Christmas Week

After the wedding, the daughter and I made a quick dash to Tennessee to welcome the new grandbaby. I have to admit he is a real cutie - but then what would you expect me to say? He seems to be quite content to sit and look around until it's either time to eat or sleep. It was hard, but we said goodbye today and started on the way back to Texas. When checking the weather and road situation for the trek back the word was snow and/or freezing rain so we stopped in Nashville and got a room at the Gaylord Opryland for a night or two. Not the trip or Christmas that we had planned but we'll see how the weather thingy works out and hopefully only be here for the night. If not, we're determined to have a great time here anyway.

Sending Merry Christmas wishes to one and all...be safe, happy, and hug those you hold dear - and even those you don't!

Breach

From James:

I didn't realize it was urgent till I burst through the door into labor and delivery.

I knew the woman in labor had a fetus in the breech position with one foot wanting to come out first. I'd told the midwife to alert me when she was completely dilated so I could assist the delivery.

Sarah came and told me that the woman was about to deliver so I wandered back over to the hospital.

When I opened the door, I sized up the situation instantly and sprang into action.

I saw a woman lying on metal table with her legs spread apart and coming out of her was an abdomen with two legs attached, flopping down onto the bed. No arms or head was visible. My first thought was gloves but as I reached for the ones I'd washed and hung to dry earlier I realized they were still too moist to get on quickly so I dove in with my bare hands.

When the baby comes out feet first it's very important that she deliver quickly because if not the umbilical cord coming out of the abdomen will be compressed by the fetal head blocking off the blood circulation and its crucial supply of oxygen to the baby.

I had no time to lose since who knows how many minutes had flown by with the head stuck before I arrived.

I reached inside to try and free up the first arm. It wouldn't budge. I twisted the baby around so the other arm was on top. This time I was able to hook it with my index finger and drag it down and out. I turned the baby over again and freed up the other arm. Then I stuck my finger in the baby's mouth and pulled his chin down to his chest all the while pulling with my other hand firmly grasping the baby's feet between my fingers.

The head popped out and the baby flopped to the table. No tone. No cry. No breathing. Grayish blue color.

I quickly clamped and cut the cord and moved the limp mass over to the reanimation table. I started rapidly pressing the chest with one had while I quickly grabbed the bulb suction with the other and tried to clear his airway. He had a faint, slow heartbeat. For those of you who know, APGAR at one minute was one.

I kept doing chest compressions while the midwife dried, stimulated and sucked the gunk out of his nostrils.

After what seemed like hours, but was really minutes the heartbeat started to pick up. He grimaced a little and seemed like he wanted to cough.

We continued our efforts.

Slowly but surely he started to pink up and his heartrate became normal. Still pretty floppy and no breathing.

Don't stop now.

Finally, his legs and arms started to curl up. He was getting some muscle tone and his body was now pink.

At last, after I turned him over and gave him a good whack on the back he started screaming like a banshee.

Amazingly enough, APGAR at 5 minutes was nine! He was discharged home in good condition two days later.

The Dress for the Wedding

What a whirlwind week it was last week. I drove from So Cal to just south of Ft. Worth arriving in 19 hours. I was surprised myself, but glad that I wasn't on the road for the 24 hours that I had planned on. There was hardly time to do anything but run here and there making sure that all of the decorations for the church would work, finding enough food to make sure that all of the out of town guests would have something to eat and just tying up all of the loose ends that are always there for special events like the wedding.

It was a wonderful 73 degrees the day of the wedding and I must admit that I was second guessing my choice of stretch velvet for my dress when I was fanning myself to stay cool during the wedding. The pattern, Butterick 5280, turned out to be a great pattern. I decided to do a FBA just to make sure that it would fit better and not so tight even though it was designed to fit snuggly and I was glad that I had. An adjustment for square shoulders and adding to the length were the only other adjustments that I had to make.

After making the FBA I remember reading on someone's blog about the two sides of a wrap top not matching after making that adjustment and then showing the solution. I finally found the information here: http://thesewingdivas.wordpress.com/2007/03/09/adjusting-for-a-full-bust-on-a-wrap-top/, followed the directions and it worked perfectly. All that being said, I will be making this pattern again as it fit great and was really comfortable.


This is my niece, Kristen and her new husband, Wil. The only reason I am in this picture is because I capitulated and agreed to be my sister's gofer for the wedding. It was fun and we had a great time.

We are now stuck in Texas as the weather it the big news here. Freezing rain, sleet and icy roads are all over the area until sometime this afternoon so we are sitting tight in front of the fire until things warm up a bit.

Blue Baby

I finished my dress for my niece's wedding and will post pictures next week - after the event. Even though I could only find black stretch velvet to make it out of, the dress went together quickly and actually is a fairly decent fit. What a crazy time it is around the holidays to be doing weddings! Oh, and I have a new grandbaby. Jonah Keith, 8lbs. 7 ozs. born Dec 5. No pictures of him yet. (No, he is not the blue baby this post is about!)

Now from James:

Dr. Jacques knocks on the door.

"I just assited an uncomplicated vaginal delivery, but the baby is having
respiratory distress. The nares are flaring, the intercostal muscles are
retracting and he's just having a hard time. I tried aspirating to see if
he had any mucus but it seems his nose is blocked...it's like there's just
no connection to the throat."

In my mind I'm thinking, "yeah, right, he must just not know how to stick a
tube down a baby's nose..." but my better judgement says I should just go
and look.

I enter the dimly lit corridor and push open the labor and delivery room
door into a brightly lit, but small chamber. A quick glance takes in a
young woman lying comfortably on the bed, not much blood around, and
breathing and glancing around normally. She's fine.

I turn to the baby reanimation table and see a chubby, bluish gray baby with
a disproportionately tiny head (normal newborns heads are huge compared to
their bodies) lying staring up and grunting but not really breathing.

I grab him around the chest, flip him over on my hand and slap him hard on
his back. He starts to cry vigourously. I think that must be it. They
just are afraid of these supposedly fragile little beings and don't
stimulate them enough.

I flip him back over on his back on the green, brightly patterned cloth
underneath him and reach for the aspirator. A tiny tube goes into a small
canister with a slightly larger tube coming out the same top. I slip the
bigger end in my mouth ready to suck and slide the smaller tube into the
baby's nose. It only goes in 1-2cm and is stuck. I wiggle it around and
then try the other nostril. Still no passage. I stick my finger into the
newborn's mouth straight back into his throat. He starts to gag as I feel
around and confirm, there's no opening between his nostrils and his airway.

Now, here's the problem. Instinctively, a newborn is an obligatory nose
breather. This allows him to nurse and breath at the same time, two very
important things God makes sure they now how to do instinctively because
there's just no spare time to have to learn it in. He only breaths through
his mouth if he cries.

We can't just make him cry all the time, he just won't do it. He cries a
little and starts to pink up and then goes back to sucking in impotently on
his blocked up nostrils.

What to do? I think quickly and go to the OR to find some probes and see if
there isn't some passage back there after all that's just blocked up.

The probes go nowhere. I've brought the hemorroidectomy kit as that's the
only one I know of with probes.

I call the father in and explain the situation.

"He can't breath through his mouth because it's against his instinct and he
can't live without breathing and we can try to poke a hole through but he
could bleed a lot and die or we could damage some important things, but the
bottom line is he won't live if we do nothing. What do you think?"

"Do what you have to, it's in God's hands."

I grab a Kelly clamp and probe downward in the right nostril to where the
palatte seems thinnest between the nose and mouth. I poke through. I then
do the same on the other side. However, he still can't breath because the
mucosa of the mouth just falls back in place. We need something to keep it
open. I grab the aspirator and cut off a piece of the bigger tubing. I
reach the clamp through into the mouth, grasp the tube and pull it out
through the nose. The first time it pops all the way out. I then attach
another clamp onto the mouth and and pull it through again, this time the
clamp prevents it from coming all the way out. I repeat it for the other
nostril.

I suck up some blood out of the nose and mouth and down the tubes using
what's left of the newborn aspirator. He's still struggling but I can hear
and feel air coming out the two tubes.

I then insert a feeding tube in the mouth and the mother starts squeezing
out breastmild which we feed the baby through the tube with a syringe.

He's already pinking up, only his hands and feet stay blueish gray.

Yep, he's in God's hands all right.

Morning

From James:

It's early morning and I can't sleep again. This time, though, it's because I'm excited. For the first time in several weeks I'll actually be doing something. My ankle wound that just won't heal has kept me from doing just the bare minimum. I go up to the hospital, quickly see the hospitalized patients, do all the scheduled surgeries and then retire home to elevate my swollen foot. My day revolves around how fast I can get home to make the swelling go down and do a dressing change and take antibiotics. I even got so scared for a few days that I had Sarah start an IV on me and give me IV antibiotics.

