I’m no stranger to feeling my way forward in the dark. Spending five years in an un-electrified village (with a chronic shortage of candles and kerosene), living out the years since with daily power cuts, having only weak Indian batteries in my flashlight and frequenting outhouses at midnight (due to multiple mugs of chai) have provided me with ample practice in the aforementioned art. Despite having this niche expertise, it is still uncomfortable to find one’s self driving along precipitous Himalayan roads at three in the morning with the headlights... off. The discomfort approaches alarm when it is compounded by the fact that there is a man bleeding to death in your back seat. Driving slow would mean to risk his death. Driving fast would be to risk everyone’s. In such a situation, one can’t help but ask themselves once again, “How did I get here?”
Sitting on the front porch in the afternoon’s weak winter light, Amanda and I were asking each other, “How did we get here?”
While we are engaged more or less in the same work which we’d plotted out before our arrival in Kaffer in 2009, the day to day logistical realities are far from our original vision. At the core of our vision was to not start any new organizations, not to own anything ourselves but instead help existing institutions rise to the tasks at hand. It seemed that we would have a broad network of support through the church, Hayden Hall and other bodies to carry out the nuts and bolts operations of our plans. Additionally, some very promising partners from North American were on board. In this expectation we planned big, really big. It has been two and a half years since becoming Kafferites and big things have happened. A shocking amount of progress has been made. On the contrary, one thing hasn’t come together... a sufficient crew to man the ship. The strong support we expected has turned out to be mostly superficial. The different partners have come and gone in their own seasons for varying reasons. While many people will pat us on the back and support us on an ideological level, very few have rolled up their sleeves, pulled on their rubber boots, donned their gloves and headed down into the trenches with us. Things haven’t turned out like expected.
While talking on our own front porch, it became obvious that we are in over our heads again. We decided that if by the middle of the year real solid help and camaraderie doesn’t materialize in the form of long term partners... then an exit strategy would be necessary. We’d need to pick the one or two things we can do fully and as for the rest... delegation, donation or elimination. With that said, as we sipped our tea we began to indulge in a multitude of other dreams we’re chronically cooking up. All of the what if’s excited our other senses. Desires we’ve been repressing came to the surface.
_____
A mother, 20 days post Caesarean, was bleeding heavily. Lamit Didi called in the case from Pemling. It was the first emergency since Simon had returned from his training at Gayaganga... which had only been the day before. We assessed the patient together and he, now with more experienced hands than mine, inserted the IV catheter. The men stood out on the cement roof top as the mother changed inside. Even the critically ill want to put on their best clothes to go to the hospital. Maybe the hospital will one day put on the same for them. Simon and I chatted about all the remote villages visible in the vast panorama. The husband came near and remarked, “Sir, you’ve done a good thing by coming here. There was no solution before. It has been a help to so many of us. Keep it up.”
The compliment made me recall the conversation we’d been in the midst of when the call came in. How could I abandon this... even if it is too much and the help doesn’t come. It pricked my conscious but didn’t resolve the reality of the situation we’re in. The mother was done changing... it was time to go. By the time we reached Kaffer (en route to Kalimpong) the mother was fully stabilized. I hopped out and Simon escorted her to the hospital. It dawned on me that I did have partner after all; one who has already stuck with us for over a year. But even with Simon on the roster we are still a skeleton crew. Still, after several months of rough sailing it is nice to even have another skeleton deck.
There is a trend with emergency calls in our region of service. A person may be mildly or even critically ill or injured all day long and pay it little heed but once the sunsets any ailment becomes serious. In the dark, the mind plays tricks. When sight is deprived, the other senses heighten. This reaction amplifies the tiniest stimuli into something worthy of attention. Those blinded by the light of day finally realize in the shadows that something is terribly wrong. After warming by the fire, I quickly slipped into to bed so as not to lose the heat. After slipping into bed the phone rang, which meant I was going to lose some sleep. I was surprised to see Lamit’s number again. “Sir, please come. An old man was drunk. He fell and busted his head open. It happened at three this afternoon and he has bled way too much. Please come quick.”
