Trauma Drama

Today Linguisa (aka Little Link as the name means Portuguese small sausage) died. He was the baby in our house (aka kitty kingdom). Gabriel found him about two months ago dirty and flea-covered wandering around the compound. So he took him, cleaned him, fed him, and then Linguisa followed us like a shadow incessantly. He was never content unless he was by our sides and even just last night spent quality time with Papa Gabriel in front of the charcoal fire watching the beans cook and the bread rise.

But then we think he took a fall of death. You see, we don’t have normal tranquil kitties. We have gangsta kitties who are not content to just hang out on our spacious back porch. No, several of them busted a hole in our screen and escaped. We patched it with more screen and then cardboard but still those gangsta kitties would bust through. But Linguisa wouldn’t escape for the outside, no, he would scale the screen to the top of the metal roof and then climb into the 10 inch space in between our two roofs, walk across to the other side and come crying on the front porch where he would sometimes find us. 

Today he was sprawled out on the concrete floor next to where he liked to climb up into the roof, dead. He had been perfectly normal just an hour before.

His death, though, was not as unexpected as that of Greta, our German Shepherd puppy. 

When we left for furlough she and her sister were fat, happy, healthy, rambunctious puppies. Just one week later, after copious vomiting, diarrhea and refusal to eat, she was buried in the hard Chadian dirt. The missionaries there tried to do what they could to save her to no avail. My best guess is that she caught a weird GI illness or she ate a poisoned pigeon. Our neighbors over the wall are the tuberculosis patients. They hang out there for weeks or months getting treatment and obviously need to keep eating. So they sometimes put poison on top of the wall for the pigeons to land on and eat. The pigeons then fall over (hopefully) onto their side and they cook them for three days to get the poison out.

Death is ever closely linked with life here. The death of little ones is harder to swallow. We’ve lost four lambs, three kittens, one puppy and one bunny during our short year and a half here. Chad is just plain hard. I am always pleasantly surprised when the number of living children a woman reports currently having when I ask her obstetrical history is the same as the number of babies she has delivered.

Certainly our hospital has many cases who come close to death but by healing or sometimes a miracle from God return to their homes in health. One night a few weeks ago I was called by the ER for a “trauma.” I found a man with a right shoulder shredded by a bullet. His deltoid and proximal biceps were torn and bleeding. I called our ER specialist, Olen, for help and then saw the other two gunshot wounds that had come in also. Our Chadian doctor took care of the man with the gunshot to the foot and a visiting resident friend and I took care of the gunshot to the elbow. 

The story we were told is that that Arabs in their nearby town were not happy with the move the local market took sometime in the not too distant past. So that night some Arab military guys opened fire on citizens. The clinic there took care of the minor wounds, four people were dead. Some came to us on motorcycles then the townsfolk called the hospital to send an ambulance to pick up a few more.

So we sent a few of our volunteers who were ready for an adventure. And I’m just going to sugar coat the story here and say they were not treated very kindly. I found them having just arrived at 10:30pm when I was called for a woman referred from the hospital 1.5 hours of wretched dirt road away. She had delivered six babies before, but this one she had been unable to push out after many hours of labor. The reason for referral was: lack of electricity.

When I arrived outside the OR I found the volunteers with dirt smeared faces, one of the victims already dead, one with a thigh wound and the other on the table getting prepared for an exploratory laparotomy as he had caught his bullet in his belly. After he was explored and miraculously found without internal damage, my lady got on the table and I c sectioned out a rather large, thankfully still living, baby.

The other remarkable living baby was the one month old who watched (ok not really watched since one month olds can’t see very well) his mother undergoing CPR. She had been admitted for malaria that she contracted about one month out from delivery at home. She had been hospitalized for a few days, and just the day before, she had asked to go home since she felt better. But to make sure she could eat well with the difficult to tolerate quinine pills, I kept her one last night. And it was her last night in the hospital, but it was also her last night. The night was marked with respiratory distress. I found her struggling moderately to breath. Her glucose was in the normal range (hypoglycemia with malaria is a killer here), but I gave her a bit of dextrose to keep it up since I doubted she would be wanting to eat. She had pitting edema in her lower legs and crackles in her lung bases. Her blood pressure was on the low end of normal. I thought of postpartum cardiomyopathy, so I tried a whiff of furosemide to see if the fluid in her lungs would diminish and help her breathing. She was no better and no worse afterwards. I ultrasounded her heart (I am still quite an amateur with the ultrasound) and felt her heart seemed a bit enlarged with decreased ejection fraction. 

Suddenly an hour later I found Danae, our longtime surgical/obstetrical/gynecological specialist on the floor doing CPR on her chest. We coded her for half an hour without success. Dismayed, we told her family we could not revive her. If we had an ICU or high flow oxygen or a ventilator or cardiac monitoring or lab chemistries or... the list is endless... then maybe we could have saved her.

Hopefully one thing we did save the other day was the chewing ability of the man gored in the mouth by a bull. Bulls are unfortunately the height of mandibles, and his was cracked in two. So Olen taught me how to wire his jaw shut. I jammed the iron wire through his overgrown gingiva, and we twisted his jaw closed. I gave him a piece of some small suction tubing for a straw, and here’s hoping he doesn’t need to vomit in the next 6 weeks.

Thankfully Gabriel and I haven’t been vomiting recently. We praise God for the last month of good health. Gabriel has become quite the master of bread, vegan cheese and pizzas recently. So much so that he built an outdoor oven we are hoping to master to save on propane since our tank only has about a week’s worth of gas left. His pizzas especially are very tasty, an edible comfort in a dramatic world.

“But he was wounded for our transgressions, he was bruised for our iniquities: the chastisement of our peace was upon him; and with his stripes we are healed.”

Isaiah 53:5