20 Hours

May 17, 12:30 pm - My phone rings. Its Danae saying there is a delivery in process. I drop everything, hastily change into scrubs and bolt for the hospital. These African women deliver quickly and I know every second counts. Breathlessly I arrive at the delivery room just to find out I have at least an hour to wait. Since I am working the night shift starting at 3 pm I figure I should take the opportunity to go back to get my things for work and eat lunch. Twenty minutes later, I’ve accomplished both and am walking back to the hospital. The delivery room is humid and the air is stagnant despite the ceiling fan. Though she has regular contractions the progress is slow. I settle in for the long haul. I'm determined not to miss this delivery. Sitting on the exam table my eyes start to lull and close. It isn't even 2 p.m. yet. I wonder how I will ever make it through the night.

As it gets closer to shift change I get nervous. What if she delivers when I am getting report? Reluctantly I leave the delivery room for report but instruct them to call me the minute something happens. Sure enough, not even halfway through report I hear my name. I dash down the hall, only to find it was a false alarm. I quickly finish report and return to find her close to delivery. She is having difficulty. The baby’s head is visible but she is worn out. We check the baby's heart rate and find it is too low. If she doesn't get this kid out it will die. I'm worried. The last kid I delivered was dead. I want so much to deliver a live baby. Finally with much encouragement the mother uses the last of her energy to deliver a healthy baby girl. My hands, guided by the experienced hands of the other nurse, bring her into the world. I cut the umbilical cord and am passed the baby. She cries lustily. I am glad!

Although I am glad to have experienced a healthy delivery, I am now faced with a big mess to clean up right at the beginning of my shift. Thankfully the other nurses stay over time to help get things back to normal and complete the paperwork. The Maternity ward has 8 beds and 9 patients on the registry. Before the night is out it will have 10. Two patients also have babies receiving treatment for infections or malaria. An IV needs to be replaced and medications haven't been started. I take a deep breath.

Surgery has 10 patients as well, but thankfully does not have complicated medications to give. One patient however is agitated. Three of his family members have to hold him in the bed to keep him from pulling out his catheter and IV. I try to ask my 2 other nurses on duty what to do, but both are too busy to give me an answer. After calling Danae, I write for Diazepam and attempt to answer all the family's questions. I am in the middle of trying to get an IV to work for 6 pm meds when 3 student nurses arrive from Moundou. Apparently they are here for a month to do a practicum. One of them, a smiley young lady, chooses to work with me. Praise God! I have help tonight! God has provided yet again! Although she doesn't feel comfortable working independent of me, it is good to have another person to talk to. I can't tell you how good it was just to have the company! God is good.

The women who delivered tells me she has a lot of blood and pain. Although i don't see any frank hemorrhaging I think her uterus isn't as hard as it should be. I call Danae who tells me to hook her up to fluids with a oxytocin drip. Later, Danae (bless her heart) comes to check on me. Thankfully the woman doesn't need oxytocin after all. Just then a woman comes in with broken water at roughly 8 months. Danae was right there to assess and proscribe a treatment plan. Since she's had 2 C-sections already it is impossible for her to deliver vaginally. I am instructed to keep her NPO and watch her for the night. One person is at the door asking me to come. Another behind them is anxious I know their family member’s IV fluid is finish. A patient without a bed is asking where to put her stuff. I try to focus on one task at a time. I feel like I'm saying "wait a little . . . wait a little please" every other sentence. I pray silently for grace and continue taking one thing at a time.

Close to 9 pm meds, thunder rolls. I smile. I thank God for sending all my patients in to me. It’s very difficult to find them scattered around the hospital grounds in the dark. When they’re outside with their families, I try unsuccessfully to call out names like Kounmendgneu Dossuoum, and spend half my time simply hunting them down. Within minutes a torrential rainstorm hits. Calmly I lean in a doorway and enjoy watching the people stream inside past me. Things don't settle down until after 9 pm meds. Finally everyone has their medications and have asked their questions. The rain has stopped and the fresh air calls me outside. The moon is full and the clouds have broken up. I visit my other nurses. They have all finished as well. We stand together laughing and talking. I am reminded how much I love them all. One of them once again talks of getting me an African husband . . . like himself. This gave the other nurses much merriment. He promised to only have one wife and to become Adventist. I assure him it is good to be Adventist, but it should be for God not for me.

Close to midnight everyone is resting. I walk out into one of the open yards of the hospital compound. I stand there watching the clouds slowly blow by the full moon. I watch until there are no clouds left. The night sounds are comforting and all is peace. I talk with God. I marvel and am astonished before Him as I think of where He has brought me. I think of the 180 hours of night shift, learning French, feeling discouraged, having malaria . . . it all passes by my mind’s eye. My thoughts go back to the day when I first watched the mission DVD about Tchad. I remember the first time I felt the conviction to become a missionary nurse. Four years later - here I am . . . my stethoscope slung around my neck . . . in Tchad Africa. How strange, and yet wonderful. I wonder about the future and where God will lead next.

The need to give midnight meds tears me away from my peaceful ponderings. It doesn't take long. I go to my favorite sleeping spot: the concrete benches in front of Urgence. Stretching out, I breath deeply and soak in the night-sky’s beauty. I drift off for an hour, then get up to check the baby IV's. A man comes into Urgence with head trauma, and another for an infected stab wound. As is my habit I get up to see if i can help. The rest of the night passes with me checking the IV's and pre-term labor woman every 1 or 2 hours. The woman complains of some contractions so I check her every 30 minutes. Soon it is nearly time for 5 a.m. meds. The sky begins to lighten and the bats begin to fly and chatter excitedly.

Morning meds and vital signs are a juggling act for me as I work with my student nurse. It takes longer than I think they should. I cut my fingers when trying to open a Penta ampule and shake my head at my clumsiness. My fatigue is getting to me. I hear them singing hymns for morning worship as I take my last vital signs. One of my maternity ladies calls me over as I pass by. Her breast is one massive abscess and the dressing is already soaked in puss. The dressing change is the job of the day shift, but it needs to be changed now. I wheel in the treatment cart and proceed to milk out the puss. The smell gets to me a few times so I turn my head away for fresh air. She is so young. It hurts her terribly. She winces and sometimes reaches up to stop my hand. I don't know how to say "I'm so sorry it hurts" in Arabic. I wish I did.

May 18 8: 30 am - I've given report for both departments. I'm more than happy to turn over the patients to the capable hands of the 4 day-shift nurses. Walking home I look at my watch. It’s been 20 hours.