Simon and I were rolling again and had one of the roughest roads in the region ahead. As we went I briefed him on bleeding control and on the signs and symptoms of shock. We delegated responsibilities and made a treatment strategy. After an hour and a half of jostling we arrived at the end of the road. There was a short moonlit walk through harvested rice paddies to reach the stone and mud house. Inside we found a blood bath surrounded by a host of worried neighbours. Simon started in on vitals as I took a history. Estimated blood loss was tabulated in cloth rather than liquid measure. How much does it take to soak 3 pillows, 2 quilts and a cotton mattress? One and a half litres? Two litres? More? It couldn’t be more, but it looked like more. After pressure bandaging the bleed we pulled out a new weapon in the arsenal. Our friends from Mercy in Action had given us a pair of non-pneumatic anti-shock pants. It was my first time using them... mere weeks after receiving them. They pumped the pressure up to 60/40 so Simon could set a line. After an hour and a half of effort he was stable enough to endure the journey. I called to the patient’s son, “Okay, it is time to take him to the hospital. Go get the stretcher.”
A woman of the house protested, “Wait Sir, wait. You have to eat rice first.”
Was this really necessary? By Western EMS standards a 1 ½ hour response time, 1 ½ hours on scene and eating a meal in mid transport would result in one’s termination. But this isn’t the West. It is the East and with four hour’s rough cold journey to the hospital, which wouldn’t provide food, a hot meal is a good strategy. The stretcher bearers ate. The patient party ate. We ate. Despite the fact that our batteries were recharged, the Rhino’s were not. During the descent the head lights had been dimming. I’d just installed a back up battery and set of jumper cables (homemade at the blacksmiths since they aren’t available anywhere) in each of the ambulances. Simon used them to turn the engine over and we got rolling. Simon held the bottle of saline and I held the wheel. By the time we reached the dense jungle above Joreline the battery petered out. The dense forest blocked out any moonlight and my mind started envisioning our patient expiring in the back of our lifeless Rhino. I looked at my watch. It was 12:46 a.m. Friday the 13th.
As Simon swapped the empty bottle of Ringer’s for another, I swapped the empty 12 volt as well. Thinking we were in the clear we headed on, but by the time we reached Lolay the headlights were glowing like two weak coals and the engine was stuttering. Calling another vehicle would mean a fatal delay for Mangal Singh. There was only one option left... to turn the headlights off. My eyes slowly adjusted. The near full moon was bright and the sky was clear. The edges of the road came into view, then the forest and past the cliff the distant mountains. It was a beautiful night. I was seeing those roads and hills in a way I’d never seen them before. The only thing impossible to detect were the pot holes, but we’re getting used to some bumps along the way. It was not an impossible endeavour. At first I crept forward in the dark and after a few minutes we were travelling at near normal speed. It had never struck me what tunnel vision trusting your own lights gives you. It so easy to demand that God shine a 1000 watt spotlight light on our path. It’s so easy to try to light it up under our power. But when our illumination fails, our eyes adjust to the present moment. It becomes obvious God’s nature has already provided enough light for us to feel our ways forward. The mountains shine with it. It was a beautiful night for a moonlit escapade.
Just above Relli the forest thickened, the road darkened. Scared of what the dark would bring, I decided to trust my low beams again... with expected results. The Rhino rounded the corner to reveal a Tata full of sand. Generally, I hate the Tata’s which carry sand and gravel up from the Relli. The ambulance always gets stuck behind them as they crawl up the mountain. They batter the pavement and crowd the narrow road. On the contrary, when I saw the rear wooden fender with “BLOW HORN” written in multi-coloured Indian truck art... this time I said a “PRAISE GOD” to myself. The Tata’s over-powering, often cursed, high beams left a wake of illumination for us. My mobile started ringing at 3:20 am with an unknown number, which signalled another emergency. To pull over before picking up, as I’d sternly instructed the drivers on multiple occasions, would mean to lose the lamp unto our path. So I broke my own rule and received the call, “Sir. There was an accident here in Nok Dara. A JCB flipped over and crushed the handy boy to death. The police have made the report and no one else will take the body for the post-mortem. Will you send a vehicle?”
