Tuesday, October 18, 2011

The God of Broken Things: Part Three, by Ryan Phillips


Here is the final of the three weeks I mentioned in the first newsletter entitled The God of Broken Things. Thank you for giving me a way to process the last month and come to grips with everything that has happened. I hope these stories bless you.

Wednesday, October 5
Monday and Tuesday provided a little time to rest and heal from my case of cellulitis (the worst pain I’ve been in for years), even though I was the only one on duty for the Rhino. Purna drove the Elephant down to Gayaganga on Tuesday with Sandeep in tow for treatment. Saran was juggling the non-stop maternity cases in the Donkey without any major hang-ups or bang-ups. On Wednesday, the last thing I wanted to be doing was heading to Siliguri, again, but there I was riding in the back of the Rhino with Purna (who was supposed to be on holiday already) behind the wheel. Despite the fact that I’d incised the central abscess with a scalpel and self-extracted the “eye,” I was far from healed. An anti-embolism stocking on my left leg was helping to keep the edema down, and a gauze pad was absorbing the fluids, which constantly leaked from the sinus. That morning I’d woken up to Amanda holding her chest and coughing. She was having strong and abnormal heart palpitations in her thirty-seventh week of pregnancy. Asher’s emergency C-section, Leaf’s miscarriage, and Shepherd’s threatened miscarriage came hurtling back into my mind. I was seized by a sense of doom, which is abnormal for me. My mind instantly started concocting dreadful scenarios.
On a broken section of road, en route to the cardiac center, we passed a body lying in the middle of a blind curve on National Highway-31A. I blurted out, “Oh, come on buddy. If you’re going to drink, at least don’t pass out in the middle of the highway.”
There was a bandage on his leg that was stained with blood. His arm was limp and outstretched. It seemed to beckon acquaintance with a tire. The cars were swerving around him, coating his body with a fine grey dust. My conscience darted back and forth. Amanda was the one to speak up, “Shouldn’t we stop and help him?”
Purna pulled over. I hopped out of the back and hobbled back around the bend towards the body. In my mind I was saying, “Oh, come on, Jesus. Are you really putting me to the test right now? How about a break today? Can’t I just care for me and my own . . . just for today?”
I was relieved to find that he was alive and simply drunk. It wouldn’t have been surprising to find he was having a heart attack or something, which would have required loading him into the ambulance. Being a bit indignant, I gave him five hard smacks on the face before he regained even a semblance of consciousness. The wound on his leg was well-bandaged . . . perhaps back at the hospital in Rambi. Doing a fireman’s carry, we stumbled together . . . his legs shaky from drink, mine from pain. He mumbled incoherent sentences about his pants to me and I gave him some sharp reprimands that were probably equally as incoherent to him. There was a nice cozy patch of grass thirty meters away. I’d like to say that I made him a comfy little bed of leaves and pillow of heather to sleep it off in. I’d like to say that I held his hand and prayed for him until he came out of his stupor. In actuality, I did little more than drop him in a heap in the first secure spot I could find. It looked safe enough and comfy enough . . . for a drunken stranger.
While Amanda’s symptoms did last for several hours, by the time we reached Siliguri and met the cardiologist they’d mostly subsided. The ECG came back clear. Her condition seemed to have been caused by high levels of MSG in the momos and barbecued chicken (chased with a strong cup of hot chocolate) she’d had the night before. Relieved but exhausted, we began the long journey home, with me hoping that we wouldn’t run across any bodies or even anybody else. Then, as we came upon the spot where I’d left our inebriated speed bump, I saw that it was empty. It looked like it was good enough after all. But would it have been good enough for my son if he were the drunk? Would it have been good enough for me?

Thursday, October 6
            The next morning brought another surprise, this time a pleasant one. I was able to walk without much pain. After breakfast, Mom and I went to wash the Elephant (which was still puke streaked from Tuesday’s mass transport). The Bengali tourists were teeming up at the lodge, taking in the views of Kangchenjunga, and breathing fresh mountain air. I brushed the road dust off the Rhino with a wand made of chicken feathers and called it a day. In between patients we spent the afternoon sipping tea and sunning in the porch swing. I even had time to read a book.

