Late morning on April the 30th, I was filling out vaccination cards at the nurses station, directly in front of the NICU. I reached for my glass, found it empty and sighed with a faint longing. I would complete the documentation, because I wanted that out of the way, but my mouth was dry. A few minutes later, my head was aching and my sense of malaise was growing. Suddenly, I missed home. Homesickness comes in ebbs and flows to expat workers and I have learned to accommodate it, along with all the highs and lows that go along with my work here. It's when I am feeling unwell though, that I struggle the most with the distance between me and and my family in Scotland. At a time when I want, need and would benefit from caring gestures, I must do without them and I must take care of myself. I feel so alone at those times.
Absent mindedly, feeling weak and nauseated, I reached again for the red plastic tumbler - the empty red tumbler, and found it half full! ' There were few things I would have appreciated more at that moment than that icy cold water, to ease the pain and settle the nausea..'and the water doesn't taste Haitian, it tastes of home,' I told my Facebook friends at lunchtime. It was the last most of them would hear from me for a week.
Mesi Bondye!! I didn't understand the reason for this little act of loving kindness, but I was confident that was what it was. A gesture of compassion from a loving father. I had taken some aspirin. The headache had lifted and I enjoyed a mid-day meal of pasta and pesto sauce. As my shift came to a close, a vague discomfort in my upper abdomen shifted lower in my belly, and became a dull ache, but I made it through to the end of my working day with a smile on my face. I joked with the nannies and chatted with the volunteers over dinner.
At 8pm that night, I was suddenly gripped by a sharp and severe pain in my belly, and I seriously contemplated whether that glass of water had somehow been contaminated on route from heaven. Later, I came close to posting something to that effect on my Facebook page. I had been violently sick and the pain had pain eased, but I was tired, and I couldn't be bothered logging on to my laptop. I fell asleep, waking sometime around mid-night with a high fever that caused my muscles to rigor. I had suffered from frequent migraines since before I was a teenager. Debilitating though they could be I'd had to learn to live with them. As a result, I could bear the pain I felt now.
I developed diarrhoea. It was not severe, but there were signs that it was caused by a bacterial infection. I didn't believe in taking to my bed. I did believe in the capacity of my body to heal itself, which, had always been remarkable. However, the exhaustion and lethargy I felt during those days was incredible, like nothing I had ever experienced. I reasoned that the long hours I had put in stabilizing Jusmy, followed by a week of night shifts that I had pulled to cover staff sickness, one of which, backed onto a day shift, had drained me. I started a protocol for travelers diarrhoea. It consists of oral rehydration solution and an antibiotic. Diarrhoea is such a common problem in the developing world that it is not considered necessary or practical to visit a Doctor and obtain stool cultures before antibiotics are started. Doctors provide the guidelines for self-treatment and nurses and travelers commence treatment by themselves, and seek medical help if their symptoms worsen. The pattern of my fever strongly suggested that I had a bacterial infection. I knew well enough that my immune system was not handling the infection this time. I knew well enough that I better not try to work anymore than was absolutely necessary, so, I swallowed the pills and I took to my bed.
My fever climbed over the days that followed, and my dreams became increasingly more vivid, brighter than techni-colour. I remember flying over the ocean in a flying saucer, being amazed by the depth and intensity of its blue shades. I remember being aboard a ship. I remember standing on its deck, and feeling a strikingly cold, briny wind lash me. Thank you! Thank you! I was so hot. So, so hot!
On Thursday Afternoon, I lurched between delirium and lucidity, and developed some worrying signs that suggested I needed medical help. The pain had moved very low in my pelvis on the right side, and my abdomen was tender. I realised that I hadn't eaten for 3 days. I'd had no appetite. Despite Almost 72 hours on antibiotics, my fever had not broken, and diarrhoea was still a problem. It hurt to move, it hurt to breathe. Miss Vicky, an American nurse, walked by outside my room. It was raining heavily. I couldn't muster a deep enough breath to call out to her. Something was wrong. I suspected appendicitis. I told my roommate I needed to see a Doctor. She grimaced. I knew it would be dangerous to drive down the mountain in this weather. Tomorrow, we agreed. Tomorrow morning.
On Thursday Afternoon, I lurched between delirium and lucidity, and developed some worrying signs that suggested I needed medical help. The pain had moved very low in my pelvis on the right side, and my abdomen was tender. I realised that I hadn't eaten for 3 days. I'd had no appetite. Despite Almost 72 hours on antibiotics, my fever had not broken, and diarrhoea was still a problem. It hurt to move, it hurt to breathe. Miss Vicky, an American nurse, walked by outside my room. It was raining heavily. I couldn't muster a deep enough breath to call out to her. Something was wrong. I suspected appendicitis. I told my roommate I needed to see a Doctor. She grimaced. I knew it would be dangerous to drive down the mountain in this weather. Tomorrow, we agreed. Tomorrow morning.
