Thursday, August 30, 2012
Or rather, 2 cockroaches -the biggest most horrendous walking-fig-look-alike-with-horrid-spin- tentacle cockroaches - ghastly legs and other dreadful appendages included, they were each about the size of a guinea hen egg.
I don't think I can adequately describe how much I abhor cockroaches.
There are no words to express my fear and revulsion.
When I got here, I listed "to kill a cockroach" as an item on my Tchadian bucket list.
And, well, I see now that that is simply unrealistic and have no problem leaving that misguided wish blissfully unfulfilled.
So, i had grabbed my bag of shower stuff and was headed out the door and to the shower - and it all happened so fast - but in between screams i saw one fall from my hand that was holding my bag onto the floor - and then of course I threw everything i was carrying and a second evil one crawled out from under my towel.
I turned and ran as fast as I could into the night and then from the shadows frantically called the pharmacist to come and kill them.
He proceeded to laugh hysterically, call me a child, which I heartily agreed to being in that moment, and grab the wretched insect by one of its graspy moving legs and started walking towards me, refusing to kill it no matter how emphatically i insisted that death was the only acceptable fate.
I am still shuddering all over just thinking about it.
So then i gather up the courage to actually touch my shower stuff again (this took a jumpy and tentative serious of maneuvers in which the pharmacist was required to heavily assist me) and headed for the shower.
I was just ready to get in the shower when i see.... a frog
and then i look up and see.....a bat
And that was it.
The switch was flipped.
and I decided I was ready to go.
When I related this story to Bronwyn, who, incidentally, found a COW in her house yesterday, she decided the the God of the little things had sent the cockroaches to help me start on the path of being okay about leaving.
While I don't necessarily subscribe to this theory ( if God cares about the little things, maybe he could save a few kids while he's tucking cockroaches in next to my conditioner), it is true that since the cockroach incident I have stopped moping around and decided that I want to leave.
And then yesterday I received 2 lovely emails from my brother Daniel and my friend David who are both free spirits that are on the road right now - and it reminded me about wanderlust, and how I am a gypsy at heart, and I felt the tug of the open road calling me, and I started feeling excited about my next dive into the unknown.
because of course I can't stay. I am not yet at the point where I can do that - I have too many dreams that have yet to be freed - and even though it is bitter to leave I have to embrace the intoxicating sweet of being a tumbleweed.
If I had never left TN I would not have fallen in love with this place and people - and it is because of this that I must leave again - because there is a vast expanse of rich experience and relationships awaiting me if I can only find the courage to open my heart and take risks - and one day I will be able to look back and say....If I had never left Tchad I would not have.........
I cannot complain because this is the life I have chosen - this is the life that calls to me.
Maybe some day I will stop dancing with the wind, but that time has not yet come, today is not that day, so instead I'll follow the invisible forces that are tugging at my soul - persistently turning my face to new sunrises and northbound blacktop, calm only when my feet begin to wander.
So I'm headed across country to the last frontier - to a tiny town at the end of a road, a dot on the shores of a bay.
I hope there aren't any cockroaches in Alaska.
Wednesday, August 29, 2012
Saturday, August 25, 2012
I know I can't stay.
But how I am supposed to leave?
Today I had the most wonderful day with the most wonderful friend.
We just took the day off from the chaos and the countdown - went out into the bush and lay under a tree, our own cool green pocket of peace and solitude, an oasis in the frantic grab for survival, a pause in the tick of time.
Surround twitter of birdsound and the sun was slanting and rippling through the leaves. Looking up and tracing the intricate tangle of the vines curling around the rough everbranching twigs.
We listened to Nickel Creek and talked about life, love, death, and the color and detail and awe of the present moment - the goosebump tiny splashes of laughter and detail that rest lightly, briefly in the palm like an iridescent bubble blown from the fat grinning wild lips of childhood.
We ate homemade chocolate pudding cake, sopping the perfect sponge of cocoa with the rich tan of condensed milk from the can, dipped perfectly crisped bits of toasted bread into the zesty spice of fresh tomato, pepper, and onion salsa, dripping red and heaping next to slathers of mashed avocado lime guacomole.
We read poetry and ate almonds and watched as the sun slipped its circle around us.
spontaneous, we wanted to go swimming in the river.
There is wide-spread flooding - 7 villages are underwater - but we decided to go swimming anyway.
We set out for the river - both somehow believing we would make it there (this is the kind of friend that I can believe something like that with), that we would find a path that led there, and that we be able to swim when we got there.
We set off charging through the sand - and halfway to the river - we met....the river. We stopped. We considered.
We could have turned back
but we didn't.
Instead - we rolled up our pants above our knees and waded in - we were going to the river. We were going swimming.
We waded out through what used to be the road, past drowning cornfields and trees whose branches brushed a slight ripple onto the tip of the vast expanse of water, the tiny waves sloshing around our knees and bleeding into the blues and purples floating fabric.
We could have turned back -
but we didn't
About 1 km later - the water was waist high - there was a break in the path - we were surrounded by the tops of bushes and the contrasting half forms of bold and twisted trees - and we could look across the lake of what used to be a field.
The sky turned a brilliant golden grey roil of fluid puffing glory, and we just stopped.
We watched, breathless, and then we went swimming.
We set the backpack and our shoes on the top of the nearest tree and sank down into the murk resting our chins on the surface, sitting on the bottom of the path.
The yellow green of the cornstalk were perfectly mirrored in shimmering reflection, the clouds were zizag and fluid and watery upside down - the gnarled trees trembling stalwart in the breeze, staring back at themselves
It was placid, beautiful, like we had glided into the fairy jungle of another world.
There is power and solace and danger in the water.
Water unlocks something in the bedrock of the soul that nothing else can.
Water is a voyager too - the first and the last to rip its canyons through the walls of time,
It has a constancy, an eternity, an agelessness, like the water that in the beginning formed the wave capped surface of the deep is the same that spilled over the banks of the Bere river, that goes downstream laughing and snaking in its current, splashing like raindrops back into our wind-chapped faces.
There is something about water that takes carries you away as it leads you home.
Something about its current that grounds you.
Something enveloping, and wistful, and free.
We could have turned back,
but we didn't.
