Leaving?

“I am not sure how much more of this I can take.”

“I wonder what it feels like to have a nervous breakdown, will the GC insurance cover that?”

Such were my musings as I headed over to the generator room for the umptenth time in the last couple of hours to flip a breaker switch and restore power to the hospital. The electrical problems were really taking a toll on my psyche. It is a daily battle, sometimes it was the generator itself overheating, sometimes the generator would switch off because it didn’t like the phase distribution. Other times it was either the house batteries or the hospital batteries not charging, and so either the house or hospital or both were out of power soon after the generator shut down. Or there was the day when every five minutes the power would go out for 40 seconds or so and then come back on for 5 or 6 minutes. Never did figure out why that happened.

I don’t want to forget the arm amputation that I completed in just the ambient light the glass blocks let into the OR. The great thing about operating on a dark skinned patient in the dark is that they don’t bleed, at least not that you can see, that is of course until you notice the puddle around your bare feet (I do wear clogs, but no socks).

It’s not that there haven’t been electrical issues and various breakdowns in places we have lived in the US. I remember operating for 20 minutes in the dark at St. Joes when we lost power and both generators promptly went down. And in that OR, which has no outside windows or glass blocks, it is really really dark. And we have had plenty of occasions to call on Bo when things broke down on our house in Clarkston, or on Gene Augustin when we had problems with the house in Tillamook. But not everyday, multiple times every day. In fact every morning we get up wondering what is going to breakdown today. I remember one Thursday, I had just come home about 6 pm, and as Bekki and I talked and compared notes from the day we realized nothing had broken down that day, we had power all day, it had been error free day. Not five minutes later the house was suddenly plunged into darkness. OK so much for perfect Thursday. You know how businesses have signs posted, “Accident Free For 235 Days”, well we have signs posted “No Breakdowns For 6 Minutes”.

So it was this that was prompting the thoughts of a nervous breakdown, and wondering how much longer I could take this. Sometime shortly after this I received a text from my nephew, Dr. Olen Netteburg, the medical director at the Adventist Hospital in Bere, Tchad.

“Scott, have you seen the new authorization to function for the Surgical Center that puts it in the SDA Church’s name?”

Well as a matter of fact I had not. It turns out he had not either. That story begins 13 months ago when we found out that CCAM (Centre Chirurgical Adventiste de Moundou) was registered with the Tchadien Government under the name of James Appel, who started the Center. This was a problem because I am a Church employee and as such can’t work at a private institution. So the West African Division (WAD) gave us 6 months to rectify the situation. Three months later I received notice that the paper work was now in order, we were an official SDA Church institution. But neither Olen nor I ever actually saw the document.

We called our contact in N’djamena who had done the legwork on getting the proper authorization.

“Oh, no,” he told us, “That paperwork was lost just before the Minister of Health was to sign it. You are still operating under the original authorization in the name of Dr. Appel.”

Oh, boy, this was a problem. Not only were we 7 months past the deadline, we had lied (unintentionally) to the Union and Division Officers, our bosses. The consequence? They could require us to leave Moundou and put us at an official SDA Institution, somewhere. It was a very real possibility.

So we started talking about the various options, Batouri, Rwanda, Nigeria, Guam, or just send us home. It was when I was faced with the possibility of having to leave Moundou that I began to realize that despite all the problems I really didn’t want to leave. I am surrounded by a team of employees and volunteers that I really love and care about. We have worked hard to develop systems of care that seem to work well here. We have built up the infrastructure. We have projects in the works that we want to see fulfilled. We have passed over so many learning curves, the operations, French, the local shopping, many of the idiosyncrasies of the house and hospital, and more. Bekki has her network of contacts in town, we have volunteers who are scheduled to come work with us, we have volunteers who are with us now. I enjoy, for the most part, my practice here. I don’t have to do OB (really, really important). I sleep almost every night (last night being an exception).

I was sitting in church this morning thinking how much I was going to miss church here in Moundou, when we finally do go on permanent return. I will miss the dancing choir, the French hymns, the Sabbath School lesson study, watching poor Alphons try to translate for our pastor who preaches for about a minute then gives him all of 5 seconds to say the same thing in Ngombaye before cutting him off.

