4/12 – Never Really Say Goodbye

It was 5am and Tabi and I were awoken by Dr. Jean because there was a retained placenta case at the hospital. This was my last full day in Saboba, and I wanted to spend it saying goodbye to people, but I was so glad that I got myself up out of bed to go with her to the hospital.

When we got to the maternity ward, Tabi slapped on some gloves and put her hand all the way up into the uterus. She was probably in up to her forearm! Tabi needed to start creating a plane between the placenta and the uterine tissue in order to separate them from each other. Meanwhile, she was using her other hand on the lower abdomen to push down on the fundus of the uterus to create some leverage. It took several minutes of very careful digging around, going centimeter by centimeter.

Tabi said it was stuck there like cement, and she needed to be extra careful that this woman didn’t bleed to death. Finally the strange circularish mass came out, with the umbilical cord rising from its middle. It was checked to make sure no pieces were missing, and that all of it was out of the uterus. Indeed, all the edges matched up and everything looked great. That was the first time Tabi had ever removed a retained placenta! I thought she did an amazing job! Our patient was asked to be monitored for bleeding.

Tabi thought it might be beneficial to round the female ward while we were at the hospital for the morning. All I wanted to do was go back home and eat and sleep until 9, but I sucked it up and went along with her. Luckily, rounds flew by and by 7 we were on our way back to the bungalow for breakfast. Ti doon Uwumbor!

After this, Tabi went back to round with Dr. Jean, but I stayed at home to write letters to my friends in the hospital. I wanted to give them to each ward and department so they’d have something to remember me by, and so that those nurses and staff who weren’t present today would be able to read it later and know that I didn’t leave without “goodbye-ing” them.

It was a painstaking process. I hate goodbyes more than anything. Whether it’s a loved one that has passed away, or a mere semester-long absence from a friend, goodbyes are always hard for me. I had to fight back tears, but I eventually got through all of them and headed on my way to make their deliveries.

At each place… the lab, the male, female, maternity, and childrens’ wards, I stopped and bid farewell to my friends that I had known and grown to love over the past 10 weeks. It was so hard to think about them continuing their way of life here in Saboba, while I am all the way in San Diego. I wanted them to know above all that they mean so much to me, and I will never forget them or stop praying for them. We took pictures together, ones that I will cherish forever.

Dr. Jean and Dr. Tabi were in the theater with the fellas, performing a laparotomy on a patient with severe abdominal pain. I walked in, and there was bile-green fluid everywhere. It was a humongous pyloric ulcer the width of your index finger. Solo was back from his family’s funeral (I was so glad to see him!), and was dumping a total of 4 liters of fluid into his veins to replace what he had lost. I had come in for the end of the operation, and Jean was on her way out, flushing everything with normal saline and sewing things up.

Things at the hospital were moving at breakneck speed today–Tabi and I still had to do childrens’ ward rounds after the laparotomy, so we headed there while Dr. Jean and Alex were performing more hernias, and we checked on all the patients–they were all improving and doing well, except that the family of the baby with the broken femur was requesting that he be transferred to Tamale. All of us really doubted that he would get better treatment at that hospital, but even so, the parents insisted, so we had to take apart the device that Bob, Ishmael, and Tabi constructed with such care and effort, and sent the baby off to back West.

The childrens’ ward was not about to let us move on quite yet, though! While Dr. Tabi was finishing up writing orders at the nurse’s station and we were about to move on to the post-rounds tasks of the day, a small boy came into the wards with a head that looked like a balloon. The poor thing’s face was so swollen that his eyes were closed shut! He had been bitten on the head by a snake. How on the head, you ask? Well, he was sleeping on the floor of his compound, which is so common here. His family even opened up a polythene (plastic bag) and showed us the tiny dead snake that had bitten him. I knew that baby snakes often can’t control the amount of venom they release, therefore bites from baby snakes can be most dangerous. We ordered clotting times and got some ASV for the little kid pronto. He would be alright.

I got to witness Pullsheet David pull another pick-up line on Dr. Tabi, and it was hilarious. She just told him flat-out that she doesn’t like men with “Fufu bellies,” and the entire nurse’s station cracked up, including Pullsheet David. Poor guy!

It was a brief comic relief, however, because Tabi and I had to rush back to the male ward to see what to do about our alcoholic patient with his infected leg wounds. The fellas and I brought him in, and put him on the operating table between his moans of pain. It wasn’t looking good–the bottom part of his leg near his ankle was peeling black skin and leaving raw, red parts underneath–it was necrotizing fasciitis. What made it worse was that there was a part of his upper thigh near his groin that he never showed to us, and always kept covered under a cloth. That, too, was infected with gas gangrene–the bacteria that was in his leg were producing gas as a product of their reproduction, and it wasn’t pretty at all.

Jean inserted a needle to test the area, and he began oozing bright red blood that wouldn’t clot. She decided that we couldn’t flay his leg in the theater like we wanted to, in order to get rid of the infection. It was impossible because he would bleed to death. Our cautery was broken, and we just didn’t have the resources to cut. Instead, we put him on high-dose wide-range antibiotics and hoped for the best. His family was all gathered around, and Jean had the unpleasant task of breaking the news to them that there was a possibility they could lose him. I was shocked and immediately believed the worst, but Jean in her wise manner, declared, “Where there is life, there is hope.” That is the attitude a doctor should have, and I was immediately shamed. I put away my pessimistic perspective and resolved to pray hard and trust in God’s will for this man and his family. He was put into a private room in the back of the male ward, with his relatives all gathered around him.