Friday, October 7
            Within an hour we received four calls for maternal transports: one from Lolay, one from Pochowk, one from Nok Dara, and one from Nimbong. Two were in labor and needed transport to the hospital and two were postpartums needing a ride home. There was an extended volley of calls and misunderstandings. The four parties were, of course, located at four distant corners of our region of service. The Lolay group was by the roadside and ready to roll, but the Pochowk group had called first. They had been “going to arrive in Buddhabare in five minutes” for well over an hour. In reality they were rigging plastic over the homemade stretcher to protect the mother from a freak fall shower.
            Saran returned from Kalimpong later that evening, transporting both postpartums at the same time. We met at Deorali around sundown. He headed off towards Nok Dara with one family and I headed off towards Nimbong with the other. We were both alone and had rough roads ahead. There was still a large open sore on the back of my calf, but fortunately I could operate the clutch without pain. Halfway there, the newborn began to cry. Pulling over the Rhino in the middle of the jungle, I told the new parents that the baby was hungry. The first-time mother jostled the baby, still adjusting to feeding a child. The father smiled and played with the baby’s cheek. The forest was illuminated with bright moonlight and was alive with cicadas and bird calls. For fifteen minutes we sat in the semi-quiet as the baby suckled deep draughts. It dawned on me that I do actually love my job.
            The new parents lived only a stone’s throw from Basil’s house. Of course it would mean a late night but I ducked in to see them just as they were getting ready for bed. They made me a hot cup of NescafĂ© and we chatted after a long absence. Jen Boyd and a team of medical volunteers are scheduled to come in late November. Basil and I plotted together where to have the camps. Would Ghanti Dara be best, or how about Paila Line? Let’s not forget Sungure and Manzing! Would the vehicle make it? We chatted about politics, faith, and health. As they tucked in for the night, I headed home, listening to good music and the roar of the diesel engine.
           
Saturday, October 8
            In the morning, I received multiple calls from Dabling and realized that the first week of our “month of rest and preparation” had blazed by at a furious rate. The first case was only “thirty minutes below Dokan Dara” and it sounded like congestive heart failure. Thirty minutes didn’t sound that bad . . . but it ended up involving around 1,500 feet of descent. I wondered how long it would take to head back up, and there were still the other houses to visit. Inside the kitchen, the family was gathered. The grandmother sat on a bed, propped vertical by pillows, swollen like the Stay-Puft Marshmallow Man and fighting for breath. Her bronchi sounded like a waterslide. Her hands were the size of grapefruits which retained two-inch-deep pits in them after I let them go. After a good evaluation, I gave her a Lasix (furosemide) injection for the swelling. It was only when the family beckoned me to come for tea in the main house that I realized the full story.
            The traditional mud and stone walls were spider-webbed with cracks from the recent earthquake. Part of the rear wall and the supports for the upper story had collapsed outward. They served me tea and biscuits in their broken home.
“Look,” I said, “I can’t come down here every couple days to give her this injection. Even if I did . . . I’m just doctoring the symptoms here. Her heart is failing. If you do nothing, it could be a slow miserable death.”
            “Yeah. We would like to take her down to Gayaganga, but our house is ruined and we’ve got to fix it as well. We’re just figuring out how to manage it all.”
            “Okay . . . but I really think you should go on Tuesday. If you need any help, we’ll find a way.”
            As I headed out the door, the grandmother was heading to the toilet. The fluids had already begun to drain from her body. By evening she would be breathing normally and able to fit inside her skin again.