The last few months we have been able to see how much of a difference we do make here. The people who are walking on two strong healthy legs because we were here, the children who are still alive and well because we and our Center were here when they had a perforated appendix, or malaria or typhoid.

All of a sudden all the electrical, plumbing, cultural, and language issues, all the annoyances that come with mission life didn’t seem that important or overwhelming. I didn’t want to leave. I don’t want to go to Batouri, Bere, Rwanda, Nigeria, Guam, India, the US, or anywhere else, at least not yet. We have work to do here. We are needed here. Someday we will leave, but please God, not yet, not now.

The next morning Olen wrote a beautiful letter to the Division and Union officers explaining the situation and apologizing for the errors we had made. That night we received an encouraging letter from the Division president, telling us they appreciated our efforts and would wait as we worked through the process with the government of Tchad. Not a word about trading us for cash and future draft choices to another Division or Union.

I thank God. I thank Him for letting us stay in Moundou, I thank Him for sending us here, and I thank Him for giving me a glimpse, just a glimpse, into an alternate reality where we are forced to leave, so I could put all the trials into perspective.

It still drives me crazy at times, but we make sure our Goal Zero battery is charged each night so we can charge our phones and run our fan at night, we make sure we have a bucket of water in the bathroom so in the morning when there is no water we can wash our faces and flush the toilet, and we put blocks of ice in the fridge each night to keep it cool when the power goes out. And hey, OR lights, cautery, and air conditioning are just for wimps.

They say that when you have trials and it seems the devil is after you, it means you must be doing something right because you are making him mad. If that is true, bring it on, we have Jesus.

For those of you new to our blog please look around at the other pages, the “About” page tells a bit of who we are and our background, the “Definitions” page explains some terms that are used that some of you may not be familiar with, such as GC or AHI. The “Timeline” gives an idea of where we will be throughout the year, and the “Video” page has a video Bekki made of Koza Hospital as well as the videos she has made of Moundou. There is also the Surgical Pictures Page, but be forewarned, it has some very graphic pictures, so if you don’t like blood and guts, stay away from that page. You will also find links to other missionary blogs such as Olen and Danae Netteburg and others. Finally, if you like our blog and want to receive each new post directly to your e-mail, please sign up with your e-mail in the subscribe box. It doesn’t cost anything, there is no commitment, it just makes it easier to follow us.

We welcome volunteers.

-Scott Gardner

Demons

« Docteur, il y a un nouveau cas qui est venu au Centre, c’est une petite, elle est très malade, et il n’y a pas de l’électricité à l’hôpital. »

Roughly translated, “Doctor Scott, please come start the generator.”

And so started my day, not a particularly unusual start to my day, as I often have to start the generator because the batteries are dead, or start the water pump to fill the water tower because we have no water. What made this different was that it was 11:00 pm. We should have had plenty of battery power, at least enough to last most of the night.

I got my scrubs on and headed over to the generator. I first checked to make sure there was no city power, no. Check the batteries, all lights red, not good. Check the generator. Ready to start, but I thought I should check the fuel gauge, empty. OK check the four gas cans sitting next to the generator, empty. OK, check the barrel of diesel outside the generator room, empty. Sooooo…, we have a nice generator with no fuel, and no battery power and no city power, and a sick kid, well actually a hospital full of sick people.

Fortunately, we have our little generator, so I hauled it over to the electrical room, filled it with gas, plugged it in, and started her up. Lights came back on in the hospital! Woo-hoo. Back to bed.

This morning, I woke up to a house with dead batteries, and no water. To get power from the little generator to the house I have to run our two long extension cords, and plug the house in. I got that done before morning worship and voila, lights in the house. I also started the water pump, so we would have water in an hour.

At staff meeting after worship I found out that the air conditioner we installed in the new Lab is not working because no one ever charged it with free-on, or whatever they charge it with. I am guessing they were waiting for my OK to do that, but since no one told me it needed done, I never bothered to give the OK. So I gave my blessing.
During the meeting, and in fact for much of the morning the power kept cycling on and off. 5 minute with lights and fans, 5 minutes without. Still not sure why, I asked why, got an explanation that I don’t think I would have understood in English, let alone French. Myself, I am going with demons.