After giving him Purna’s number, giving the necessary instructions and hanging up the jungle thinned and the moonlight shone through. Without even having to BLOW HORN, the Tata signalled me to pass. Thinking about our front porch conversation, I said a prayer I’d long neglected. “God send us the help we need, when we need it... not the help we think we need when we think we need it. Help us to finish what we’ve started here.” That prayer had brought us Brad, Mom, Sara, Kara and Saran the year before. They helped keep our ship on course but in Kalimpong... we were speeding the wrong way down the one way. I tried the siren but it sounded like half-dead, drunken moose. I tried the lights but they produced about as much warning as a cobalt blue lava lamp. Thank God it was four in the morning in a sleepy hill town.
Inside, the ER nurses and doctor on duty were eventually roused from the back rooms. Mangal Singh’s head was sewn up like an old burlap sack and he was deposited in a corner like a bag of potatoes to await morning rounds. Having seen the standard at Gayaganga first hand, Simon was horrified afresh. Outside, the Rhino wouldn’t turn over, nothing more than a dull CLICK. The last ounce of juice of our back up battery had been used as we pulled in. In the dark, we decided that it was time for some sleep and crashed out on the stretcher. Simon said he wouldn’t be able to sleep but it only took him around 45 seconds to start breathing heavily. About the same time, over in the dark of Nok Dara, the police pushed each other back and forth. “You do it.”
“No... you do it.”
“No, you!”
Purna and Kailash finally packed up the disfigured corpse which not even the investigators were willing to touch. The scene was too grisly and there were too many shadows. Ahead, as dawn broke on the 13th , the four wheel drive police jeep nimbly climbed the mountain. Behind, the Elephant spun its rear tires on the frost, barely maintaining traction. Ahead, the police chit chatted as they bumped along. Behind, a couple young boys were prodding the beast up the mountain with the officer’s nightmare in tow. Yes, the first will come last. Perhaps, I’ve got some up and coming partners.
_____
The light of dawn cracked our bleary eyes as well. I pushed the ambulance down a small slope and Simon dropped the clutch. The Rhino was defibrillated. Afraid to shut it off again, we cruised the city looking for a mechanic. Everyone was closed or out on business. A memory came out of the void... “The German families at 12th mile! I bet they have tools and maybe a battery charger. I’ve been trying to meet them forever.”
As the battery charged and Simon fixed with the loose alternator, I drank some hot coffee after the long cold night. The wives of both families were nurses and they shared with me their ideas for a birth-centre, pre-natal/motherhood awareness programs and a home for unwanted babies. Their skills and intentions seemed to precisely fill in the gaps in our own work. Their major problem was finding a place to actually put their hearts into action. So far all the doors have been closed. As the caffeine surged into my veins, renewed hope followed on its tail. During my third cup, the Elephant passed on its way home. During my fourth, Saran drove the Donkey by carrying a delivery... also from Pemling. It was Friday, market day in Kaffer and Amanda was calling to ask about mastoiditis, skin problems and hearing loss. She was juggling the kids and non-stop patients. My conscious pricked again, the batteries charged again, the ambulance repaired again... we headed home. I drove and Simon slept like the dead in the back.
____
“Did you hear, Ryan?”
“What?”
“They’re bringing a delivery here?”
“Yup, I sent the Rhino with Purna and Kailash. Everything prepped?”
Minutes later phone was ringing again with an unknown number. With a near trembling hand, I picked it up. “Sir... umm, well I’m calling from down here by where you used to live at Sunil’s house. You see, there was this dead body found in the jungle... no one knows who it is, or was I mean... and the police are here. They’ve finished the report and the body needs to be taken for post-mortem.”