            While still climbing back up from depths of Panditgaon, the second house was already on its way to fetch me. It was Michael’s house, where I’d delivered a baby just a month earlier. His mother had been in the hospital the day of the delivery and was now home. They’d spent thousands on her treatment but she hadn’t had an ounce of relief. I perused her meds and paperwork and found that she’d been treated for an ulcer. There were multiple other meds that didn’t match up, including Lasix. I didn’t find any gastric symptoms in her checkup, but she did have a cardiac problem. Her heart sounds were shockingly loud, and there was a pulsating bulge between her ribs just beside her heart. Although she was a grandmother, she was still in her mid-fifties.
            “Your mother has a very serious heart condition. In fact, there is no telling when things could take a turn for the worse. She really needs to go to the hospital.”
            “We just spent so much on her treatment, for nothing. They didn’t say anything about a heart problem. They treated her for gastric.”
            “I know, but look . . . she is really in a fragile state. It would be best if she went today.”
            “We can’t go today . . . but perhaps we can go on Tuesday to Gayaganga with the others. That’ll be cheaper.”
            They brought out tea and biscuits, of course, along with the new baby. I had to give the new parents the breastfeeding talk again: No, babies can’t digest cow’s milk, and yes, mother’s milk will be enough. I looked over the meds again and it clicked.
“Hey, you have Lasix tabs here and your mother doesn’t need them. Take them down to Panditgaon . . . that will help the other patient make it to Tuesday.”
After making arrangements and saying farewell, I was led on toward’s Sugen’s in-laws house. In between rapid difficult breaths, Sugen’s father-in-law told me, “I get this sharp pain in my chest. Then everything goes black. There is this tingling sensation that rushes over my face and shoulder’s. Everything feels so tight and it’s hard to breathe.”
            “Oh, and he also has really bad diarrhea,” Sugen interjected.
            His heart was arrhythmic and his pulse had skyrocketed. His breathing was painful to listen to. I told Sugen, “Look, he’s probably having a heart attack. We need to go to the hospital now. I’m really concerned for him.”
            Sugen studied the floor for a few moments, “Sir, the rest of the family isn’t here. We really can’t make that decision alone. There’s money that has to be arranged and someone to go with him.”
            I told Sugen again, “I’m really concerned for him. I can’t say what will happen if we wait.” flashing eyes which strained to silently say, “This guy could kick the bucket any minute.”
            “We’ll talk about it as a family and let you know this evening.”
            The tea and biscuits came again. It was hard to enjoy them, listening to the not so old man gasping beside me. I taught them how to deal with the diarrhea and the warning signs to watch out for (at this point little more than clutching his chest and sudden death) and headed on towards lunch. During the five-minute walk, we passed a home for which Amanda had done a delivery. The mother-in-law was lying on a mat in the sun.
“I threw my back out working this morning. I can barely stand up. Got anything for that?”
            “Um . . . sure,” I said, half chuckling to myself at how ridiculous this day was getting.

