at this point in the story, the character's eyes are closed nearly all the time. despite the fatigue, sleep eludes him. he is replaced with a halfness, a part of him awake, part of him not. at night he sleeps in fits. he approaches dreams, but never quite arrives. this morning, while walking to work, at the corner, the one with the half buried tire, a mini cyclone picked itself up off the road. it whirled dervishly in widening ellipses, then blew itself into a closed green door, opening it. his eyes met those of the man seated behind it who calmly stood from his chair and closed it again, as if cyclones came knocking all of the time. the character thought to himself, who needs dreams when days are so extraordinary?
i am more than halfway through my mission, and am overdue for a break. though my time in ethiopia was more about tuberculosis than rest, it did allow me to step away from abyei. so i delayed a vacation partly because i wanted a true experience, to spend my full time in the field, to arrive at all the important points in the mission so that i could better understand them. i have discovered that fatigue, however, is like the personal experience of illness. though being sick is valuable, particularly as a physician, because it increases ones empathy, only a fool would court it. so too exhaustion.
but, here it is. a halfness. i remember talking with friends about how i could manage to work during my residency, to spend 30 sleepless hours in the hospital, leave it to sleep, then return. i explained that the last thing to leave was my capacity to perform medical tasks. i could sort out a high potassium at five in the morning. what i lost was my ability to do it as myself. to enjoy it, to make the patient feel less afraid, to offer them something beyond the task. i would walk in, inject the proper drugs in the correct amounts into their IV, mumble something neither of us understood, then stumble out to do something else.
the tiredness i feel now is different. it has been a slow erosion. bits of sand have ground me down. i can still recognize the best things in the day, but am just not able to participate in them fully. half.
part of the slow erosion has been due to being on call all of the time. every third or fourth night, i take emergency calls from the hospitals, dealing with new cases or inpatients that worsen. no matter how busy the night is, the next day is a full one. the other nights, i still sleep with the handset. if one of the doctors or medical technicians has something beyond their abilities, they call me. trauma, obstructed labour, sexual assault. it doesn't happen every night, just enough, here and there, bits of sand. enough so that a hushed voice through a grass wall is a call through the handset, the sharp night crack of contracting sheet metal is the rap of the guard on my door.
i realized, during my long residency, that there is a merit to being on call that extends beyond treating sick patients quickly. one learns not just how to sort out high potassiums when there is noone around to ask, but also how to lose the voice inside that gets annoyed when you are paged at 4 in the morning on the friday of a long weekend after just lying down for the first time all day. with time, that voice that says "so what if mrs. snow is having pain? does she know what time it is? how tired i am? that i haven't eaten?" fades, and is replaced by, "i'll be right there". it is beaten out of ones spirit by thousands and thousands of repetitive beeps. and, with it, that dissatisfied narrator that wishes only that things were other than the way they were, grows quieter in general.
some members of my team have suggested that i not take call, that we have enough staff to make it possible. i have thought about it, but i think i would miss it. caring for someone who is sick is such an incredibly human act. often, it makes up the best part of my day. I get to meet someone, someone new, listen to their story and feel their anxiety. I get to to touch their child's forehead, then quietly listen to his heart. and sometimes, I get to put my hand on the father's shoulder, tell him that everything is going to be alright, I promise, that i can't say such things very often in abyei, but this time i can, and at least today, this child, his child, is going to be ok. and i get to feel the coolness of his relief. i am more at home in the hospital than i am in my tukul and my tangled bed.
one of my friends once told me that once, when she was having a personally difficult time (someone in her family was sick and her relationship was deteriorating), she poured herself into her general practice. the more she worked, the more patients would stop on the street and say "hello, doctor soandso", the more they would send flowers. not only was she caring, she was being cared for. of course, in the end, this was not an equitable relationship, not the true contact someone needs to feed their bruised spirt, and after several months, she burned out.
i will not, though i can feel the heat. i can understand it better. i am due for a break in 16 days. i started counting yesterday.