It took a volley of confirmation to convince me it wasn’t some sort of joke. The Rhino was bringing the delivery... another case from Pemling. The Donkey had been called to even more remote Ghanti Dara to transport another mother to the Kalimpong hospital for delivery. At least Simon got to sleep some on the ride home, so I sent him with the Elephant. I hadn’t slept but there was no one left to back up Amanda, duty calls. Soon after Simon was off the Rhino pulled in and Purna called, “Sir get the stretcher up her quick this mom’s gonna go!”
This Freaky Friday was getting out of hand. The sun had set and the darkness returned. God only knew what was coming our way. Amanda and I had prayed over the birth room. Death had had its fill and it was time to welcome a new life into the world. I ran across the field with stretcher in hand.
____
As dawn broke the next morning our children slept peacefully. Meena’s first child, a baby girl slept, nursed and snuggled warmly against her mother’s breast. The previous evening the labour had gone quickly. Without complication or drama, the waifish mother had delivered at healthy 3.8 kg baby. Bleeding was minimal and the placenta was delivered clean. The mother was overjoyed and cried as she passed the news onto her family back home. We fed the family (including a kind and compassionate mother-in-law) bowls of hot soup and kept the new electric heater pumping. Amanda and I had a cup of tea together and made it to bed before ten.
The winter fog had lifted. Kangchenjunga and it counterparts were revealed in their full majesty. I assembled logs in the front yard and got a bonfire going. I wanted there to be a bed of hot coals ready. The Germans were coming for a Barbeque/Picnic. Soon enough the jeep arrived. So that Amanda would have the same opportunity that I’d had the day before, I took Asher, Shepherd and their combined seven children on a top secret mission. First, we attacked the enemy’s base (the old burned out Forest Department complex) and then captured the mountain top fortress (the big rock at Sunset Point). After the mission was complete, the battalion came back to find chickens roasting on the grill, bread, cake and salads set on the table. All of the battle weary shared a feast together. Why had I neglected that prayer for so long? That evening the children were exhausted from play and imagination. We dropped into bed early with still bulging bellies and our phones were silent.
_____
It was 11:30 pm and someone was banging out front. There were missed calls on my phone. I slipped back into my now frigid garments and went to answer the door. A woman from the bazaar who’d always rubbed me the wrong way, was standing there with her little sister. The 21 year old unmarried girl, looked visibly ill but came walking on her own.
“She’s got gas; give her some gas medicine.”
“Umm, first I’m going too...”
“Sir, please just give me some medicine quick. It hurts really bad.”
“... do a complete check up. I can’t give the correct treatment without first knowing the problem.”
“She ate at that picnic earlier (not our picnic), came home and threw up a bunch. I told her not to sit in the cold eating chicken!”
“I’ve got got gas. Please just give me some medicine it hurts really bad.”
“After I do a check up.”
No Fever. Heart rate elevated. Respirations elevated. Blood pressure... none. Check again... none. Switch arms... none. Switch instruments... none.
“Simon take her pressure and tell me what you get.”
His face shifted into perplexity as he went through the same process. The initial history pointed towards food poison leading to vomiting, dehydration and volume shock. The anti-shock pants came out again. They bumped up the pressure enough to get a line in again. The patient immediately began to improve... again. But something wasn’t right. Her respirations and heart rate were slowly climbing. Continuing to probe for clues it came out that she was undergoing treatment for TB. She’d had Gland TB but stopped treatment mid-course. This gave the disease the opportunity to spread into her abdomen. She had come close to death but after 2 months of treatment she was making a strong recovery.
“Sir, please give me something for the pain. I need some gas medicine. I had this before and gas medicine made it go away.”
I called Dr. Das from the PHC in Gitdabling.
“Doctor, I have one of your patients here and this is what I’ve found...”
After hearing the full report he told me, “On her scan there were several lesions on her intestines from the TB. One of them could have ruptured from the vomiting.”