Up at Purni’s a feast was being prepared. As I was sipping another round of tea and munching on biscuits, it turned out that Grandma was sick. In fact, she was having an asthma attack and, oh yes, her daughter had a 103 degree fever as a result of a case of tonsillitis so bad that her airway was half obstructed. Good thing there was an entire case of medicines up in the Rhino.
            Back in Kaffer, I decided to sit in the sun for a bit and also that it was time for a haircut. Still prickly and unbathed . . . my phone rang.
            “This is P.B. Sir. My brother-in-law is quite sick. In fact, he’s really bad. Would you come down to the house and check him out?”
            “Umm . . . I just got home . . . and I’m covered in hair . . . I mean I just had a haircut. Let me get a bath. I’ll try to be fast.”
            The Dashain festivities were in full swing. All the far-flung family members had come home and it was time to celebrate. But when I arrived at my neighbor’s house, the local shaman in residence was circling a bronze plate with a burning lamp around the patient. I waited patiently for the flowers and rice to be cast into the air and the mantras to finish. The shaman’s work done, D.B. exited the room. I joked, “Now that the local doctor is done, its time to try the foreign doctor as well!”
            We both had a good laugh, but I stopped quickly when I saw the patient. I listened to his heart sounds. Every time the arrhythmia flared up, I watched him wince in pain and clench his fists.
“I get so dizzy and this tingling feeling shoots out to my extremities. I get breathless and throw up. There’s this pain in my chest.”
            I sat speechless for a second. Part of me wanted to scream out, “What the heck is going on here? Why is everybody’s hearts broken?”
            The speech I gave to the family was starting to sound really canned that day. Tea and biscuits came out again and I wondered if I could handle anymore caffeine and sugar. The brother-in-law ran out of the room and wretched repeatedly. He sat down holding his chest with his hand and his head with his knees. This family decided to go “immediately” because, well, because they had money. Any of the other families would have chosen the same if they’d had the resources. I readied the Rhino and got out the AED (automated external defibrillator). How was I going to monitor this patient and drive at the same time? [Sign of the cross.] Cross that bridge when you come to it. Drive.
As I drove, I thought about the other cases. Why had I hopped up at an instant and traveled to Siliguri half-hobbled when my wife had the least palpitation? Why was I willing to spend every last rupee and dollar to my name for her? Because she is my wife. Because I love her. But what about these others? Why wasn’t I willing to do the same for them? Why was the man with a monthly government salary the only one to reach the hospital in his time of need? Why did the others have to wait till Tuesday, fighting for blood and for breath? Are those with more valuables more valuable? Are those closest to us more human? Is the stranger a lesser creation?

Sunday, Monday, and Tuesday provided enough rest for my leg to heal up most of the way. There was a steady stream of patients at the house but fortunately no more heart attacks. We tried to rest and prepare for our own upcoming birth.

