Hospital Headaches

I wrote this during our first month in Mabaruma. It was a time of great frustration and little sleep. Many things changed for the better since I wrote it.

Last night was not an example of Mabaruma Hospital at its finest.

We had just got back from dinner at the house of a very kind family from Canada who have upped sticks to live in Mabaruma and run a little yellow Cessna plane for emergency ‘med-evac’. On the way home we had dropped in on the boys at the little bar next to our house, where every evening from 6 to 11 (the hours of electricity supply) they play deafeningly loud soca and drink ‘high wine’- 70% distilled rum. We paid for some sugar we had borrowed a few days earlier and had a chat to the owner, Sion, who was a bit plastered, as were the others. They seemed gentle and kind, and in a boozey way, were sorrowful for the loss of past American occupants of our house. One of them, Fred, kept wanting to shake our hand and mumble something drunken and friendly.

Later in bed we heard a little scuffle outside and a knock on our door followed soon after. It was Fred’s sister. Could the Doctor come please? Fred had been in a fight. My first reaction - perhaps to my discredit - was anger. It had been a long working day, and we were just drifting off to sleep through the Soca beats. Whereas with a ‘genuine’ emergency I feel a sense of duty toward a patient, when it is the result of a fight it seems so stupidly avoidable that resentment is difficult to resist. Perhaps I should have expected some form of disturbance, it being pay-day; the whole town was on the razzle, and just like any town in the UK on a Friday night, trouble was fairly predictable.

As I walked with Fred’s sister she told me what had happened: Fred had got really drunk, and had left his phone on a seat outside the tiny shack that Sion serves from. He’d popped over the road for something, then staggered back only to find the boys had hid it as a prank. A fight ensued, and Sion, perhaps still feeling emotional about his long lost friends, had taken to him with a long iron bar.

In the hospital I asked where the on-duty Medex was. There are two, one living 5 minutes from the hospital, the other much closer, just opposite me. It turned out the closer Medex was actually Fred’s uncle, and that in a moment of familial synchrony he was “so drunk he doesn’t know himself, Doctor”. That left me with the improbably named Nurse Herod to patch up Fred’s head.

Fred was in the treatment room. It looked like a scene from Sweeney Todd: the whole of his upper body was covered in drying dark blood, with quick little streams of brighter fresh red running on to the floor from a big bump on his head. He had lost the use of his left arm which had a small gash just above the elbow. He was writhing around on the bed splattering blood on the floor, walls and everyone near him. His family stood around looking worried and there was a big-bicepped policeman present who had attended to the scene with a rifle slung on his shoulder. Strangely given the circumstances it was the rifle that unsettled me the most.

My mild irritation at the start of the episode progressed to disbelief and anger over the next 20 minutes. I was here as an unpaid volunteer, not to replace anyone, but to add capacity. With Medex drunk, I was in effect covering for his alcohol problem – “how ‘charitable’ of me”, I thought. Nurse Herod showed off her credentials as the worst Nurse I have ever worked with by doing nothing but yap to her friends on her cellphone instead of helping as any sensible person would do- to find a suture set, or get some anaesthetic. With (blunt) suture finally finding its way into Fred’s scalp, she commanded me to stop - it was two minutes to eleven and the electricity was about to be turned off. I was half way through the first of what needed to be about 15 stitches and having disturbed the clot on Fred’s head, blood was starting to pour out again.

“What about the hospital generator?”

“Porter not here, me can’t turn it on without he”

Pay day: the Hospital Porter was legless at home, too.

In an unusual moment of inspiration Nurse Herod called the men at the generator plant to ask for an extension. I was leaning over the patient for 2 minutes in suspense before she looked glumly at me and said: “They never answer, generator too noisy.”

The lights went out. I was still attached to Fred via the black suture when a boy turned up with a battery-operated strip light. We decided to continue with that until, just as we got Fred to cooperate by turning his head the right way, the battery ran out. Next up was the oil lamp, and in its Dickensian glow we tried to fumble around with the stitch. The lamp started to sizzle whoever’s hands were holding it, and the heat it emanated was adding to my discomfort. Fred was wriggling again. It was a lost cause.

We downed tools and Nurse Herod cursed at Fred for cursing. He started flicking excess blood off his face onto the floor. Most of his family huddled in the doorway.

I asked Nurse Herod to do a pressure bandage on his head to stem the flow until it was daylight and he was sober. She left the room and made a call without doing the dressing. Fred continued to bleed.

