“That’s good,” Solange said, taking hold of Agwe Bourg’s hand. “Standing over a patient, looking down at him, is so impersonal. I like being on their level. It makes for a better rapport.” Gently, she gave the man’s hand a squeeze, then watched as he squeezed back. “Good muscle tone. Good reflexes. Do either of you have a stethoscope?”
Paul pulled one from his pocket and handed it to her. She listened to Agwe’s breath sounds for a moment, then handed the stethoscope back. “Clear lungs.” She looked at Agwe. “Do you have a cough?”
He shrugged to indicate he didn’t understand. So Solange repeated the question in Creole—the language spoken by most of the rurals. On Kijé, the languages were a mixed bag. Broken English, Creole, and, among the uppercrust, French.
“OK, no,” Agwe said.
“Do you think the TB might be going active?” Allain asked, totally captivated by Solange’s gentle bedside manner.
Paul noticed that the younger doctor had barely taken a breath as he watched Solange check Mr Bourg. It was such a subtle lesson she was teaching. One about eliminating the impersonal tone in medical practice and making the patient feel cared for. A chair at the side of the bed, a squeeze of the hand…these were such simple little things that mattered so much. With all the haste and hurry around his hospital, Paul thought about how often the simple things were overlooked, and he admired Solange for remembering. Somehow, she would always manage them no matter how rushed she was, and he admired that even more.
“His TB going active is a possibility,” Solange said. “It can do that, depending upon certain factors—more exposure to the active disease, other physical illnesses or weaknesses. But I think Mr Bourg is doing fine. Probably suffering from some kind of secondary infection outside Pott’s, if I’m not mistaken. Because when I took his hand, he shifted in the bed and moved his legs. Just a little, mind you, but I saw movement.” Her eyes crinkled a smile at Paul over the top of her mask. “You did, too, didn’t you?”
Paul nodded, his eyes smiling back. “So I think we’re all in agreement now that’s it’s probably not Pott’s disease, and Mr Bourg is one lucky man because of it. But we’ll still need some blood tests to rule it out.”
Solaina bent forward to speak to Agwe, to which he responded by pulling down his mask and giving her a great big grin, revealing a mouth full of rotten brown teeth. Friendly, but infected. And there it was. An uncomplicated thing now. “There, Doctors, is the source of our initial infection, I believe. Our patient here said he’s been pulling out his own teeth.”
Paul looked down at Solange over the top of his mask, and the instant their eyes met, the look they shared confirmed a diagnosis for Agwe Bourg. “Osteomyelitis,” they said at the same time.
“Told you it wasn’t quacking like a duck,” Allain chimed in. “And if it’s osteomyelitis, the pain’s probably so bad that Mr Bourg just quit moving to avoid it. So I guess he yanked his infected tooth and the infection spread.”
“When you don’t have a dentist, that’s what you do. And, personally, I’ve always hated the dentist,” Solange commented, shuddering. “But pulling your own teeth…I think I’d rather cut myself open and remove my own appendix, without anesthesia, over pulling out my teeth.”
“Well, I’m pretty good at removing an appendix, if you ever have a need,” Allain said, already bending over Agwe with a penlight and peering into his mouth. “And from the looks of things in here, I’d guess I’m about to get good with dental extractions, because we’ve got at least three potential sources for infection festering away right now.” Dental infections were often the cause of serious, even fatal, illnesses that resulted from harmful bacteria escaping into the bloodstream. When they lodged in the heart, which was common, it was called bacterial endocarditis, and out here, more often than not, it was fatal. And when they lodged in the bone, it was called osteomyelitis, and could be fatal if not treated, but if caught it was treatable. Today was Agwe Bourg’s lucky day. He was treatable.
“Allain’s the enthusiastic kind,” Paul commented. “He’ll take on anything.”
“Especially eight straight hours of sleep,” Allain called after them as Paul and Solange left the tiny room. “If anybody’s interested in giving them to me.”
“He’s a good doctor,” Paul said once Allain was out of earshot. “Young, a little unorthodox, enthusiastic, and great instincts. I’m glad Frère Léon found him.”
“Another one?”
Paul nodded. “Like I said, he’s a tricky devil.”
Solange laid her hand on Paul’s arm and gave him a gentle squeeze. “With or without Frère Léon, this is a nice hospital, Paul. If I weren’t already involved up in the mountains, I’d be honored to work here.”
“And I would be honored to have you work here.” He glanced down at her hand on his arm, and drew in a sharp breath. Another one of the simple things Solange did, and he could feel the sparks of it all the way down to his toes.
“We’re divided into several large wards, accommodating sixteen beds maximum in each one. Plus, as you’re noticing, we’ve got patients in the halls.” Bed after bed lining the walls. “With any luck, we’ll be starting a building project in a few months to add on two more patient wards and a children’s ward.”
Times like this, when he needed so much more, gave Paul the overwhelming urge to get back out there and find the support. “Right now we’re over the maximum capacity, and we’re beginning to feel it because, like the rest of the medical world, we’re short-staffed.”
“Did you anticipate this kind of need when you set up here?”
“I anticipated a few patients straggling in every day, and I’ll be the first one to admit that I was wrong.” He shook his head. “It’s frustrating at times, but we don’t turn anybody away.” Paul stepped aside to allow Solange her first good look into one of the men’s wards. “It’s not modern by any standards, but it works quite nicely,” he explained.
“Modern?” Solange exclaimed, stepping up to look through the glass in the door. “This is wonderful, Paul. Even my clinic in Miami wasn’t this nice.” Of course, Mauricio had cut corners every time he’d found one to cut, saving that money for his upscale move. Their upscale move. Only she hadn’t known it at the time. “And, believe me, if I could ever come anywhere close to something like this, I’d think I’d died and gone to heaven.”
It was a bare-essentials set-up. A bed, a bedside stand, a patient—sixteen of them lined up in two well-kept rows of eight each. There wasn’t much room in the ward, but it was tidy. “Thanks to Frère Léon?” she asked.
“In part, yes. He supplied the craftsmen to get it built. Locals who wanted a hospital nearby. He had an army of them, and it went up much like an Amish barn-raising. The men working, the women feeding the men, the children playing around the area.” He chuckled. “I think Frère Léon told them if they didn’t get it done quickly, Joanna and I might change our minds and leave.”
“The tricky devil,” Solange laughed.
“And you said you’re in an old mission chapel?”
Solange nodded. “Ayida and Keskeya—my nurses—and I actually live in the chapel, and the infirmary is in a brand-new building separate from it.” It was a nice, comfortable set-up and she loved it. “The whole compound was a cloister a century ago, but the monks moved to the other side of the mountains about seventy years ago to be closer to the major throughways.” She smiled, thinking about how glad she was they’d left the old compound behind. It was the perfect place, where several roads led in and out. The villagers were using them now to come to The Mission, as it was called, for clinic days, where medical services were offered at the infirmary instead of out in the