Wednesday, October 12
            The most common reason I wake in the middle of the night is my phone. The second most common is the racing of my own mind. In a not so distant third is nausea complemented by sulfurous belches. That is why I was not too surprised at three a.m. to awaken to the gaseous discomfort. After fifteen minutes of the standard denial, I stumbled over to the clinic to get some Metronidazole and an anti-emetic. At sunrise I woke again, this time due to my second most common reason. But the thought which was racing around my mind said, “I’m not going anywhere today. I’m not doing anything.”
I rolled over and went back to sleep. It was not simply a result of the giardia still churning my gut and zapping my life force; September had spilled into October and it was hard to shake the exhaustion. It was going to take more than a few sunny afternoons sipping tea to recover. Even in bed I could hear the patients coming to the door and asking for “doctor.” Amanda took care of them all. The Matri Yaan paperwork, which had to be submitted in Pedong, was delegated to Saran. After barely stomaching breakfast, I meandered into the office to check some email, to do some writing. Not too surprisingly my phone rang soon after I sat down. It was a call for the maternal ambulance. I let the party know that I would dispatch it immediately but then something unusual happened.
“My wife wants to say something to you. Here . . . here she is . . .”
Dadju (older brother),” she said, “Please come. Please come for me quickly.”
“Okay . . . I will.”
It was an unexpected exchange. I’d never received a direct appeal from the mother. It was always the men who spoke on their behalf. There was something in her voice. She called me older brother, instead of “sir” or “doctor.” It sounded like Amanda calling me from a different dimension. The feeling of doom came over me again, but even stronger than before. Before I knew it the Matri Yaan papers were back in my bag and Saran was taking me to Deorali to meet up with the Donkey. There were multiple frantic calls en route asking us where we’d reached, but when we got down to Hari Golai . . . the family wasn’t there. We waited for awhile before a girl came up to inform us, “She’s better already. It happened while they were carrying her. Don’t worry about coming.”
Still not able to shake the feeling, I grabbed a birth kit and BP cuff out of the Donkey and started walking. The sun was hot for the fall and it was melting away the little bit of strength in my reserve. In the bushes beside the trail, I spotted an enormous snake hissing at me. It was a sisirey, five to six feet long and fat as a ferret all the way up to its head. Sandeep hit it with a large rock full force but it only jumped and slithered back into the undergrowth. “What’s up, does this kind of snake not die or what?” he exclaimed.
It took almost a half an hour to get to the house, and my head was really foggy by the time I did. The blood-covered mother was sitting on a dirty burlap sack beside a Hindu temple, her child between her legs. Everyone was standing at a distance shaking their heads and tssk-ing. The tssk-ing was like the hissing. Looking at the mother’s condition and the situation, it felt like sometimes the snake and curse just won’t die.
“How long has it been since the baby was born?”
The father came near, “The baby was born at ten oh-five.”
It had been an hour already. In front of the small crowd that had developed, I had the mother squat and I tried a little cord traction, expecting it to drop right out. The placenta wasn’t budging.
“We’ve got to get this mother in a house and get this placenta out. Whose house is that?”
An old lady sheepishly said, “It’s mine but . . . how can we bring a sutkeri (unclean postpartum mother) into a temple house?”
“She’s already delivered here beside the temple! The blood is already here, it’s already polluted. What’s going to happen?”
After hearing something mumbled about it not being permitted, my temper flared, “Look, do you think God takes pleasure in sending people to their death or saving people’s lives. Taking care of this mother is God’s work . . . now knock off that silly superstition and open the door.”
The mother moaned, “But the baby’s still attached . . . how can I walk there?”
After breaking open the birth kit and clamping the cord, I heard the mother protest, “Don’t cut it. Don’t cut it. The cord will go back inside and it’ll never come out.”
I said, “No, it won’t go back in. Look how long it is. It will come out.”
As soon as the cord was cut, the father grabbed a hold of it for dear life. The baby was very lethargic and had some significant swelling in its face. A bit of massage brought on some weak cries. It was wrapped in a clean, warm blanket and handed to the father. We headed in doors. Just as the mother was lying down on the clean sheet of plastic the government ANM (Auxiliary Nurse Midwife) from Lolay arrived. She instantly spotted the problem and got out a catheter. It took a few minutes for the bladder to drain and I had the mother’s sister massage her nipples to stimulate contractions. Anu finally removed an intact placenta and I administered an injection of methergine. The uterus began to clamp down and the bleeding stopped. It was a good thing too, her dress was soaked with blood up to the back of her neck. Neither of us had everything we needed to do what was required. I was thankful for Anu, and she was for me. The ANM started in on the usual postpartum dialogue, “Why didn’t you go to the hospital earlier. This baby was forty-three weeks! Why were you so careless?”
The exhausted and aching mother said simply, “I didn’t want to go there. I didn’t want to go. All they do is cut you and stitch you back up.”
