June 2009

Like a kite tethered to the mountains the Southern Cross hung on the south side of the Waghi Valley at midnight on Tuesday, May 10. Scorpius arched across a cloudless sky, below a sliver of moon, above a corrugated tin roof where, just below, a simple bedroom chair plays host to my favorite clothes, despite my wife Marsha’s disapproval.

As night call approached I had reshuffled the well-used pile, opting for my scrubs on top, allowing retrieval in the dark and more rest for Marsha.

Around midnight, adrift in a twilight zone, neither asleep nor fully conscious, I jolted when a mechanized intruder sounded off near my ear.

Finding the handle I faked a willing response and struggled to discern the message. “We have two patients in the emergency room” the nurse told me – “a severely dehydrated baby girl and a woman beaten by her husband.”

For a quarter century “pen-keys-stethoscope” has been my mantra when leaving the house on such calls.  More recently glasses and, regrettably, teeth have been added to the list but please allow me my denial. Armed with my essentials I stepped into the cool night air to the monotonous rhythms of crickets.

Cool and calm evaporated as I entered an emergency room crowded with bodies and emotion.  The baby girl lay on a wooden table, limp and pale and too weak to cry, with parents hovering and a nurse working to start IV fluids.

In an adjacent bed the abused woman screamed and flailed a distorted right arm, which swiveled at the bicep.  An anxious man, maybe her brother, grasped at the twirling appendage but in truth only exacerbated the deformity.

With a fracture so fluid, ever shifting like a perpetual motion machine, an X-ray doesn’t help. I knocked her out with an injection into her veins.  I pulled on her elbow and aligned the bone as best I could. I began to wrap. Gauze with Plaster of Paris, wetted in a basin of water, though soupy on application, hardens into a solid splint in seconds.

Meanwhile the toddler was quiet, too quiet, not making a sound despite my nurse’s stabbing attempts at IV access.  There would be no stopping to address this baby’s needs. The nurse’s efforts would have to suffice. A phone call from the nursery summoned me to an infant boy who had stopped breathing.

Water swept away the bulk of the plaster crust from my hands and I hurried to the nursery.  Two nurses were helping the child, only three days old, supine and flaccid in an incubator cot shared with another newborn.  Continued efforts with a bag and mask restored breathing.  I watched as the blue baby turned pink, then vanished in total darkness.

Power outages are commonplace but this was especially ill-timed.  I switched on a small headlamp, its Triple-A beam adequate to illuminate the boy’s rising and falling chest.

From the darkness beyond the focused beam came news that a mother, having just delivered, was bleeding heavily. Reluctantly I redirected the headlamp and found her lying in a pool of blood still spreading ominously on her bed.

We tripped and scrambled for intravenous fluids and medicines to stop her bleeding.  No time for a wasted word, I spewed out a crash refresher in the essentials of uterine massage and stationed a student nurse at the mom’s side, then left them in darkness.

Restoring power was the essential task. A mother in shock, a newborn boy struggling to breath, in the ER a critically ill baby girl and a woman I’d abandoned under anesthesia, we desperately needed lights.

I strained to focus my thoughts on the logistics of starting the emergency generator: Keys then switches, one “on,” another “off,” and two different locations, and each step performed in the correct order. I had passed the drill for this scenario but the trial run had failed to fully encompass present realities. Nevertheless, my clumsy efforts were followed by the sound of an engine and, a second later, hospital lights.

Returning to the ER, I found a nurse pumping a bag with mask on the dehydrated girl. We had never been able to establish an adequate IV and while the power was out, invisible to family or staff, she had quit breathing.  I joined in the effort but in vain.

While I had thought myself in a race against time, as if such a contest could ever be winnable, this child had slipped away far beyond my grasp, out of the temporal and into the eternal.

The woman with the broken arm was groggy but stable. The nursery baby was breathing on his own. The new mother was stronger, no longer bleeding, and out of danger.

I retraced my journey home under the same calm night sky to a bed and the same half-sleep as before, but with additional questions and conflicts and a greater yearning for the rising sun.

Photo Album of Other Happenings Around Kudjip:

Barnabas Awards to Dr. William Walker and to Ed and Carol Bos of WorldWide Labs. Presented at Thailand CMDA Conference in February.

The new Nazarene Hospital is very near completion. Plans to occupy in early August.

Bill and Marsha's new granddaughter Aubrey-Shay McCoy