I took a mental step back to summarise the situation: no Medex, no Porter, no Nurse, no light; blunt needles, drunk patient, blood everywhere.

The lovely, and very rotund Nurse Phillips arrived with bed hair. She smiled and squeezed my nose. Straight away she dressed the wound, winding the elastic bandage round and round Fred’s head and chin with like she was waving an imaginary wand, and as if by magic it was all over.

But it wasn’t, because the Policeman had been doing a bit of thinking too, and now he suddenly grabbed Fred’s arm where the gash was, where his humerus had probably been fractured. He demanded Fred keep still, which seemed strange because every time he squeezed Fred’s arm, he fell around the bed in even greater agony, as if electrocuted. It struck me as very sinister that the Policeman had noticed so keenly the extent of Fred’s apparently minor arm injury. Fred screamed out. The Policeman’s arm sleeves were rolled high up his arms. “I’ll show you pain, boy”, he said, and squeezed harder.

“Beddy-byes”, giggled Nurse Phillips. I felt bewildered about what I was seeing and unclear what it meant. Perhaps the policeman was helping the nursing staff to ensure Fred would stay in his bed for the night. In his drunken state he clearly wouldn’t though. Fred’s mother said “Tie he to the bed, make sure he no move”. In retrospect that would have been far less harmful than what was happening. Feeling tired, powerless and confused in a strange country, I obediently wandered into the star-speckled darkness hearing Fred’s screams and kicks getting quieter. I lay in bed for a good hour afterwards reflecting on an evening, which had begun with an act of humanity and ended in torture.

The funeral

Dorothy was 77 when she died. The first time I met her she was sitting in an armchair, the second time she was lying in bed, the third time she was unconscious. I loved visiting her and her family. She would sit virtually mute and motionless, her straight white hair pulled tight over her head watching as three generations of her offspring laughed, gyaffed, and ran around her. She and her husband now had 36 grandchildren and 12 great grand children. “I’m having trouble remembering all their names,” her husband Desmond told me. Mark the plumber was her son and lived downstairs.

Every time I visited I would be greeted by a chorus of stout-looking ladies breastfeeding in the little living space separated from the bedroom by some beautifully patterned dark bullet wood from the local forest. “Yes, Doctor”, “Good afternoon, Doc”, “Go right though”. When I came out their numbers would have swelled as other relatives and their children gathered to hear my verdict for that visit. Then, update over, I would be about to leave when one of them would pipe up with something like, “Doc, I’m troubled by pressure. Would you kindly take it for me?” It was always only one, it was like they had all silently agreed in my absence who was sick that day and that the focus should be on them. It didn’t seem to matter that the really sick patient – granny – was slowly dying next door.

Trying to get to grips with the Amerindian psyche has been a confusing and fascinating experience. They appear indifferent to almost everything around them, and the few emotional responses you do get seem somewhat muted by the absence of accompanying facial expression or physical movement. It’s like they’re speaking their lines, but not acting their part. “Mark got angry with Dick today” I once told Becky, recounting a major incident between the two people who make up the Mabaruma plumbing unit. “He didn’t scowl of frown but he just stared and said ‘I don’t know what they did to that boy when he was born, but his head is full of air’ Then he lapsed into silence again” In Amerindian culture this was noteworthy for its passion and verbosity. It was certainly the longest uninterrupted speech I had heard from Mark to date.

The rest of the family, generous and caring as they were, displayed the same baffling lack of emotional range. When I told Desmond that his wife was shortly to pass on and that we needed to think about stopping actively treating her with antibiotics and such, and start concentrating on things that would keep her comfortable in her last days, he just looked at me and said, matter-of-factly, “Well lets take down the drip, Doc”
“Well I would like you all to have the chance to think about this decision before rushing into it”
“OK. Take it down”
“You wouldn’t prefer to talk as a family first?”
One of the five plump middle aged daughters, each of identically short stature, interrupted from the head of granny’s bed.
“Daddy, what Doctor is saying is: we should make a decision tonight, then tell he tomorrow”
“Oh…” said Dad, looking sad and powerless. Tears had finally started to well up in his eyes.

Mark picked me up at 4pm the next day for what had become, in Dorothy’s final illness, a regular afternoon visit to their home in Thomas Hill. Several days back it had started to be less about Dorothy and more about a pastoral role for those around her. By being there and focusing on what was happening to her I felt that the family could focus too - despite their attempts to distract with their blood pressure ‘emergencies’. By talking about what seemed to be getting closer and closer they might all be better prepared for Dorothy’s passing.