After worship I found out our anesthetist was not coming back from his grandmother’s funeral today, even though he had been told yesterday, that he was to be at work today. Which meant another day of juggling nurses to keep everything covered. Fortunately, our hospital nurse can do anesthesia, so he has been covering. It also means we will be having a 2 or 3 hour disciplinary meeting next week to meet out a suspension for insubordination for not coming to work, which means another 3 days of being short our anesthetist.

Good news is that Adrian was able to take the ambulance into town and got the gas cans filled with diesel and gasoline. So by 11 our big generator was back on line. However, the power kept cutting out during surgery, which I found out later was due to the generator overheating, which has been a problem lately. Somehow, apparently the coolant system is not working well. Isaac our maintenance guy told me it was the water pump and he fixed it. But it still kept overheating today. Fortunately the only things affected were the air conditioner in the OR and the electro cautery. So I perspired a lot, and tied off vessels instead of frying them.

Every day starts out with something akin to disorganized chaos. Today was no exception. People show up by 8 am and want to be seen right away…by me…even though they have been told I don’t see patients till after 3 pm. So they sit there, all day, not eating, drinking a little… and often by 3 pm, they are tired, hungry and cranky. The more aggressive ones will just walk into my office, at which point we have to chase them out. The quieter ones just sit and seethe. Some days I can see some patients in the morning, today was one of those days. It was good because we ended up operating until 5:30.

Yesterday I felt terrible because I had seen this man in the morning and prescribed some ibuprofen (I know, but that and Tylenol are my two most prescribed meds). Later in the morning some pushy man stopped me outside my office and shoved his carnet (medical record), in my face. I am usually about 30 minutes behind, so when that happens I just take the carnet, tell them to wait outside and I will call them when it is their turn. If I take the time to figure out what they want I will now be 40 minutes behind. So I took this guy’s carnet and put it on the bottom of the stack, and he went outside to wait. Finally about 6:30 in the evening I got to his carnet. We called him in, and as I looked through his carnet I realized I had just seen him that morning, so I asked what the problem was.
“Oh, doctor, the medicine you prescribed (ibuprofen) gives me an upset stomach, is there anything you can do for that?”

I felt like such a heel, this poor guy had waited all afternoon just so I would give him another prescription for cimetidine for his stomach.

Back to today, I started the day telling a lady in her late 40’s early 50’s that she had uterine cancer and was going to die, that there was nothing I could do for her. Actually I told her daughter who speaks French. I don’t know what her daughter chose to tell her. Her hemoglobin is down to 8 from bleeding. I did not say anything about transfusion, nor did I give her any iron. Hopefully, her hemoglobin will drift on down and she will slowly bleed to death, because all she has in front of her is untold pain and suffering from this cancer that is filling her pelvis.

I then went to the OR and opened a wound on a man who had bladder surgery (elsewhere) last fall. They found he had bladder cancer and closed him up. Problem is he didn’t heal. So today I opened the wound that is draining pus and debris and found a mess of necrotic (dead) muscle and bladder. By the time I got done he had a quarter sized hole in his bladder that I can’t repair. So I put in a catheter through his lower abdominal wall and packed off his wound. I am not going to check his hemoglobin either. There is nothing good in his future, except to finally die and be out of his misery. Most days when I see him on rounds he is lying on a vinyl mattress without any sheets, and his clothes are soaked with urine because he is incontinent.

I fixed a hernia, took out several hydroceles and a lipoma and finished the day re-fixing a leg that I fixed earlier in the week. A 12 year old boy with an open tibia/fibula fracture that I put an external fixator on. Last evening he got up on his own, with one crutch and he fell. He bent one of the screws and his leg was now crooked, again. So we took him back today and straightened his leg, again, and found that our muscle flap was happily intact. Unfortunately, I found out later that the family is blaming our Mexican volunteer nurse, Diana, for his fall because she had him get out of bed earlier in the day, with appropriate assistance. Not sure I follow the logic in why she is responsible for him later getting out of bed on his own and only using one crutch, and why they are not responsible for the fact they left him alone. Well, I actually do follow it, it leads to money, as in Diana should pay for the second operation. Not!