We watched the grey in the clouds deepen and the brilliance of the gold begin to reflect a silvered hint of pink and everything about it was brilliant and glory and indescribable.
I lifted my arms high into the sky and i felt reverence and gratitude and wonder, wading back dripping and soaking and peaceful and wild and free and barefoot, the sand and stray grass of the path cool and forbidden beneath my toes
the edge of the water turning to the slime of mud, a rippling voice singing sad and strong from the bush, the glutted stare of a bullfrog, and the sky, the sky, the kind of sky that held a rainbow of grey in its fleeting smile.
we could have turned back
but we didn't.
moments such as these are rare in this lifetime
friends like these are rarer still.
a friend that, in so many ways,
could have turned back.
so tell me,
how am I supposed to turn my back
how am I supposed to leave?
Monday, August 20, 2012
And today - it was her first baby - but the contractions became farther and fewer between, there was meconium, and the baby was delivered with the chord wrapped tightly around its neck - no heart beat.
Danae breathing for her - tiny white grey fingers, I'm doing CPR with middle and index finger - listening, straining, what that a heartbeat, or did we just want there to be one.
Making little inky footprints and rolling them onto crisp white paper - wrapping her in the orange and maroon flowered cloth that had been brought to bring her home in - the mother hemorrhaging afterward - her groaning and rolling with pain as Bikaou scrapes the clots from her uterus with gloved hands - the uterus that wasn't contracting properly.
Having a baby here means you are risking your life.
if you knew there was a 1 in 8 chance you would die if you walked to the mailbox this morning, would you go get the mail anyway?
This country has one of the highest infant and maternal mortality rates in the world.
The happiest moment in her life becomes the saddest.
And then the man, i would have liked to take a baseball bat to his skull - his wife had had 8 pregnancies already - by that time her uterus is tired, she is much more susceptible to complications and to dying in child birth.
He had four wives.
He refused to let her go on birth control.
She said she was tired. "its God who gives children, its God who decides." he said, fat, grinning,
"it is not your right to say you are tired."
and there it is.
The reason why every time you get pregnant there is a reasonable chance you or the child will die.
The reason why there is little child spacing and so much malnutrition.
The reason that 1 in 5 little ones never make it past childhood.
because here, if you are a woman, you don't have any rights - not to your child, not to your future, not to your own body.
"its not your right to say you are tired"
I have been interviewing men and women here for the past 5 months.
this is not just a passing sentiment - it completely encapsulates the prevailing attitude.
Women are valuable because they give children.
If they have no children - or stop having children,
Then they are nothing.
If there is a divorce, a separation, or a violent grey area in between - the man will always get the children.
Even if he beat his wife with a rock and bit her in 8 places and left her bruised and bleeding to die, he still has a right to the child after they turn 7.
Why isn't it her right to be tired?
Because he payed the dowry.
Because he bought her.
Because her purpose is to deliver children.
Because he wants to be replaced.
it is not her right to say she is tired.
What is death?
How does it actually happen?
Physiologically - the heart beats its last. The lungs gasp one more time. The tiny cells shut down one by one. No more ATP, no more oxygen, and then they die.
Do they die like dominoes?
Or layer upon layer?
Or all at once?
We are just cells anyway - packed into organs and stretched into skin and curving into smiles across the lips and sagging blue under the eyes.
- and there is the shadowy part of death, the part when the soul leaves.
- but if there is a soul - where does it live? in what tangle of dendrites or burst of heartblood or deep twist of gut?
Which cells lodge love? passion? hatred?
Where does it go, when it slips away, what happens to that entire catalog of smiles and laughter and memories and colors and dreams and wishes and small grinning secret things?
Everything that made that person a person - their everything that slips away with that last breath,
where does it go?
Is the soul really just an intricate series of neuronal pathways?
Can you really pack the sum of a person into a mass of dying cells?
Here, they want to keep the soul with the body.
Here, the soul is separate. Even in life.
Here, a woman will run barefoot and screaming for 14 kilometers, to the most powerful traditional healer, desperate to get her soul back.
She will fall shaking on the ground because the shaman whose child was suffering in the bed next to hers took her soul with him when he left - all because she didn't eat with him when he invited her. She will throw herself down wild and inconsolable clawing the earth with cracking fingernails.
Here, losing your soul is worse than death.
Here, you must not lose your soul to death.
Here, in the moments before, in those vague and misty seconds between vibrant being and decomposition, the mothers will press their thumbs tightly over the eyelids, pushing them shut, pulling the jaw upwards towards the teeth - keeping the soul inside.
Here, they will sometimes press crunch and smother before they are even dead.
Here, i have to rip their hands away from the eyelids, open up the airway, tell them, le coeur n'est pas arreter. Votre enfant vie encore.
Here, they often know before I do - the minutes before they take their last breathe - the tears slip faster down the high tribally scarred cheekbones, the hand covers the face, and somewhere between telling them we aren't done trying, the gaze locks into nothing and the eyelight melts into another world.
It surrounds us here.
so much so that we barely notice it
so much so that we can joke about it
so much so that it keeps us awake at night
so much so that it blurs our vision
so much so that its just another day
Today was just another day for me,
but today was also someone else's last day.
although i hold the intricate lace of binds the breathe to the body in my hands every day -
although Minnie's heart stopped beating under our hands just over a week ago -
although I fought for and lost many in Pediatrics -
although I know one day I too will die -
I still cannot stretch my mind far enough around it -
I still cannot reach far enough or contort my thoughts or twist my heart into a lens that would give me any vision or understanding.
Although I have been surrounded by it -
I am no closer to understanding how a heart stops beating.
I am no closer to understanding how stacks of grinning souls could have been a crowd of frightened and desperate people,
how piles of shoes could have had feet to fill them,
how the children struck down by malaria melt away into memories - silent, leaving not so much as a footprint,
or if the soul flies away on the wings of last breath,
or if forcing the eyes shut can keep it with the body,
or if there is any such thing as a soul at all,
how we cross that thin invisible divide between loved and loving and worm food.
What is death?
How does it actually happen?
There are some things you just aren't supposed to do.
There are some things that are unprecedented, uninvited, unmapped.
There are some things that are still firsts in the vast millenia of repeated epiphanies.
There are some things you aren't supposed to prepare yourself for.
