happy new day

it’s too early to be up, i think, and blink one eye open to see if it stays, and it does. i roll away from the beds heavy divot, the pressed form of the person whose room i inherited, and push my hands through the mosquito net onto the cool wall.

it’s too early to be up, i think, and blink one eye open to see if it stays, and it does. i roll away from the beds heavy divot, the pressed form of the person whose room i inherited, and push my hands through the mosquito net onto the cool wall. i linger here, letting my dreams sift back to their soft world, then push myself up through the plastic gauze and into the early light of a compound deeply asleep.  a breeze flutters my torn curtain, as i scrape my chair to the corner of my room and the computer that sits there on the desk i hammered together on my first day.

where to start.  so much happens in a moments infinite breadth. during the medical meeting a glimpse through the wire of a woman hanging her bright scarf on the branch of a tree, and then a bird swoops smoothly into the frame in and the world is born new again.  it seems no matter where you find yourself, you are always in the middle of your story,  the landscape racing away in even distances at all sides, like future and the past.

our medical meeting informs us, each day,  of the night’s events, patients added to our census, coughing and feverish, or subtracted, their body loaded onto a donkey cart at first light.

the bird wheels away, and she turns to watch it fly.

“maternity....twelve admissions.....nine deliveries...”

the afternoon before, i left a child huffing and breathless on a  plastic bed, his parents beside him. he had fever for days before his  mother took him to the health post, the clinical officer there taking one look at his shaking frame before calling a car to take him to the hospital.  i was returning from the lab when i saw the land-cruiser enter the hospital grounds, fast and bumping, and seconds later, the driver was trotting across the yard towards my ward, the boy cradled against his chest, arms and legs dangling.

“ mother has failed to progress, and will be taken to theatre...”

he was four years old, previously well, until he caught a fever. seizures started yesterday.

“ ward...five admissions....four discharges...”

he was unconscious when he arrived, and you could feel his hotness before your hand hit the skin.  his malaria check was negative, his  blood sugar normal.  we cooled him with tepid water, gave him intravenous tylenol, but the convulsions continued.  his body didn’t move much, exhausted from all the shaking, but you could tell the seizures from his eyes, the way they looked up and to the right, just over your shoulder, like he was seeing something you couldn’t.

“ patients in the adult ward....17....”

we eventually sedated him enough that his seizures stopped, giving his brain a rest from the electrical short circuit that if perpetuated, would scar it, maybe already had.  his breathing became regular, and his lids closed. if you pried them open, the irises stared dully forward.  we moved him to the bed nearest the front, and set him resting on his mothers lap.

“....pediatrics ward....”

i went back a few minutes later, and someone was trying to give him milk while he was on his back.  no, no, i said, taking the cup, shaking my head.  he’s too sleepy.  and when he wakes, you sit him up, so he doesn’t choke, like this.  when he’s sleepy, leave him on his side.  do you understand?  i turned to the nurse beside me and said, make sure she understands.  he nodded.  the next time i checked back, the child was sputtering, milk bubbling from his nose, his breaths coming in jags.

“ admission...”

he worsened over the next two hours.  i sat on the edge of the bed, with his worried mother, shaking him when he stopped breathing, trying to figure out what to do.   he needed a ventilator to let his small ribs rest, but we have none, nor was there one nearer than nairobi. i decided to to take him to the operating theatre and intubate him, suck what milk i could from his lungs before it got pushed to the edges, suffocating him further.    i explained to his mother that there’s a chance it might make him worse, and only a small chance it would help.  it was, however, a chance, and it’s what i would do if it was my fathermothersisterbrother, and its the only thing i can think of that is doing something besides hoping, each time, that when he stops breathing, he starts again.  she agreed, and when the OT team arrived, we removed him from his oxygen.  she took him in her arms followed us across the hot, blowing yard.

“....five discharges...”

an hour later, he was lying on his side, back in the pediatrics ward. we removed only a few teaspoons of milk, and watched, our hearts in our throats, as he coughed and coughed and coughed when we removed the tracheal tube, our flutter settling with his heart rate.  now, back on the plastic bed, oxygen whistling into his nose, he was breathing easier.  not as fast, not as ragged, no pauses.  the truck was calling for me to come to the gate.  it was near curfew.  coming, i called into the handset, and left him, huffing, beside his mother.



“ patients in the pediatric ward...24...”

i left the meeting and walked to the first bed.  he was there, eyes closed, working, taking it from the top with each breath, but alive,  still in the middle of his story.  he remained there when i left him again last night, eyes closed on his blue bed.

we do what we can when we’ve the chance.  sometimes, in places far away from the world’s eyes and priorities which seem more focused on 3D TV’s (it’s almost like the real world!) than half breathing refugee kids, it’s not enough, but the trick is to not let defeats diminish the verve for trying honestly each time, let motivation to rise, again and again, as new as each moment.

compounds up.  coffee time.  happy new day.