I am a bit of a local celebrity. I clued in last week. I was suturing a man who had thought it wise to use a bush-knife to swat away some flies…instead he cut his scalp. I had a good laugh. Not very doctor like, I know, but I needed a chuckle. While I was suturing him, and giggling to myself, a man with an arm wound inflicted by a 2 pm knife-fight is talking away in tok pisin. Now, I am no expert in the language, but I can recognize "Canada" and “white mary doctor”. So I bluff, look up at him and say ”You know, you better be careful, I can understand what you are saying” and smile. The smile makes him smile, and that is a relief since I do not want to be his 3 pm victim.
“How do you know where I am from?”
“Word gets around boss.”
There is that word of mouth at work for you. “And we saw you on TV”. Six o’clock news. So much for anonymity.
I have been sick on and off for the last week. Nothing serious. I took a couple of days off. In my post sickness haze, I walk into the emergency department with a feeling of dread, past the putrid smells, the patients lining the halls eternally surprised to see a white doctor, and the filth-covered door.
I start rounds on the patients that had been seen the prior night. I examine a patient in whom I suspect appendicitis. I press her belly and all the signs are there. If I call the only over-worked surgeon in the hospital he will leave her in the “no man’s land” hallway at the back of the emergency department…she will get worse, and then I won’t be able to do anything for her. I ask her if she can afford an ultrasound at a nearby clinic. I hate that question; it separates the haves and the have-nots. Most are have-nots. As I wait for an answer, raspy breathing sounds call for my attention. I look around and trace their origin to a patient one bed over. I scan his body and look at his half-closed eyes. His chest takes in air in a whoosh, and then lets it out with a coarse gurgle, and I know.
I turn back to my first patient, but my eyes betray me…they drag me back to his body. What if I am wrong?
I walk over to him. I grab the chart. Its pages weave the same old story. Twenty-four-year old. Cerebral malaria. Kidney failure. Blackwater fever. Nobody had monitored him overnight. He had received 6 liters of fluid, and a touch of lasix and he had not urinated. Which means that all the extra fluid is pooled in his lungs, drowning him. He must have seized overnight; he has bit his tongue, blood trickling down the side of his face. His breathing is agonal, his most basic reflexes fighting to hold on. I look at his eyes, and…
I wasn’t wrong.
His ghost and I stand there, our backs to him, trying to distract ourselves with other patients. Everyone else seems nonplussed. Everyone except his father, whose quizzical gaze I try to avoid. The three of us are fixated on his breathing. Deep, laboured, instinctual. Deep, laboured, instinctual. Deep…
Then there was silence. Ephemeral life.
His ghost has stayed with me all day. He is still here next to me as I write. He tries to crack some jokes to try to cheer me up. He tells me that my entries are too macabre for anyone to want to read them. I tell him that I can’t help myself. If I don’t write it down, it will fester inside of me. I am irritated, and worn down…my room is filled with the ghosts of those that I cannot do anything about because I am bogged down by bureaucracy, and corruption, and social injustice. There isn’t enough room on my bed for all of us.
A couple of days ago, I heard about an expat young guy in Rabaul that came down with blackwater fever…he got evacuated to Australia, where he will receive dialysis and 24 hour intensive care monitoring, and he will likely pull through.
The haves and the have-nots.