Rain Dreams

There is a tense, distinctly palpable feeling of dread in South Africa, emulating the calm before a storm... serene, but teetering on the edge of chaos; you don't have to go out of your way for the experience. For the past week, the residence hall where I've been staying has had no electricity, and the (cold) water only came back on Tuesday. The toilets wouldn't flush, trash piled up, and, most disturbingly, security gates didn't lock. One of the orthopedics registrars (residents) offered to let me shower in their on-call room, but the idea of lathering up in the hospital wasn't the most appealing... I joked about setting up a basin in one of the trauma bays just before morning sign-out... "excuse me, guys, could you please get my back?". Well... it was funny, maybe you had to be there, but after three days of, essentially, camping, I decided it was time to move out. Colin's landlady, Michelle, offered me a room in her house and, after some confusion (and a very upset black Labrador retriever), I packed up my things and, with Colin's help, moved over. Michelle is South African and her husband is Greek, a fact that's confirmed by the myriad of aromas steaming (yes, literally) out from the kitchen. The house is beautiful... small, decorated in an eclectic Afro-European style, and complete with a sweet, hyper sausage dog and a very fluffy, horribly allergenic cat. My room looks out into the garden with a small, oval swimming pool tucked between an exotic collection of trees and plants... I'm in heaven. I have already been spending a lot of time at the house, hanging out with Colin on evenings off, so being able to stay here overnight is just an added bonus.

Work is more of the same... so much more that I'm shocked at my lingering empathy. Some stories look like they could have been plucked from season premiers of Grey's Anatomy, except that the drama seems secondary when you're dealing with real human beings laying out in front of you. A 35-year-old woman, Thembe, came in yesterday, hit by a car speeding along a side road... she had just turned 35, it was actually her birthday. Although she was "stable", her c-spine x-rays showed suspicious shadows and markings... a reconstruction CT demonstrated a c4-c5 avulsion that severed her spinal cord... in other words, in all likelihood, she'll never walk again. I assisted the orthopedic surgeon as he screwed calipers into her skull, attaching 7 kg of weight for spinal traction. She moaned quietly and asked me repeatedly to reposition her legs. I would have, except that they were already lying flat... she just didn't yet realize that she simply couldn't feel anything. I swallowed hard, and for once was greateful that I don't speak Zulu, that I had a convenient excuse to not explain the details. Her family came and left, obviously upset but not hysterical. This is Africa, this is what happens in Africa. It happens everywhere, really, but here it is so commonplace that the senselessness seems to be more the rule than an exception to it. I gave her 3 of morphine and her vital signs dropped... 115/70, 103/65, 92/55. I was nervous, watching the monitor, but held back on giving epinephrine.... after all, with her spine paralyzed, she had a diminished sympathetic tone... in other words, even her body was struggling to understand what was going on, struggling - and failing - to maintain her vascular tone. She was eventually moved upstairs to the ICU, and I pasted her ID sticker into my notebook, vowing to check up on her in a few days. Thembe's scenario disturbs me, as she is living out my worst nightmare.... just an innocent bystander, just walking, for god's sake, and now paralyzed. I think that I would rather be dead than paralyzed.

I pushed more morphine into her veins before they took her up, wishing her a drugged, dizzy sleep where she would dream of anything else. Then I went home, to my new, comfortable bed, and fell asleep nestled in a thick sea-green comforter. I dreamt of merciless rainstorms, pounding down on the earth, flooding it, drowning everything. I woke up, shaking but still dry; outside the ground was soaked, naked branches swinging in the passing wind. I shut my eyes for a few more minutes, willing Africa out of my nightmares.