that sort of thing. She is making a fortune as she sits, day in, day out, planting sproutlets of hair onto bald domes. “Just think,” she told me, “no insurance hassles! No nights or weekends or holidays. You even have background music while you work.”

“New Age?” I asked her doubtfully.

“Anything you want,” she told me.

What do I want?

Perched on that step, a warm Coke in my hand, I contemplate an image of myself sitting in a quiet room performing one simple task at a time with pleasant music in the background, surrounded by polite professional nurses, and patients who don't vomit on my shoes. The image seems comforting in a way. I even think of a slogan for myself: “Stop doing good and start doing great!”

Simon appears out of the darkness, looking grim. “There is a child here,” he tells me. “Very, very sick. Could you please come?”

I sigh and get up. Candle aloft, I light my way back down the path following Simon.

In the last tent a father is sitting on a mat with his child in his arms—a boy—maybe seven or eight. I kneel down beside them and lift up the candle in order to see. The child's head lolls back—his eyes are open and glazed yellow from jaundice. I look up and my eyes meet the father's eyes. His expression is unreadable.

I pull the child from his father's lap onto the matted floor. Automatically I reach for the IVs I keep in my bush jacket pocket. An 18-gauge is all I can find. I need something smaller. The child lies motionless; his matchstick limbs collapse away from him, completely flaccid. His face is sunken, hollow. He is clearly septic and desperately dehydrated.

“Simon,” I whisper fiercely. “Quick, quick, get me some IVs and some ampicillin.” Simon stays rooted to his spot, though, staring down at the child. I look again and then grope for a pulse. I try the wrist but there is nothing there. I fumble, trying to feel for the carotid.

Nothing. The child is dead.

“I see,” I say to Simon, who must have known before I did. “Never mind.”

Simon kneels to tell the father. The father looks down at the child. He hasn't known before this either, I realize. There was still hope. Now the hope is gone.

“How long has he been here?” I ask Simon fiercely.

“Since just after you left for dinner.”

I thump the ground before the child. “Was the child alive when they got here?”

Simon leans over and speaks to the father softly in Hausa. They stop. Simon shrugs. “The father says, yes, he was alive.”

“When did this child die?” It suddenly seemed important to know. I glance at my watch. It is now eleven and I left at six
P.M.
The father must have been here almost five hours, and during that time his son died in his arms here while he waited for the doctor. Would he have held his son in his arms until morning if I hadn't been here to round? How many hours had he been protecting something no longer his child but a corpse?