As I was sitting in my office contemplating the day and marveling that this day, like every other day, had started out with an impossible work load, that had no hope of ever getting done, and yet magically now all was done. At least all was done that was going to get done. I thought about how that was truly the way every day goes. I thought about how I need to stop stressing at the start of the day, because it always works out in the end. Then suddenly, all was black. The power was out again, despite the gentle throb of the diesel engine of our generator. I flicked on my headlight and headed, once again, for the electrical room.

We spent the evening resetting the breaker switch every 5 minutes, until we finally gave up and went on battery power. Is it a short? Is it a bad circuit breaker? Or is it still those demons. I am sticking with demons, and I have proof. Just read 1 Peter 5:8.

It is almost time for bed, but since the batteries for the hospital are not charging very well, I expect they will be dead shortly after the city power shuts off around midnight. Tite, our night nurse will probably be on our doorstep soon after.

« Docteur, il y a un nouveau cas qui est venu au Centre, c’est une petite, elle est très malade, et il n’y a pas de l’électricité à l’hôpital. »

For those of you new to our blog please look around at the other pages, the “About” page tells a bit of who we are and our background, the “Definitions” page explains some terms that are used that some of you may not be familiar with, such as GC or AHI. The “Timeline” gives an idea of where we will be throughout the year, and the “Video” page has a video Bekki made of Koza Hospital as well as the videos she has made of Moundou. There is also the Surgical Pictures Page, but be forewarned, it has some very graphic pictures, so if you don’t like blood and guts, stay away from that page. You will also find links to other missionary blogs such as Olen and Danae Netteburg and others. Finally, if you like our blog and want to receive each new post directly to your e-mail, please sign up with your e-mail in the subscribe box. It doesn’t cost anything, there is no commitment, it just makes it easier to follow us.

We welcome volunteers.

-Scott Gardner

Electricity

Sunday afternoon I was sitting in my office contentedly doing consults when the lights went out, and the fan slowly spun to a stop. I knew Isaac our maintenance man was at a funeral and likely to be gone all day, so when I finished the consult I headed out to the generator, which was now quiet and restarted it. Two consults later, the lights went out again, the fan spun slowly to a stop and my heart sank. Something was wrong with the generator, Isaac was gone, and we had had city power for most of the last two days, which meant it was not likely to come around again for a while (this was true). So I went back out to the generator and this time really looked at it. Temperature warning, so when I restarted it I watched it start out at 85 degrees, normal operating temperature and fairly quickly rise to 89-92-93-95-99-102-106 at which point it shut itself off.

Adrian and I looked all over the generator, and deduced that although the radiator did not have a reservoir, it was full, the fan worked, but clearly the water pump was not pumping. It was now almost dark and the hospital had no power. No power means no water pump to fill the water tower. Fortunately no one was on oxygen, so other than being dark the hospital was fine.

At the house we got busy filling buckets and trash cans with water, and getting the new portable generator (thank you Clarkston Church) going and hooked up to at least provide the house with power. I felt like a real jerk having power at the house while the hospital was dark, but not bad enough to switch it off, and I didn’t know how to hook up the little generator to the hospital (I do now). Besides the hospital had power all last week when we were dark in the house.

God answered our prayers when Isaac showed up at 8 pm and got the fluid flowing again in the radiator. However, this was just the culmination of the electrical problems we have struggled with since returning from Europe. The charger unit for our house batteries died in October so Isaac bought the best one on the market here in Moundou, turned out to be the only one on the market, and it is a car battery charger, not a deep cycle battery charger. It really wasn’t charging the batteries well, just partially. So an hour after the generator shut off the batteries would die. Even with the generator going the inverter would shut off every few minutes leaving us in darkness. That was fine from midnight to five am, but in the evening it really put a damper on things. For a while we didn’t know if the problem was the batteries, the inverter or the charger. We couldn’t find anyone who knew enough about it to tell us, but the missionaries in Koutou came through with an old charger they were not using. It worked!! Now we just have to find another charger like it, so they can have theirs back.