Mark turned the car around. It was one of five private cars in Mabaruma, what would be called a ‘sedan’ in America, but that sounds far too flashy. It was a real banger, with bits hanging off by pieces of string. Sitting in the passenger seat I could feel clumps of grass brushing the underside of the vehicle and sometimes my legs would jolt upwards when a particularly large clump hit the loose floor. Today there were only eight people on the backseat, most under the age of seven. The record of eleven people set a month previously still stood. I offered one or two to come and share with me in the front but they refused.

“So how’s Dorothy today, Mark?”

Mark paused, looked at the steering wheel, and said “She dead” and threw the car into first, pulling off like he was furious. He wasn’t. “Yes, she died. I think it was the Diabetes tablets that did it”

Here we were again. Something or somebody had to be to blame. Despite my attempts to explain that Dorothy had been very old, that she had diabetes and had had a stroke a while back; despite telling them that during the 5 months I had known her she had slowly got weaker; despite all of this in Guyana there always has to be a single reason for the unwanted event. In some ways this has a lot in common with the scientific model: pathologically speaking she died of a single illness: bronchopneumonia. But the reality was that she had slipped away gradually over the previous few months. It’s an unfashionable way to put it, but she had died of old age.

I tried to re-iterate these ideas to Mark, especially as I knew his Dad was beating himself up for having given Diabetes tablets to his wife when she wasn’t eating. She had developed an unreadably low blood sugar in her last days of life, which he thought the tablets were responsible for. He may have been right, partially, but stopping the tablets hadn’t improved her sugar levels, and anyway she got sick before her sugars plummeted, not the other way round. Mark thought for a while. Or at least I think he was thinking. People who think usually move their eyes from side to side, external movement being an indication to what’s going on inside. Mark’s eyes weren’t moving, just staring straight over the steering wheel, his fleshy face completely still.

We passed somebody’s pet macaw sitting on a fence squawking.

“You see my birds, Doc?”, he said with a hint of animation.
“No, you keep birds?”
“Yes. I got some green lovebirds”
“Oh, really?”
“Yes”

We drove on in silence.

“So….how did you catch them?”
“In a trap”

The sun set over Chan-a-Sou’s marshy coconut palm field.

“Why do you keep them? Are they pets or do you sell them?”
“I sell them. You sell them in Georgetown you get 60, 70, 80 thousand dollars for a bird.”

He recited the figures rhythmically. He stared over the wheel again for a while.

“But you got to get a passion in them. You keep a black cloth over the cage. Then you leave it until the passion grows. The bird wants to see the other birds but you musn’t let it. When you take the cloth off the bird has plenty of passion, and starts to spread. This is something it does with its wings. Spreading. It spreads and makes a beautiful song. People will pay good money to buy a bird with a good song.”
“Who are these people?”
“Georgetown bird men. They’ll hear a good song and they’ll start what’s known as a bid. One will bid an amount of money then the next will make a higher bid and so. And sometimes there’ll be a competition. A singing competition. First bird to sing 25 times. Winner can take 30000 dollar.” Again his voice danced as he spoke of the sums, but his face was set.
“So when are you taking your birds to town?”
“Next time I get the opportunity. Not long now.”

We arrived. A carpenter was already engaged and had constructed the frame of the coffin in the middle of the yard. A few people had gathered and were sitting in chairs watching him work. A tarpaulin had been pulled over a wooden frame that I hadn’t noticed on previous visits. The whole yard had been turned into a big tent. Mark sat alone in the car while I went upstairs to express my condolences with Desmond.

The same five daughters were standing in the same place at the head of the bed. This time they were red eyed, and embracing each other. Granny had been moved to the living room. I sat with her husband on the bed she had died on.

“I want to thank you Doc from myself and on behalf of the whole family from the bottom of my heart for everything you’ve done for us. Our people don’t get time from our own”

I always feel a bit embarrassed when people are as profuse as this, especially people who are not profuse by nature.

“How are you doing?” I asked, “Are you coping OK?”

“Well I didn’t sleep at all last night, and I won’t sleep tonight”

This is traditional practice here. We lapsed into silence. I found myself thinking about Dorothy. I had spent hours with her family, but she and I had probably exchanged no more than four sentences the whole time. Sometimes in the UK people like to recall positive memories after a bereavement. So I asked:

“Do you think she enjoyed her life? You didn’t meet in your home village did you?

“Well, I came here from Maruca [a riverine area 60 miles south]. I was a drunkard, you know. But then I became a Christian. We met right here and got married. We had plenty of children, started young you know. Then she died. Yes. I suppose it was a good life.”

