Friday

Dr. Tenpenny drew the hot blade across the back of the little girl's skull. Dr Harvey looked on. The patient was fully sedated, but I helped the nurse hold her legs down, just in case. The blade sizzled in spurts, cutting a red canyon in her black skin. It smells like burning plastic army men with matches. Then from the gash leapt a sudden parabola of blood. It made a crimson line before Dr. Harvey's face. Two more followed. The doctors looked at each other. "There's pressure alright," said Dr. Harvey. Dr. Tenpenny nodded and kept on cutting.

I have observed surgeries in the United States, but never before have I seen the entirety of a patient's journey through a hospital. And Pioneer Christian Hospital is not normal, at least, not compared to where I've been. It is not a big building, but a group of small ones spread out over at least 15 acres, a medical facility stuffed into the skeleton of a Communist Youth Camp

The ambulance was a green and yellow Toyota taxi-cab. I was walking out of the administration building when I saw it pull up to the ER. Inside was a young man with skin lacerations on his legs and face. They looked like continents of pink surrounded by oceans of black. He had fallen off his motorcycle, the most common accident in Impfondo, but he had done so from hitting a little girl. 

The girl wasn't responding. Kacie said she was five years old. When I first saw her she was lying on a stretcher, her eyes closed and her head swelling up from the trauma. Kacie, Tammy, and Becky, volunteer nurses from a hospital-ship in Point Noir, told me the head-wound looked grim. It would continue to swell for 48 hours after the collision, increasing the pressure on her brain. The little girl's lump already looked the size of one of the papyas sold in the market. Kacie rushed off to find the doctors who had just begun their rounds. The others began wheeling the little girl's bed toward the Surgery building, or "The Bloc," as most of us call it. I pushed the bed from behind, and I cursed every bump in those narrow, communist-made sidewalks. But I shouldn't have worried; the little girl was nearly unconscious. 

Watching a surgery in the United States is like sitting in on a college faculty meeting. This was a little more like attending a party: a very serious party. Everyone wore brightly colored scrubs, some with crazy stripe and lizard patterns. The radio played cheerful Christian music, the words in French and Lingala.  Above us was a sky-light. In it I saw a few cobwebs drifting in the jungle sun.

Dr. Tenpenny peeled back a thick layer of skin and Ben, a pre-med from Oregon, used a sterile towel to soak up the blood that was blanketing the bone. Ben lifted his towel and revealed the skull, severely cracked with several islands of free floating bone. Tenpenny removed these loose fragments to relieve pressure.  The brain oozed up around the newly created opening. Tenpenny then made a quick incision in the dura mater, and out came a gush of clear liquid.

I'd seen cerebrospinal fluid before, but that was in a lab dissecting the brains of genetically mutated mice under a magnifying glass. This, of course, was very different.

The girl was still breathing and her vitals read normal. Dr. Harvey mentioned that when no vital monitors are available some surgical teams in the Congo tape a piece of paper to the patient's nose. If it keeps flapping, all's well. 

Everyone had started cleaning up as Dr. Tenpenny began to suture. I followed Dr. Harvey into the next room for another surgery, this time a woman with severe abdominal pain and swelling. We drained a brownish fluid from her abdominal cavity for a good 15 minutes. We looked back through the glass into the previous room. Dr. Tenpenny gave us the thumbs up, his eyes smiling from behind his surgical mask.

Harvey went back to his office to visit a crowd of outpatients who'd been waiting since early morning. Tenpenny continued making rounds. A few hours later I saw the little girl back in the Emergency Room. Her head was all wrapped in white bandages, her eyes wide open.