Minutes

31 July 2020

"You're going to love every minute!"

I heard these words two years ago, during those last few months, those months of preparation and anticipation and trepidation. Before France. Before Tchad.
I've wondered many times since then, was it a prediction? A recommendation or admonition? A hope or a blessing? Just a friendly way of saying goodbye and not meant to be agonized over like this?

If it was a prediction, it was a little off. If it was an admonition, then I've failed to live up to it. I have particularly thought this during those most difficult-to-love moments.

  • "The family came and took her away in the night."
    "What?!? She's still too sick! I had just bought all of her medications for her! She had just barely started to get better!"
    *nurse shrugs*
  • The phone call just as I'm finally tucking in the mosquito net to fall into bed after a long day and a busy evening. "Good evening, doctor. It's maternity." And then the call again at 3 am and 5 am and realizing that sleep isn't happening tonight.
  • "I can't help my relative buy the medications anymore. The baby's father called and threatened me and said he wants the baby to come home without treatment. He doesn't want the baby to live."
  • "This baby with malaria has a hemoglobin of 4. This other one here is 3. We have two donors, but we can't accept their blood because all of the HIV tests have run out."
  • Realizing that my SIM card isn't malfunctioning. The government has just decided that only the capital city should have internet access. Indefinitely.
  • "I have three wives, and they all have many children. I can't afford to buy malaria medications for all these kids! We just came for the free blood transfusion, and I'm taking him home now."
  • Difficult meetings to deal with administrative challenges.
  • Diagnosing advanced inoperable cancer and trying to explain it to the patient, who still thinks that finding the right surgeon will cure her. Cancer is terrible. Cancer in Tchad--without chemotherapy or radiation, without real pain medications, without palliative care--is even worse.
  • Telling the nurse she can stop breathing for the baby. She's not coming back.
  • Calling in another more senior doctor to say the same thing when the baby belongs to our colleague. I'm still manually breathing for the patient, and I just can't bring myself to make the call.

On the other hand, those easy-to-love moments also exist.

  • "She stuck this peanut in her nose/swallowed this coin/put this rock in his ear/has this piece of wood in her eye." Removing the foreign body successfully and handing it to the mom or dad who thanks us profusely and rushes out to show off the freshly-removed object to the rest of the family. This physical problem that they could easily see and diagnose but couldn't fix with any traditional methods at home is suddenly and obviously resolved, and everyone is incredibly grateful.
  • "We tried to treat his malaria at the health center, and he didn't get any better, but now after two days of treatment here he's finally getting well!"
  • "The patient says she wants to thank you for helping her child when she couldn't buy his medications. He was so sick but now he is in good health!"
  • The regional referral hospital said, "Once a cesarean section, always a cesarean section. Time for your repeat cesarean delivery." She wanted a live baby and a normal delivery for her second pregnancy, after having had a cesarean and a stillbirth last time. That moment when she gives one last good push and the baby takes her first breath and expels it forcefully in a strong cry. First normal delivery and first live baby for this mom. Healthy mom, healthy baby, and now she has a great chance at future normal deliveries, too.
  • My patient is back for her follow-up visit after curettage for molar pregnancy. Pregnancy test is negative. No more molar pregnancy!
  • Suturing an eyelid back together after a traumatic injury and a sketchy repair at a health center, and then admiring the healing whenever I run into the patient while I'm out walking the dog.
  • Walking by the rice fields in rainy season.
  • Feeling healthy again and motivated and especially empathetic for the malaria patients, right after finishing treatment for my own malaria.
  • Enjoying good food with friends--missionary-style or local style or an expat-local fusion
  • Sleeping to the sound of rain on a metal roof
  • Driving the motorcycle to the market.
  • Driving the truck to the village, mud puddles and all, and not stalling or getting permanently stuck anywhere along the way (which is important with the truck that requires a push-start)!
  • Floating down the river on an inner tube during hot season, while being laughed at by the kids and fishermen on shore.
  • A warm mug of tea or hot chocolate on a chilly wet day in the middle of rainy season.
  • Singing and guitar for Sabbath evening vespers with fellow missionaries.
Many minutes here are one extreme or the other--painful and draining or beautiful and fulfilling.
I don't love every minute, but maybe the point was to love as many minutes as possible. Because appreciating the lovable moments makes it easier to face the difficult-to-love ones.