This morning, though, my ankle seems to have turned the corner and I'm up, happy to be doing something I want to do. I'm going flying with Gary to N'Djamena. I'd needed to go to N'Djamena for a while, but with my foot, the idea of a long, bumpy ride in the back of a Toyota mini-bus just wasn't that appealing. With Gary's return after a 6 month absence, getting to N'Djamena has turned into a two hour pleasant flight over the African plain.

It's still dark, but since I can't sleep anyway, I get up and fix "breakfast" which consists of frying up some day old rice and beans with little bit of curry. Not a typical American breakfast but sometimes you have to eat for strength and not for sport (as some of my friends used to tell me in the early days when I was first in Tchad).

With the roosters having started their crowing since about 3am, the dogs barking and the drums and dancing having just stopped, the morning is quiet and peaceful with just the lulling, rhythmic sound of crickets breaking the early dawn's silence. I step outside into the desert cold. I quickly go back in and put on a sweatshirt. I pull my small North Face backpack over the sweatshirt and slip on my Crocs.

The ankle is a little stiff, but it feels good to be out on the deep, sandy road towards Bere's laterite airstrip. It's a 2 km walk and I have the village mostly to myself.

An early morning fog rests over the tops of the thatched roof, brownish red clay huts combined with the pungent smoke of wood and dried grass fires. The only ones awake are a few women pounding millet in homemade wooden mortars with 6 feet long wooden pestles. The dooomp, dooomp of the pounding of grain into the base for the typical Chadian breakfast porridge echos across the stillness. A few children are also up trying to chase away the night's chill around hastly gathered grass and stick fires. Their dark faces hidden amidst the white smoke wafting from the incompletely dried weed fires break into toothy grins as they see the "Nasara" walking steadily and gingerly away from the hospital. It's not every day that something this new and exciting happens!

They are mostly dressed in ragged shorts, holey pants and torn t-shirts. It's no wonder they're cold as the dry season has descended upon us leaving us with the extremes of up to 40 degrees Fahrenheit difference between day and night temperatures. The luscious greenness of the rainy season has rapidly evaporated into the brown, dead grass powdery dusty dryness of the majority of the year here in the heart of Africa.

I approach some of them, who eye me warily with looks of mixed curiosity and fear. I extend my hand, palm up. Several of the bigger, braver ones approach to shake hands. I shake my head and show them how to "give me five."

"Tak kebeng (slap my hand)" I encourage them in Nangjere. When they finally get up the courage to try, everyone wants to get in on the action and they all start giggling and laughing. What a privilege to really smack hard the hand of a grown-up, much less a foreigner!

I finally get to the airstrip where the early morning sunrise colors the mostly white plane with a tinge of pink. Gary is testing the oil and fuel and filling up the wing tanks with his bright red cans of Cameroonian gasoline. A few kids have gathered around as usual, but not the usual crowd since it's still so early. After Gary eats a "late" breakfast, we slide into the tiny Cessna loaded up with empty fuel and propane containers and after a short taxi we are soaring up and over where the 10,000 inhabitants of a Chadian county seat disappear quickly into the groves of mango trees with just occasional glimpses of thatched or rarely, tin roofed, houses give us a clue that there's actually a village hidden in this vast plane. We bank over the hospital to get a good aerial view and it also suddenly seems so small and insignificant when seen from on high.

We're on our way to N'Djamena...

Thanksgiving

From James:

It all started with a little lying. I had too, otherwise I would've spoiled the surprise.

Monday, I went to Moundou to check up on the remodeling project for our new outpatient surgery center in Chad's second largest city. The route is simple: follow the bumpy, dirt road to Kelo and turn left onto the paved road until you hit Moundou. In Kelo, as we turned left, I saw the post office. I decided to stop. I found 14 packages waiting for our student missionaries. I paid for them all, loaded to car and continued to Moundou.

The project is going well, I talked over a few details with the builder and then he joined us for the ride back to Bere so he could look over our existing operating room to better understand what we were shooting for. It was when we were back on the road to Bere that I had the wonderful idea for my surprise. Little did I know how much deception I would have to employ in order for it to succeed.

The first thing was to swear our driver, Levi, to secrecy. We then had to quickly unload the packages into my house without the student missionaries seeing them. Since Thursday was Thanksgiving but American holidays tend to get neglected or rolled into one, I decided to turn it into an early Christmas surprise. I wasn't going to tell them I'd picked up their packages sent from home, not until Thanksgiving morning.

I didn't count on our volunteers' desperation to have those goodies.

The very next day, Stephan came to me to explain how he'd arranged everything with our Administrator, Andre, to have the day off so he could take a motorcycle taxi to Kelo to see if they had any packages. They were all expecting some that would have things to make Thanksgiving dinner with.

I put on my severest, coldest boss face.

"Stephan, did you come here to work, or to get packages. You should've told me yesterday. I passed right by the post-office and could've easily checked to see if there was anything for you guys. We're really busy right now, besides, how are you going to get a bunch of packages back on a motorcycle. It's just not a good idea. I'll probably be making another trip early next week, I can pick them up then."

Stephan's face falls, but he has no choice but to accept.

"Well, ok, but Kristin was going to go with me, maybe she can just go. She's not scheduled till this evening so she wouldn't miss work."

Thinking quickly, I'm amazed at how easily I continue the deception. "Stephan, do you really think it's a good idea for a girl to go by herself to Kelo? It's just not very smart. It'll be even harder for her to carry all those packages back. Plus, this is Chad, it could be dangerous." I'm lying through my teeth, but somehow keep a straight, concerned face.

Stephan turns sadly away to go back to his accounting office. I smile inwardly at my success. It is short lived as lies tend to pile on top of each other; once you start it's hard to stop.

I have to repeat a bunch more to Kristin later on as she is unwilling to accept Stephan's explanation and feels that if she talks to me personally, maybe this mean boss will change his mind. I hold firm and convince her it's just not a good idea. Besides, there's other things already planned and we won't really have a real Thanksgiving anyway, we might as well just wait and have our Thanksgiving next week sometime. She's crestfallen but also has to accept.

Tuesday night, I find myself chatting with Kristin and Ansley and, unfortunately, they've come up with a solution that I can't lie my way out of. I'm forced to spill the beans. They are excited but agree with me to keep it a secret from the others. Ansley joins to lying as she announces to the others on Wednesday that due to her 6 episodes of explosive diarrhea the night before she's just not up to a trip to Kelo and Emily shouldn't go by herself.

Early Thursday morning, I pull the 14 packages and numerous letters out of my closet and carry them over to the SM's common room in the middle house. I leave a note that says "ho, ho, ho, merry thanksgiving, merry thanksgiving." And it turns out to be just that...after a long day at work.

Work starts out with rounds on a completely full hospital with no beds to spare. Then, I have a tubal ligation, a D&C/tubal ligation combo, a rectal polyp to remove on an 8 year old Arab boy, a bilateral inguinal hernia repair with mosquito net, another emergency D&C for an incomplete spontaneous abortion and finally finish at 4:30pm just in time to go to Gilbert's going away party that Jason has organized.

I slip into the courtyard where many of the staff and Gilbert's friends are already seated on a variety of chairs and stools and mats. I slip off my Crocs and settle onto a mat. My ankle is aching a little and somewhat swollen after a long day upright in the OR, but it's not too bad. I exhange pleasantries with Job and Koumakoy and nod at Simeon and Abel who I've spent all day with in surgery. Gilbert slides onto the mat next to me and we have some decent small talk as Jason serves us the best "bouille" I've had in Chad. Zachee, our cook, is the best and Jason contracted him for the feast. The "bouille" is a rice porridge with milk, sugar, cinnamon and peanut paste. I grab the crude metal bowl from Jason and slurp it up without a spoon.

The second course is either roasted goat or chicken in a tomato sauce with boiled sweet potatoes, all served over mushy rice. It's quite tasty, but I'm trying to save room for Thanksgiving dinner later.

At 6pm, we all head to my house to prepare the feast. We have invited Gary and Wendy and their volunteers (Steve, Jeremy and Annie) as well our our 6 student missionaries, Maria (our Danish volunteer) and Sarah and I. Jacob's mom has sent 5 packages stuffed with everything needed. The menu is impressive: Fri-Chik, garlic mashed potatoes and gravy, cranberry sauce and relish, anti-pasta salad, stuffing, spiced apple cider, candied yams, and a pumpkin pie spice squash dessert with real whipped cream! Gary and Wendy add some real (not powder) mashed potatoes, more gravy, a cranberry-like hibiscus flower sauce, and some stuffing made from scratch. Jeremy and Annie bring a fresh garden salad of tomatoes, lettuce, cucumbers and sprouts; fresh squeezed lemonade; and boiled beets.

