John was losing at ping pong and seemed fine with it. That should have been my first clue that something was wrong. We were at the weekly campus potluck at the boys’ school. Most of the teachers were there and many of the students. We’d stayed later in weeks past, but John said he wasn’t feeling well, so we rounded up the kids and left. By the time we got into the car, he was throwing up. It was Friday night.
Shortly after arriving home, John was in bed, shaking and moaning and as cold as ice. It seemed like an infection, and I begged him to get into the car so I could take him to the hospital. He adamantly refused, saying it was kidney stone pain and he would be fine by morning. He just needed some ibuprofen. He took a prescription dose and suffered through the night. It was a long one. By morning, he was up and about, and I insisted on taking him to one of the few private hospitals in town with a good reputation for weekend care. Despite feeling better, he had not been able to keep anything down—including water—since the night before. By the time we arrived, the pain had returned with a vengeance.
The Saturday on-call doctor was a Malawian radiologist. He listened to John’s symptoms then ordered a CT scan. After running a blood test and urinalysis, he determined that John was too dehydrated to withstand the contrast dye needed for a scan of his kidneys. He asked us to wait while he called in the head doctor, who was taking the day off, to confer. Within minutes Dr. Smith, the son of lifelong missionaries to Africa, was greeting us in an American accent. He was very pleasant and didn’t seem to mind at all that it was his weekend. He and the radiologist talked openly in the hallway where John and I sat waiting, and finally decided the first order of business would be an IV to rehydrate him enough for the scan. Nothing could be done without more information. In the meantime, they would start a regiment of pain medicine. Dr Smith turned to me and asked if I wanted to keep him in the hospital overnight or take him home. (John’s vote didn’t really count as he was drifting into a state of semi-consciousness from the intensity of the pain.) I didn’t know anything about IVs and wasn’t sure administering narcotics was a good idea, so I voted to keep him in the hospital. It wasn’t until the next day that I began to understand why that was even an option. It wasn’t until the next day that I learned that the word “nurse” carries a different meaning around here.
The room was old but clean. There were two hospital beds, without rails. The nurse asked if I wanted them both made up so I could sleep in the room with John. I didn’t want to leave the boys at home alone, so I said no. There was one large window with a tear in the screen. A cotton ball plugged the hole in such a way that only the most eager mosquito would find its way in. Malaria is always a concern. There was a fan and a fluorescent light and a water jug in the corner, that I didn’t feel completely comfortable drinking from and wasn’t sure we were supposed to. The bathroom had about a six-inch tall threshold step, which vanished into the all-white tile it was made from. I tripped on that many times over the course of the following few days.
After John was comforted with Demerol and was sleeping—although not peacefully—Dr. Smith came in to check on him and talk to me about his situation. He brought books for John to read should he wake up, and even offered the leftovers from his dinner since the kitchen had closed. He treated John more like a friend than a patient and that helped lessen the blow of facing a life-threatening illness in one of the poorest countries in the world. I learned that he lived on hospital property, which is how he was able to come and go so often. He assured me we simply needed a scan to know how to proceed and that the IV should hydrate him enough to get one in the morning. I left John to sleep by himself, assuming the nurses would care for him overnight.
The next morning, instead of going to church, I brought the kids to the hospital to find that John had been up at night, throwing up IV fluids. There was no one there to get him water or take him to the bathroom, because the few nurses on duty were sleeping and there is no call button. It was a miracle that he made it over the bathroom step to get to the toilet while on pain meds. I could barely do that completely sober. When he told me that he walked down the hallway, carrying his IV bag to find someone to give him more pain medicine, I thanked God for His grace and knew I had better not count on Him hanging around to do my job any longer. I wasn’t upset with the nurses as much as I was surprised and embarrassed that I had assumed too much. It’s not that they weren’t doing their jobs, but that their jobs are not what I expected. They have been trained to perform certain tasks at certain times and not to truly care for people. We’ve been told that many of them have been thrust into their positions because they desired higher education and the government funding that they needed to pay for that higher education mandated their course of study. I don’t know if I got the facts of that completely straight, but I have been here long enough to see that there’s an apathy that can only be explained by the fact that no matter how hard you try, there are simply not enough resources to make up the difference to save a life. Caring that someone is starving when there is no food to give them or dying of a disease without medicine to administer can make you crazy—if you look at it too closely. Nurses do not cater to a patient’s every whim as they do in the States, which is probably why Dr. Smith had solicited my help in taking care of John at home and why the nurse offered to make up the bed beside him.
Though John was not yet hydrated enough for a contrast scan, the doctor ordered one without the dye. The situation was looking desperate and we needed answers. I drove him to another clinic in town to have the CT scan done, praying that he could walk in and out without assistance, because none was guaranteed. In the meantime, Dr. Smith called ahead and arranged the test. Two clinicians were waiting inside to open the doors, which are normally closed on Sunday. They were very professional and efficient and we had the reading in no time, thanks to their diligence in handwriting the results instead of waiting on the complete report, which would take hours to generate. On our way back to the clinic, friends from school called and offered to pick the kids up and take them to their house. Others offered to bring us dinner. I accepted on both counts, thankful to not be alone.
The good news from the scan was also the bad news. The stone was large enough to see without dye but too large to remove any other way than surgically. It was lodged in the ureter, the tube that carries urine from the kidney to the bladder. The pain and vomiting was coming from the fact that urine was backing up in the kidney with no way of escape. Something had to be done immediately. The doctor called our insurance company to explain the situation and to schedule a medical evacuation to South Africa. The company said because John has had kidney stones in the past, they would not cover any part of the procedure or the evacuation. I called our sponsoring church in the States to explain and to get counsel. One of our elders called the insurance company and, after getting nowhere, went ahead and ordered the evacuation as if it were covered, because they planned to pay for it and were concerned only with John’s health. Thankfully, Dr. Smith had an epiphany at the same time. “I could put a catheter into his kidney to drain it and buy you some more time. It’s perfectly safe, I just need to order the parts. It will take a day to get them here, but it will get us out of the danger zone.” It was Monday and Dr. Smith was about to save John’s life.
