I slept well last night, and into the morning – a normal morning, thank goodness; Lord knows I’ve needed one of those for a while. No alarm, just heavy eyes waking on their own accord. First a shower then a leisurely shave followed by a lovely date with myself to the bakery. “Two breads with cheese?” The gal behind the counter knows me too well. “Yes, two breads with cheese” I smile my normal smile and confirm my normal order. Two blocks later I slide into my usual internet café. My sister is doing well in Egypt and I’m happy to talk with her. “Take care of yourself, Ben - I love you”. I love you too, Lizz.That is the last I remember of things normal.
The hospital was flooded with an inch and a half of soapy water, and people were all over each other like ants in an ant farm. Half the nurses were pushing years worth of gunk around with squeegees. This all comes as a result of the Minister’s suggestion that we wash the floors. At the time the Warden was embarrassed, but today he’s smirk, pacing up and down the halls, overseeing the large cleaning project like someone important.
I puddle-jumped my way back to minor surg and opened the doors: jam-packed and out of beds. There is a guy on the floor laying in a pool of blood. Safadi looks up at me from his knees in relief: “Ben. Oxygen. Scope. Tube.” Welcome to work. There is no leapfrogging this time – just a mad split-splattering dash down the hall, hopping over oncoming waves of water. The laryngyscope is where it’s supposed to be, but (not surprisingly) the free tank is without oxygen, so I take one from someone less needy. And alas, the stock room is out of intubation tubes, so I’m redirected to the OR, but they’re not in any hurry. Four minutes later I’m back with things we should have had in fourteen seconds.
The next few minutes go fast: oxygenation, intubation and two units of blood, but there is a bullet through his kidney, and what we pour in he pees out. That, and his abdomen is rigid – blood filled through some other hole, and soon enough his heart stops beating. The patient is too big for the gurney, so I straddle his head with the only real estate left and rhythmically sink the base of my palms into his chest – it gets easier when his ribs crack. But after a while I look down and my pants are soaked with the same juice I’ve seen trickle out of other post-mortem bodies, and there is no more hope in the air.
The awful brokenness of human souls fills the room when his family enters; his brother is shouting, his mother is weeping, and his sister is kissing his face - all trying to bring his life back the best they know how. But life is cruel and they cannot, and there is no embalming to buy them time, so friends and family gather and an hour later the funeral procession marches down the street. If ever I’m shot, I’ve decided to catch a cab to the airport and a plane to Quito rather than take my chances here in Esmeraldas.Later in the evening I’m sewing up a badly cut leg, halfway down an 8-inch gap and putting in more anesthesia when the syringe slips, the needle flips, and I’m stuck with a finger prick and a few moments of awkward silence. We just look at each other, scared. Neither of us is sure what to do about this roll reversal. I am his patient and his past is my healthcare provider. His blood is about to make some pretty big decisions in my life. And yet his leg is still open – he is still my patient. His healthcare hinges on me, and my healthcare hinges on him. Neither one of us is sure of our outcomes.
“How long does it take to get the results?” I ask. My colleague responds half an hour, but the question is stupid and the answer doesn’t matter. I might as well have asked someone from Timbuktu whereabouts in the city they live because by that point I had no context for time. Thirty minutes or thirty hours would have felt like the same breathless expanse of nothingness. And I didn’t want to think about anything other than cryogenically freezing my being until the results came back.
Negative. Thank God. I’m happy, he’s happy and his grandmother shakes my hand. I could have kissed her feet, or her grandson’s feet, or anyone’s feet for that matter. Yes, if anyone had given me their foot, I would have kissed it in that moment just to feel my lips again and to allow my body to wake back up to the sensations of the world.
There is still the ever so small chance of a false-negative – that is, perhaps he has HIV that wasn’t picked up by the exam. In this scenario, perhaps then I also have HIV developing inside me. Protocol anywhere is to begin a regimen of anti-retro viral medications (ARVs) as prophylactic treatment in cases of recent exposure. This has been shown to be most effective if begun within the first 6 hours. But – there’s always a but, a lingering sucker punch, an awful aftertaste – I’m told the only ARVs in town are at the ministry of public health, which isn’t open on Saturday nights and which won’t open again until Monday morning. So I finished out the shift, then went home and slept 10 hours - woke up with no energy, washed my scrubs by hand and lay in bed watching them dry, thinking of nothing again. Waiting. waiting. WAiTIng.
Turns out the hospital did have ARVs – the doctors just were not aware of that fact. Also turns out the medication available is statistically useless if not taken within the aforementioned first 6 hours, so I leave empty-handed and wondering why they told me this. In a country of government subsidized free healthcare, what did the lady behind the counter care whether or not I popped a pill a day – at least I’d have had the psychological comfort of believing I was doing something. But no. We wait now and test again in three months – the time the virus needs to proliferate itself to detectable levels in my blood.
BH
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