It was already late afternoon, but we were still busy–there were three maternity ward patients that Tabi was going to perform some ultrasounds on. Two of them turned out to be normal, but the last one had a set of twins, one of which was almost at full term, and the other was at 36 weeks, meaning it had died. It was going to be a difficult and tragic delivery. I wasn’t going to be around for it, but I am going to keep the family, Dr. Jean, Dr. Tabi, and the midwives in my prayers.

It was dark by then, and we were all very hungry and tired, but there was still one more hernia to do! It would be my last surgery with Dr. Jean, so I scrubbed in and savored every moment of that theater. I hated to think that soon I would be gone, and it would be a very long time before I saw the place again. The little scenes of the past surgeries I observed and assisted in ran through my mind–Dr. Jean’s surgery play list that I basically knew by heart, Alex dancing to the grooves, Ishmael giving “therapeutic touches,” to the patients, the first baby I saw sectioned, my little typhoid perforation girl Tikala, the surgeries with no electricity…

This one was a left inguinal hernia. Over the past weeks, I learned to anticipate what instrument Jean needed next, how to slap them firmly in her hand, how to cut sutures, how to think about keeping everything sterile during every second of surgery. I got a tiny introduction to key-hole anatomy and what it’s like to find the all parts, even if the patient’s anatomy varies from the textbook. Jean even said, “You are ready for med school and one step ahead of the game!“ I don’t know if she meant it, because I still think I don’t know enough, but it really encouraged me to hear it from her. It had been an amazing hands-on experience to scrub in with the team, and such an honor to learn from these guys who were so welcoming and willing to help me. I am already missing it.

After that last surgery, the team was itching to go home. I don’t think we’ve ever spent that long in the theater during the entire 10 weeks that I had been there, and we were all exhausted! But I wouldn’t let them leave without a photo together. I gave each of them a big hug, presented my letter, and let them know again how much I would be missing them and praying for them back at home. They are all so special to me. From the first day that I met them, they immediately endeared themselves to me, and I would not forget how kind they had been, and how enjoyable it was to spend time with them working and relaxing, too. It was a sad goodbye, but a hopeful one. Hopeful for a return to this place.

Back at the bungie, I briefly forgot my impending departure, and happily inhaled a bowl of redred and plaintains. Favorite Ghanaian meal, right up there tied with TZ and groundnut soup. Perfect farewell dinner, especially with the leftover cake and ice cream from Raymond’s visit yesterday.

I was gathering up all my presents for Pastor Jonah and his family, when a storm hit. They come super fast here, and before I knew it, there was wind, lightning, tremendous claps of thunder, and torrents of rain. I was about to head out and run to the Manyan compound with my bag of gifts, but for fear of being hit by a falling tree like our trauma patients the other night, I was not permitted. I was heartbroken that I wouldn’t be able to see the compound one last time and bid a proper goodbye to my best friend here in Saboba. Why, God, why? But I called and Pastor Jonah was not even at the compound. What consoled me slightly was that he would be coming with us in the lorry to Yendi the next day early in the morning. If I didn’t get to see Aggie, Ruben, James, and Gloria, at least I got to say goodbye to Pastor Jonah.

It was the middle of the night when the rain stopped. I still wouldn’t be able to visit Pastor Jonah and his sleeping family, but Tabi and I were able to visit the hospital to check on the laparotomy patient, the leg infection patient, the maternity ward’s small babies, and the mother with the twins. Everything was looking alright. Finally the mothers in the maternity ward were following the directions we gave them, and we thanked the nurses for also working so hard on them.

When we were checking on our mother who was about to give birth to one full-term twin only, Dr. Tabi was able to teach Musah, an adept nurse with experience in delivery, how to do a vaginal exam and measure fetal heart rate. Musah is a good learner–I recounted the story to Tabi and the other nurse there, of how Musah caught a baby all by himself, clipped the cord and cut it, and everything. Jean had walked into the labor ward from the emergency call to the hospital, and found that he had done everything correctly already! I have high hopes for the further instruction that Dr. Tabi gives to Musah. She is doing a great work, teaching them things in such a detailed way, and allowing them to improve their skills. I was very encouraged as we said goodbye to them and came home.

The thunder began to clash again as we returned to the bungalow. Tabi and I were both quite exhausted, and even though I was going to miss my wonderful new friend very much, both of us couldn’t stay awake, and we fell fast asleep almost as soon as our heads hit the pillows. It had been a wonderful week-ish that I had been able to spend with her. I love her sense of humor, her bluntness, her passion for medicine and serving people, and her heart for Ghana. I learned so much from and was greatly encouraged by Dr. Tabi. I am so grateful that the end of my trip was highlighted by her presence; I just wish it could have lasted longer.

There just never seems to be enough time wherever I am with the people I love. No matter where I am–Berkeley, San Diego, San Jose, Los Angeles, France, Ghana, or a multitude of other places… There are always people I live apart from whom I wish were with me all the time. I get mournful, but then I think about the end of our lives when we are all gathered together at home in heaven, where we were truly made to be. It’s going to be wonderful. Marvelous. Indescribable. They will all be there, we’ll all rejoice together. It will be more happiness than we could ever imagine to worship there around the throne. Even across the country, across the globe, Christ unites us. We’re all heading for the same place, and the wait-period to get there will just be a small little blip in time compared to eternity together with God.

Goodbye, Saboba! Goodbye friends! Until we meet again, if not in this life, then the next J

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