Tragedy

From James:


"Hurry to the ER! James! Run!" The familiar words come not in the usual African French but in the familiar English of our friends, Gary and Wendy Roberts (our mission pilot & his wife, based in Bere) as they whiz by the house on their motorcycle.

I'd just gotten up a little before 5:00am to write email when I heard the roar of the moto and the cries of the anguished parents.

I quickly pull on some scrubs and rush out the door where I run into Sarah who's just come to get me. She is just finishing up a night shift in the ER. It's about 6:00am.

The hospital is bathed with an early morning tranquility that would've been soothing on any other morning but this one.

I arrive at the ER and see Gary bent over his son, Caleb, giving him mouth to mouth as his pale, limp body wants to sink into the top of the desk he's lying on.

"He was still breathing as we were coming but he just stopped. He has no heart beat!"

I start giving chest compressions as I bark out orders to Sarah, Wendy, Koumabas, Hortance and Augustin who luckily happens to be there.

"Get some IV glucose and some IV tubing!"

"Someone look for an IV!"

"Call the lab for a hemoglobin and glucose check!"

"Get the pulse ox from the OR!"

As they rush off to find the material I look closer at Caleb. His body is flaccid, his face is pale and haggard, eyes closed, mouth half open, a mild gurgling coming out of his throat with each chest compression. He has no heart beat and his lungs sound filled with fluid. His belly is soft with an enlarged liver.

Gary takes over chest compressions as Hortance hands me the D5W attached to some IV tubing which I quickly insert under the skin of his stomach for a subcutaneous perfusion of glucose in case his blood sugar is low.

"Give him half an ampoule of IV furosemide IM.

Augustin is patiently searching for an IV on Caleb's small, white hands and arms. Sarah arrives with the pulse oximeter. We continue chest compressions. The O2 sat is 15%. I have Gary start rescue breathing again. The pulse ox stops working.

"Sarah, get some Adrenaline and Atropine from the OR!"

Still no IV.

"Koumabas, get me a blue IV catheter and a 5cc seringe!"

I keep doing compressions while Gary does two rescue breaths every 10 cardiac compressions.

Wendy has come back with an epi-pen and accidentally sticks her thumb with it instead of Caleb's leg.

Sarah gives Adrenaline and Atropine intramuscularly.

I listen and detect a faint, slow heart beat.

We continue CPR.

"Wendy, find me one of those small red, urine catheters in the OR so we can empty his bladder!"

Koumabas gives me the IV catheter with which I miraculously find his right femoral vein on the first try despite feeling no pulse and am able to thread the catheter in. I attach the IV glucose bottle and let it run in.

Meanwhile Mathieu has arrived and now has the results: hemoglobin a little low and blood sugar extremely low.

Wendy returns with the foley and Augustin drains Caleb's bladder. Calebs lungs are clearer. He still has a faint heartbeat.

"Sarah, inject the Adrenaline as rapidly as you can....now!" I quickly pump Caleb's heart has fast as I can with my external compressions to get the medicine to his heart.

"Sarah, take over chest compressions, I'm going to find some Magnesium in my office!"

The magnesium goes in the IV fluids and slowly trickles in.
Gary still does rescue breathing. Wendy offers to take over but Gary wants to keep going.

"Mathieu, can we do a Potassium?"

"Oui!"

I draw a milliliter of dark blood from Caleb's femoral vein and Mathieu hurries off to the lab.

CPR continues. We've been going for 40 minutes.

I listen to Caleb's chest. No heartbeat.

We continue CPR.

"Sarah, more atropine."

Gary speaks up after his 2 rescue breaths. "Should we stop?"

"Let's go just a little more."

Atropine is in. We continue CPR 5 more minutes.

I listen to Caleb's heart...

Nothing.

We stop.

Gary and Wendy collapse weeping into each others arms as sobs explode from within my chest. I grab Gary from the side my arm draped across his neck. Sarah is on the other side hugging Wendy.

Gary solemnly wraps up the still, little body.