Jacob's mom has also sent Thanksgiving-themed plates, napkins and decorations and with the half-cut into pumpkin-like squash in the center of the table we're only missing NFL football to make it feel like a real American holiday.

Right before eating, Sarah comes over to tell me that she's already hospitalized 5 kids with malaria, 3 of them with severe anemia needing blood transfusions. Luckily, Samedi is on with her until 9pm so they're managing, but the hospital has been filled back up despite being cleared out by me in the morning. She refuses my offer to eat with us, saying she'd rather I just brought her something later.

We all sit around the table and go around with each person saying one thing they're thankful for for each of the 5 kernels of corn placed before them. We pray and then we chow down.

Just as I'm finishing my overloaded plate (the first one done of course) Hortance, the midwife, comes knocking to tell me about a woman, 8 months pregnant with vaginal bleeding referred from the health center 2 days ago but just now arriving. She is severly anemic with a hemoglobin of 4.8 g/dl and has a placenta previa where the placenta wants to come out before the baby. I think I find a fetal heart beat so we quickly resuscitate her with two large bore IV's and a lot of IV fluids, give her anti-biotics, and take her to the OR. Fortunately, her blood type is AB + making her a universal recipient (i.e. she can take blood from anyone) so we have both her brother and father give blood while we prep her for surgery.

We start the first bag of blood running as we pull out a dead baby with skin already peeling off meaning he's been gone for a few days. Fortunately, there's not much bleeding and we quickly close her up as the second bag runs in. Her heartbeat is almost normal now and her blood pressure has come up. We wheel her into the wards almost running over some Arab women who've spread their sleeping mats right across the entrance and then are forced to leave her on the gurney for the night since there are no available beds.

I come home at about 10pm and we play Settler of Catan and Citadels until almost 2 in the morning when I fall into a deep, contented sleep.

Happy Thanksgiving!

Wedding Dress

It is only two weeks until I leave for my niece's wedding in Dallas. It seems like I just returned from there and the thought of packing everything up and heading back makes me want to just sit down and eat some cookies! But I will resist the urge and start thinking about what to wear.

I can't wear any shade of winter white, the bridesmaids dresses are red so that is out, and black is not socially correct (unless you live in California...) That being said, when looking for a pattern for a new dress I found this one

The one on the right is made from a beautiful brown stretch velvet and it is a classy look. A trip around town looking at the local selections of stretch velvet have left me with the choice of.............black. The only other option is a trip to the garment district but I'm not sure there is time. I will get the pattern ready tonight and see how we are on time this week and then decide on what to do about the fabric.

Since I will be coordinating the wedding I really need something that is comfortable, warm, appropriate and of course, chic. (oh, and I forgot, slimming!) We'll see if this is the magic dress.

There was another choice

but with all of the moving about, up and down and all over the church and reception hall, I was afraid I would need to do more adjusting of the top to make it comfortable to do all of those things. I really like the lines of this one so maybe it will be just a holiday dress in any color of my choosing.

I am so glad that it is Thanksgiving week as I have so much for which to be thankful. Even with all of the happenings in the United States and the world and despite my personal circumstances, I am blessed and every day I have to remind myself to list those things in order to keep life in perspective. I hope you all have a chance this week to take inventory of your life and surroundings and find even the smallest things for which to be thankful. If you happen to be reading this - I am thankful for you.

Tragedy

Today we were notified that 4 college students, at a small college in Northern California that both of my children attended, were killed last night. Our hearts and prayers go out to the parents, siblings, other family members, friends of these young men and to the faculty, deans and other staff at the college. Life is so precious - hug your kids a little tighter and longer tonight.

To Vegan or Not to Vegan

Our family has vacillated between eating vegan and not eating vegan. We are now beginning once again to pay attention to what we are eating so that we will reduce our risk of heart disease and stroke. Tonight I made a recipe out of a vegan mediterranean cookbook that was definitely a hit so I thought I would post it here for any who might be interested.

2 tablespoons extra-virgin olive oil
2 bunches scallions (12 to 16), white parts chopped, 1/2 cup thinly sliced green tops reserved.
4 ounces (about 2 small) carrots, chopped
1 stalk celery, chopped
2 large cloves garlic, finely chopped
4 cups vegetable broth
1 cup water
1 cup lentils, rinsed and picked over (I use the red lentils because I love their flavor but any lentil would work, I'm sure)
1/4 cup brown rice
1 (14 oz) can whole tomatoes, drained, seeded, and coarsely chopped, juices reserved
1/2 teaspoon dried thyme leaves
1 large bay leaf
Salt and freshly ground black pepper, to taste

In a medium stockpot. heat the oil over medium heat. Add the white parts of he scallions, the carrots, celery and garlic; cook, stirring often, until softened, about 5 minutes.

Add the broth, water, lentils, rice, tomatoes and their juices, thyme, bay leaf, salt and pepper, bring to a boil over medium-high heat. reduce the heat and simmer gently, partially covered , until the lentils and rice are tender, stirring occasionally 50 to 60 minutes. Discard the bay leaf. Serve hot, garnished with the reserved scallion greens.

To complete the meal, we just added fresh baked wheat bread and a fresh salad. Oh, the hard part of being vegan is what to use on you bread if you don't use butter - tonight we used roasted red pepper hummus - delicious!

Here's to health - our most valuable possession in this life!

Sweater Refashion

Last week I went through my closet and reduced the bulk by about half. Even though I know I won't wear some of the remaining clothes with their current look, I still couldn't bring myself to put them in the give away bag.

One of those left is a pink sweater that I have had for years, yes, many years, but I still love it.

So I got on the internet and looked to see what was out there as far asrefashioning sweaters goes. I found some helpful sites that gave me more confidence to cut into my treasured sweater and turn it into a cardigan. So today I took the plunge and cut right up the front of the sweater. The first thing I did though was iron some fusible interfacing on the back and 1" on either side of the center of the sweater front.
I then made sure that I was following the same knit channel from top to bottom and whacked away.
It was easier that I thought it would be to cut that knit and it didn't start to ravel immediately. But just in case I serged the edges and then pinned a separating zipper in the front. Next I turned under the serged edge, making sure to follow the same knit row, and pinned it to the zipper. Although I hand basted and machine basted one side I am not completely happy with the way it looks so tomorrow I will take the basting out and start again to see if I can accomplish a better, non-homemade, look. We'll see what happens.

Buttonhole Attachment

I happened to read The Sewing Divas blog tonight where Gigi showed buttonhole attachments that she has recently acquired. When I saw the pictures of the buttonhole attachments she was recommending I wondered if there might be one that was similar in the sewing cabinet that I inherited from my mother-in-law. Because everyone else in the house is asleep, I only looked briefly and quietly and found one that I hadn't seen before...it looks like this

The instruction booklet was first published in 1939 with my copy being a 1946 version. I am excited to get up tomorrow and play with making buttonholes! This should be fun.

Silhouettes That Will Work

I have way too many patterns for one thing and having to go through them all and find silhouettes that work together for the SWAP 2009 was another. That being said, it was actually fun trying to put things together and then once it was all on the storyboard, it was exciting to think that I might really like these pieces together - and might even wear them!

One of the tops is my TNT pattern that I really like and the others, well, I have never made any of them! With my niece's wedding and a new grandbaby before Christmas I am at least hoping to get the patterns fitted and maybe muslins made by then so I can start the sewing after the first of the year.

In looking through my fabric stash, I have to admit that black and white are the predominant colors and will probably be the basics of my SWAP unless on a second look through I can come up with something else. The bright other color decision hasn't been so easy so I will spend some time this week figuring that out.

I had really wanted to make a white shirt (you know Tim Gunn says that is a must!) to go with the SWAP but can't figure out how it will look with the collarless jacket. I love that jacket, but it really limited my choices for tops. I loved this top but after looking at the storyboard saw that it wouldn't work with the jacket and had to x it.


Well, here is the latest version of my storyboard - we'll see how it goes!

SWAP 2009

I had a little time to spend reading some sewing blogs and websites last night and came across the SG SWAP 2009. I have been following the SWAP Contest for the last couple of years and had decided to join this year but had not seen the official rules until last night. The nice thing is that the contest covers a longer period of time to complete the sewing - I'm thrilled about that!

Since I haven't been even thinking about this before last night I need to double my efforts to see what I can come up with today in the way of a plan for these garments and their fabric. I would love to use what I can of the fabric in my stash and then fill in with a trip to the Garment District in LA.