Anyway, the point is, you never realize how dependent you are on something until you don’t have it. Those of you who have gone through blackouts can relate. Unfortunately here it seems like it is one electrical problem after another. Fortunately, we brought a bunch of stuff like the generator, cables, solar powered lights and so on to get us through the dark times. At this moment in time, all is well, we have power, the hospital has power, and the internet is working reasonably well. Let the good times roll.

Bekki enjoying one organized, clean corner of the house, because...

Bekki enjoying one organized, clean corner of the house, because…

...this is what the rest of the house looked like.

…this is what the rest of the house looked like.

Other news from the home front, our volunteers are all safely in the nest. Adrian Sarli of course met us in Paris and came down to N’djamena with us a couple weeks ago. Last Sunday Diana Hernandez, a nurse from Mexico, joined us after spending two weeks in Bere. Both have fit in beautifully here and are a huge help as we continue to try and get settled and organized. We have been so blessed with our volunteers, they are so helpful and cheerful and such an encouragement to us. Friday afternoon we met Dr. Orie Kaltenbaugh, an orthopedic surgeon from Clarkston, Washington, at the bus station. I cannot begin to tell you how nice it is to have a real orthopod here. He has already taught me so much and given so much helpful advice. And just having another doctor to talk things over with is a huge relief. Thank you Lisa for sharing him with us for a couple of weeks. While I am at it, thanks to all of you who have shared your kids, spouses, brothers, sisters, whatever, with us for a time as volunteers. We did the three weeks in October with no volunteers and I am telling you, it was not fun.
Dr. Orie, inspecting a wound as Diana changes the dressing.

Dr. Orie, inspecting a wound as Diana changes the dressing.

Saturday night we had our first party of the season. We had a couple of young ladies who are here teaching English for a year and an older missionary, all from the Mennonite mission over to have smoothies, pop corn, and play games. One of the girls plays the piano so for worship we had real live piano accompaniment as we sang some favorite hymns. We partied hard, laughing, talking, telling stories until late into the night (9 pm) when our guests had to return home. Reality is everyone is usually pretty tired by then anyway, so it felt really late.

One of the blessings of life in the mission field is that no day, no part of the day is ever boring. Another blessing is that you never have to look for trouble, it will find you soon enough. In fact you never have to wait for the other shoe to drop, it dropped 10 minutes ago. That being said, we continuously marvel that we have this opportunity to be here. Thank you all for your love and support.

For those of you new to our blog please look around at the other pages, the “About” page tells a bit of who we are and our background, the “Definitions” page explains some terms that are used that some of you may not be familiar with, such as GC or AHI. The “Timeline” gives an idea of where we will be throughout the year, and the “Video” page has a video Bekki made of Koza Hospital as well as the videos she has made of Moundou. There is also the Surgical Pictures Page, but be forewarned, it has some very graphic pictures, so if you don’t like blood and guts, stay away from that page. You will also find links to other missionary blogs such as Olen and Danae Netteburg, Jaime and Tammy Parker and others. Finally, if you like our blog and want to receive each new post directly to your e-mail, please sign up with your e-mail in the subscribe box. It doesn’t cost anything, there is no commitment, it just makes it easier to follow us. For our Francophone friends there is a French translation of our blog that you can find at http://gardnersenafrique.wordpress.com.

We welcome volunteers.

-Scott Gardner

Three Days in May

I am sitting at our table listening to the most beautiful sound in the world, our generator. You have to understand why this is a significant statement. The first question most people ask when they hear our generator, “Is that your generator, or does the train come through the hospital?” To say it is loud and annoying is an understatement of epic proportions. But for now, it is the most beautiful sound in the world. It is the sound of lights, of food not spoiling in the refrigerator, of lights in the OR, of a working ultrasound machine, of fans, of batteries charging, yes of electricity.

These last three days in May have been memorable, more memorable than most. It started early Monday afternoon when the air conditioner quit during our last operation. This is always bad because it is hot and humid and wearing a gown under the OR lights is pretty miserable. So after we finished the case we headed out to find out why the air conditioner quit. The generator was off, which was strange because we didn’t have city power so we needed the generator. That was when we found out the bad news, both generators were down. One is leaking oil pretty badly, and the other had a bad piston. Isaac would have to go to N’djamena and try and find a new piston and get it put in the generator. That would take days. So after much discussion it was decided to move a good piston from the leaking generator into the other one. OK so we had a plan, but within the hour the batteries were dead in the hospital, so no lights, no fans, no nothing.

