Traffic scuffles, "African Man", 6 but 1, vacuum dressings and "private nursing

It's been another 2 weeks filled with life, Liberian life...  I've moved into a nice apartment on the 3rd floor of a building approximately 1 mile or so from the hospital.  It's a bit difficult to find if you don't know the area...you pass S.O.S clinic and a "No Lemon" ?!? sign then there is a dirt road on your left.  It looks like you need a Hummer to make it down the road because it is so uneven, but we make it in just about any type of vehicle regardless, as long as we take it slow.  I was joking with a Liberian friend that you have to pass No Lemon and take your first left, drive past 3 mud lakes (huge puddles), 1 naked baby (passed by him one morning) and a chicken standing in front of 2 shacks on your right.  When you see 5 stray dogs you take another left.  When you reach the next mud lake you'll see a red gate.  That's where I  live.  TGH apartments, Apt 19.  It's a great place...I have a balcony that overlooks the area including out over the ocean.   Every morning I wake up around 6:30 am, look out from my balcony over Liberia and thank God.  I've gotten into my routine - shower, eat some fruit for breakfast and then wait downstairs for my ride.  Alvin, a hospital driver, picks me up at 7:30.  Traffic is crazy by that time and we take Old Road to bypass much of it, but Old Road is no walk in the park, by that time it's filled with people rushing to market or kids going to school.  We stay on the horn so we can pass.  Old Road leads to Tubman Blvd and then we hit the heavy motor vehicle traffic.  At that hour there are some police directing traffic, as there are no stop signs or lights, and the 4 lane highway turns into 3 lanes going downtown and 1 going out.  

The other day, on our way to work we were moving slowly in traffic when a motorcyclist tried to squeeze past and scraped our car.  I was looking out the passenger window when it happened and before I knew what had really happened my driver, Alvin, jumped out yelling.  The motorcyclist sped off and Alvin ran after him.  We were in an area of major traffic and a few police were nearby.  I heard Alvin yell for the police to grab the motorcyclist but they didn't budge.  Alvin kept chase and remarkably caught up with the man as he tried to squeeze through another tighter spot.  Alvin picked up the back of the motorbike so the rear wheel didn't contact the ground and just kept spinning.  The man jumped off the bike and ran but of course Alvin caught him and then the police got involved.  The man was detained until he made arrangements to pay for the damages.  Dr. McDonald, the Hospital Administrator was also in the car and explained it this way, "Alvin's been driving here all throughout the war, so he's been through alot."  When he got in the car and we started back on our way I joked with him that I didn't realize he was that fast and that I didn't jump out because it wasn't my side (unwritten rule).  

Saturday I went into work for a half a day then went to a friend's for lunch.  My friend, Lydia, was cooking traditional Liberian food to celebrate one of her friends' birthday.  It was a small gathering; Ibrahim from UNICEF was celebrating his birthday.  He brought his colleague, a university professor from Sierre Leone.  Another friend, deputy minister of justice also came.  It was great fun.  The food was fantastic and the company interesting.  I listened intently to the discussion of Liberian politics and about the similarities between the culture in Liberia and Sierre Leone.  Throughout the conversation they would joke about the crazy behaviors of people in the region and summed it up by saying, "African Man," then laughing.   I also heard for the 2nd time what fantastic beaches Sierre Leone has and so I plan on taking a weekend trip.  

After dinner I went to hang with the other birthday girl, Camille (Peds resident from CHOP), and friends.  We went to La Noche and had dinner then went to  a nightclub DeJa Vu.  The music was great and I danced for hours (lost about 10 lbs).  

Sunday was tragic.  A man ran his car off the road into a crowd off people. I was called by an ER nurse to come to the hospital quickly.  I arrived and people would lying all over the place in the trauma room.  The ER docs, Emilie and Meera were already there and filled me in quickly.  2 had been brought in D.O.A.  One man was gasping for air, his pupils were blown and he died about a half hour later.  I started seeing patients and a few minutes later, I found Emilie and Meera performing CPR on a little girl.  Sadly, she didn't make it.  One man was complaining of a lot of pain  and was bleeding from his leg.  I threw a suture in his leg and stopped the bleeding.  Otherwise he was breathing heavily and was tachycardic.  He had a deformity of his right wrist and right leg that looked like old injuries but was relatively stable so I moved on to assess the other patients.  About a half hour later a nurse came running to tell me that he was getting agitated.  I went over to him and he was looking worse and sounding confused.  His breathing was more labored so we checked his vitals and he wasn't breathing properly and his O2 saturation was 70's and dropping.  We made a team decision to intubate him, which was an event to say the least, then we were able to hook him up to the only ventilator we have, after it shorted out the first time we plugged it in.  Emilie and Meera set up a drip to try to keep him sedated and we moved onto the other patients.  Just when it began to quiet another women came in unconscious with a severe laceration to her head.  Her pupils were also blown and she wasn't breathing on her own.  We were not able to resuscitate her.  6 people died in all.

The next day I came in and went directly to the trauma room.  I walked to the area where the intubated patient had been left and found that the bed was empty.  Usually that is a very bad sign so I asked a nurse what happened to that young man and she pointed to a man sitting in a makeshift wheelchair!  I couldn't believe it and if it wasn't for the deformities in his right wrist and leg i wouldn't have believed it was him.  I asked him, "What are you doing?!?"  He responded, "It's painin me, doc," pointing to different parts of his body.  He stood up!  I looked him over.  He walked.  The nurse told me that overnight he had woken up and pulled the tube out of his throat.  His vitals stabilized and he continued to improve up until then.  I saw him again about an hour later and his family was there.  I told them that he was a miracle, that he had almost died last night.  They told me that he had survived not only this but he had also survived the "Lutheran Church Massacre" and that is why he had the deformities on his wrist and leg.  I told them that it was clear then, "God wants him to live," and they agreed.  We all laughed and smiled and thanked God for but one miracle.  

6 deaths but 1 miracle.  One miracle is enough to remind me why I'm here.

The rest of the week has been relatively quiet.  I had a minor victory today when I was able to put together the first wound vac dressing on a patient.  Everyone thought I was crazy when I started stuffing sponges into an open infected wound then attached a tube to it and sealed with plastic.  I had to run around town to gather parts so that i could run a small vacuum machine to create the suction.  It then took me an hour to get it set up.  I had 5 young male patients looking over my shoulder and telling me I was doing good for them and that the vacuum was working.  They told me they would keep an eye on it and make sure it kept working properly throughout the night.  That's the Liberian equivalent of a private nurse.

I'll see how things are going tomorrow.  

And life goes on.  As Shannon, an elderly hospital driver, put it to me the other day when commenting on a confused driver puttering around in front of us nearly causing another accident,  "This is no time to be sufferin from indecision."  I like that.  It's a great saying and I've adopted it.  "No time to be sufferin from indecision."  Too much life to live.