Awwww, then there is the fitting of the pattern to think about - it is still a struggle for me to get garments to fit me the way I think they should - guess I had better start on that right away too so I am ready to sew as soon as possible.

I am off to the sewing room to see what I can dream up.

Mistake

From James:

Have you ever been glad you made a mistake? I was sure the elderly man had
a gallbladder problem. I mean, I'm no ultrasound expert, but there was
obviously something inside that gall bladder that shouldn't have been there.
Besides, he was complaining of pain right over that spot that was worse when
he ate. And his bilirubin was elevated, another sign that could point to
gall bladder problem.

I was hesitant to operate, though, because he was a friend. In fact, he is
the chief of our neighborhood here in Bere. Totho Timothée. His brother
has AIDS and is a motorcycle taximan who takes us often back and forth to
Kélo when our car isn't running or the rainy season makes the roads all but
impassible for anything except a moto.

But, I finally decided it was the right thing to do. I was sure he needed
an operation for his gallbladder. I was wrong.

I stand to his right side. Franklin has given him a "high spinal"
anesthetic so I can make a somewhat relaxed incision right below his right
ribs. We pray and I start cutting with Abel and Jacques assisting. I've
decided to splurge today, since it's a gall bladder, and have set up the
electrocautery. Soon the smell of barbecuing human flesh fills the room as
I burn through the abdominal muscles before entering the peritoneal cavity.

We also are using the air conditioner since it's about 110 degrees
fahrenheit outside. Jacques, however, having just recently arrived from
Togo where it's relatively cooler, is having a hard time as the sweat runs
in rivulets down his face. I usually don't notice until afterwards when I
pull off my gown and find my scrubs are soaked with my own sweat.

I have Abel retract the liver gently and I get a good look at the
gallbladder. It looks normal. I pinch it between my fingers. It feels
normal. I'm starting to feel sheepish. Especially since on entering the
abdomen I found a lot of ascites fluid and now I see that he has advanced
liver cirrhosis. Of course the bilirubin was elevated! I'm starting to
realize I was wrong to operate on him and it could've maybe even endangered
his life. Better close and get out of here before I do more harm.

Then I notice something out of the corner of my eye that gives me pause.

"Jacques, pull the stomach back a little again. Yeah, just like that."

I see a small black spot on the first part of the small intestine coming
right out of the stomach. Before my brain can even formulate it's idea of
what it is, the spot confirms itself by opening up right before my eyes and
letting out a stream of clear, gooey liquid.

A duodenal ulcer just perforated before my very eyes! Abel quickly
aspirates up the stomach acid with the suction tip and I call for some
suture.

I place some interrupted sutures along the edge of the ulcer and leave them
untied till I have a whole row ready to close the wound. I then pull some
of the omentum back from the stomach edge and lay it across the perforation.
I tie the sutures across the omentum patching up the hole. I irrigate and
suction and then close up the muscle, fascia and skin of the abdominal wall.

I've just witnessed a miracle to save our friend, Timothée's life. If I
hadn't mistakenly misread the ultrasound I wouldn't have operated. If I
hadn't mistakenly thought it was the gallbladder I wouldn't have made the
perfect incision to allow me to see and close the ulcer. If I'd have waited
half and hour more it would have perforated letting stomach acid all in the
stomach to burn and irritate the intestines and cause all kinds of
complications. If it had happened a day or two before I did the operation,
he'd probably be dead...especially with having already liver cirrhosis.

Sometimes it's ok to make a mistake!

Too Late

From James:

I squat on the ground outside the operating room. A thin Muslim man squats in front of me, his green Arabic robe pulled tightly across his knees as he hugs them with his arms. He is staring at the blue basin between us. The insides of the basin is covered with a blood-soaked, brightly-patterned yellow wrap around skirt. I lift up the cloth with a gloved hand covered with dried blood. Underneath is a dead infant with a huge head (hydrocephalos). His blank eyes stare up at us as his neck bends back at an impossible angle. Underneath is the placenta still attached to the child by the umbilical cord. All is cold, lifeless and bloody.

I do my best to explain to him in Arabic what happened.

"The child, dead, when arrived, dead already. The head, big, not come out. The house of the child broken, the child come out here (point to my stomach). Blood come out, a lot, here also. The woman there, she not have much blood when she arrive not have. Si there is not much blood, she found death."

"Both of them, the two of them, both dead?" The man asks in disbelief.

"Yes, both dead, all dead," I repeat a million images of the last two hours flashing through my head...

"Doctor, doctor!"

I slowly stumble out of a deep sleep and a pleasant dream. "Yeah, what is it?"

"It's me, Augustin, I have a case to present to you."

"Ok, I'm coming." I pull on a pair of scrub bottoms and feel my way through the dark to the door and out onto the porch. Augustin is standing outside the screen door with a headlamp and a "carnet" or portable medical record.

"There's a woman, referred, in labor for two days..." Augustin stumbles through presenting the woman. He is one of our laziest nurses and often does as little as possible. I'm a little irritated.

"Whoa, whoa! Start over, give me that!" I take the labor and delivery sheet. I glance quickly over it and it's incomplete. I see the vital signs, heart rate 60 bpm, blood pressure 100/70, temperature 37 degrees Celsius. I'll regret later not noticing how generically normal they were.

"What? What's going on?" A voice comes from the room next to us where Jacques, our newly arrived doc fresh from medical school in Mali, has been sleeping.

"I'm talking to Dr. James," replies Augustin. Jacques quickly appears outside just as I'm telling Augustin to go get more information and come back to see me with the chart completely filled out.

As Augustin and Jacques walk off together I almost yell after him to check a hemoglobin. I catch myself, thinking I'll be over to see her shortly anyway. The second thing I later regret not doing.

I go back to my room and decide to lie down, after all it's been a long week filled with tons of surgeries and the training seminar I've been doing for the village health care workers on HIV and tuberculosis. I'll just close my eyes for a few minutes until Augustin and Jacques get back. The third thing I later regret.

"Docteur? Docteur?" The soft voice of Jacques floats across my subconscious. I go to the door. I glance up at the clock. It reads 4:25 am. I didn't look at the clock when Augustin first came, but I did hear the fridge running which it's programmed to do 4 times a day for an hour at a time: at 6am, noon, 6pm and midnight. It's been 3-4 hours since I saw Augustin and Jacques walking off together. A strange sense of foreboding falls over me.

"I've examined the woman and I think she has a ruptureed uterus."

"Go call Abel and Dr. Franklin and I'll be right there."

I pull on a scrub top, grab my keys and I'm out the door. I stop by the other house real quick to make sure Franklin's awake and then make my way across the compound to the labor and delivery room just past the OR.

As I walk in the room and glance at the patient, my heart skips a beat. A tiny Arabic woman lies stretched out on the table with one knee bent in the air. Blood has pooled between her legs. An IV with Glucose and I quickly assume Oxytocin is dripping into her left arm. Her thin abdomen is grossly distorted with several large, not normal pregnancy looking lumps. But what arrests my attention is when I look at her face.

Her head is flopped to one side and her eyes are rolled back in her head. She is pale and her only breaths are occasional sighs. She is on death's door and I see it instantly. I quickly feel for her heartbeat which is present but slow. I flip down her eyelids with my finger and my blood freezes. Her conjonctiva is white. She has practically bled to death in our hospital.

"Augustin, quick call the lab, we need blood! Abre, run and get me some Ringers!" Franklin arrives and quickly starts looking for a better IV. Then she stops breathing and I start chest compressions. Franklin has found an IV in her neck and we get fluids running. Abel has arrived and we take turns with chest compressions.

"Franklin, what about the monitor from the OR?" He runs quickly and arrives. We get no blood pressure and a weak O2 sat.

Finally, after what seems like hours the lab guy arrives.

"Abre, what blood type are you?"

"O positive."

"Mathieu, just check to see if she's positive or negative and if she's positive Abre will give."

She is B positive and Jacques and Abre run off to donate a bag of blood each. Augustin is B positive and refuses to give.

Abel and I keep up the chest compressions while Franklin guards her airway.

We get the first bag which is only a third full of Abre's blood. We hang it up.

"Abel, you and Abre get the stretcher and lets take her to the OR."

We flop her bloodied body onto the stretcher and Abel and Augustin carry her quickly to the OR while I continue chest compressions and Franklin carries the blood and IVs.

We get her all set up on the OR table with blood splashed everywhere. Still no heartbeat so we continue our ressucitation hoping that if we can keep her oxygen circulating until we replace her blood loss maybe we can save her.

We try some Atropine to start her heart. We try shocking her. Nothing. We have no Adrenaline. Then I remember we have some spinal kits. I open up two kits so we can use the adrenaline inside. Nothing works so we continue CPR.