Checking her abdomen again, we found that it was indeed further distended, becoming taught with liquid. It was the coldest night of the winter so far. The little electric heater was struggling to keep up. It was pouring out heat which was simply draining away into the dark frigid night. The bottle of Dextrose was struggling to keep up; it was pouring fluid into veins and, after a brief delay in the circulatory system, was leaking into the abdominal cavity. Realizing the gravity of the situation, my mind started painting scary scenarios again. Like Mangal Singh, Susma needed to be stable enough to endure a trip on these roads. Simon spent the rest of the night monitoring her vitals, holding Susma’s hand and talking to her. I took a moment to rest up for the more than likely transport ahead. Simon came in around six to wake me up. “Sir, she was doing really well but now her pressure is going down again.”
“Ok, then... let’s get going.”
Up at the bazaar, the older sister gathered all the essentials for the hospital... thermos, blankets, pillows, carrying case for meals. We briefed the village men on the plan. Things didn’t look good for Kalimpong. It was Sunday. Staff at the Government hospital would be low. She needed an immediate operation to stop the internal bleeding. So we were heading to Gayaganga with the option to stop in Kalimpong if things started to collapse. Since there were no male family members, Prakash accompanied the family.
“Sir, I think it is great what you are doing. It is an unbelievable service to the people here and it brings glory to God. It is really great.”
“Thanks, but in the end I’m just a man and can only do so much. In the end, everyone’s life is in God’s hands. All I can do is do to my neighbour as I’d do to myself. Above and beyond that is His territory.”
We went on having a nice conversation about faith, God and social service. It help pass the time as I again travelled the route through Relli. We’d had a similar conversation before as I brought his nephew back from surgery. After two hours on the road our patient’s BP was back down to 40/20 despite five bottles of saline and our anti-shock garment. With little hope, we had to try Kalimpong. After a full report of her condition the Doctor shook his head, “This girl needs to be in an ICU. We don’t have that capability here. Take her to the Medical College. You’ve only been delayed in coming here.”
“I know... but I don’t think she’ll make it. That’s why we decided to try here anyway.”
“Yes but... there’s nothing here to be done.”
We headed on with prayers on our lips. As we neared the plains her conditioned worsened. As we fuelled up in Luha Pul, she begged me to take the pants off so that she could go to the toilet. No one in the vehicle could grasp how fragile her condition was. Further down the road the sisters were both sleeping as we approached Coronation Bridge. The patient’s face muscles relaxed and eyes began fluttering. Deep spasmodic gulps of breath signalled that the end was near. I checked her vitals finding a barely audible heart beat and un-detectable BP. Prakash looked at me with enquiring eyes. I signalled that hope had faded. Perhaps his perceptions of my saintliness faded as well. My prayers had brought no miracle. There was nothing I could do but sit and watch the process in its entirety. Near the end I realized how unsalvageable Sumila’s case had been the fall before and felt degree of relief that I had not failed her. Instinct suddenly caused the older sister to rouse. “What’s happening? What’s happening? Little sister, little sister?!? Is she okay? She’s not breathing is she?”
Looking at her agonal gasps I humbly said, “She’s still breathing.”
“Save her Sir, save her! Do something... Oh God!”
Prayers and mantras began to pour from her lips and spill over the top of her penitent hands. “Save her sir, save her! It will be a great act of dharma if you do! God will bless you! He’ll bless you.” And the recitations began again.
I’d been praying since the night before as well. Her prayers turned to pleas which turned into cries which became protests. Near Salugara, just miles from the hospitals of Siliguri, I asked Purna to pull over. “Didi, she’s stopped breathing now. She’s left us.”
“No! It’s not true! Don’t cover her face! Don’t cover her with a white sheet! How could you sin against me like this? How could you! Oh God, it’s not true. God is not true. He’s never there when you call to him. How could you sin against me like this? What did I do? ”
Prakash helped to keep her under control as we cleaned the ambulance and arranged the body. Through the sobs, I heard the entirety of their family history recited as a lamentation. Their mother and father had died only weeks apart. At the time they were very young. The three siblings, including a brother who was in Calcutta on that day, had struggled to survive. The older siblings had made great sacrifices so that the youngest could study. She had recently finished school and become engaged to a driver from Samthar. He was a good boy and was planning to buy his own vehicle so he could support the family.