No generator means we can’t charge the batteries, it means we can’t pump water into the water tower, which is our only source of potable water. It means everything in our refrigerators goes bad, blood, food etc. There is no water to flush the toilet. There is no water in the hospital for the patients or nurses to wash their hands, their bodies, their clothes, no water to cook with or drink. And we rarely have city power so we can’t count on that. And we still have patients to take care of and to see, and emergencies that still come in. Yea, big problem.

The hospital at night without power

The hospital at night without power

We immediately went into conservation mode. We filled every container we could with water, turned off all lights and unplugged everything. So the only thing drawing off our batteries was the refrigerator, which was full of food Bekki and Johnnie had just bought. Monday night we were up late trying to get everything in order, but finally went to bed about midnight. Many of you read Bekki’s request for special prayer on facebook. At 1:30 Johnnie woke me up to tell me we had city power. What an answer to prayer! We were able to get the water tower filled, and give the batteries a little boost until the power went back off at 5:30.

Tuesday: Isaac was busy working on the generators getting the piston moved. We started out in the dark, well except for the ambient light coming in from the windows. We had surgeries to do, so with ambient light, a battery operated pulse oximeter and a very weak headlight we did our first case. I think it was a hernia, it was kinda dark, so could have been maybe an appendectomy, no I am pretty sure it was a hernia. At least when I got done I had a hernia sac in my hand, and he had an incision in his groin.

That was the easy case, we then had a man with an open tibia fracture. And it was in pieces, four actually, the tibia that is. With no power, no lights and no aircompressor I was not interested in trying to put in a nail, so we just washed him out really well, got the pieces of bone back together and then wrapped #5 steel wire around the pieces to help hold them in place while I put a cast on him. We have external fixators, but no screws for them. Today we cut a window in his cast so we could do dressing changes.

Sometime during the afternoon Isaac found a small generator he was able to use to charge the batteries with. Great! We had lights in the hospital and the house. We quickly got things plugged in to start charging, phones, computers, the Goal Zero, etc. It was during supper that a very unsettling thought occurred to me. Isaac was just charging the hospital batteries, not our house batteries. Hence we had spent the last several hours draining our precious battery power. I jumped up from the table, ripped cords from the wall and turned all the lights out. All that was left was the gentle green glow of the refrigerator light. Bekki, Johnnie and Brandon sat in stunned silence at this turn of events. We turned on our little solar lights and finished the meal in the dark. It was like camping said I.

Bekki, Brandon, and Johnny eating supper after I shut things down.

Bekki, Brandon, and Johnny eating supper after I shut things down.

This was serious, there were a lot of prayers going up. I really did not know how long it would take Isaac to get the generator working, and we needed the small generator to power the hospital, but the house batteries were dead, dead, dead, with no way to charge them. It was really hard not to think about our container with two perfectly good generators on it, sitting in Cameroon as it has for the last 3 months. So it was with hearts full of gratitude and praise that we heard the generator come on at 10 this morning. It has run all day, doing it’s thing, making lots of beautiful generator music. Thank you God.

Scott operating on the hernia on Tuesday (just kidding)

Scott operating on the hernia on Tuesday (just kidding)