There are some things you shouldn't have to make sense of afterward.
If you are Julie:
You aren't supposed to find your friend unconscious, unresponsive.
You aren't supposed to go running across the ragged soccer field to get the nurse, purple skirt flying in the wind behind you.
You aren't supposed to try to wake Minnie up - to shake her - to scream her name - to feel the mounting panic when she doesn't open her eyes.
You aren't supposed to learn to take her vitals and spend sleepless vigils with the nurse - anxiously monitoring blood pressure and counting respirations on for a full minute from your phone.
You aren't supposed to see the one person that was nicest to you - the person that cooked for and with you every warm village evening - the person that you always went to the nutrition
center with - the person that never failed to ask you if you were okay, that always cared about the response - to see that person looking through you, not understanding that you are there any more, not knowing how badly your heart is tearing.
You aren't supposed to be called in at 10:30 pm from an exhausting day of worrying - the nurse on the other end of the line explaining how she needed to go pack up her hut, and could you just come in for 2 hours?
You aren't supposed to get up out of bed when you barely went to sleep, already sick and exhausted.
You aren't supposed to be told - "I'll be right back - if she starts seizing - just call me and I'll run back and give diazepam."
You aren't supposed to be left with a message like that.
You aren't supposed to be left alone in that room without a nurse there too.
You aren't supposed to be left to take and interpret the vitals by yourself when you are a nutritionist - when you don't have experience with critical care.
You aren't supposed to be told, "she is sleeping - we just turned her so she should be comfortable there for 2 hours," and then see the door shut leaving you alone.
You aren't supposed to go over to the bed, puzzled, realizing that the breathing was deeper, more irregular, feeling mounting dread as you stand there and count respirations.
You aren't supposed to see that its only 10 per minute instead of the usual 20.
You aren't supposed to frantically dial the number of the nurse, you aren't supposed to say "You need to get back here - she isn't breathing well."
You aren't supposed to stand there - taking vital signs because you don't know what else to do - watching the breathing slow and become more labored, wishing you understood, wishing you could stop it, wishing that door would open and you wouldn't be alone anymore.
You aren't supposed to watch helplessly, hysterically, as the breathing grew more ragged, until the door burst open, and the events started spiraling blurmotion out of control.
You aren't supposed to hold the IV fluid up high, to become the IV pole so the lines would reach the floor.
You aren't supposed to wish you could do more, wish you knew what to do, wonder if you had done everything or anything right those past 10 minutes.
If you are Bronwyn:
You aren't supposed to lose the best friend that you had in Tchad - the only other long-termer - the only other one that wasn't going to leave after putting in their year.
You aren't supposed to lose the person that understood you on the level that doesn't need words.
You aren't supposed to be worried and frazzled and already over-worked, scrambling for someone to work your shifts so you could spend extra time with Minnie.
You aren't supposed to lean over her and pray with her and give her the kind of support that none of the rest of us could offer.
You aren't supposed to decide whether or not you can accompany Minnie to Nairobi, whether or not you are the best person for that.
You aren't supposed to be asked to pack up her entire world before the life-flight.
You aren't supposed to run back and find her dying - to listen to her heart and hear nothing.
You aren't supposed to kneel over her, crying and pleading, breathe Minnie, breathe.
You aren't supposed to press your lips to Minnie's, firmly and fervently giving everything you have in your lungs.
You aren't supposed to taste the death of your best friend.
You aren't supposed to be the one who starts CPR on your best friend.
You aren't supposed to feel her ribs cracking beneath your hands.
You aren't supposed to keep pushing, over and over, a perfect rhythmic cadence of love grit and endurance.
You aren't supposed to be the one that stops CPR.
You aren't supposed to feel the Doctor's hands over yours, gently telling you that that was the last push.
You aren't supposed to pick out Minnie's best outfit, and make her look beautiful, and brush her hair away from her face.
You aren't supposed to lay the same Bible that you read to her hours earlier on her chest.
You aren't supposed to leave her there, to walk away, to have to snap into action borne of no other recourse and be the one to lead the others in organizing her belongings.
You aren't supposed to fly with Minnie to NDJ - to because of space spend the flight with her feet in your lap - to be told to be prepared if they shifted slightly in your hands due to the elevation.
You aren't supposed to be expected to carry on as if none of this ever happened.
You aren't supposed to feel more alone than you ever have in your life.
You aren't supposed to realize that the one person you want to talk to about all of this isn't here anymore.
If you are Marci:
You aren't supposed to bathe your colleague.
You aren't supposed to be the one that helps the nurse wash her with warm pleasantly steaming water from Tammy's kitchen.
You aren't supposed to be the only other one that worked as a CNA which therefore makes you the most qualified.
You aren't supposed to help turn Minnie every 2 hours - placing folded swaths of sleeping bag behind her back and gently floating her heels off pillows.
You aren't supposed to wash her after death - to remove the IVs and gently scrub the blood away.
You aren't supposed to fold the plastic over her, taking a corner and lifting her into the plane.
You aren't supposed to be the strong one when your friends are completely falling apart around you.
You aren't supposed to have to store Minnie's things in your office - to walk around them, trip over them, and work among them until one day you feel like you can sort and organize.
You aren't supposed to have to organize her funeral in the church.
You aren't supposed to have make the slide show for her funeral - to pull pictures off yours and everyone else's computers and pick a song to play she would have loved.
You aren't supposed to have tell the community what happened, to have to field questions when everyone wonders why you partner in Project 21 isn't coming out to the village anymore.
You aren't supposed to smile and shake hands and explain over and over and over the same circumstances.
You aren't supposed to have that burden fall completely on you when all you want to do is talk to no one.
You aren't supposed to receive a delegation of chieftains in the church - all coming to say I'm sorry - to say how much Minnie meant to them.
You aren't supposed to not be able to pause or rest but instead continue on with Project 21 - the huge public health initiative for the district of Bere that was originally inspired by Minnie.
If you are Olen:
You aren't supposed to be the Doctor for your friend.
You aren't supposed to be at home sick with malaria - get up to answer the knock on the door, and hear through the quinine-induced ringing in your ears that the volunteer you are already treating with the strongest and best malaria medicine was just found unconscious.