Finally, a third bag of blood is running and I decide to take out the baby. We slosh Betadine on the belly, I quickly open up a C-section kit and put on a gown and sterile gloves. One slash and I'm in the belly. I cut the baby's face but he's dead already. His head is 5 times normal size with hydrocephalus. That's why he couldn't come out. Her uterus is in tatters. I pull out the baby and placenta. Place some clamps across what's left of the uterus and cut it out. I tie off the clamps, dump some Celox in the pelvis and hold pressure for 5 minutes. The whole thing takes about 15 minutes. All the donated blood is in, we've been working on her for almost 2 hours and she still is flatlined. I tell the guys to stop CPR, I sew up the belly and I go out to tell the husband.

As I'm kneeling in front of the Muslim husband, having just told him his wife and the unborn child between us are dead, I'm not sure how he'll react. A brief image flashes through my mind of the violence of two weeks ago with Arabs stabbing and killing Africans and vice versa and the chaos in the hospital trying to save as many as possible. But there is no revenge taken on me today. Instead, a gentle chanting in classic Arabic rises from the depths of his sorrowed heart.

"Illallah le Allah wa rassulloh Mahamat." The Muslim creed repeated over and over seems to soothe the sorrow. "Al hamdullilah" (Allah be praised) breaks in occasionally. A fellow Muslim from Lai comes and kneels down beside him reciting some Koranic verses in a low voice.

"Find me some brothers of Islam here. All the believers here in the hospital." The other Muslim goes off and soon a small group of robed and turbaned men surround us.

I ask him if he'd like to see his wife. He nods and we go into the OR where Abel and Jacques have been cleaning and covering the body. A portly Arab with a beige robe and white turban accompanies us. The woman is lying on the stretcher covered with a black, Muslim woman's cloth with intricate Arabic designs in gold woven into the fabric. The husband uncovers the wife's face and asks for water.

I get some water from the faucet and bring it to him in a small basin.

"Put a little over my hands," he asks me in Arabic.

I pour water over his right hand and he uses it to gently wash and wipe down his dead wife's face closing the eyes. The other Arab also moves his hand down the face to close the eyes and then they cover her back up. As we take her out to the morgue I hear some low sobs coming back from the OR.

15 minutes later, the brothers from the Mosque have arrived and I carefully explain in broken Arabic again what has happened.

"Xalas, inshallah, mashallah, al hamdullilah" come out in intervals from all present. The accept and comfort and then take the body off to be appropriately buried as soon as possible in the Muslim fashion.

I go home.

HOME AT LAST

After almost 2 months I am home in my own bed with my own bathroom...doesn't get better than that! And I was able to spend my birthday at home - doing what I wanted - nothing! It only lasted a day so I am not worried about turning into a doorstop that doesn't do anything.

Everything from Dad's house has been taken care of - either with Dad to his new house, to Janet's house, or to mine, or sold or given away, and we are all happy. What could have been a relationship destroying activity turned into a bonding time with my sister and me. I couldn't have asked for anyone to be more caring and willing to give and take with others in mind that my sister, Janet. I was truly blessed.

Remember the patterns I told you about that she bought for me? I'll start adding pictures of them so you can what treasures were in my bag. The sizes and their measurements are a little shocking...according to what is printed I would probably be a 22 or so.








The 14's have a bust of 34 and the 12's a bust of 30. The size 12 1/2 is size 33 ????? This is just a start of the patterns as I will add some each time I post. It might be after the first of the year before I get a chance to try any of them. Can't wait.

And now to bed - in my own bed!

CRIPPLE

From James:

My life as a cripple began insignificantly enough.

As far as I can tell, it started with digging that latrine last Sunday
morning.  I must have accidently hit the inside of my right ankle with the
pickax.  Whatever the cause, by Sunday night it was swollen and painful.  By
Monday morning, I could barely walk and it was red and angry.  I tried to go
to work, hobbled around on lightning rounds before I couldn't take the pain.

At the same time, I was hit with the worst attack of Malaria since the first
time I got it in 2004.  By the time I hobbled home my muscles were twitching
so badly and my teeth chattering so hard you'd of thought I was in the midst
of a Danish blizzard instead of 110 degree sub-saharan Africa.

I slammed down 8 anti-malarial combo pills straight in from China and
huddled under the blankets desperately trying to fight off the cold.

Did I mention my ankle was killing me?

After a day or two, the malaria was better, but as of last night, I hadn't
walked in a week.

I'd been hoping there wouldn't be any surgical emergencies as you can
imagine.  Despite two symphysiotomies performed resting my bum leg on a
stool on wheels in order to bring in two floppy, but eventually revivable
newborns, things had been relatively calm.

Until last night...

After a leisurely Saturday lounging around with my foot elevated to control
the edema listening to David Asherick talk about living in the End of Time,
I found myself strangely drawn to the window around 5pm that evening.  I
picked up my crutches (hand made in Chad and borrowed from a bed-ridden
patient) and limped over to the screen door facing the fence between us and
the Emergency Room.

It was hard to see because of the two screens and the distance between me
and the action, but I saw a group of people gathering hurredly.  A couple of
push carts moved back and forth.  Two people were carrying a stretcher.

I was not surprised to see one of the Intern nurses, Aimée, coming up the
path a few minutes later.

"There's a situation," she blurted out, gasping for breath.  "There's been a
fight at the market.  They've brought in a bunch of victims.  One woman's
dead.  A man has a huge knife wound to his neck.  This other woman is all
beat up around the head and unconscious.  There's a baby that's been
wounded..."

"Ok, ok, I'll be right there."

I pull on some scrubs as quickly as a cripple can and somehow cram my
swollen foot into my crocs and hobble over.  Crutches over moist, sandy soil
is not easy.

I pull aside the curtain to the ER and see groups of people huddled around
bloody clothes with arms and legs sticking out everywhere.  Some are on
beds, some on the ground.  Sarah looks up.

"I think this one is the most critical.  She's pregnant too.  We can't get
the baby's heart beat.  She has a huge wound on her head."

In the midst of a bloody pile I see a slender, young Arab girl with a
bulging middle sticking out of a brightly colored dress made even more
bright by her life's fluid spilled all over it.  Her face is irrecognizably
swollen, contorted and bloodied.  One eye is completely swollen shut and her
long, tight braids are matted with the dark, drying human liquid.

Jason tells me one pupil doesn't react well.  I don't bother to confirm.

Samedi and Abel have arrived.  Simeon is there shortly.  Ansley, Kristin,
Emily and Jacob are also there.

I start shouting out orders.

"Get IV's started on everyone.

"I want one liter of Ringers running full speed.

"Give them all 2 grams of Ampicilline.

"Where's Stephan?  Stephan, get a carton of those 1 L Ringers that just came
yesterday.

"Is there a pharmacist?  Where's Pierre?"

Andre has arrived and speaks up.

"I'll call him and get him right in," he says already punching in numbers on
his cell phone.

"That guy there is probably the second sickest," Sarah shouts across the
room as she attaches IV tubing to the arm of the first woman.

A young man is staring at me calmly.  His once white pants are now tie dyed
in his own color of red wine.  A bundle of gauze has been taped under his
right jaw on his neck.

I pull it off and see a 10cm laceration cut neatly from right under his chin
to under his ear.  It's about 5 cm deep and oozing a lot of blood until I
push the compresses back in the gaping wound.  It doesn't appear he got his
jugular or carotid though.  And he's breathing fine.

"Nathaneal, come and push on this as hard as you can...right there in the
center of the wound.  Don't let go."

IVs are running and nurses are frantically mixing up and administering
Ampicillin.

"Jacob, you and Jason...et Abel aussi...go get the gurney from
surgery...ABEL...LE BRANCARD...AU BLOC!"  I yell at Abel since he's almost
deaf, but one of our hardest workers and head nurse in surgery.

"Jacob, never mind, Jason and Abel can get the gurney, here take my keys and
bring me the ultrasound from my office."

I briefly look at the other two women who are beat up and bruised but
otherwise look ok.  One is pregnant and I quickly do an ultrasound
confirming the fetus is doing well.

Justine walks in with the baby who's mom had been killed, strapped to her
back.

"She's not injured at all luckily, we just thought so at first because she
was covered with blood."

"C'est bon!" I quip and head off to the OR.

In the OR, the lights aren't on so I hobble into the battery room/solar
panel master control room and flip on the switch giving us solar power to
light up the OR.

People scrambling around.  IVs going up and flowing in.  Needles, seringes,
gauze, scalpels, instruments, suture, gloves, scissors, razors, shaved
braids, and blood, blood everywhere.