And just in time, too. I would not want to have done today’s cases without power. The first patient had come in 2 weeks ago while I was in Bere. He had the typical proximal tibia fracture, in pieces, 2 weeks old already, and badly infected. His thigh was swollen, pus pouring out of the wound. We took him to the OR, opened up the wound, cleaned it out and I put a plate on the tibia to stabilize it. But the bone ends did not look healthy. The last two weeks have been very discouraging. Every day I take his dressing off to be greeted by pools of pus, and bone ends that are just plain dead. I tried getting the pockets opened up more, placed drains, nothing worked. So today I took him back determined to find every bit of pus that was there. The main pocket seemed to be coming from behind his knee, Oh great. That is where all the vessels and nerves live. So I carefully tried to open up the pocket from behind the knee. I tried to keep it superficial, really I did. One more gentle push with the clamp and I was in the pocket, and…was greeted by audible bleeding. As you can guess audible bleeding, ie bleeding you can hear, is not good, in fact it is very bad. I quickly got my finger in the hole and was able to stop it long enough for Daniel to get our tourniquet on his leg. Great, I could breathe again, but how am I going to get back there to fix the hole in the vessel? So I extended the incision and started trying to dissect down to the vessels, but was greeted with pus and more pus, with tunnels going up his thigh. And then I would look at the bone. I knew that short of a miracle that bone was never going to heal, it was dead. He really just needed the leg off. Fortunately he was awake and we brought his uncle in and showed him the infection and explained the situation and they agreed to the amputation.

In the meantime he suddenly dropped his oxygen saturation. Pulse and blood pressure were fine, but he was hyperventilating. Pulmonary Embolus? Probably, but I have nothing to treat it with, and no way to diagnose it. With oxygen he was better. Then during the amputation he dropped again, he was already on maximum (for us) oxygen. His pressure dropped this time as well. We were losing him. It was all hands on deck time. Bekki came in and did jaw thrust, Brandon scrambled to get everything we needed, Abel scrubbed out to help Daniel with the IV’s. We got blood and more fluids in him, some epinephrine, and lots of prayers. As he started to come back around, Johnnie and I got the leg off. That is also not an easy feat right now. We have no saw to cut the bone with, other that the power saw with the air compressor that is not working. So I had to chisel through his femur with a hammer and chisel. Not elegant but it got the leg off.

By the end of the case he was awake, breathing on his own and talking. He is currently sitting up in recovery drinking and eating with no idea how close he came to dying this morning.

After a badly needed rest at lunch we started our second case. This was an older woman who looked 12 months pregnant. Ultrasound had confirmed it was a large ovarian mass, probably cancer. But she was so miserable with this I had to try and get it out. Besides it could be benign. So that was the plan, get the mass out, with possibly a hysterectomy.

Now, I have uncovered a truism, if you have a problem that all the Tchadiens want a picture of, this is a bad thing for you. We take pictures of everything, but when all the nurses and students have their phones out snapping pictures, it is generally really impressive, in a negative sense. That goes for this mass. It was definitely ovarian cancer, and for you medical types, almost certainly a mucinous adenocarcinoma (who is going to prove me wrong?), it was at least 30 cm across, bigger than a basketball, and running up her ovarian vein toward the left kidney, with ascites. I got the ovary out, but couldn’t cure her, but at least she will feel better in the short term.

It was now getting close to 3:00 in the afternoon. For Brandon, that has taken on a whole new meaning, because at three the night nurses and students come on duty. It seems that one of the students has taken a shine to him, even sent him a good night text message last night. And she comes on duty at three. Just before three he left the hospital for the residence compound so fast he left tracks in the sand.

I finished up the afternoon catching up on ultrasounds, found a prostate that needs to come out, found two early pregnancies, and did a trigger point injection. I then came home and studied french for an hour and a half. And so ends our three days in May, with a whimper. But honestly after the last three days, that is all we have left is a whimper. But at least it’s a whimper with electricity.

God is good, all the time.

For those of you new to our blog please look around at the other pages, the “About” page tells a bit of who we are and our background, the “Definitions” page explains some terms that are used that some of you may not be familiar with, such as GC or AHI. The “Timeline” gives an idea of where we will be throughout the year, and the “Video” page has a video Bekki made of Koza Hospital, where we initially were to be. Soon there will be a new video about Moundou. There is also the Surgical Pictures Page, but be forewarned, it has some very graphic pictures, so if you don’t like blood and guts, stay away from that page. You will also find links to other missionary blogs such as Olen and Danae Netteburg, Jaime and Tammy Parker and others. Finally, if you like our blog and want to receive each new post directly to your e-mail, please sign up with your e-mail in the subscribe box. It doesn’t cost anything, there is no commitment, it just makes it easier to follow us. For our Francophone friends there is a French translation of our blog that you can find at http://gardnersenafrique.wordpress.com.

We welcome volunteers.

-Scott Gardner