Jonathan’s Blog

What’s in a name?

4/17

We had been called into the clinic at night on only three other occasions. The first time for the woman in labor, several days ago for a boy with a laceration of his nose, two nights ago for some run-of-the-mill dysenteric cramping. But last night was the first true emergency. I had just played the opening Scrabble move when Bob got a text from Flora that “She needed someone that took poison”. Intoxication—a subject about which, despite four years of medical school, I still know very little. When I am the intern on call in just a few short months and am presented with a poisoned patient I will not hesitate to call the poison control hotline. But alas there is no poison control hotline on Bumbire.

         So it was already dark and we grabbed our flashlights and walked down the dirt path to the clinic. The ward is lit only be a lantern and on the bed I could make out a woman, 19 years old, moaning incoherently and occasionally retching, being held by some man—perhaps her husband. Four or five other people stood in the corners of the room obscured by shadow. Bob tried to get the story from the man, but it was clear that he only understood some of the story. He says that his Swahili is worse at night. He thinks because he cannot read the expressions on people’s faces as they listen. From what he could make out (and I was proud that I could make it out as well), the woman had ingested 20 tylenol and an unknown quantity of home-distilled alcohol (I didn’t make out the home-distilled part). Only she didn’t smell of alcohol and nobody had witness the event. Obtaining a history in this kind of situation is hard enough when you speak the same language. Here it was nearly impossible to discern exactly what happened. But regardless, here we were with a nearly comatose woman, who despite her stable vitals, seemed anything but okay. To make matters worse we did not have N-acetylcysteine (the antidote to a Tylenol overdose) to prevent liver damage. At least she picked a toxidrome I remembered. And if we did have the antidote, we would have no idea how much she really took, when she took it, or even if she took it. She took something though; there was no doubt about that. Supportive care was really all we could offer.

So Flora made a phone calls to the higher-ups in Nairobi, and arrangements were made to have the woman evacuated by boat to the nearest hospital—a long and treacherous journey by night. Even after they would arrive at the mainland in Bukoba at best an hour later, they would still have to track down and pay for a Dala Dala (an overstuffed van-sized taxi) to get to the hospital. The prevailing opinion was that it was unlikely the hospital had the antidote either. But at least they could, at least theoretically, get a couple blood chemistries and place an IV. We also could have placed an IV, but Flora was not comfortable with it.

In preparation for their journey, Bob had to write a letter addressed to “Doctor in Charge” explaining his assessment and treatment plan. He pointed out to me the patient’s eerily appropriate name “Aiba”, which means “Shame” in Swahili. Apparently such names are not uncommon. For every “Grace” and “Patience” there is a “Misfortune”, or a “Hatred”. Did she ever have a chance?

We walked back over for a final assessment before they set off. It’s lucky we checked in when we did because one of the family members who emerged from the shadows (let’s call her “Trouble”) was trying to pour milk down the throat of the semiconscious woman. “Hapana maziwa!” “No milk!” Or water for that matter. The family was incredulous that this was not good medicine, and Bob grew more stern at repeated attempts by the well-intentioned woman to drown the patient. After the confrontation was over, we wished them a safari njema and they were off.

As Bob and I walked back up the hill to resume our Scrabble game I noted that the sky was completely clear and that I had only seen so many stars during summers on the Outer Banks. Only I was sure that the constellations were different in the Northern Hemisphere. He pointed out the Southern Cross and the upside-down Big Dipper. Off to the West I spotted Orion, turned on his side, and pointing his arrow into the middle of the Lake.