You aren't supposed to have to mentally tick through the options of what could be causing the coma - and realize that since its not hypoglycemia her malaria is now cerebral.
You aren't supposed to be the first one to really comprehend the seriousness of the situation - because you know what the others don't - that once an adult's malaria goes cerebral they rarely ever come back intact.
You aren't supposed to rack your brain and search your medical books and literature for anything that might offer an improved prognosis.
You aren't supposed to be solely responsible the whole hospital, responsible for the health of all the volunteers, responsible for all the current projects, responsible for keeping your family safe and intact, responsible for maintaining the reputation of the mission both locally and globally
You aren't supposed to try to make yourself be objective - to focus on the fact that you are the doctor and this is your patient - despite the fact that this is not your patient, this is your friend, this is your volunteer, this is the person you have lived and worked with for over a year.
You aren't supposed to have a sick volunteer in a hospital in the middle of one of the poorest countries in the world, in a hospital that has no oxygen, that has no ventilator, that has no local nurses trained to provide critical care or life support.
You aren't supposed to be unable transfer her to the ICU, or consult with Infection Disease, or to share the decisions about her care with a group of your colleagues.
You aren't supposed to have the decision about where she goes when she is life-flighted out of your hands - despite the fact that you are responsible, despite the fact that you understand through experience what the "experts" do not - that IV quinine may be the only medicine strong enough to save her life - that the falciparum strain endemic to this area often only responds to IV quinine although the literature suggests otherwise - that if she goes to Europe or America, they will not give her quinine.
You aren't supposed to know that her best chance for survival may in fact be in your hospital - yet with the impossible flip side that your hospital also cannot provide sustained life support.
You aren't supposed to give clear orders to the nurse and know that even though it isn't enough, there is nothing more to be done.
You aren't supposed to have to call her brother - to tell him that his sister is gravely ill - to have to be the one to explain to a desperate family the particulars of her illness.
You aren't supposed to have to be the one with all the answers, the one that has to be strong for everyone else.
You aren't supposed to spend the entire day and evening on the phone with family members and medical evacuation insurance companies and interruptions and then finally fall exhausted into bed.
You aren't supposed to be woken up minutes later by frantic and desperate phone call from your nurse - telling you that Minnie's 02sat is in the 40's and falling, telling you to come now.
You aren't supposed to run through the night towards this surreal situation - knowing better than anyone else the odds rapidly stacking up against her survival - yet deciding to fight with all you have no matter what.
You aren't supposed to arrive to see CPR already being started on the floor, to have to instantly transition into ER doctor mode, to clinically distance yourself despite the fact that everything about this situation is personal.
You aren't supposed to be the Doctor running the code on your friend.
You aren't supposed to have to be the rock, to be the calm one.
You aren't supposed to have a code team that is wearing pajamas instead of scrubs.
You aren't supposed to look around at all the faces of the ex-pats and realize that you have to keep this code going just as much for them as for Minnie.
You aren't supposed to run the code from the head of the patient while being completely responsible for her airway, not having Respiratory Therapy there to take over for you.
You aren't supposed to see the minute hand wind its way around the clock - to realize that even after 3 ampules of Atropine, 9 ampules of Epi, after re-starting her heart twice and losing it twice, after dextrose and mannitol and an epi drip and another line and suction and strong perfect CPR, that your monitor still showed Asystole.
You aren't supposed to have to say "Give one more amp of Epi - we will continue CPR and respirations for 2 more minutes."
You aren't supposed to have to say "‘Unless anybody has any other ideas or any objections, we’re stopping."
You aren't supposed to be the Doctor telling a roomful of your friends to stop the code on their friend.
You aren't supposed to have to say "12:45, time of death."
You aren't supposed to have run a code for a full hour exactly.
You aren't supposed to have to call Minnie's family to tell them that their loved one is dead.
You aren't supposed to immediately have to start working on all the arrangements for repatriation without having time to process any of it.
You aren't supposed to go back after her sunrise funeral and have to see a hospital full of patients.
You aren't supposed to be the one that has to be there for your volunteers, for a hospital staff and grieving community of Tchadians, for your friends, for your family, while having to work just as hard as before with no option of a break.
You aren't supposed to have been the Doctor for your friend.
There are some things that just aren't supposed to happen.
There are some things you just aren't supposed to do.
If you are Janna:
You aren't supposed to be the nurse for your friend.
You aren't supposed to be be medically responsible for the life of someone you are close to.
You aren't supposed to say goodbye in the morning, after a night of checking the quinine drip and making her promise to tell you if she needed anything, to tell her Julie would be by every hour, to make her promise to keep sipping the guava juice, not realizing its the last conversation you would ever have.
You aren't supposed to see Julie running towards you - feeling something old and cold in the pit of your stomach when you learn that Minnie slipped into a coma.
You aren't supposed to interrupt a surgery in the OR to tell Danae that the patient isn't responding.
You aren't supposed to call them a patient when its really your friend.
You aren't supposed to give a sternal rub that barely elicits a response - to quickly take the vitals - to order a hemoglobin and glucose test - to realize with a sinking dread that the coma isn't due to hypoglycemia because the blood sugar is 201 and not below 60, that this is probably cerebral malaria.
You aren't supposed to find Olen coming in already, to tell him rapid-fire the vitals and what has already been done - to watch as he tries to get her to wake up - respond to painful stimulus.
You aren't supposed to realize that you are completely out of your element yet it is you who is the most qualified of the nurses to be with her.
You aren't supposed to realize she needs the best care and that has to come from you because there is no one else who has even remotely worked in critical care.
You aren't supposed to start one hour vitals just because you don't know what else to do.
You aren't supposed to look up from the mat on the floor, to see the muscles contracting, to go over to the bed, to try decide if she is seizing, posturing, or are her muscles just contracting?
You aren't supposed to give diazepam 13 times in one night - dancing the delicate line between stopping her seizures and not compromising respirations.
You aren't supposed to turn your friend on her side so she wouldn't aspirate because she was too weak to vomit - to kick everyone out of the room to put an NGT in, to see the forest green serous bile slowly snaking down the tubing and into the bag.
You aren't supposed to be trusted this much - to try to be worthy of that trust by taking accurate I/O's, hourly vitals, replacing ml for ml the NGT output, counting and analyzing trends.