After Abel finishes taking off a life's worth of braided African hair in a
few minutes time, Samedi gets going suturing up the huge upside down V
shaped gash in her scalp.  She starts to moan, she had been unconscious we
thought.

"Simeon, get her some Ketamine and Diazepam and put her under."

Meanwhile, there's a baby with anemia that no one has been able to find an
IV on all day.  They'd brought him to me at the house and I had tried
putting a needle into the bone marrow of his tibia, but I didn't have the
right needle and the others just kept bending.  It was about this time that
I was called for the mass casualty.  Now, the baby is before me again.

"Jacob, give the baby a milliliter of Ketamine IM and strap him into the
Papoose."

As Samedi starts suturing up the head wound, I slice into the baby's ankle
and dissect down to the saphenous vein.  I find it and slide in an IV
catheter.  We hook up the blood, see it's running in and I suture the wound
closed around the IV.

They've now brought in the young man with the neck wound.

"Kristin, you and Ansley take this baby off to peds.  Simeon, you and
Jackson (Jason) move the man onto this gurney."

"If it wasn't for Allah, I'd be dead."  The young man stares at me
earnestly, speaking in Chadian Arabic.

"Alhamdullilah!"  I reply and he nods and closes his eyes as he starts
softly repeating Koranic verses.

I stay seated on my stool as Simeon puts him under anesthesia with the usual
meds.

A couple sutures to bring the muscles together after washing it out well and
a few loose skin stitches and I'm done.

"ABEL...PANSEMENT!"  I point to the gauze bucket and to the man's neck.
Abel and I have our own sign language between us.  He nods and dives right
in.

Meanwhile Emily has brought the ultrasound in to the OR and I do a quick
ultrasound on the woman that Samedi has just finished stitching up her
scalp.  Her fetus is also doing well and at 32 weeks should survive even if
the mom dies if we can do a C-section quick enough.

I grab my crutches and swing outside.  Sarah is coming from the OR.

"They've just brought in another guy...a Nangjere man.  The sous-prefet's
truck is out looking for other victims.  This one doesn't look too bad."

He's got some cuts on his hand and a stab wound to the shoulder blade that
isn't deep.  I leave it for Samedi and hobble home with the volunteers.

After a game of Settlers of Catan our second game is quickly interrupted
with the arrival of more victims.

This time there're people scattered all over.  Camouflaged gendarmes armed
with AK47s and Kalishnikovs are unloading people from the truck.  I just
head straight to the OR and tell them to bring the worst one's in.

Samedi is just finishing up with the man I'd left him.

"James, I just heard the story of how it all started.  It started with this
guy..."

Apparently, the man was out in his field and saw some cows eating his rice.
He challenged the herdsman, an Arab nomad.  The nomad started to pull out
his bow and arrow so the Nangjere man rushed him and grappled with him.  The
Arab pulled out his knife and the Nangjere grabbed the blade with his hand
(hence the cuts).  He quickly let go and the Arab stabbed him in the back.
The man fainted and the Arab fled.  The women watching assumed the Nangjere
man was dead and ran to the market screaming bloody murder.  When their
relatives heard that their "brother" was dead, they attacked a group of Arab
women just leaving the market.  Hence our first wave of casualties.  Now
both sides were on the prowl and apparently a group of Nangjere had headed
to the Arab village going from door to door dragging women and children out
and the Arab men were organizing their reprisals.  There weren't enough
gendarmes to control it so they were just picking up bodies and wounded.

Samedi finished and wheeled the man outside.  At some point later on, he
wisely dissappeared.

Now, they bring in a wiry Arab with the face of Kobe Bryant who has a huge
slash across his right lower chest.  It's about 25 cm long and all the way
down to the ribs God gave him to protect his liver and lung.  The other Arab
is a wizened middle aged man with cuts all over.  His main complaint is
they've taken out his left eye but closer examination reveals a 10cm slash
across his cheek and a left eye swollen shut.  Small laceration cover his
body and arms.  An open dislocation of a finger I quickly "pop" back in.  He
also has a stab wound to his leg which has broken his tibia.

I put the tibia back in place, wash out the wound well, slosh some Betadine
of a gauze and place it over the wound.

"Jacob, hold that tight.  Jackson, keep pulling on his leg and hold it in
this position.  ABEL...PLATRE...PPPPLLLLLAAAATTTRRREEE!"  He doesn't
understand so I point him to the wound which he holds pressure to.

"Jacob, go get all the stuff for a cast.  Just like we did last Saturday
night:  webroll, tubing, plaster, a basin of water, scissors"

"Simeon, Diazepam and Ketamine for this guy too."  I point to the man with
the chest wound.

"Ashadu Allah illaha ilalallah, wa ashadu ana Muhammador rasullallah."  He
starts to repeat over and over his Muslim creed until he drifts off.

But he doesn't go quietly.  He starts to have a reaction to the Ketamine and
tenses all up not wanting to breath.

"Sarah, get me some Chlorpromazine."  She can't find it.

"Someone get me some from the Pharmacy."

"There is none."  replies Samedi.  "I needed some last night and we're all
out."

Just then Sarah comes out of the inside OR, "I found one ampoule."

The man finally calms down and I do a running subcutaneous suture to bring
the muscles and fascia back together and then some loose interrupteds to
bring the skin partly together, still allowing it to drain since it's
contaminated.

"ABEL...PANSEMENT!" and I turn back to put the cast on the other Arab's leg
while Samedi finishes suturing up all the lacerations.

Meanwhile, Kristin and Ansely and Augustin (who's just joined us) are
working on another man just brought into the room on a stretcher.

"His intestine is sticking out his side and he's got a ton of cuts."

"Start an IV with Ringers.  Simeon, Ampicilline 2g, Gentamycin 4 ampoules,
Flagyl 2 bottles!  Augustin, urinary catheter.  Abel, nasogastric tube!"

I turn back to the fracture and Jacob has already wrapped it well.  I wet
the plaster and quickly wind it around the leg while Jason holds it in
position.

"Hold it there until it's dry."

I turn to the guy on the floor.  They've got all the antibiotics and tubes
in and an IV is running well.

"Simeon, start the generator.  Let's move him into the operating room."

A few minutes later I hop in on one foot having just scrubbed my hands and
arms.  I dry off and Abel puts on my gowns and gloves.  The room is lit just
by the two overhead OR lights focused on the betadined abdomen.  Jacob slips
me my stool and I position myself on the right side of the patient.  We
drape him and then Augustin prays.

I open him up from his sternum to his belly button and dark blood surges
out.  I suck it up and start exploring.  There's no major gusher anywhere.
In fact, I don't see any injury.  The liver is fine.  There is no stool in
the abdomen.  The stomach and intestines are undamaged.  I pull out the
omentum which is what had come out his side and cut off the contaminated
part, tying off the vessels.  As I can now examine the spleen as well I'm
surprised to see no damage to that either.  Where's the blood coming from?

Finally, I get Abel to give me a good look at the wound and I see air and
blood spurting into the abdomen with each breath.  Of course, it's coming
from his lung through the punctured diaphragm.

That would also explain his poor oxygen saturation.  Duh!

I suture up the diaphragmatic tear.  Suck out as much blood as possible.
Re-examine the spleen since I can't believe the knife left a 3cm laceration
in the diaphragm right over the spleen without touching it, but the spleen
is clean.  I leave in a drain and close up.

Then I poke in a chest tube, hear the welcome rush of released air and a
smattering of blood, hook him up to the water-seal/suction apparatus, suture
up the large gash on his arm, the three small gashes on his back, and
finally come to the left buttock.

Jacob and Abel hold him as we roll him on his right side.  The wound is 15cm
long and 10cm deep and bloody.  I use a huge needle to bring the deep
muscles together and then sew the fascia shut.  I leave the skin loosely
approximated and Abel and Simeon dress all the wounds.

It's a half hour after midnight when I get home.  The truck drives up again
an hour later but since no one comes to get me I fall back asleep.  At six
o-clock, my haggard, yet still beautiful wife shakes me awake.

"Well, they brought in a bunch more Arab women but they all only have minor
injuries so I didn't wake you.  They also brought in three more bodies.  "Do
you want to continue antibiotics or anything else on that guy you operated
on?"

Oh yeah, post-op orders would be nice.  Sarah smilingly holds out an OR
order sheet that I quickly fill out.

She comes back at 8am showing me her lab slip.

"Yeah, not only was that the craziest night shift I've ever done, but I had
malaria the whole time!"

An hour later, I limp over to the hospital on my crutches to see the
patients.  Everyone is doing well.  All the women are awake, and while in
pain and swollen all over are able to sit up and take some water.  The neck
and chest wound men are also awake and praising Allah.  The man with the
punctured lung is also stable but not too awake yet.