“... and what will I tell him? How can I tell him? Without my sister what is there left to live for? There is nobody now... no one.”
We turned around and headed for home. Just above Coronation Bridge, near the Hindu temple where travellers entreat the gods to give them safe passage on NH-31A, the fiancé’s jeep passed in the opposite direction. The Rhino pulled over and waited. He turned around and caught up with us. Inside, he stroked the face of his lost love in disbelief and wept bitterly. It was painful to watch and a bitter thought came into my mind. The old man in Pemling, the old alcoholic shaman who after performing a ceremony had fallen and busted his head open, he had been in as critical condition as this girl... yet he survived. It was his fault after all. He’d lived a reasonably long life. Shouldn’t he have died and she lived? Shouldn’t our prayers and treatment done in love have staved off death for the freshly graduated, newly engaged, young and innocent orphan... instead of the drunk ol’ witch doctor? Yet we are told not to judge. We are not the bearers of life and death.
_____
I’d never seen the bazaar so red faced and morose. Hushed rumours circulated blaming the death on greasy chicken, spicy food, sour food, enjoying the picnic too much, egg consumption, packaged chip consumption and none other than the deadly vector... cold air. Not once did I hear TB blamed as the culprit. The women sat up all night under the glow of burning lamps, weeping. Then men stuffed away their emotions by playing cards and gambling till sunrise. That night Simon decided to sleep at Ganesh’s house instead of downstairs by himself. It was hard for him to believe that the girl whose hand he’d just held through the night was gone. In my bed I feared that the phone would ring, that I’d miss another night’s sleep and have to look reality dead in the eye... again. Even though we’d provided treatment above and beyond what could be given in any other ambulance in the area, even though we kept a girl who would have died around midnight on Friday the 13th alive for an additional 12 hours, even though we’d done the best we could do with the information, skills and equipment available... I feared that someone would blame me. After all, if such an unexpected death of a young person could be almost unanimously blamed on a cool breeze... why not me too?
____
Years ago, in the dark of the night and the fog of sleep I had a dream. At first I was on a beach on a bright sunny day. Despite the fact that I had no skill as a shipwright, I set to work on an old wreck with planer and hammer in hand. Despite the fact that I had no nautical experience, I pushed the boat into the surf and opened the sails. Things went well at first and I tried my hand at the ropes in the afternoon light. After sunset, a violent storm engulfed me. In dream time it seemed as if weeks, maybe months passed... not just one single night. My craft was battered by waves and I realized how little I knew of the sea, how ill equipped I was for the task. Every wave seemed like the final blow. I was the only hand on deck and there was no respite. After an eternity the sea calmed and the clouds thinned. It was still night but at least a full moon night. A steady cool breeze pushed my boat not towards death but life. The vessel lightly skipped across the surface of the ocean. In the distance a small island appeared. The approach took hours. It was one of those rare nights, so luminous that a hint of colour was actually discernable and as I approached the shore the palm fronds shone green and the waters pale blue. Pink flittered on the horizon. A mild wave pushed my boat ashore and I felt the belly of the ship grate against the sand. At this moment I awoke from the best dream I ever had to the light of a new day coming through my window.
It is not time to abandon ship. It is time to stay the course. We’ve had some rough sailing over the years but perhaps the storm is coming to its end. The clouds may be parting and the moon starting to shine through. When my eyes finally adjust to its beautiful light I’ll find that I’m not sailing alone. We’re not sailing alone. I hope soon to find that there’s a whole crew to share the journey with. We’re not skeletons on the deck but instead living breathing souls. There’s still a long way to the destination but we’ll arrive just in time for the light of the new day. When it dawns there’ll be nothing left to fear.
In Him,
Ryan
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