Patience and Patients
It was hard to concentrate; even with the only air-conditioner in the community cranked high, the operating room was sweltering. Rachel could feel sweat droplets slithering down into places she would rather they did not go, and she cringed.
The boy—Rachel thought his name was Jonah—lay on the operating table unconscious, though his open eyes flickered and darted around, showing that he was still alive. His mum, who had been present while he was going under the ketamine general anaesthetic, had since exited the room. Dr. Francie stood opposite her at the boy’s head, Rachel by his side; both had a grip on his right arm. They were leaning away from each other, trying with equal weight to force the bone back into the arm. It was a bad break; the bone had come out at the elbow. Unfortunately, it had taken the family a few days to walk from their village to the hospital. The boy had been in a lot of pain when Rachel had first seen him. It was a good thing the he was now “asleep.”
“OK, I think that is enough for the moment,” Dr. Francie gasped, letting go of Jonah’s arm. Rachel released her grip at the same time, gently laying his arm on the sheet.
“Now, if you can wash the arm and clean up the dead muscle, we will try to align the bones properly when you are finished,” Dr. Francie tossed over her shoulder as she exited.
“I need the forceps and scalpel now please, Lena,” Rachel requested from the theatre nurse who was standing next to her.
This was going to be a tedious chore. She had to remember where the nerve in the arm was so that she would not cut it. The boy’s arm was so swollen that it was hard to see anything. If she cut the nerve, he would end up with a numb limb.
There was a loud crash behind her as the sterilized instruments fell to the floor. Rachel groaned; the staff seemed to work at a snail’s pace at the best of times. How long is it going to take to replace the instruments?
“Oh, sorry, Dr. Rachel,” Lena apologized, hurrying toward the door, her voice filled with the shame that Rachel was beginning to notice regularly overtook Papua New Guineans. “I will go and get the other bundle.”
Rachel sat back in her chair and started her breathing exercises.
She was starting to lose her temper with the staff on a regular basis. Last week was worse. There had been several situations where she had thought the staff needed to take more care in administering the right medicine, in the regular care of wounds, and even in basic compassion towards the patients. Nevertheless, she had to admit that her reactions to the staff in every case left something to be desired.
Six hours later Rachel bit into the toasted cheese sandwich that was supposed to have been her lunch. It was now four o’clock; she had finally gotten away from the hospital and was still irritated over what had happened in the operating room. Where patients were concerned, Rachel had no problem giving understanding and being compassionate. They were the sick ones, and she was here to make them better. With the staff, she knew had a lot of soul-searching to do in terms of her attitude.
She was beginning realize that the hospital staff were not just her work colleagues; she saw them every single day of the week. She saw them in church, at mid-week Bible study, even down at the river on a Saturday afternoon. This whole subject called into question to whom she was really here to minister. As a doctor, her immediate response was that she was here for the patients. However, maybe the circle of those whom she was here to serve was wider than the obvious.
The next morning, Rachel walked through the special-care ward where the critically-ill patients stayed. The ward was full, with every bed taken. Even the floor between most beds “housed” a relative or guardian for the patient. Cooking pots, extra clothes, food, and even children combined to create—in Rachel’s opinion—utter chaos.
“Which patient are we seeing?” Rachel asked Lena.
“Here, bed five.”
The small boy was lying still on one of the wooden beds, his head propped up on a bundle of clothes. Rachel still could not understand how the patients could sleep on those hard beds. None of them had mattresses; when she had first arrived, she had thought the beds were wooden benches.
It was Jonah, the boy from the previous morning. His arm was being forced into the air by the ancient wooden traction she and a nurse had put him in the day before. His arm had been too swollen for her and Dr. Francie to really be sure the bones had aligned properly, so they were waiting for the swelling to come down.
“What is the problem?” Rachel asked. The boy moaned in his sleep and tried to turn over but was held in position by his arm.
“He has a really high fever,” Lena replied worriedly.
“Has he been given antibiotics?”
Rachel reached for his patient book as Lena shrugged. Nothing had been entered. Her jaw clenched in irritation; her orders had not been followed, and now the boy’s arm was probably infected. For crying out loud, how was anyone supposed to get better in this blasted hospital when staff cannot even follow simple instructions?!
“He needs to be on antibiotics right now!” Rachel whispered furiously to Lena. “He obviously has an infection, which is spreading.” Rachel reached down and touched the boy’s face; he was burning up. “This boy could die!” she continued, her voice rising.
Rachel almost screamed in frustration when Lena told her that Sister Josie, the nurse in charge of special care, had gone home for lunch. It was eleven o’clock, and the lunch hour did not start until twelve.
What am I doing wrong? Rachel agonized. She had clearly given the nurse her instructions and had written them down: the type of antibiotics, the dosage, and how many times a day it was to be given. This was the third time her specific instructions had not been followed this week—and it was only Tuesday!
“I’ll get the medicine myself.” Rachel stalked out of the ward in disgust and headed for the dispensary, muttering to herself. They had better have the medicine in stock, or else—she stopped her mental tirade, noticing several patients openly staring at her as if she had gone off the deep end.
