SWEAT

From James:

I'm trying not to move. The feel of sweat trickling slowly down my face is not as bad as feeling the stickiness of my back against the cheap mattress. Crickets and other night insect sounds are the only relief from the otherwise oppressive heaviness of the still, hot Chadian night. I am lying down on Gary's porch listening to the Pineapple Story on Gary's MP3 player. Trixie, Caroline and Stefan are there along with Wendy, Jeremy and Annie. It's a boring Saturday night in the bush and we've just polished off the popcorn that Gary somehow thought would be better with left-over pesto sauce.

Gary's phone rings.

"It's for you!" Gary hands me the phone.

Jacques is on the other end. "We have an open tibia fracture that just came in."

I drag myself out of the pool of sweat that has gathered underneath my half-naked body and pull on my shirt. Stepping outside I feel a slight change in temperature from about 110 degrees Fahrenheit to about 100. I slip on my Tampa Bay Buccaneer Crocs and swing into the saddle. Sarah's in N'Djamena welcoming Dr. Bond and his team back to Chad so I'm riding Pepper, aka Mini Seabiscuit.

It's pitch black, no moon and while the stars are brilliant they only give a vague outline of trees and shacks from time to time. Pepper likes going home as quickly as possible and I can feel his muscles tense in expectation under my thigh as he stamps and snorts while I wait for Trixie who's riding Bob.

A slight release on the reins and Pepper starts out at a fast walk which quickly turns into a fast trot. Up and down, up and down I keep in rhythm with my fast little pony's cadence. Suddenly, things smooth out and the wind kicks into my face as Pepper leaps out into a gallop. Unknown dark shadows are hurtling by right and left. The road is windy and while Pepper somehow knows the path I can't anticipate in order to keep my balance. I'm hanging on by a thread when he suddenly turns left. My right foot pops out of the stirrup but I manage to stay on and with a quick pull Pepper comes to a stop. Sarah has trained him well and I'm grateful as I'd have certainly fallen off if I hadn't been able to stop quickly.

Feet back in the stirrup and we're off again on our mad dash to the hospital. The 2-3 kilometers whirr by in a matter of minutes as we pull up to the front gate. Lazare runs up to open up, I unsaddle at the stable and rush home to change into scrubs.

In the ER, a light-skinned Fulani man sits with his left lower leg twisted and contorted in a pool of blood draped with a dirty cloth. We hurry him off to surgery as Samedi calls Simeon and Abel.

Washed, scrubbed, prepped with Betadine, draped with sterile towels and anesthetized with Ketamine (aka Vitamin K or Special K for you US druggies) the leg still looks bad under the glowing overhead lights. We pray and I take a 10 blade scalpel and enlarge the wound inferiorly down the middle of his shin to expose the fracture. It's a clean, 45 degree angle brake. I wash, scrub and irrigate with liters of Dakins and normal saline. I put the bone back in place and have Abel reach under the drape and hold it in place while I suture up the wound leaving just the most superior part of the original cut open.

Breaking scrub but leaving one hand sterile, I grab a cordless drill and insert a threaded Steinmann pin. I slice open a tiny hole and start to drill the pin into the lower tibia. The drill runs out of power, it hasn't been charged.

Now what? I call for some hand drills, they finish the job on the lower pin but I can't get the two upper pins started. I completely scrub out and walk home. I find another drill with a cord, saw off a couple pieces of old PVC pipe, wash the mud out of the center of the pipes and come back to the OR. I put sterile gloves back on and drill in the last two pins. Then I make sure the bone is still aligned and drill holes through the PVC pipe so the pins can be hammered through holding the bone in position.

As I'm finishing, Simeon tells me that he thinks his jaw is broken. Sure enough, his mandible has at least two fractures leaving the front part of his lower teeth completely mobile. I search for and finally find some 4-0 steel sutures. I twist tie one of them around the tooth on the posterior side of the right sided fracture and another one on the anterior side. Then I have Jacques push the jaw into position while I twist the two ends together to bring the two teeth (along with the mandible) back together. I do the same for the left fracture. It's still unstable. I then do two more teeth on each side of the fracture and the corresponding teeth on the upper jaw and wire those together so his mouth is completely wired shut with his teeth coming together in a functional position.

It's then I notice that my shirt, pants, surgical cap and hair is all soaked despite the courageous efforts of the small AC unit. I take a few bried moments of pure heaven with my faced almost pressed against the cold air coming out of the AC before going home to my own personal pool of sweat.