Ten minutes after being roused by Jemilla, I was in the operating room, scrubbed in and gloved up. The sole light source was a halogen lamp hanging from chains over the operating table, powered by the battery in Colin’s Land Rover.
The boy on the table was a very small four-year-old who, according to his mother, had wandered too close to the chain-link boundary and had been struck by a bullet to his chest.
Sabeena, our irascible and irreplaceable head nurse, her long braids tied up in a colorful head scarf, was wearing scrubs and pink Skechers left to her by a doctor who’d gone back to Rio.
By the time I arrived, she had efficiently swabbed the child down, anesthetized him, and laid out clean instruments for me in a tray. As I looked him over, Sabeena gave me a rundown on his vitals.
The child was bleeding like crazy, and, given his small size, he could barely afford blood loss at all. I saw that the bullet had gone in under his right nipple and had exited through his back, just under his right shoulder blade. The boy’s mother was standing there with a tiny new baby in her arms, her tears plopping onto the contractor’s garbage bag she wore as a sterilized poncho over her rags.
English was the official language here, and, although probably sixty tribal languages were in use, plain English was understood.
I asked, “Mother, what’s his name? Tell me his name.”
“Nuru,” the woman said. “My God. My little son.”
I said to the unconscious child, “Nuru, I’m your doctor. My name is Brigid. Your mommy is here, too. Hang tough, little guy.”
Sabeena wrote Nuru’s name on a strip of tape, wrapped it around the boy’s wrist while I did a FAST exam with our portable ultrasound. There was so much blood still coming from this small boy, I had to find out if the bullet had gone through only his chest or if he also had an intra-abdominal injury.
I looked at the ultrasound.
“There’s no blood in his stomach. That’s one good thing, anyway,” I said to our head nurse. “Maybe the only good thing.”
Sabeena clucked her tongue and shook her head. Then she hung a bag of blood and threaded an IV needle into the boy’s vein while I considered what to do.
It was my call. It was all up to me.
I had recently finished my residency at Johns Hopkins and had volunteered with Kind Hands thinking, like almost everyone here, that I knew what to expect. But the books and documentaries that had inspired me to come here had given me only the slightest inkling of the reality of South Sudan.
Since 1983, the normally dire, antithetical-to-life conditions had gotten worse, with the country now divided and its people and their villages, families, and livelihoods shredded by genocide.
The number of displaced persons in South Sudan continued to swell. Food shortages, a lack of potable water and medicine, contagious disease, killing floods, and droughts had been compounded by gangs of murderous teenage boys and actual army militias doling out unspeakable violence.
And now I stood in an operating room that was bare to the bone. We had two standard operating tables, six beds, a few shelves of expired medical supplies. Instruments were sterilized in pots of boiling water hanging from bicycle handlebars positioned over the fire pit outside the back door. Along with the car battery, we had a small, noisy generator.
We made medical equipment with tire pumps, duct tape, and cotton jersey. I could do a lot with an empty coffee can and a length of plastic tubing.
This was it, the real hell on earth.
Everything here was desperate and chaotic. Except that right now, the radio was plugged into the generator. The Red Sox and Yankees were playing at Fenway. David Ortiz was stepping to the plate with two outs in the bottom of the ninth. The score was tied, 3-3. If Ortiz could somehow get hold of one, maybe Nuru, too, could go deep.
I had hope.
Chapter 2
ONLY MINUTES had passed since I met my young patient, Nuru. Sabeena was bagging the child, and I had determined my course of action, when my colleague, Colin, came up from behind, saying, “Step aside, Brigid. This kid could drown in his blood.”
Dr. Colin Whitehead was a late thirty-something, tireless, bright, frequently cranky surgeon who had left his practice in Manchester, England, to come here.
Why? It was commonly believed that we were all running away from something, whether we knew it or not.
Colin had ten years on me and was in his fourth month of doing what he called meatball surgery. Nuru was my patient, but I handed the scalpel to Colin. It was always exciting to learn from this man.
Colin held a penlight between his teeth and made his incision on the right side of Nuru’s chest. He followed up the incision by using a hand retractor to spread open a space between the boy’s ribs. Then he put in a tube to drain the blood that just kept coming.
I saw what Colin saw: plenty of blood and no clear source of the bleeding. And so Colin reached into Nuru’s chest and twisted the child’s lung, a brilliant move that I understood might temporarily stanch the flow.
I had clamps in hand and was ready to take Colin’s direction when we were interrupted by the awful clamor of people charging into the O.R.
Our settlement was poorly guarded, and outlaw gangs constantly roamed outside the fences. Everyone on the medical staff had been given a death sentence by the outlaws. Our pictures were posted in the nearby villages. Colin wore a T-shirt under his gown with a target on the front and back.
He had a very black sense of humor, my mentor, Colin Whitehead.
Maybe that darkness in him was what brought him here, and maybe it was why he stayed. Colin didn’t look up. He shouted over his shoulder at the intruders.
“If you’re here to kill us, get it over with. Otherwise, get the hell out of my surgery!”
A man called out, “Help, Doctor. My daughter is dying.”
Just then, Nuru’s mother tugged on my arm. To her, I was still her son’s doctor. I was the one in charge.
I said to her, “Mother, please. Nuru is getting the best care. He’ll be okay.”
I turned back to little Nuru as Colin threw his scalpel into a metal bowl and stripped off his gloves.
That quickly, Nuru had stopped breathing.
The little boy was gone.
Chapter 3
COLIN SAID, “Well, that’s it, then,” and headed off to the new patient on the second table.
Nuru’s mother screamed, “Noooooooooo!”
Her days-old infant wailed. Her little boy was dead, and already flies were circling. Sabeena started to cover him with a scrap of a sheet, but I just couldn’t stand to lose another child.
I said, “Nope, stop right there, Sabeena. I’m not done here. I’m opening his left side.”
Sabeena looked at me like, Yeah, right.
I said, “Can’t hurt, could help, get me?”
“Yes, I do, Doctor, dear. Better hurry.”
“Berna, Rafi. Someone take care of Mommy and the baby. Please.”
The procedure Colin had performed is called a limited or anterior lateral thoracotomy, a cut into the chest cavity through the side of the rib cage. Colin had opened Nuru’s right side. And now, although it was highly unlikely that I would find a torn artery in the side of the chest opposite the bullet hole, we hadn’t found the leak. And there had to be one.
Meanwhile, Nuru wasn’t breathing, and his heart had stopped. The technical term for this is “dead.”
But in my mind, he wasn’t too dead.
“Stay with me, Nuru. I know you can hear me.”
I made my incision on his left side and used the hand retractor, and as Sabeena held a penlight for me, I peered inside. The heart wasn’t beating, but blood was still filling the chest cavity from the force of gravity.