Later I returned on a borrowed bicycle to join the wake. I had been to one before. Our good friend David’s aunt had died in Georgetown and it was taking a long time to get the body flown back to be buried in Mabaruma. Every night for five days they had gathered at her immediate family’s house, just behind ours. Becs was away again so I went along alone, expecting a sober, sad occasion. Far from it: laughter guided me to the little house, and inside there were women cooking up some chicken and rice and children playing cards on the floor with an overweight, slightly dim young man with an oversized head and a big smile. I joined in cross-legged and he started to tease my poor playing skills. We were playing “War” (pronounced Waargh) and I was losing again.

“What’s your secret?” I asked. He took his shoes off and gestured to his feet.
“Six toes”, he said, “It lucky”

The children started laughing and pointing.
“Don’t trouble me, now. Trouble me six toes and you’ll grow more yourself! Even more!”
“More than 6?”
“Yes! 7 or 8 even!”
The children stopped laughing.

In Thomas Hill about seventy people were gathered. Just like at the six-toes party the deceased wasn’t mentioned. Small tables were occupied by groups of men playing cards and young children playing dominoes, while others looked on eating little plastic bowls of cook-up rice with sweet black tea. I joined one of the kids’ tables. Dominoes is the simplest game in the world, but somehow every time I play I get beaten. The loser leaves the table and is replaced after each game. I left after every single game I played with those 6 year olds and then had to beg to be allowed to join the table again. Eventually I gave up and started watching the carpenter who was now using a small power sander to smooth off the coffin right in the middle of the party. He was lit by a strip light hanging from a wooden beam. The coffin looked really good. Heavy, chunky looking, with nice routing, and a detachable ‘open casket’ head section.

The following day I made sure to get to the funeral. I had checked the hospital first and found a teenager lying on the observation bed, accompanied by her mother, both dressed in black. The patient was one of Dorothy’s granddaughters, who had been brought up by Dorothy, presumably because mum had her hands full already with the other kids. That afternoon, during the church service in Thomas Hill she had developed cramps in her arms. Experience told me that the cramps were caused by anxiety. Just as we in the UK get panic attacks with over breathing and hand tingling, over here they get cramps and body pains. We talked about how she was feeling. They agreed it would be best to go to the cemetery to say goodbye. We started to stroll.

At the cemetery twenty or so people had gathered and were waiting for the Thomas Hill group to arrive. Everybody wore something black, whether a top, a skirt or just dark glasses. I stood with Yvonne, a powerful matriarchal figure in her 70’s who used to be Regional Chairman and retained the authority of that role, but also had a wonderfully warm sense of humour. We watched as the clouds darkened and lightning started flashing.

“Did you know Dorothy well?” I ventured.

“Oh yes. Oh, look at those cows.” Some black cows were eating grass on the near edge of Chan-a-Sou’s orchard just opposite the cemetery. “It looks like they know something we don’t.”

Then we started talking about cows.

“I kept cows from 1972 all the way to 1998”

“Oh?” I said “Did you eat them?” They don’t milk cows here.

“Oh yes, but not straight away. I had to put the meat in the fridge for a few days before I could do that”

Another woman had appeared.

“I never eat” she said

“What, cow?” I said

She looked at me. “Beef. Its called beef after it dies”

“After you kill it!” chuckled Yvonne

“I never eat it. Get too attached. Aunty Denise’s daughter, she was the same. I would find her sobbing, weeping on the wall. ‘What’s wrong, dear?’ I would ask ‘Rosy the cow died’ she would cry and the tears streamed down her face”

“You can’t get too close to them,” advised Yvonne, “you can’t give them names.”

The funeral procession arrived. Three cars and two buses slowly squeaked to a halt. Throngs of people had arrived. Half the town must have been there: crazy Billie, Mrs Willis, Ron the Gil Scott-Heron doppelganger, the cleaners from the hospital, Dick the useless plumber, the Regional Chairman, the Chief of Police (in uniform) and Desmond and Dorothy’s 48 progeny.

Ken Door, the seven foot American New Testament Church Missionary, was their pastor. He usually looked like a kindly bear, but today he looked more specifically like a big panda; presumably he hadn’t slept either. His wife and daughter, dressed in black like Amish people followed him looking stern. They both had sharp looking noses and were extremely unattractive. Ken’s wife strapped on an accordion and they processed towards the grave through the baggy jeans, tight skirts and shades like a mediaeval circus act: a panda bear and his musical witches.

