Thanatopsis

We are strangers in a foreign land, our work uniform the only vestige of our old life, and even that will remain after we've long departed this hospital.  I cannot return from what I've seen here, such immense pain superimposed upon the very essence of being. 

I've never spent much time in hospitals, so at the current moment, I'm having trouble discerning the source of the emotions I'm experiencing: is it injury or death that troubles me, or is it injury and death here in this place that disturbs me so?  Only time will tell.  All I know is my childhood has been explained by my experiences here.  Trampolines, four-wheelers, helmet-less bike rides...these were things not condoned in our family.  If your family followed the American Academy of Pediatrics for safe practices like mine did, you probably missed out on them, too.  As a child, blissfully ignorant of pain, injury, and death, I held some form of resentment for my pediatrician father: everyone else has these things, I'd silently quip, why can't I?  


I showed up to work last Friday--the final day of my surgical rotation--to a crowded ward.  "Last night was a busy night," Muff said.  Muff, short for Muffadel, was an intern from Mombasa finishing up his training in Kitale.  We had bonded after work the week before, and I was beholden to him for always including us in the rounds, patiently answering any questions we had.  His busy evening had been preceded by a major automobile accident near the town.

Hordes of interns and doctors crowded around the sole light board in the surgical ward, looking at a cervical spine x-ray.  C4 through C6 were all fractured badly.

"How's the patient doing this morning?" I asked. 

"He passed."  Muff's voice trailed off.

After a little bit of time, you learn to spot the patients that have died.  Though just like the patients that are trying to get a little bit of sleep before being disturbed by morning rounds, a notable rise and fall of the chest is absent in the sheet that covers their head.

"In an equipped facility, you might go in and stabilize the fracture somehow.  Here, this is not possible.  It's really a shame."

"A shame that you don't have spinal surgery capabilities?" I asked.  I thought that was asking a bit much of this hospital, of this town.  A shortage of sutures, that's a shame.  A shortage of neurosurgeons?  That's a problem in some towns in America.

"No, a shame he had to die because an ambulance wasn't available," Muff responded.

Then came the kicker.

"They don't even have collars here, and they won't let us improvise." He was talking about cervical stabilizing collars.  "Sand is all you need.  And how cheap is that?  I can go out back and dig up some fucking sand."  His tone grated my ears.

And so I took all this in.  I can't say that it really struck me until 10 minutes later when the harsh clanging of the gurney that carried the dead was heard at the door of the ward.  Two guys, very workmen like, both dressed in second-hand, mismatched clothing came into the room, the plodding of their thick rubber boots quite audible.  They tore back the curtain that divided the two beds, one for the dead man, the other for a patient that seemed nonplussed at the sight.  One man hopped up onto the bed, his feet straddling the man's head, facing his feet.  He tossed back the sheet that covered the man's body and began looking for a hand-hold.  Sliding his hand through the man's collar and grabbing the bottom of his shirt sleeves, the orderly looked for confirmation from his assistant, received it, and then hoisted this man of the bed.  His head lie to the right--probably as he was found--and his body was stiff from the rigor mortis, long set.

The chatter of the ongoing rounds behind me faded.  I couldn't be bothered to listen to that now.  It wasn't the first dead person I'd ever seen.  It was, however, the first strapping, muscular body I had seen devoid of life.  The man was easily 6'4".  His arms resembled any athlete's I had seen.  Perhaps he was a laborer, perhaps a mechanic.  I imagined him ripping through firewood with ease, the sweat glistening down his back the only sign that he was taxed by the chore.  Here was a man taken too early, an ox that had many more fields to plow already retired to some fallow pasture.

What a shame.  The people here have a common reaction to sights better left unseen.  A gentle tk tk is all that escapes from their pursed lips, the East African tisk, tisk.  A reaction muted by necessity, no doubt.

In that moment, I'd had enough of this place.  It'll tear your heart out if you let it.

Sitting outside, trying to warm myself in the morning sun, a hand grabbed my elbow.  It was Muff.  He could tell I was affected by what I had seen and offered some words of encouragement.  It went a long way in getting me through that morning.

In what turned out to be an introspective day, my conclusion to surgery that Friday, I found myself thinking of a poem introduced to me many years ago.  William Cullen Bryant's Thanatopsis, specifically the last stanza, resounded in my head:

So live, that when thy summons comes to join

The innumerable caravan which moves

To that mysterious realm where each shall take

His chamber in the silent halls of death,

Thou go not, like the quarry-slave at night,

Scourged by his dungeon; but, sustain'd and soothed

By an unfaltering trust, approach thy grave,

Like one who wraps the drapery of his couch

About him, and lies down to pleasant dreams.

 

A death wholly preventable, yet unavoidable.  If only everyone were given that opportunity, to lie down to pleasant dreams.