You aren't supposed to run a mini ICU in the same room where rats run in and out at night and mosquitoes clings to the walls with nurses who think code blue is a color
You aren't supposed to wonder why you don't try this hard for everybody.
You aren't supposed to leave your patient.
You aren't supposed to leave her to pack up her hut in preparation for a life-flight to Nairobi - to listen to Minnie's lungs multiple times before you left, to look at that last set of vitals, to decide that she was resting and was stable.
You aren't supposed to get a call saying that 10 minutes after you decided that, that the breathing had changed.
You aren't supposed to run into the room, to see that the person you have known your entire year here has stopped breathing, to take the 02 sat and realize its 47%, to frantically dial the doctor, to tell him to get here now.
You aren't supposed to see your friend as your patient - to realize that the patient's heart stopped beating
You aren't supposed to throw Minnie on the floor because there isn't a backboard for good compressions - to start Bronwyn and Julie on CPR - to run barefoot to the pharmacy for the Mannitol and Dextrose Olen ordered, to run back and see your friend Bronwyn doing mouth to mouth on Minnie - her best friend here.
You aren't supposed to feel hysterical and responsible and shaking all over.
You aren't supposed to have to be told by the doctor who walked into the scene to calm down, that rushing won't help Minnie.
You aren't supposed to call Danae and tell her - Olen says run to the OR now and set up suction, we are coding Minnie.
You aren't supposed to start coding your friend
You aren't supposed to see strong and perfect chest compressions being done as sweat and tears rolled off Jamie and Marci and Bronwyn's faces.
You aren't supposed to have to give Epi and Atropine to your friend the first time you have ever done it - raising her arm every time because you vaguely remember that's how you did it when you took ACLS.
You aren't supposed to realize that you forgot ACLS.
You aren't supposed to be one of 9 expats in an OR room in the middle of the night in Tchad, Africa, being part of a desperate, determined, loving breaking, unbelievably competent team of your friends, all trying in their own way and in their own role to do every single thing possible.
You aren't supposed to see the flat line of Asystole, to desperately hope to get the heart back - to watch the numbers on the screen, mentally hoping and screaming and praying for them to stabilize.
You aren't supposed to hear the warm calm voice of Olen, cutting through the fog - "we will continue for 2 more minutes."
You aren't supposed to give that last Epi.
You aren't supposed to see that last chest compression.
You aren't supposed to stop coding your friend.
You aren't supposed to ever stop.
You aren't supposed to look at the clock on the wall and see that it has been a full hour - and that now it is over.
You aren't supposed to walk out of the room, jaw set, grim and blind with the guilt crushing you and pinning you against a wall of nothingness
You aren't supposed to ignore the doctors when they tell you you are a good nurse, to walk right past them into the night, telling yourself that it isn't true.
You aren't supposed to be hit with a parade of crystal clear moments - clear points where you can see in hindsight all the things you could of done, should have done, must have missed.
You aren't supposed to break down walking in aimless circles, believing that you were that last person on earth that should have been trusted to take care of her.
You aren't supposed to feel like you betrayed everyone at the exact time when it mattered the most.
You aren't supposed to not be able to help the others prepare her body.
You aren't supposed to have three hours to with your friends sort, organize, and clean her hut, to make snap decisions about what goes and what stays, to be in the position of wondering what would the family want to have, what would Minnie have wanted to leave behind, who would she wanted to have left it to.
You aren't supposed to roll and tuck and place someone's entire life into suitcases and snap them shut.
You aren't supposed to make public the cherished belongings of the most private person you know.
You aren't supposed to find bump along the rugged road to Bendele, splashing over puddles, Minnie in the back, alive in the front.
You aren't supposed to sing hymns at sunrise, breaking down because you want to slap every hopeful joyous note in the face.
You aren't supposed to watch your friend being lovingly wrapped in plastic and placed in a tiny airplane.
You aren't supposed to watch that airplane fly away and then keep looking at the sky seeing only puffy unconcerned clouds - clouds that say they don't know when you ask them where God is.
You aren't supposed to have to write to your friends, past and present volunteers, telling what they no doubt have already been hearing, that Minnie is dead.
You aren't supposed to try to wrap your mind around the surreal and horrific events of the last 12 hours.
You aren't supposed to live in a world where something as simple and preventable as malaria could take the life of a warm and loving person who had so much left to give.
You aren't supposed to spend the day curled up in the dental chair - surrounded by piles and boxes of Minnie's things - unable to move or think or function or sleep or imagine a time when you won't feel as completely wrecked as you do right now.
You aren't supposed to wake up at 10:30 pm in Tammy Parker's house - and start crying hysterically because it was dark and Marci and Julie had left you, and you didn't know where they were, and you didn't know what to do.
You aren't supposed to let Marci sleep on her floor because you can't spend the night alone.
You aren't supposed to spend the next week replaying the last 2 hours of her life and your role in it over and over and over again.
You aren't supposed to keep playing this movie every waking moment, crushed by the guilt of supposed hindsight, tears spilling out of your eyes feeling that you never should have been so completely trusted, that you never should have left that room.
You aren't supposed to feel professionally devastated, to wonder if you can even trust your own gut anymore, to wonder if you should even be a nurse, to wonder if you can ever be confident in your abilities again.
You aren't supposed to feel this guilty about something that wasn't your fault.
You aren't supposed to skip work the next day, not telling anyone you weren't coming in, just because you couldn't do it.
You aren't supposed to spend the day instead "death-proofing" your hut, your computer, your journal - sluggishly arranging and writing and encrypting and cleaning so just in case are gored by a bull or don't come back one day no one will wonder what to do with the remnants of your life.
You aren't supposed to see your friend wake up - a wild look in her eyes - saying, "do you want me to take one hour vitals? Where is Minnie?"
You aren't supposed to go back to work the day after - to be expected to do just as much work as before - yet to feel completely weary and uncaring.
You aren't supposed to see everyone cracking around you - to see the various stages of grief and anger and numbness and denial and try to find something to say that means anything at all.
You aren't supposed to make this about you when you are the one still living and breathing and loving.
You aren't supposed to to wake up one day and realize that you are okay, that weeks later the guilt has subsided and the sun still shines and children still smile and jump up and down and scream "Nasara! Lapia!" in squealing frantic little voices.
