le 27 mars 2013
I used to think of writing (or doing
anything inside) by headlamp as spelunking. It was certainly more practical
than my first year PCV strategy of candles and kerosene lamp propped on various
books and papers—before I had a table—and sitting hunched over to the in the
right part of the penumbra.
It’s a funny thing about light.
The
Constant Gardener came out weeks before I left for
Peace Corps in Cameroon. Without mention anything else I love about the movie
(which was great for terrifying many parents of about-to-be PCVs about to move
to Africa), the light struck me. The quality of it. I’d noticed years before
that Paris has its own quality of light. Some photos, movies capture it (Amélie does). I don’t think you can
successfully pretend that something is filmed in Paris.
This light, though, the Kenya-in-the-movie
light, was unlike anything I’d ever seen.
And then I moved to Cameroon.
It’s the same light. Gazing across the city
at very familiar views this morning (Yaoundé, like Rome or San Francisco, is a
city of hills), I remembered it. I have photos of the same view, and in the US
they look—faded. Light-stained. But that’s how things actually look.
The forest almost never comes out, either.
I think it’s more greens than the human eye can discern (we can see sixteen
shades of gray, I recently learned, on CT scans).
**
I was reminded of why the old Snickers ad (Not
going anywhere for awhile?) and Green Day (“I’ve been…waiting a long
time….) used to enter my head so often. It took almost three hours to print and
copy one document, for various reasons. On the way to the second printing
place, though, I heard someone call my name. I turned. And it was a friend I
hadn’t seen in 4 years. Now, he’s at the hospital where I will be this time,
Centre Hospitalier et Universitaire de Yaoundé, a different one from where we
were previously (he’s a resident). Currently, he’s working in the ICU, which is
reanimation here. It’s about coding. (“Code
blue”). Come back from the dead, make something alive or lively. Resuscitation,
they call it, instead of our Intensive Care. Shortened, it’s “Réa” – it sounds flip in a hopeful way.
This—the chance meeting—is something that
happens. In Ebolowa, my provincial capital, I couldn’t go anywhere without
seeing people I knew; it was amazing and heartening a year and a half after I’d
initially left. And it used to happen in Yaoundé, occasionally. When I had my
first chance run-in in NYC, I knew I really lived there. And here? Apparently,
I still do.
**
I’m waiting for the chief medical officer
of the hospital to meet me and certify that I can be here. All I know thus far
about the hospital is from the two French nurses who just left. They saw an
upper GI bleeder come in. Died. They didn’t know exactly what was done or what
happened.
This time, I’ll learn about the medical
management here—what’s the same, what’s different, and what doesn’t exist. I learned
some of that, before. And that you have to buy everything down to the IV
tubing.
ER. Six weeks ago, I was in an ER in
Guatemala (working, not sick). Small rural hospital compared to one of the top
four in Cameroon, a major teaching hospital. There, they were oddly
over-staffed. Here, I am the functional sub-I, or intern to the residents, or
whatever approximated role.
Here, I walked in to see the repair of a
scalp laceration, and by scalp lac I mean the cut penetrated to the dura mater,
through the skull. Assault by machete. I’ve seen that, but the one I remember
was due to a machete accidentally dropped from a tree. That kid looked like he
was partly scalped. (And that was one of Doc’s gleeful moments, showing anatomy
on monkey bones). Now, I wonder if, in the US, we’d put a JP brain in before
closing the laceration. The kid is going to CT. Don’t know.
Next case. Moto accident led to a
comminuted tibial fracture and a shattered fibula. We waited while the
patient’s brother bought all the supplies requested. (Were I not there, would
they still have had him buy two pairs of sterile gloves….? How to reconcile
“teaching hospital” with patients paying for everything you use on them?
It was the first time I’d sutured in over
two years. The light is weak and far away, we can’t raise the bed, the
patient’s ankle is a mess with visible bones, he hasn’t had any pain killers
and crying/screaming…(we did use local anesthetic)… But medicine is already
(re)baptism by fire. Everywhere. This is nothing new. It’s vaguely remembering
hand tying and instrument ties (it slowly returns), correctly angling the
crescent-shaped needle, with the surgery resident showing me where to close
because in that erratic wound with jagged layers, I have no idea.
Later in the day, I go to Hôpital Centrale
to meet Dr. Bwelle for his medical student teaching rounds. He shows me the
tall, modern glass-and-brick structure that looks like an added-on center to
the other, spoked buildings. It was a Swiss project, he says, supposed to be dedicated
to neurosurgery. But the people building it forgot that they were building a
hospital. The floors are all completely flat—in ORs, this means nowhere to
direct water. It’s all stairwells, for four stories. No elevators. The building
has been empty for the past four years.
This is all too common a story.
**
As always, every day is every emotion.
Aggravating (the personal level—dérangements, harassment, etc), but then also
the men speaking in Bulu about me this morning led to “mintangen a wôk” – you know, the white woman understands you. And
then I sat down with my spaghetti omelet and bread and “coffee,” (I’d forgotten
about the sweetened condensed milk) and we chatted over their morning beer.
(or, it’s evening for at least the one who drives trucks overnight).
But running from hospital to hospital (and
angry when the taximan who had
accepted my negotiated price then refused it and wanted more money), an
exquisitely-peeled (not a good enough word. It’s beautiful, geometric)
green-fleshed orange is just perfect to raise blood sugar back to awake-enough
levels.
**
63 year-old woman. Altered mental status,
sudden onset. Fever. Tachycardic. (and immunocompromised…) My mind starts
racing through differentials, I try to rule out meningitis, I start to think
about how to work up…and, wait, what we can work up, and I go talk to the
attending. “It’s probably neuro-malaria.”
Oh. Right.
~j
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