on bugs and concentration

The pace for the day began at 3 am when I was awakened by Star making strange, half-whine half-snuffle noises that I recognize as distress. And as I rolled out of bed with my flashlight (Scott went to Kampala or I would have definitely woken HIM up to check on our safety) and walked outside, I diagnosed the problem as sharp stings attacked my bare feet. Biting ants had invaded Star's dog house space, and though she had stretched the leash she's on at night to the max, she could not escape them. I released her and she shot into the house, where I helped her get some of them off and sprayed, and she ensconced herself in Caleb's room for the rest of the night.

That pretty much set the tone for the day. We may build with cement and connect to electricity, but this is still an equatorial jungle. The insects rule.

By morning the invasion had formed an orderly line running less than a meter from our door. I stepped over it and noticed that there was a lot of debris on the side-porch bougainvillea-covered patio. Debris interspersed with tiny grey bird feathers. Then I looked up and saw that the line of mpali was marching up the trunk of the bougainvillea, into the branches, and swarming itself around a nest of presumably ring-necked doves that like to live there. A seething mass of ants had devoured the birds. Which happened the one time we tried to have pet parrots. . . Nature in Africa is not for the faint of heart. Thankfully my neighbor Saulo who does yard-work for us is quite competent with ant-killer and a panga, so I left him to deal with the mess and went down to the hospital.

Patient 1: a very very ill, anemic, 8-year-old boy, who desperately needed a blood transfusion, but we were out of his type. Phone calls, some small money to help him get to Bundibugyo. As his mother hurriedly picked up their mattress and things and left, I began on the next bed, Patient 2: a very confusing and unusual case of massive ascites in another young boy. While I began to see him, Heidi noticed a few roaches left behind from Patient 1's departure, and very reasonably reached into the store room to pull out a can of Bop, the insecticide spray. None of us could have imagined the horror movie result. The three modest roaches died. But the spray disturbed the dozens, maybe a hundred or more, other roaches that were hiding behind beds, in cabinets, in dark spaces all around. Suddenly there were 3, then 5 then 10, then 30. Huge ones. Flying ones. Scurrying ones. I keep trying to examine my patient which is not easy when an occasional nuclear-powered roach tries to crawl up my leg. Nathan arrives and tries stomping them out. Nurses and patients are laughing and stomping here and there, not nearly as perturbed I'm sure as Heidi and I were. I'm listening for subtle heart sounds but rather distracted by the 3-inch roach crawling across my patient's sheet. Hitchcock should have had film running.

And it kept going with that whole area of the ward. I was reminded of a video game. We aren't too high tech but Jack plays one on my phone where he's trying to knock things out of the sky while simultaneously being shot at. The idea is to focus. Good prep for this kind of medicine I guess.

And at the end of the day, Nathan got his turn to test his focus. I was helping him learn to do a lumbar puncture on a very ill neonate (15 year old mom delivered at home then after a week came in because the baby cries so much). As he's about to put the needle in, the baby shoots a warm orange stream of stool explosively out his bottom. Quick-reflexes, Nathan jumps back. We re-clean and re-glove, and he's through the skin on try 2 when another patient bursts into the treatment room with a convulsing child, and absolutely no qualms about getting right in our way. Heidi thankfully moves them over to the side and administers valium just as thick yellow purulent CSF fluid begins to eke out of the needle. Not what you want coating your brain, and we are not surprised the baby cries a lot . . .

Bugs, seizures, streams of diarrhea, and other hazards not withstanding, we finally finished the day relatively intact. Until I got back home to be informed that though the mpali are now gone (many dead, thousands and millions more diverted) one small problem remains: a cobra came out of the cocoa behind our house and got away before they could kill it.