You aren't supposed to write a blog like this.
You aren't supposed to post it.
You aren't supposed to have been the nurse for your friend.
There are some things that just aren't supposed to happen.
There are some things you just aren't supposed to do.
If you are her family:
You aren't supposed to have to read this about the person that you love and cherish.
There are some things that just aren't supposed to happen.
There are some things you just aren't supposed to do.
**Photo: Janna, Bronwyn, Minnie
Monday, August 13, 2012
nothing like retail therapy in the form of deep fried "haricots" (ground black eyed peas, garlic, onion, spices, pepper - dropped into sizzling oil over the glowing coals - magical consistency of chicken nuggets) and cold slender bottles of mango puree.
Bria makes me happy.
Here, when happy comes, we hold it tightly in our fists, letting the magic dust of the present moment fall glittering from our hands - and when the smiles come - we let them split our faces.
This one lived.
because this one lived!
Friday, August 10, 2012
Thursday, August 9, 2012
fact that as far as you can see, in any direction, is just a waving
green expanse of grass, bush, and
wind of my face
green under my eyes
this is real
I am in Africa
I just saw giraffes
I am living a dream
Myself and Julie Andersen, Marci's sister-in-law who holds Master's in Nutrition and Public Health from Loma Linda, got to go. We have spent the last 2 days in Am Timan, observing the malnutrition center and outreach program that MSF is running here in eastern Chad. The malnutrition rates are 3% in this area (and also in Bere I suspect if we did surveys). We got to observe their outreach program, watch rounds on the pediatrics ward, access all their protocols, and learn all kinds of valuable and life-saving information that Wendy and Julie can use as they start the center.
For myself, well, I think I got to go because it is no secret that my dearest with is to work with MSF (Doctor's Without Borders) one day. I think people were tired of hearing me talk about it and thought this just might shut me up! Its my life's dream and kind of the reason I came to Tchad - that, and seeing James' original documentary about the hospital here. So, it has been such a wonderful and rare privilege to be able to see their work first hand, meet the team at Am Timan, and I have gone away both daunted and encouraged but also with overwhelming clarity that this is indeed the organization that I want to work for.
Then In between flying to Am Timan we have had the awesome and rare opportunty of staying at Zakouma National Park. The amount of animals here both rivals and exceeds those of the more well-known game parks in Kenya and Tanzania. Unfortunately, it is the rainy season here - so the animals are dispersed and many not even in the park. During the dry season, the only source of water is in the park so the concentration and variety of animals is said to be truly rare and breathtaking. It is logistically challenging and expensive to get here so I cannot express how lucky and blessed I feel to have this opportunity.
So far, we have seen giraffe's twice - a large "herd" (i don't know the proper giraffe group-age expression), then later today saw three magnificent giraffes running. They are glorious and although lanky were wild and graceful, galloping over the grasslands as Gary kept circling the plane. Seeing that was one of the most breath-taking and glorious things I have ever seen - their orange/brown and white spotted coats was shinning in the sun, contrasting with the lush tall brilliantly green grass - they were so beautiful and free.
We saw a herd of male elephants that has been hanging out near the park - it is reportedly the older ones that have been kicked out of the larger herd. Zakouma used to have the largest number of elephants in the world, but now their numbers are dwindling because of poachers, many of whom come in from Sudan or surprisingly enterprising Chinese businessmen who supply the poachers with guns in return for the ivory. There is currently a large-scale conservation project underway at the park and many of the elephants wear tracking collars.
We saw ostriches, water buffalo, gazelles, wart hogs, and various birds.
Tomorrow at sunrise we are going to fly around more and continue the search. Gary has been so amazing about taking the time to try to let us experience the park. I have my fingers crossed for a lion.
I am laying under a much-needed bug net as the insects here are fierce, unsympathetic, large, frantic, and determined. I am enjoying the fastest internet I've ever had in Tchad, drinking water that is actually ice cold and am lodged in a cute little round hut with pink trim decorated with copious amounts of slimy clinging slugs.
I am grateful to be away from the madness and surrounded by so much natural beauty and splendor.
there is freedom with the wild things
surrounding Minnie's death. He has said it far better than I ever
could. To read this blog on his site and the many other fascinating
blogs click on the link I have on the left page of my site. Their blog
is http://missionarydoctors.blogspot.com. Olen is a fantastic writer
and presents a raw, clear, funny, hopeful, searing, and honest portrayal
of their life as the sole doctors at Bere Adventist Hospital.
Thank you to everyone for your prayers, emails of encouragement, and for
letting us know you are here for us, even if it from thousands of miles
Minnie continues to be missed and remembered.
Tuesday, August 7, 2012
One of the volunteers here, Minnie Pardillo, died Sunday morning at
12:45 AM from cerebral malaria.
From every avenue and angle - everything possible was done by everyone
involved to save her life.
Her death is surreal, shocking, horrifying, senseless.
There are no words.
Yet a thousand pages would not be enough to fully express everything I
I was the nurse primarily taking care of her.
I am professionally devastated.
Everyone here is trying to grapple with this and its ramifications in
their own way.
Don't ask us if we are okay because none of us are.
I'm not doing okay.
Not in any way, not even a little bit.
I have never felt as completely wrecked as I do right now.
I feel like all my strength, willpower, passion, love, and endurance has
been emptied onto the dirt and that I'm just sitting there staring at mud.
Myself and everyone here could use your non-judgmental love, support,
encouragement, and prayers.
Minnie was a rare individual in that she was genuine and pure in her
passion for people, and she was dedicated to serving her God no matter
the cost to herself.
She was loving and and kind and steadfast in what she believed to be her
calling - to follow her Jesus no matter where he led her - and to
unselfishly share that Jesus.
She radiated peace, joy, and love and saw people as individuals -
demonstrating in countless ways how much she cared about them personally.
She cared deeply for the Tchadian people, and they for her. She always
I would like to extend my sincere condolences to her family. Please
know that many people's lives were changed and their suffering was
lessened simply because her path merged with theirs.
If there ever was a child of God - this was one.
To quote my friend Cristin: "...she truly believed she was fulfilling
her purpose in life, and that is more than most of us ever achieve."
