Six Months in Sudan (20 page)

the rest of the reason is the tumult of daily experience. emotions are cast through their full register. the delight of receiving a package and a letter from home is followed immediately by the anticipation of the thursday night meal, the one where we can stay up a bit later, the carpet being pulled from beneath you when you’re called to the hospital to see a woman who has been raped. the world never lets go, and we are tossed about by its circumstances. like the first rain, with no protection, we feel more acutely its true weight.

“M
MM … EVERYONE
… welcome to our first … meeting as a team,” Marco says. “Mmm … I’m sorry for my English … it’s out of practice … Where’s Antonia?”

We all look around.

“I’ll go get her,” Paola says, and leaves.

Marco smiles at all of us and shrugs. “Already, it’s not so easy.”

He arrived last week. In his luggage he had brought with him, all the way from Geneva, a package for me. It had inside of it a portable fan, several D-size batteries, and a box of cookies. It must have weighed at least 5 kilograms, a third of his allowed baggage weight. When I thanked him, embarrassed, he shrugged. “A package from home is important, no?”

For three days he was either bent over a map with Bev, reading glasses on the tip of his nose as she spoke in rapid-fire English about the military intricacies of Abyei, or roaring around in a Land Cruiser so he could see for himself.

He has worked in South Sudan before, but this is his first mission as a field coordinator. He told me that after he accepted the mission, he started reading my blog and changed his mind. Not because this project was any different from the one he had worked in before, but because it was so familiar. In the end, he agreed. We’re lucky. Bev’s lucky. She was hanging on at the end.

Paola emerges from Antonia’s tukul. Antonia is behind her, brushing her hair.

“Sorry, everybody. Sorry. Terrible,” she says, and lights a cigarette.

Marco looks at her closely, clears his throat. “So, welcome. This is our first meeting as a team. James, Tim, David, you are surrounded by Italians. I hope you are ready.”

David pushes his chair away from the table and stands up. “No. I refuse. When I signed up for water sanitation they told me about the soldiers, but no one said anything about Italians. I leave immediately. Goodbye.” He marches away.

Marco’s eyes widen. A minute later David emerges from the kitchen, a large bottle of water in one hand, six glasses in the other.

“He’s French,” I say to Marco, as explanation. David has been here for a week now. He’s a former logistician. No one knew he was coming. We got an email from Khartoum announcing that he would be arriving from the South in few days, then he was here. Officially, he is here to sort out the borehole. Unofficially, he is our new logistician, whether he likes it or not. Luckily he does. He spent today driving around, trying to find the best bricks for the new office Geneva just approved.

“Already it is not easy,” Marco says again.

David pours water for himself, Tim, and me, then sets the bottle down, waiting for a reaction. He gets none and fills the other three glasses. Marco sighs.

I didn’t get David at first. He talked too much. Then, one day, in the pouring rain, we climbed on the slippery walls of the gazebo, fixed yellow plastic sheeting to its sides, and shouted to each other over the storm “up a bit, down a bit.” Now I think he’s the best. Every doctor secretly wants to be a logistician.

“So.” Marco looks around the table, surveying us all, drawing out a long pause. “Welcome.”

I pick up Tim’s package of cigarettes. He nods.

“This is the first of our weekly meetings. We will meet here Wednesday at four o’clock. To talk about our week. Or the problems. Is that time okay?”

We all shrug. Silence.

“Okay. Wednesday.”

The generator clacks on.

“Before we begin, I would like to start this meeting off with a small game. It’s okay?”

Paola sighs, Antonia continues to brush her hair. David is expressionless.

“Sure,” Tim says finally.

“Okay. Everyone stand up. Everyone. You too, Paola. You don’t
like games? Okay. Move to the center of the floor. Good.” He points at us in turn. “Remember your number. One, two, three, four, five.”

“Why don’t you get a number?” Paola asks.

“You’ll see in a minute. Now, I want you to start moving around each other. Move. Walk. Faster. Don’t stop. Faster. Try to use as much space as you can. Okay. Now, when I call out a number, that person, you make a loud sound, yes? A loud sound like you are dying and then fall backward. The others must make a catch to you. Okay? Faster … Two!”

Antonia lets loose a wide yell, “Oh! I’m dying!” and starts to slump to the ground. David grabs her under her arms.

“Good! Good! Okay, more moving. Move, move. Faster … Three!”

David gasps,
“Mon dieu!”
and falls to one knee. Paola and Antonia sandwich him, pull him to his feet.

“Good! Okay. Move … One!”

I clutch my chest, start to fall backwards. Tim, nearby, stops me.

“Okay. Well done. Very good. Let’s sit down.”

We sit back around the table, smiling.

“Antonia, very good dying,” Marco says.

“Oh, yes. I am very wonderful at it.”

“Good. Now, does anyone know what the game is meaning?”

We look at one an other.

“Like, a trust thing? You have to trust your team to catch you?” Tim volunteers.

“Yes, a little.”

“I know,” Paola says. “It’s about how you fall.”

“More.”

“If you make a big sound, like Antonia, people know how to catch you. If you make no sound, like James, no one knows you are going to fall.”

“And then you hit the ground,” Marco says, smiling at me.