The ANM decided to accompany her up to Kalimpong. There was a significant risk of infection and the baby was presenting some abnormal signs. I made the stiff walk back. Saran came from washing the Elephant to pick me up. The Matri Yaan reports still had to be submitted in Pedong. Within minutes, I was asleep in the back of the ambulance, in a giardia induced coma, barely able to be roused when we reached our destination. A few days earlier I’d given Sandeep a big lecture about how he needed to care for his own health, that if he wasn’t healthy himself he couldn’t contribute to the health of others. The hypocrisy was running thick but what was I supposed to do? While submitting my reports to the Block Accounts Manager, he received a call. A Matri Yaan operator from Algarah wanted to meet me. Alarm bells went off in my mind. Hadn’t some people from Algarah been involved in the scuffle over the Samthar vehicle? Who was this and what were they up to?
On our way home, we passed through Algarah and Dushant was waiting for us at the chowk. He led us to his home and sat us down in the receiving room., saying, “I’ve wanted to meet you for a long time. I heard about your work even before Matri Yaan came up. The medical officers are saying that you’re doing an incredible job and have the best ambulance around. My hope was that you could show me how to do this job better.”
My cynicism faded and the tea came. As we munched on the biscuits he continued, “I’ve wanted to talk to someone about my experiences. Listen to what happened on my very first transport. There was this mentally handicapped lady up in Lava. Her neighbors called in the delivery and we headed out to pick her up. No one knew who the father was. She didn’t have any family or friends . . . so I made the neighbors come along. I don’t have any experience in this or any training after all. Then, halfway to Kalimpong, the baby was delivered in the vehicle but not all the way . . . it was kind of stuck. I had no idea and was totally shocked, so we rushed on . . .”
He continued his tales and two plates of chow mein came out for Saran and I. We prayed before starting. “Oh, I see that you are Christians as well. I am too. I wanted to do something for my community . . . to provide a really good service.  Then this opportunity came along. I’m not in it for money like the others. Can you help me? Can you help me do a better job, perhaps get some training?”
“Let me think a bit and talk to some people,” I said. “We’ll figure something out. Every driver should at least have some basic training and a couple of birth kits on hand.”
It was getting late. We had our Small Christian Community meeting/dinner scheduled at our house that evening. It was time to head home. On the way, I thought about the day’s events. It was a huge relief to meet an ANM who kicked off her heels and ran barefoot on a rocky trail for a mother in need. It was a blessing to meet Dushant, a man of faith who was putting his belief into action. We live in a world that teaches to care for ourselves first, those nearest and dearest second, our community third, and the global situation last of all. There is logic behind it just like there is behind a mother putting on her own oxygen mask before her child’s in an in-flight emergency. But when does it come time to break from logic, to scrap wisdom, and to act anyways? If it is my own wife, I would gladly hobble to Siliguri on an afflicted leg without a second thought. So what if it is their wife instead of mine? What if we are sick and run down after one of the hardest months of our life? How do we know when to draw the line, to say enough’s enough?
We like to philosophize and theologize about obscure scriptures, doctrines, and dogma. But I’m still trying to crack the most basic teaching in the whole darn book: Do to your neighbor as you would have done to yourself. Love your neighbor as yourself. Why couldn’t there have been some more law: Thou Shall Have Sunday Off. Thou Shall Work Only Forty Hours A Week. Thou Shall Take Sick Days. But instead of a law we have freedom; freedom to love in an ever deepening definition of the word. I hope that I never have to pick a bleeding stranger up off the side of the road again while rushing my wife to a Cardiac Center. That is surely a once in a lifetime event, right? But if I do, I hope I do it in a spirit of love and freedom instead of submission to a law.
While that exact set of circumstances will more than likely not happen again, we are all faced with that decision every day. Who do I love first? Myself? My kin? My community? My nation? All humanity? And if we pick to love all humanity equally because of our “high ideals,” are we ready to face the ramifications of that decision. But if we pick “me and my own” today, we will soon find that our security is on shaky ground. In a world striving for individualism, we think of health as an individual, private matter. The reality is that no one, not even a very small group, can be independently healthy for long. Think small pox, think tuberculosis, think polio—as long as one is ill we may all become ill. The only way to achieve health for “me and my own” is by achieving health for all. The only way to achieve health for all is for us to wholly embrace a reality that we only pay lip service to. His wife is as important as mine. Her children are as valuable as mine. He has just as much right to life, liberty, and health as I. Why are there so many people who are sick, so many hearts that are broken? Perhaps, it is because some can buy for cash what others can’t even get for blood. Perhaps, it is because even though we acknowledge that all men are created equal, we do not live lives of equality and justice. The only way for anyone to be healthy is for ALL of us to love our neighbor as our self. So when it comes down to it, even if your wife’s life is on the line, or even your own health . . . yes, we are still called to help the stranger bleeding on the side of the road. The entirety of the law and the prophets hang on it. Thank you for reminding me, Amanda.
In the end all I can pray is, “Father in heaven you are holy. Your kingdom come. Your will be done. Let it be here on Earth just as it is in Heaven,” even as I am half terrified, half elated to find out how good Heaven really is.

In Him,
Ryan and family

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