A hymn about meeting one’s comforter. I leaned over to Yvonne to tell her I may have to disappear quickly mid-service. It was because of a bad egg. I had run out of food that day and had tried to buy eggs for lunch. The little hut above where David lived had run out, as had everyone else as the fortnightly steamer was delayed. The fat woman who ran it asked me to wait while she plodded around her garden looking for eggs her ‘bush fowl’ had laid among the vegetables. Eventually she found just one, and gave it to me for free. It was small, and the dirty dark shell felt more delicate than usual, but I was starving. It was 2pm and I had missed breakfast. Back at the house I cooked up everything I could find: pasta, tuna, oil and then I cracked the egg in. It opened far too easily and before I could do anything its contents ran away into the pan. I think I may have smelt ammonia, but my stomach overruled my nose and after cooking it as well as I could I wolfed it down. That was four hours ago. Now I was getting churning feelings and cold sweats.

“You’re not going to….you know” Yvonne made as if to vomit “here are you?” and gave me a stern look.
“No, I’ll get well away before I need to do that. I just thought I should tell you in case I need to run away”
“Okay, dear” she smiled and turned back to the service.

Ken called for a few minutes silence to reflect on our love for Dorothy, during which several small groups of men started noisily chatting while the Regional Executive Officer’s secretary, a big boned lady with Dame Edna style glasses, started doing what looked like an impression of someone doing the twist after too much High Wine. This caused much hilarity among the women she was standing with. My phone rang. It didn’t matter in the slightest.

A group of three elderly ladies stood stooped over behind us. Perhaps it was my lunch, but they reminded me of sensa chickens like you find out in the river communities. Their hair was slightly ruffled, they all faced different directions and now and again one of them would stamp on the wet trodden grass and scrape a twig around with her foot. Occasionally one would suddenly turn her head sideways to squint inquisitively at the gathering storm clouds. They seemed oblivious to the proceedings.

Kens voice took on a climactic, spiritual cadence, rising and falling like he was intoning a spell to contact the afterworld, which I suppose he was in a way. Then he said to everyone that if we wanted to have a last look at Dorothy to come now. Everyone looked around. Most had had a good gawp at the dead body, even a few passers-by who clearly didn’t have anything to do with the funeral. It was just like the hospital, where people would drop in and stare at the sick person. “Are you family?” I would ask “Then go away!”

The three old ladies were still strutting and scraping. All three were bespectacled. Two looked up, hard of hearing. “Eh?” We gestured for them to come. They hobbled over. “What? What is it?” the first one asked, who was wearing a sort of black lace bandana.

Yvonne said: “Do you want to see Dorothy one last time?”

“No!” hollered Bandana Granny “No! I don’t want to do that!”

“Me neither!” said Grannies 2 and 3

“It’s my glasses!” she yelled and pulled them off to show Yvonne. Two hundred people looked on. She continued shouting “I can’t see more than 6 inches with them! I don’t want to go there – I can’t see a thing! No, I’m not going!”

“Yes, yes, terrible!” joined in the other two, who had their glasses off now and were raising them to the sky as if to demonstrate how cloudy the glasses were. “Terrible, can’t see a thing!” They started comparing notes. I leaned over to let them know we had some delivered to the hospital recently if they would like to come in…

“Oh, yes. Doc! I’ve been meaning to come and see you for a while, it’s my headache…” but the growing wailing sounds drowned her out as the first shovel of earth was piled in.

People started to drift away. I wasn’t sure if we’d finished or not, so I waited. Mark was sitting a small distance from the main gathering, his face expressionless, still staring in front of him, but red from weeping. Eventually I started to move. My stomach was a ball of muscle and it felt like the vomiting might start soon.

As I left I heard several children shout in unison “Dr Sam!” I turned around. It was the dominoes kings. Nine of them were filling the back seat of Mark’s car, climbing around having fun while their parents were away. I squatted to chat through the open passenger door.

“Hey! How are you doing?” I heard a bang and one of them started crying.

“Henry pong he head on de car!” a little boy shouted and the toddler’s howling got louder.

I was about to go when a little girl I didn’t recognize stood up behind the passenger seat and faced me boldly. I stayed put. “Hello.” She didn’t reply, but continued her gaze. She had been dressed up for the funeral in a simple brown dress but had dispensed with the shoes and socks. I started to move to go when she smiled. I stopped and smiled back. She smiled again more broadly. She had two neat rows of tiny teeth and her eyes looked gentle. Then she spoke:

“Why did granny die?”

“She died of old age”

“That’s how I want to die.”

“Me too”