That night, I dreamed I was standing on a road that cut through a heavily wooded area. Soldiers were marching that road, to the horizon and beyond. A man appeared beside me. He looked as though he was in his 60's. He had soft, white curly hair and an impeccably kept beard. He was of average height and he had a muscular build. He was was wearing a tartan shirt and blue jeans. Resting his foot on a tree stump, his aura was at once relaxed and commanding. Smiling at me he made a sweeping gesture with his arm. 'How many men do you think I have there,' he asked, motioning to the soldiers that marched over a snow-capped mountain on the horizon.
'I don't know I replied, It was an awesome sight, and my mind struggled to grasp the magnitude of it 'Maybe 10,000?' I guessed.
'I've got 70,000 men out there,' the man told me. His face was beaming with pride, 'Every single one is exactly where I want them. And you,' he declared, his eyes shining, 'You are exactly where I want you.'
And then I woke up.
I was feverish, yes, and extremely sick, but I took the dream seriously. I noted than my pain has decreased significantly from the day before. I recognised that a sudden release of pain might mean that my appendix had ruptured. I understood that soon, fecal contents and puss would seep into my abdominal cavity, the lining of my digestive tract and eventually cross over into my blood stream.
Upstairs in the NICU, a pulse oximeter and blood test confirmed the seriousness of my condition. If my CRP is more than 100, I know I need a Doctor, I told myself. CRP (C-Reactive Protein) is a marker of inflammation that usually increases significantly with severe infection. A result of over 100 would be concerning, given my symptoms. My CRP result was greater than 210. It was so high that our portable analyser was unable to measure it. My CRP was off the scale!
I had an overwhelming infection. My heart was beating 165 times per minute and my tissues were poorly oxygenated at just 86% following the walk upstairs. 95-100% is considered normal. 85% is considered pre-terminal. Five minutes later, my oxygen levels were hovering at 88-91%. I knew there was little time to lose. I knew that my life was in danger. Convincing my colleagues of this, though, was another matter. I made two attempts to persuade my room mate, who worked in the office, that I needed to be transferred to the city for urgent medical evaluation. My colleagues, though, had other plans for the day - matters to be dealt with that they believed were more pressing. In a last ditch attempt, I asked my room mate to write down my vital signs and to call my boss, a Registered Nurse, who was in the Dominican Republic. I was certain that she would tell the staff that taking me to see a Doctor in the city had to be the priority. But no, an adoptive family was to appear before the local judge to get approval to adopt the child who had been matched to them. There weren't enough drivers or vehicles. I was told I would have to wait. I had no fight left in me......I should call Mme Bernard...... I needed oxygen and IV fluids.......I should call Dr Nathalie on my cell phone. She would understand....... My phone was just out of reach...... I would get it in a minute....
I had an overwhelming infection. My heart was beating 165 times per minute and my tissues were poorly oxygenated at just 86% following the walk upstairs. 95-100% is considered normal. 85% is considered pre-terminal. Five minutes later, my oxygen levels were hovering at 88-91%. I knew there was little time to lose. I knew that my life was in danger. Convincing my colleagues of this, though, was another matter. I made two attempts to persuade my room mate, who worked in the office, that I needed to be transferred to the city for urgent medical evaluation. My colleagues, though, had other plans for the day - matters to be dealt with that they believed were more pressing. In a last ditch attempt, I asked my room mate to write down my vital signs and to call my boss, a Registered Nurse, who was in the Dominican Republic. I was certain that she would tell the staff that taking me to see a Doctor in the city had to be the priority. But no, an adoptive family was to appear before the local judge to get approval to adopt the child who had been matched to them. There weren't enough drivers or vehicles. I was told I would have to wait. I had no fight left in me......I should call Mme Bernard...... I needed oxygen and IV fluids.......I should call Dr Nathalie on my cell phone. She would understand....... My phone was just out of reach...... I would get it in a minute....
I fell asleep. I woke, I got up to use the bathroom. My mind was drifting. I forgot about the oxygen, and the fluids, and Mme Bernard. I fell asleep again.
Thankfully, my heavenly father, the warrior king, commander of the troops and the God of the universe had me in the palm of his hand at that time when I couldn't take care of myself; when there was no-one else to take care of me. He and showed me his divinity and his sovereignty but also his tenderness. He had me right where he wanted me. That's what he had said.
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