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Let there be light


le 27 mars 2013

I used to think of writing (or doing anything inside) by headlamp as spelunking. It was certainly more practical than my first year PCV strategy of candles and kerosene lamp propped on various books and papers—before I had a table—and sitting hunched over to the in the right part of the penumbra.

It’s a funny thing about light.

The Constant Gardener came out weeks before I left for Peace Corps in Cameroon. Without mention anything else I love about the movie (which was great for terrifying many parents of about-to-be PCVs about to move to Africa), the light struck me. The quality of it. I’d noticed years before that Paris has its own quality of light. Some photos, movies capture it (Amélie does). I don’t think you can successfully pretend that something is filmed in Paris.

This light, though, the Kenya-in-the-movie light, was unlike anything I’d ever seen.

And then I moved to Cameroon.

It’s the same light. Gazing across the city at very familiar views this morning (Yaoundé, like Rome or San Francisco, is a city of hills), I remembered it. I have photos of the same view, and in the US they look—faded. Light-stained. But that’s how things actually look.

The forest almost never comes out, either. I think it’s more greens than the human eye can discern (we can see sixteen shades of gray, I recently learned, on CT scans).

**

I was reminded of why the old Snickers ad (Not going anywhere for awhile?) and Green Day (“I’ve been…waiting a long time….) used to enter my head so often. It took almost three hours to print and copy one document, for various reasons. On the way to the second printing place, though, I heard someone call my name. I turned. And it was a friend I hadn’t seen in 4 years. Now, he’s at the hospital where I will be this time, Centre Hospitalier et Universitaire de Yaoundé, a different one from where we were previously (he’s a resident). Currently, he’s working in the ICU, which is reanimation here. It’s about coding. (“Code blue”). Come back from the dead, make something alive or lively. Resuscitation, they call it, instead of our Intensive Care. Shortened, it’s “Réa” – it sounds flip in a hopeful way.

This—the chance meeting—is something that happens. In Ebolowa, my provincial capital, I couldn’t go anywhere without seeing people I knew; it was amazing and heartening a year and a half after I’d initially left. And it used to happen in Yaoundé, occasionally. When I had my first chance run-in in NYC, I knew I really lived there. And here? Apparently, I still do.

**

I’m waiting for the chief medical officer of the hospital to meet me and certify that I can be here. All I know thus far about the hospital is from the two French nurses who just left. They saw an upper GI bleeder come in. Died. They didn’t know exactly what was done or what happened.

This time, I’ll learn about the medical management here—what’s the same, what’s different, and what doesn’t exist. I learned some of that, before. And that you have to buy everything down to the IV tubing.

ER. Six weeks ago, I was in an ER in Guatemala (working, not sick). Small rural hospital compared to one of the top four in Cameroon, a major teaching hospital. There, they were oddly over-staffed. Here, I am the functional sub-I, or intern to the residents, or whatever approximated role.

Here, I walked in to see the repair of a scalp laceration, and by scalp lac I mean the cut penetrated to the dura mater, through the skull. Assault by machete. I’ve seen that, but the one I remember was due to a machete accidentally dropped from a tree. That kid looked like he was partly scalped. (And that was one of Doc’s gleeful moments, showing anatomy on monkey bones). Now, I wonder if, in the US, we’d put a JP brain in before closing the laceration. The kid is going to CT. Don’t know.

Next case. Moto accident led to a comminuted tibial fracture and a shattered fibula. We waited while the patient’s brother bought all the supplies requested. (Were I not there, would they still have had him buy two pairs of sterile gloves….? How to reconcile “teaching hospital” with patients paying for everything you use on them?

It was the first time I’d sutured in over two years. The light is weak and far away, we can’t raise the bed, the patient’s ankle is a mess with visible bones, he hasn’t had any pain killers and crying/screaming…(we did use local anesthetic)… But medicine is already (re)baptism by fire. Everywhere. This is nothing new. It’s vaguely remembering hand tying and instrument ties (it slowly returns), correctly angling the crescent-shaped needle, with the surgery resident showing me where to close because in that erratic wound with jagged layers, I have no idea.

Later in the day, I go to Hôpital Centrale to meet Dr. Bwelle for his medical student teaching rounds. He shows me the tall, modern glass-and-brick structure that looks like an added-on center to the other, spoked buildings. It was a Swiss project, he says, supposed to be dedicated to neurosurgery. But the people building it forgot that they were building a hospital. The floors are all completely flat—in ORs, this means nowhere to direct water. It’s all stairwells, for four stories. No elevators. The building has been empty for the past four years.

This is all too common a story.

**

As always, every day is every emotion. Aggravating (the personal level—dérangements, harassment, etc), but then also the men speaking in Bulu about me this morning led to “mintangen a wôk” – you know, the white woman understands you. And then I sat down with my spaghetti omelet and bread and “coffee,” (I’d forgotten about the sweetened condensed milk) and we chatted over their morning beer. (or, it’s evening for at least the one who drives trucks overnight).

But running from hospital to hospital (and angry when the taximan who had accepted my negotiated price then refused it and wanted more money), an exquisitely-peeled (not a good enough word. It’s beautiful, geometric) green-fleshed orange is just perfect to raise blood sugar back to awake-enough levels.

**

63 year-old woman. Altered mental status, sudden onset. Fever. Tachycardic. (and immunocompromised…) My mind starts racing through differentials, I try to rule out meningitis, I start to think about how to work up…and, wait, what we can work up, and I go talk to the attending. “It’s probably neuro-malaria.”

Oh. Right.


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