Just then, a huge group of robed and turbaned Arabs flows in accompanied by
a bunch of soldiers with machine guns.  They go through and out the back
gate to the morgue.  I continue to the ER to see the other patients who'd
arrived after I'd gone back to bed.

I've just started and Djibrine, the nurse in charge of supervising our
district's health centers comes in.

"The governor and the sous-prefet want to see all the wounded."

I find them in the wards packed in with Arabs and gendarmes.  I send most of
them out with the full support of the sous-prefet except for a couple of
guards for the governor and the rest of his team.  I show them around as
they take town everyone's name and injuries and put them either on the
Nangjere or Arab list.

I finally make it home at noon and my ankle has ballooned.

I think I might always be a cripple.

Can't Believe It!

I love to read sewing blogs and learn as much as I can. Lately I have been reading the discussion of vintage patterns. To be honest, I hadn't given "old" patterns much thought but was interested to see the patterns others were purchasing. The styles are wonderful but I was intrigued by the pages of instructions. Don't get me wrong, I love to have patterns that can just be zipped up quickly, but the intricacies of these old patterns that are posted really drew me in.

When I was at my Dad's in Texas my sister and I were discussing sewing and I told her how I thought maybe Mom had had some of the old patterns that were listed on e-bay and that I would be interested in them. It was disappointing to go through everything and find that she had gotten rid of all of her vintage patterns and that was the end of the discussion.

Today I received a call from my sister telling me that I owed her and she would take 2 dresses in her size and in the fabric that she would choose. Of course, I had no idea of what she spoke. It was then that she told me that she had been to her FIL's girlfriends garage sale and was able to purchase 36 patterns from the 50's to the 70's. One of the ones she wants has buttons down the side and she said the pattern is beautiful. She doesn't sew clothes but she was excited after she saw the dresses. When I get back to Texas next week and get the patterns I will post some pictures of my newly acquired patterns. (She only paid $.25 per pattern!) I am so excited!!

Not Sewing but Having a Great Time

It should be a bit of relief to leave the intense heat of Texas and arrive in the cool breeze of the plateau of Tennessee - but I am a heat lover! and am having to grab the blankets to stay warm. But it is worth it to be with our son, his wife and two children for a few days. We don't get to be with the grandkids too often so we are having such a great time playing games, going to the park, cooking and singing until the hour they are whisked off to bed by the parents.


While here I was able to take pictures of some little backpacks that I made for the kids about 6 months ago. I had forgotten all about this pattern until I reorganized all of my patterns and found it at the bottom of the pile. They were fun to make and the kids seem to love them. My DIL is expecting the third child, a boy, in December and just let me know that she would be expecting a backpack for the new little one....a frog! There was no frog pattern included so I will be staying up at night to come up with, design, create, copy, a frog backpack.

Le Weekend

From James:

Boy, am I glad I went to bed early Friday night!

It was still dark and sticky when I woke up around 4am thanks to the pitter
patter of little rat feet running back and forth directly over my head as I
lay in a profound sleep.  Now, I can't go back to sleep.  Every time I'm
about to find dreamland again I hear the scurrying or the flapping of a bat
outside my screen window.  I give up and get up.

I put on a headlamp so I don't wake Sarah with the overhead light and go out
to the kitchen table.  I grab my French Bible and finish preparing the
sermon I'll give in church later on this morning.  At 5am I'm finally able
to catch a few more winks before the pink early morning light filters in the
windows accompanied by the ever vigilant roosters.

I eat a simple breakfast of local peanut butter on toast with guava sauce.
Meanwhile, Sarah has gone out to feed the horses and locked me in!  I stare
out the bedroom window waiting for someone to come within calling range.
Kitty hops up to the window sill to join me in my quiet contemplation of the
African dawn.  Some purple, pipe-cleaner type flowers have shot up just
outside the screen and a zebra looking bee is buzzing merrily amongst the
bristles.  Everything is green and the guavas are getting bigger and bigger
although they're still very green.

Finally, I spot Emily, a volunteer just arrived yesterday who responds to my
pleas for freedom and unbolts the outside latch on the front door.  I pack
up my books in a tiny bag and hoist my heavy, hollowed out tree trunk drum
to my shoulder and head off to the church.

The ancient French hymns sung off key that come wafting out of the church
are soon replaced by a more African rendering as Allah, our new nurse
Augustin's 10 year old son, starts pounding out some rhythms on the drum
accompanied by my little tambourine.

I have a very interesting discussion with a bunch of young people interested
in finding out what Christianity is about.  We talk about the Bible and how
it came about and who wrote it and why it's important because it's a
collection of stories telling us how God interacts with people despite all
their warts and wrinkles.

Then I preach my sermon in French with Nangjere translation.  Afterwards,
Simeon is waiting for me outside.

"There are a couple of patients you should come see."

I hurry home, change into scrubs and mosey off to the hospital.

Our friend, Polycarpe, the child with the bleeding disorder we've been
transfusing almost every week for the last few months is having severe
abdominal pain.  He also had some bloody diarrhea.  I'd been saving the
plasma part of other people's blood transfusions by storing them in the
kerosene freezer.  Yesterday, they were supposed to thaw it out, let any
remaining red blood cells filter out and give Polycarpe the plasma.  It
hadn't been done.  I quickly hook him up to the plasma and give him some
malaria treatment.  I hope to avoid another transfusion.

A three year old child with a hemoglobin of 4.3 g/dl still hasn't got a
blood transfusion.  Seven family members have been tested with no one who
can give her the blood she needs.  Her blood type is B-, the same as me.  I
just gave blood last week, but what the heck.  I tell Simeon to call the lab
guy, find an IV and I'll be back.

I figure I'd better eat something first.  I go home and Sarah has heated up
yesterday's eggplant spaghetti sauce.  We eat and then I drink another liter
of water and head back to the hospital.

Mathieu is waiting for me.  I lie down on the examining table in my office
as Mathieu prepares the blood bag, wraps a tourniquet around my arm, uses
alcohol soaked cotton to wipe off the skin over the big vein in the middle
of my arm and slides in a huge needle effortlessly into the vein.  I pump my
fist to make the blood go out faster and I've quickly filled up the 450ml
bag.  Mathieu takes out the needle and puts a cotton ball over the puncture
wound.  I flod my arm up, sit up and get ready to go.

"Already?"  Mathieu asks, astonished.  "Aren't you dizzy?"

"No, I just ate and drank a bunch so I'm fine."

I head out the door and meet Sarah at the house where she's already saddled
my horse, Bob.  Sarah takes off on her horse, Pepper, while the volunteers
follow on foot.  I change into jeans, grab some water bottles and jump on
Bob.  Allah, my drumming friend from this morning is coming with me.  I
swing him up by his arm into the saddle behind me and we take off at a trot.
Allah bounces around and we have to stop and walk often but eventually we
catch up with the others.

The rice fields are completely swamped and the path is nothing but a swath
of still water meandering amongst the rice stalks already starting to bend
at the neck from the weight of their kernels.

It's blazing hot and the water splashing up from Bob's hooves is a welcome,
mild relief from the sweltering heat.

The river has way overflown it's banks swallowing up all the familiar
landmarks except a few trees bravely sticking their branches up from the
swirling eddies.  We wade out towards the current through what used to be a
large field leading down to the cattle crossing.  Jason, Jacob and Nathaneal
have already almost reached the current as I start out and they are quickly
swept downstream.  I find the current and swiftly catch up to them where
they rest holding onto some branches sticking out of the water as the water
rushing by makes it sound like we're in a mountain stream rather than a flat
river winding through the African bush.


I'm vaguely scared of hippos, though they probably won't like the fast
current, and am again glad there are no longer crocs in these rivers.

After several bends we pull ourselves up the bank by grabbing onto piles of
tall grasses and follow the sketchy, grown paths through the bush on the
bank of the river trying to be as loud as possible to scare off vipers.

Back where Sarah and the others are playing with some of the Chadian kids,
the guys and I head up river just a tad where we see a tree coming out of
the river near the bank and then bending out conveniently at a right angle
where we can jump off.

After some jumps to test the depth, we dive and do back flips venturing ever
higher on ever thinner branches until we've exhausted the possibilities.

Heading home on Bob with Allah I have a hard time holding the horse back as
he smells his dried corn at home already!  Packs of mosquitos buzz along
with us in the twilight as the sun has gone down over half an hour ago.
Finally, Allah can't take any more so once we hit the first huts of the
village he gets off and I let Bob go rushing off through the approaching
night with the wind whipping around me leaving the mosquitos far behind.

I arrive in time to see Augustin returning from church.  He informs me that
Samedi is looking for me as there was a motorcycle accident.