Thursday, August 2, 2012
Life now, is, well, life as normal now.
Its normal to have no electricity after dark
Its normal to shower with buckets
Its normal to pee behind trees at night because the latrine is crawling with cockroaches
Its normal to walk to work, dodging barefoot boys driving long horned cattle
Its normal to sit on the ground more than a chair
Its normal to eat rice with my hands
Its normal to speak in French
Its normal to wait 2 hours for an "urgent" blood transfusion
Its normal to get malaria
Its normal to always have something wrong - so much so you barely notice it
Its normal to pause every night to look in awe at the stars
its normal to boil water over an open fire
Its normal to sleep every night on a little back packing mat that always deflates by morning
Its normal to wear clothing with holes in it
Its normal to go without showering
Its normal to walk around barefoot
its normal to wear the same clothes 3 days in a row
its normal to be soaked in sweat
Its normal that you taxi is always a motorcycle
Its normal to pass the time without entertainment, just talking
its normal to greet everyone with a handshake, to ask about their family, an mean it
this is life now. I don't find it incredibly hard. I guess I have toughened up. falling into latrines, getting toxic hepatitis, break bones falling off fast horses, burning myself on tipsy motorcycles, and an endless procession of mystery ailments and rashes will do that to you I guess.
I can now at least be in the same vicinity as a cockroach
I am beginning to believe the lie that rats are scared of me too
I am 50 pounds lighter
I can speak French, although not fluently
I am far more intimately acquainted with Bob Dylan and have developed a life-long love affair with Eric Clapton
I am absolutely and unequivocally single and am content to remain so
and so many other small changes - some for the better, some for the worse - some i don't even realize
2 nights ago finished my last night on Peds. I have been working there since I got here. it is bittersweet. The most intense portion of my experience here. And I wouldn't trade it for anything. It built me and broke me and I will never be able to do anything else with my life - except be right in the middle of where life is the most intensely fought for and lost.
I spent one day as the chief de chirgurie
I will spent 20 days working on Maternity with Bikaou - my Tchadian mother and Sage Femme excellent trying to learn how to get those slippery little babies into the light of day. Oh and the powers have seen fit that I shall be spending 4 Sundays working totally alone in Maternity - so that will be a dangerous adventure considering I possess about the same amount of OB knowledge as a 6 year old from the 7th century.
I will be spending the 20th of August to Sept 9 doing 3 week long intensive training programs for my Community health workers. It will be their fourth training. And then the Pilot Project 21 will be over - and then the CHWs will be trained to do dental screenings and we are hoping also for a self-sustaining water project that can start in January - lack of potable water is the number one stated problem in all the quartiers. I created their entire training program, trained them myself, and now there are 42 functioning CHWs in the district of Bere (this was one branch of the project, ran in an extraordinary manner by Marci Anderson, MPH) so that is exciting - and Marci is working hard on the next phase of the project which will focus on making potable water accessible and affordable and sustainable.
I have volunteered a little bit at the Malnutrition Center in Bendele and helped them create some nursing intake paperwork. I also keep doggedly referring although few ever actually go. But I like spending time with the girls out there - they are doing a splendid job.
I will be spending my last week until I fly out in the capital, NDJ, trying to interview women in governmental positions as well as those those that work for the branch that deals with women's issues. Marci is going as well to get statistics for her malaria grant (this woman can and will eradicate malaria here)
I am working on a new hospital paperwork system, discharge papers, and post-surgery protocols and I am crossing my fingers hoping we can push it through and the administration will adopt it. I spent a lot of time thinking of feasible, sustainable solutions that could increase the quality of patient care and have written a detailed report about my findings. got to try, right? don't want all that complaining to be for nothing.
I am also frantically trying to get all the interviews I need for the book I am attempting to write on Women's rights abuses here in Tchad and specifically Bere. I started out knowing nothing, still pretty much know nothing, except how not to go about the interview process. the amount of things i need to do and find out and chase down is truly staggering. to say I am daunted is an understatement. I am so close to it all I don't know if I have amazing stories or if I don't have anything close to the caliber that i think I have. I pretty much have no idea what I'm doing. But i am going to keep trying and follow this thing through to the end. I have always wanted to write a book - I promised the women - and I have only one life to live - so, i will write.
So, I am busy, for the most part happy, not in the least excited about leaving, and just trying to do my best to leave having no regrets in any facet of my relationships and experiences here.
thanks again to everyone for being so supportive, sending me packages, prayers, encouragement, phone calls, letters, positive energy, love, emails, and pieces of writing. You have all been my lifeline.
and we are everywhere
the eye spiz
blink me dizzy baby
as long as
your lashes fall
as long as you are
as long as I am
as long as we are
tick tock blink clock
I blink you blink
to be as
I saw you as
the last time as
tick tock blink clock
don’t close your eyes
you’ll see what was
don’t open your eyes
you’ll see what is
don’t close them halfway
you’ll see what will be
tick tock blink clock
blink you were and
blink you weren’t and
blink you won’t be
you now are
tick tock blink clock
your present since
and now you aren’t
but I still am
wishing everything was
as It were
frozen stare, empty glare
when your eyes no longer
when your eyes no longer
tick tock blink clock
tell me what color
frozen stare, empty glare
I am now
because you were
am is are
be been being
I will be
as you have been
so tell me you goats,
what did you do with your being?
He died before I even had a chance to try
It was all stacked up against him anyway.
Moments, choices,conversations, countries, stacked, as collective a death.
This one was rigid, clenched fists splayed out
Eyes half closed that locked into nothing
The kind of stare where you only realized gradually that they aren’t blinking
The kind of stare that sears through all the lies
The kind of stare that makes explanations for why the world is the way it is turn and slink away
The kind of stare that scorches the excuses crooning on the tip of your tongue
The kind of stare that brands you, that cauterizes the arteries of the deep
The kind of stare that dares you to look back, look through, at what is
The kind of stare that tears through your soul with scorching clarity
The kind of stare that doesn't judge, but makes it impossible to plead not guilty
The kind of stare that will have to be crunched into submission by the calloused thumbs of crying grandmothers
The kind of stare that will have to be blindfolded by a strip of green fabric from the mothers skirt
The kind of stare that cannot forgive that which you can never forget
The kind of stare that solemnly meets the eyes that are already floating outside the hollows of their sockets, of all those of those for whom we proclaimed "never again," of all of those who were butchered and hatched while the world debated the actual definition of "genocide," of those who slipped away rotting and forgotten - that meets the eyes of the robbed masses and locks with a deadly kind of knowing
The kind of stare that knows that one day, all those eyes will be turned on us, all those billions of eyes will bore right through us, all those eyes will not let us blink, all those eyes will be locked onto us, staring the question, demanding the answer, what did you do with your being?