30/04:. X.

the long-distance hf radio crackles beside me. a guard is resting his head on the desk in front of it. every minute or so, he lifts it and calls into the mic:

“mobile 1, mobile 1 for alpha bravo, over … mobile 1 for alpha bravo, over …”

he is trying to contact our land cruiser. we have sent a patient, urgently, to the nearest surgical hospital 3 hours away. when they arrived, they were told that there would be no operative cases accepted, and another hospital was suggested, hours away. it is well past dark, and outside of a hospital in northern sudan, in the back of a car, a woman in labor and in need of surgery is waiting to see if they change their mind, or if she will have to drive through the night on a dark dangerous road. we are sitting by the radio waiting for the same news. there has been no contact recently from the driver. we are not sure how to interpret this.

“mobile 1, mobile 1 for alpha bravo, over …”

marco was saying the other night that after you do one mission, and you go back home, you are ruined. there is a distance between you and others that is irreconcilable, things that you cannot share. when you try, the people you talk to either cannot place themselves there, or they realize they don’t want to know after all. the rift becomes larger.

i am typing in the logistics tukul. i have just returned from the hospital. i got a call a few hours ago.

“dr. james? this is hospital. we have sick child. girl. 5 months. high fever. diarrhea. breathing problem.”

“all right, hospital. can you test for malaria, give the child 80 mg of paracetamol, and some cool cloths. do you copy? good. is she drinking?”

“no.”

“ok, start a cannula. weigh her and write the name down. i will be there in a few minutes.”

“dr. james … i … um … i use bag for breathing now.”

“i’m coming. over and out.”

where is the driver? no driver. i grab my stethoscope, and jog 460 paces. i arrive through the gate, people are standing in front of me, waving outpatient cards. i brush past them to the nursing room. a young mother wearing a bright yellow veil is holding a limp 5-month-old. the baby’s eyes are sunken, half open, and her small chest rises and falls with last breaths. two nurses are bent over one tiny, dangling arm that has a latex glove tied above its elbow, poking it with needles, looking for veins. the child doesn’t flinch.

they can find none. no veins, no intravenous. (yusuf, can you use the bag again … no, like this, smaller breaths … no … do you hear that sound? it means there is no seal … you know what, i’ll do it. tell the guard to start the generator for the oxygen machine.) no gas for the generator. (ok, prep the leg, the left one. with betadine. perfect. great. ok, take the bag. smaller breaths. push when she breathes. no, make a seal …)

i open the intraosseous cannula, landmark a little less than a cm below the tibial tuberosity, on the flat part of the shin just below the knee, twist and twist and twist until it pops through the thin shell of bone. marrow flows freely into the clean water of the syringe and i flush it smoothly back. the fans in the nursing room start to spin. i ask
for fluid, and antibiotics. the child’s head hangs loosely on my knee. she vomits, and breathes it in. (suction please.)

last breaths are like this:

so now i am blowing in tiny, tiny breaths through a tiny, tiny mask. i barely have to squeeze the bag, her lungs are so small. small, and full of crackles. three times my stethoscope dangles down and touches my knee, three times i feel a small pearl of hope, thinking it was her hand. i look down, and her arm hangs loosely by her side. i stay there for hours.

i think i would still be there if her breathing hadn’t worsened, but it did. she was tired, her muscles burning and inefficient from the lack of oxygen, full of lactic acid. when i would stop, instead of taking a breath, all she could manage was a grimace, a shrug of her small shoulder.

i placed an oxygen mask over her cheeks and pulled it gently snug. i put my stethoscope on her chest, and heard her heart count quietly down.

i don’t think that i will end up ruined, but there are certain things that are going to be tough to share. things that would make poor dinner
conversation (hey, have you ever heard an infant’s heart stop? don’t you think it is like the silence must be after a train wreck, deep in the forest? once the metal has stopped creaking? like all this activity, and then this final vacuum in place of all the sound?) i can imagine meeting people on the street, and being asked how my “trip” was. (… you know the feeling when you and your friends are cleaning up after some young mother dies and you can hear her baby cry and you’re all praying to yourselves, please don’t let anyone look me in the eye? you know that feeling?)

it was fine. it was all fine.

i cleaned up the emergency room, the nursing room, watched the family close the baby’s mouth with gauze. i saw some outpatients. i took a seed out of a little girl’s nose. i walked back to the compound alone. i went to the kitchen for a glass of water. paola came in to see me.

“is everything ok at the hospital? i heard the call on the radio. is the baby ok?”

“um … no … she’s dead.”

“are you ok?”

“yep, i’m good.”

“you know, you don’t have to keep everything right here,” she said, and pointed to her sternum.

“i know,” i said.

usually, as a doctor at home, it is rare to have one of these experiences, but when you do, you often bear it with others. another doctor, or nurses whom you know. you sit and talk about it. it doesn’t make it go away, but it diffuses some of the weight. i don’t do that here. i figure
everyone has enough of their own weights. so, just now, from the kitchen, i walked over to the log tukul, and started typing this. instead of keeping it here, in my sternum, i am going to put it right here:

.X.

still no news from the car. we are all quite anxious.

i don’t mean to burden anyone unnecessarily, but this is what happened tonight, just now, i am freshly back. the part of me that normally edits these stories out doesn’t want to do it today.

K
NOCKKNOCKKNOCK
.

“Hmm?”

“Dr. James? Hospital. Channel 6.”

“’Kay.”

The handset is below my bed. I sweep the cement floor for it. I have moved inside because of the rains.