I quickly pull off the muddy saddle and harness from Bob, open the door,
strip off my soaked jeans, take a fast shower and pull on scrubs to head
over to the hospital.

The ER is dimly lit by it's one flourescent bulb crowded with buzzing
insects.  A small pool of blood has formed at the foot of the bed where the
middle aged, portly woman lies with her left ankle at an impossible angle
like it's been shifted completely towards the middle.  A blood soaked gauze
pad is tied on tightly over the lateral ankle where I assume the bone came
poking out.  She has no other injuries.

They've also just brought in another elderly woman in a push cart who I can
tell needs an amputation just by the smell and the sight of the left foot
wrapped in dirty rags over a mud soaked gauze wrap.  Sure enough, cutting
off the rags and gauze reveals wet, blackened toes with the calloused skin
on the sole peeling off and a large, pus filled central wound on top
revealing the tendons and bones.


The guy driving the motorcycle that had fallen over causing the woman's
broken ankle has a swollen hand with probably some fractures.  As I wait for
the two women to pay for their surgeries, I quickly apply a combo plaster
and fiberglass cast to the man's hand and wrist, give him some Ibuprofen and
tell him to go to Moundou and get some x-rays.

The family of the woman with the broken ankle are having internal conflicts
as to who will pay so since the son of the woman with the rotten foot has
paid half and put his bicycle on as collateral, we start with her.

Hoping to do a midfoot amputation only I squeeze the blood out of her leg,
apply a blood pressure cuff as tourniquet and slice through the bottom of
her foot right into a pocket of pus.  Her foot is gone.  I quickly move up
to the middle of the lower leg and slice down to bone.  I scrape the tissue
off the bone as far up as I can then painfully and slowly saw through the
tibia and fibula with a tiny inch long saw that keeps clogging up with wet
bone paste.  Finally, I get the leg sawed off, identify the major vascular
bundles, clamp and tie them and close the muscles and skin over the stump.


The second woman has finally found a solution so we find an IV, give her
some Ketamine and Diazepam and I pull her foot down and out into position.
The fibula gets stuck on some tissue inside but with some manipulation I
free it up and get it into anatomical position.  The medial malleolus (the
part of the tibia that makes up the ankle joint) is crushed in several
pieces.  The fibula part of the ankle seems to have only one break, but it's
an open fracture.  Abel mixes up some diluted bleach solution and I wash it
out well.  I close the subcutaneous tissues, apply a dressing with Betadine
and while I try to hold the foot and ankle in as good a position as
possible, Jacob wraps the foot and leg up to the knee with web roll and then
applies a plaster cast.  I am able to mold the ankle some more and get the
foot in a good position.  The cast hardens and we take her out to her bed.

It's 11pm.

I go home.  I haven't eaten since lunch, since giving blood, since riding to
the river, since swimming and jumping off trees, since riding back and since
doing two operations.

I'm slightly hungry and am so grateful to find a skillet filled with fried
rice and eggs.  I devour it.  It's only later that Sarah informs me that was
supposed to be enough for supper and breakfast the next day.

I fall fast asleep until the rat wakes me up again at 5:30am this time.
Sarah and I get up, grab the shovels and pick and go out behind the church
to dig a latrine...a typical weekend is half over in Bere, Tchad...

Police

From James:

It's strange, because if I'd been in the US and the same thing happened, I'd be scared spitless. It happened like this...

I'm in N'Djamena to pick up Sarah from the airport. My friend and fellow AHI board member, Chief Justice Aimé, has lent me his Toyota 4-Runner. I take Sarah and her Danish sidekick, Nathaneal, to the central market. I park right in front of the Grand Mosque, just ahead of where the taxis pick up and let off passengers. I roll down the windows and sit back to watch the passersby.

A few kids come up with their metal bowls asking for alms for the mosque. I chat a little with them in my broken Arabic. One sticks his hand in and is fascinated by seeing the locks go up and down with just the push of a button. Finally, I can't get rid of them, even with the usual "Allah eftah" (God will provide) which should be followed by an "Amin" but instead these kids just say "Ma fi" (no way). Finally, I grab a bowl and toss it to the side and put on a fierce expression. They get the hint.

A young, beak-nosed Arab greets me from behind on the left. I turn my head and greet him back. As I turn back I see Sarah coming up to the window. She's just finished changing money and is about to head out to buy vegetables.

"Who was that guy and what was he doing by the window?"

"Nothing, he was just saying 'Hi'."

"Oh, he just looked suspicious."

"Don't worry about it. See you in a bit."

She heads out again with the green army duffel bag accompanied by Nathaneal.

A brand-new dark green pick up approaches from the left. "Police" is written in bold letters across the door. There are machine gun toting gendarmes in the back and a camo-wearing man with a maroon beret sticks his head out the passenger window, spots me, turns back and says something in Arabic. I hear the word "Nasara" (foreigner or "whitey") and the truck pulls in just in front of me and parks.

"Oh, boy," I think. "Here we go again."

Sure enough, the beret man and a couple of Kalishnikov bearers hop out and approach the right side of the 4-Runner. I'm a bit surprised, however, by their next move.

A young, gap-toothed teenager with his old school Russian automatic weapon opens the passenger door and gets in beside me, his gun slung loosely by his left side.

"Let's go to the police station!" barks the beret-wearing man, obviously in charge. "You're illegally parked."

I guess if I had recently arrived in Tchad I might be soiling my britches at this point, but for some reason I'm not afraid, just exasperated. I try not to sound angry and frustrated as I reply that I didn't know I was illegally parked since there is no sign and I've seen others park there often before.

The chief doesn't budge. I try a new tactic.

"I can't go because my wife is in the market and how will she know where I've gone and how will I find her?" I can see he's not convinced. "Now that you've done your job of informing me that one can't park here, I'll just move the car. Tell me where I can park and thanks for the warning, I won't park here again."

"You can park there on the other side."

I start up the car and back up and cross the one-way traffic to the other side right in front of the mosque, which seems to me a more likely spot to have a "no parking" sign, but I keep this thought to myself.

My passenger is still with me grinning stupidly at me from time to time.

The head honcho follows us over.

"Well, now that you've told us about Madame," he begins the negociations. "We'll let you off easy this time with just a 6000 francs fine."

I then pull out what I think is my ace. I reach into the glove compartment and pull out an invitation signed by the president of the republic to the year end meeting of the Supreme Court.

"This isn't even my car," I suggest. "Do you really want to haul off one of the supreme court justice's cars? One who's intimate with the Head of State himself?"

"Well, you're the one driving it now!" he retorts, "So it's you who gets to pay the fine."

What is it those Frenchies say? Touché?

At this point, a young man approaches me from the left with a bag of something.

"Are you Dr. James from Bere?"

"Yes." I reply, grateful for the distraction as time is an important element of the bargaining process.

"I've been looking all over for you. I'm the son of the man with the broken femur you operated on last week. I tried to find you earlier at the Mission guest house but I was told you weren't there. Then, my dad told me you were at the National Security Counsel office but I barely missed you there too."

"Yeah, I was there registering our new volunteer for the hospital. He just came back from Denmark with my wife. I called your dad back and told him to have you meet me here."

"So what's up with the gendarmes?"

I explain the situation to him and he starts up with explaining how I'm new to town and don't know the rules and that I'm the big doctor from Bere who just operated on his dad who is also a gendarme and one of there compatriots, etc.

The chief officer seems to be convinced...a little.

"Well, since you didn't really know and since you're here helping us out, we'll only make you pay 3000 francs."

My new friend has now gone over to the other side to talk more intimately with the police. He starts off in French but the officer quickly switches to Arabic saying he doesn't want me to hear their negociations. Unfortunately for him, I now understand a little Arabic and reply in Arabic that I understand him fine, thank you very much for asking.

He looks at me surprised and starts to laugh good-naturedly.

"Well, you obviously have money since you're driving a car so just share some with us for our tea."

"I have no money," I respond in Arabic. "If I did, why would I come from Bere on motorcycles and the common market car?"

The young, ugly, armed gendarme next to me now has a huge gap-toothed grin. He shakes his finger at me in wonder "You...you...you..." and gets out. They all walk off shaking there heads and laughing. Right before getting into their truck they turn one last time and offer a friendly wave goodbye.

As I thank my new friend and offer to carry his sack of homemade pasta to his convalescing dad, Sarah returns with Nathaneal.

It's then I realize that my cell phone has been stolen. In talking more with Sarah, it seems the guy she saw was on the right side of the car and was just pulling his head out of the window. Apparently, his partner greeted me from behind on the left so I'd turn my head long enough for the other guy to reach in the open window and take the cell phone from the central console. A slick manoeuvre.

Just when I thought Tchad was gettting boring!