He died with eyes wide open
Its braver that way -
daring anyone to meet his gaze
daring anyone to save him
forgiving that which he knows can never be forgiven
its braver that way
and I let him
it needs a name
it needs a face
it needs a footprint
it needs a foe
it needs to be illuminated
sucked out of its crumbling rat infested hospital
wrenched from its gasping breaths on the floor of mud huts
put under the brightest
placed writhing under a social microscope
i want their faces painted on the walls of every building
i want the screams of the mothers blasted from the rooftops of every city and on every radio station
I want every news channel to focus on sweat pouring off hot little bodies, on rolled back eyes, on jerky frothing convulsions
I want their stories in every book
I want their histories, their names, their pictures, in a museum
i want bricks made of their footprints to form a path that circles the world, and I want everyone to walk on it. to know that just by not knowing they are stepping on innocents.
they say genocide is when an ethnic group is purposefully wiped out
but how about a generation
how about 1 in 5 children in Sub-Saharan Africa
what do we call that?
its doesn't fit the criteria
but its the most potent term yet coined
but we should call it something else
but there isn't a word
isn't anything to depict the horror of this silent slipping shadowy evil
we call it
In the US - would we let 1 in 5 of our children not grow up?
of course we wouldn't
we have the resources
so why do we let 1 in 5 of other people's children die?
is it because declaring a "war on malaria" seems just as ambiguous as the "war on terror" or "war on drugs"
well, guess what - terror ain't going anywhere, drugs are everywhere, but the mosquito, we know where he lives, breeds, hides
we eradicated Malaria from the US decades upon decades ago. And anywhere else that had resources did the same. And guess what - you can go to war with malaria - its proven. its been done. In the US - in the swamplands and marches that are now your neighborhood. there are large geographical sections that are now free of it.
its possible - but now that your children are safe and happy and tucked into their beds with little superman sheets and swirling ceiling fans and glow in the dark stars and dull golden nightlights - now suddenly you are in your world - the one you created, the one you love, the one where you don't think every time you take your son fishing it could be the last time - now the other worlds seem more distant
and now the people with the resources don't have to worry about it. this is Africa, after all. let the Africans sort it out. except oh, there aren't really that many producers of DDT anymore. And the environmental lobbyists have a stronger voice than the millions already silenced. and now we deny the rest of the world the exact same opportunity that the Western world wouldn't have dreamed going without - eradicating Malaria.
malaria CAN BE ERADICATED
terrorists are a dime a dozen
people will always get their drugs
but children can stop dying
but this war, even though it is just as faceless and nameless and seemingly futile
this war does have a culprit
this war does have an enemy
this war does have geographical borders
this war must be fought
how will we answer, to the searing judgement of hindsight, to the future generations, when they wonder how we could have allowed this gap between rich and poor to grow wider and wider, deeper and deeper, more and more impassable? When they wonder how in this age of such stunning advances and achievements the other half of the world could be allowed to stagnate and wallow in deep suffering and despair?
wrap your mind around this. at this very moment, you are sitting at your computer. maybe you have on comfortable slippers. maybe you have nice carpet petting your toes, maybe you are leaning your elbows against a lovely oak table, maybe you are eating ice cream, maybe you have a fan blowing on you, or are in front of a crackling fire. maybe your TV is playing in the background, maybe you are blasting music from your Ipod, maybe you are stealing a moment at work. and this is all very routine. and, its a well deserved rest. no one is denying you didn't work and sacrifice and gut it out for your family, your dreams, for all you had. no one is denying that you deserve the small comforts that make it possible to get through the day - and no one is judging it.
but at this very moment - a little boy of 4 is taking gasping drowning breaths. he has pulmonary edema. and cerebral malaria. he is drowning. and now he is dead. at this very moment, a woman is dying in childbirth because she didn't have 50 cents for a prenatal visit. at this very moment, the pediatrics ward is overflowing with almost 30 patients, quinine is dripping into every hand, foot, and head, half of them are being transfused, several will die tonight, roaches are crawling over legs and hands and foreheads, rats are scurrying flash along the shadow of wallcorners, there is old food, and dust and trash, mothers, fathers grandmothers are sleeping on grass mats in every available space, stepping over snoring bodies trying to see your patient. children stop breathing, the screams are ushered outside, the drips continue largely unchecked, and this is normal
but how do you wrap your mind around this?
around the 2 worlds?
its not your fault, i just can't figure out how we got here, how we get out of here
but how can a world that sent a man to the moon, that built the space needle and spits students out of Harvard and eradicated smallpox, this world with its dizzying array of wealth and opulence and private jets and high heals, this world with sleepy dreamy rose gardens and American dreams
how can this world be the same world that lets millions of children die every year just because they live on the wrong continent? how can this world let the other half subsist on less than a dollar a day? how can this be the same world where you know you will die at 45. where you don't go to school because you are a girl. where you do backbreaking physical labor your whole life for one meal a day? where a child lays burning with fever, in a coma, convulsing, drowning in his own secretions, laying on a filthy black mattress crawling with tiny white worms, the same world that when he takes that last rattling groan of a breath there is no oxygen to give. where there is no oxygen.
how can a world that grows groovy human ears on the backs of mice and spends billions of dollars on medical research be the same world in which there is an entire country without oxygen in its hospitals.
how is this the same world?
how do you wrap your mind around this?
where do you fit into this equation?
no, how can you change the outcome of this equation?
this is the same world
but we must make it different
we must build a bridge over the gap
we could build it out of bones
or make a swaying bridge by stringing rattling teeth like swinging popcorn
or just heap enough skulls into the canyon to crunch our way across
we must build a bridge over the gap
what did you do with your being?