Sitting on her couch at home that night the events of the day replayed in her mind, and she inwardly winced. Now that she was calm, Rachel could see clearly that she had been completely out of line with her outburst. The patients on the ward were not Lena’s responsibility; she was a theatre nurse and had picked up on Jonah’s condition when she had taken time out of her day to see how he and his mother were doing. Rachel knew she should have thanked her. Lena had always been so gracious and kind to her, and in a fit of anger she had practically yelled at her and called her incompetent in front of a roomful of patients and other staff. What if she had just lost one of her only friends here? Lena was older than she was; Rachel was sure she had made an irredeemable cultural mistake confronting her in the first place. You are a volunteer, she chided herself. You are supposed to help out, not create problems. She had totally flown off the handle at someone who was innocent. Was she completely losing perspective?
The next afternoon Rachel walked briskly down the stony track to Lena’s house. She had been here for over two months, but this was the first time she had ventured to visit any staff. When she reached the row of staff houses she let out a sigh of relief—she could clearly make out the tell-tale crimson hibiscus flowers on the giant bush that almost hid Lena’s tiny black-painted wooden house.
“Hello,” she called out as she stepped through the small gate. A courtesy call-out was expected when approaching anyone’s house for a visit. Rachel thought what an interesting spectacle that would make in the city back home.
“Dr. Rachel is here,” she heard a child’s voice call out. Lena emerged from her front door where the flyscreen clung desperately to the frame by a few strands. Rachel wondered for the first time who Lena’s family was. Is she married?
“Oh, hello,” Lena greeted Rachel, obviously surprised by her visit.
“Come, sit down under the shade tree,” Lena spoke in her heavily accented English.
Rachel loved the way Papua New Guineans talked. Dr. Francie could switch her accent on and off, depending on to whom she was speaking. Rachel found it fascinating and a little hilarious—one minute Dr. Francie would be speaking very proper English, and then the next her emphasis and pronunciation of words would completely change.
She and Lena sat down on a woven reed mat that was lying on the ground. Next to them was a raised platform which was completely covered in pumpkin vines. Underneath, four enormous green vegetables hung suspended above the ground.
“That is an interesting way to grow pumpkins,” Rachel noted, raising her eyebrows to the plant. In Papua New Guinea a slight raise of the eyebrows could mean a number of things; she was finally getting the hang of watching for this subtle sign and was now bravely using it.
“It keeps them off the ground when it is wet,” Lena answered.
Rachel continued to look around the yard, taking in the flower beds and makeshift kitchen out the back. I really should make an effort to get to know people outside of work, she remonstrated herself. She had heard that Papua New Guinea was a relational culture; she just had not bothered to apply that knowledge in any way. Perhaps if she spent time with them and got to know people she would better understand how things worked.
“I want to apologize for yesterday when I got mad at you about the boy not getting antibiotics,” Rachel said slowly and quietly. She wanted Lena to understand how sincere she was, and she did not want to cause any more embarrassment for her. “I know that you do not work in special care, and I should not have spoken to you that way.”
“That’s OK, I know you were frustrated,” Lena said. “People sometimes don’t do their job properly.”
Rachel nodded, but she did not know what else to say.
“Josie’s babysitter didn’t come this week, so she needed to go home early to take care of her children,” Lena continued.
“Who’s Josie?” Rachel asked, wondering at Lena’s complete change of topic.
Lena glanced at Rachel questioningly. “Josie is the head nurse in special care,” she said, in an embarrassed whisper.
Rachel wanted to sink into the ground. The point of her not working on relationships had just been driven home with a resounding thud. Was this was one reason the staff did not listen to her? She did not even know their names! What she needed was a good injection of patience and understanding.
“Do you often visit patients in the hospital?” Rachel asked Lena, desperately trying to break the tension.
“Only if they are relatives or from my place,” Lena replied.
“Is Jonah your relative?”
“Jonah’s mother is from my village.” Lena turned toward Rachel as she began to explain. “In our culture if someone is from the same place as you, then you are responsible to take care of them. We call them wantoks. Wantok means having the same language.”
Rachel nodded, taking in this new information. It was nice to be talking with Lena about something other than operating procedures.
“Do you do anything else for the family?”
Lena smiled at her, enjoying Rachel’s new interest in her culture. “I take them food, and they will come and stay with me when Jonah gets out of hospital.”
“How is Jonah?” Rachel inquired.
“He is a bit better now that he is taking the right medicines,” Lena replied.
Rachel nodded, relieved by what Lena had said.
“In Papua New Guinean culture we like to tell stories with people,” Lena continued. “You come and visit, and we will story. Then you will know me and I will know you.”
Rachel felt incredibly humbled by Lena’s offer of friendship. “I am sorry it has taken me so long to sit down and story with you, and I am so sorry that I got mad at you yesterday.”
“That is all right. Wan bel stap.”
“What does that mean?”
“Wan bel stap means you and I are of one heart, and we are at peace.
“Thank you,” Rachel replied, smiling at her friend.