"Do you want to use the van? We can drive you back home."

Gary turns to Wendy, "No, let's just put him between us on the motorcycle and go home."

"Anything we can do?"

"No, we just want some alone time. Then in the afternoon we'll have a service." The trudge out to the motorcycle, the quiet bundle in Gary's arms.

Tears streaming down my face I walk slowly back home thinking back to September 3, 2001 when I also found myself stopping CPR on someone I loved and sadly giving them up temporarily into God's hands. Just like then when I told my twin brother, "I know where you'll be...I just better make sure I'm there as well," I think the same thing about little Caleb and can't wait to see him again, maybe even by my brother David's side, when things are finally finished down here.

But, meanwhile, I'm back home sobbing like a baby. Sarah walks in and kneels down in front of me. We embrace and cry together. Outside, the wind is blowing, whipping up a storm. It starts to rain. God is crying too.

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.

COVERSTITCH II

I really can't believe that I finished my search for a coverstitch just this morning. I have searched the internet, visited 4 stores in the area and finally drove to San Diego in search of the Babylock BLCS. Ah, the sweetness of success - I came home with the machine that I was searching for. So I will be spending some time getting acquainted with this little jewel because I am expecting great things from it as far as sewing knits and attaching bindings. Actually can't wait to do an update with pictures of sewn garments...we'll see!

COVERSTITCH

Today was the day I had decided to compare three different coverstitch machines, the Babylock BLCS, Janome 1000 and the Brother 2340?, to see which one I felt the most comfortable using. I had tried the Janome before and thought it was okay although the one I tried didn't make a great stitch. I thought that there would be no problem finding these models at a store nearby, to see a demo and sew a few stitches myself to see if I liked how they handled. I found 6 stores in my So. Cal area that carried Babylock and only 1 store even has a Babylock BLCS to try. I haven't found a Brother 2340 yet. Who would have thought!

I did contact a place in the San Diego area that had the machine I was looking for and they told me that they could not sell to me if I didn't live in their area - in fact it was one of the first questions they asked - what's up with that?

Oh, well, I am off tomorrow morning to see if I can't snag me a coverstitch machine of some kind...I am really looking forward to bringing one home!

One More

We are leaving for the last of the memorials for the plane crash victims. What a hard two weeks it has been for sure. On the positive side, there is great comfort in grieving with your friends and loved ones. Somehow you come back a little stronger and able to face life one day at a time. I am so glad for the hope of another grand reunion!

I finally put a couple more pieces of fabric through the washer and dryer in anticipation of really hitting the sewing machine on Monday...I only have to churn out 2 1/4 garments each week to finish on time for the SWAP. I'm thinking that the busyness of getting it done will be a great mind relief and I'm looking forward to it.

While at Hancock's one day I saw this great piece of fabric - rather like candy apple green or maybe chartreuse that was labeled as silky wool but on the selvage it had Donnegal Linen Ireland. I asked the help just exactly what the fabric was and of course they had no idea. It was really pretty so I bought it anyway. Well, before deciding how to pre-wash it I decided to do the burn test and cut a piece to wash and dry. The burn test indicated that it was actually polyester and the test piece that was washed and dried showed no shrinage whatsoever. Not what I thought but it is still pretty and I'll just have to figure out what to make from it.

Next week, I am looking to buy a coverstitch machine and have seen the Janome 1000 demonstrated. For the price, I guess it is a pretty good machine, although I wasn't totally sold on the stitch it made. Had thought about a commercial machine but just don't have the room. Any ideas about coverstich machines?

R.I.P.

At my son's wedding in 2000.



The picture from their Christmas card that is still on the refrigerator. The memorial is this weekend and I know I have time to sew the black dress, tonight I am wondering if I have any energy to put in to it. It's hard to sew with a broken heart.

I Am Devastated

The people killed in the plane crash today included friends of our kids! Our hearts go out to the sweet families that have lost so much today. There are five families involved and one family lost two daughters - at least that is what we understand now. The heartbreak is too much. Please keep all of the families in your prayers...