Crisis

“I know the night is not the same as the day: that all things are different, that the things of the night cannot be explained in the day, because they do not then exist…”

Ernest Hemingway, A Farewell to Arms

When you’re in another country, on a mud road with cattle crossing at their leisure in front of you, headed to yet another relative’s house, and your son is back at the village hot with fever, you begin to worry.

When, back in the village, you are entreated to sit down and enjoy chicken soup and sticky rice before heading back to town, perhaps the simplest meal you’ve been offered in Laos by the simplest people, and the chicken is the tall skinny rooster your children were chasing through the sawdust and around the pineapple plants yesterday, and you realize this meal represents a significant portion of this family’s wealth, but your son is laying lethargic on the woven mat sat on the floor near you, you want to say, “Thanks very much for killing your chicken for us, but we must get back to town.”

When you finally do load up your family in the back of the truck and head out over the mud roads that seem to have developed new washes and bumps from the day’s rain, and when you cross the one-lane, plank bridge heading out of the village and pass the two-wheeled tractors and carts heading home for the evening, you just wish everything was paved and had clear yellow center lines and speed limit signs progressively increasing, 30, 45, 55, because your wife has your son covered in wet rags in the backseat and he’s starting to ask questions that don’t make that much sense or is it just that he’s eight and sick in a foreign country and afraid?

When you finally make it to the main road next to the special economic zone and you see the acres and acres of cleared land, like a strip mine, just waiting for foreign companies to swoop in and bring modernity to Savannakhet, and as you’re trailing aging diesel trucks with black smoke that cause motorcyclists to wear masks and would be choking you right now were you in the back of the truck and not in the air conditioned cab, and though your son has grown more lucid and cool, you still wonder if anything matters besides getting back to the safety of the hotel and putting your son in the cool sheets where you hope all will be well.

When night sets in, everything goes mythical. You wake at midnight to your wife saying, “Howie, Micah is burning up, the Motrin’s not working,” and you’ve never heard that western drug cocktails don’t work so you come out of slumber to all your subconscious fears in the dark and the first thing you look for is your computer to diagnose what’s going on. The internet is not your friend at night because it’s then that its information stacks against you and you cannot interpret it lucidly: all the symptoms of malaria are your son’s symptoms, mainly because his body is entirely a fry pan. When you tell yourself that the incubation period for malaria barely overlaps with your length of stay, meaning he’d have had to have been bitten right off the plane by a mosquito with a strain of the disease that he’s not already covered by with the malaria pills your wife makes him takes religiously, full blown malaria is still the only explanation for the way he shakes in the bed.

Unless you turn to the Japanese encephalitis page, the one disease you didn’t get inoculated for, though a local doctor recommended it. If you turn to that page, you’re sure he’ll be dead by morning, and by a slow, tortured destruction of his nervous system. Even when the self-same internet page says that the odds of getting it are one in a million, all that matters instead is that the places to get it are among the rice paddies and farm animals, with fat sows trailing suckling pigs among bamboo fences and mud roads, all of which you saw the self-same evening your son came down with the fever that won’t let him go despite the west’s best over-the-counter children’s medicine.

As the night drags on and you can’t stop the cycle of paranoia and you keep getting up to check your son’s forehead and its unchanged, you think back on the ten days behind you and wonder if it’s been worth it; you look ahead to two more weeks that seem interminable, that seem like a prison sentence in a country not your own with oppressive heat and wild traffic and dangerous foods and massive poverty.

When your son wakes and begins asking things like, “Do you consider me a tough boy, mom?” you’re sure this is the end. But he’s not done. “I want to be as strong as Uncle Pong and Daddy,” he says. Then he goes Biblical. “You know what I say when I feel this way, ‘Be strong and courageous. Do not be discouraged for the Lord your God is with you where you go,’” and you know that this is the end, that hear you have a child-saint and you’ll go down to the Catholic church of Savannakhet and begin the canonization as soon as funeral arrangements are complete.

The night has now moved from mythical to mystical.

You yourself pray a desperate, I’ll-do-anything prayer, and it feels good to pray that way, cathartic, in the middle of a country where you’ve seen three churches total. You even wonder if the country that your wife fled has become a monster that demands your eldest son in payment for returning. Then you realize this is all entirely your fault for dragging your family to a country you didn’t have to go to, and you curse yourself for tempting fate and blame your son’s death entirely on yourself.

With dawn and a few hours—you can’t tell how many—of tortured sleep behind you, your son’s fever has turned to uncontrollable shivering, another symptom you read in the night, and when your wife suggests you get your sister-in-law the RN you walk immediately down the hall to wake her up. She joins you and asks about symptoms and you convince her that this is malaria and you all decide you must go to the hospital and when your son starts talking his visionary talk, she too gets weepy.

Now Grandma and Grandma’s friend come in and the consultation continues; Grandma calls another relative who’s a Lao nurse and who will come and take him to the hospital.

***

It’s 6:59 when you’re all in the Lao nurse’s pickup and you drive through streets that are largely empty, down a thoroughfare that runs two blocks off the Mekong. The world is forming in the light around you, now, and some of the night’s paranoia is melting away, but now you face dealing with a medical institution you know nothing of and distrust deeply simply because it must be primitive. On your right you see one of the nicest buildings you’ve seen in Savannakhet and hope it’s the hospital but it’s a government building with a fancy picture of a former president with a couple of flags, one of which you recognize as the international symbol for communism, and you are not heartened.

Soon you pull up to an extended building which fits well enough your view of what a hospital should be. The warm red stone arch looks professional enough, and the building’s white concrete framework is warmed by yellow walls that look professional enough. The parking lot is cramped, however, and you’re sure this means a wait akin to Soviet bread lines. You carry your son, beings as this is crisis mode, and you must wade through the humidity up tiled steps that are dingy blue. At reception you have not reached air conditioning and some young receptionists direct you to another building: pediatrics. You wind your way around buildings, following your Lao nurse-friend who’s dressed formally in a type of native sin and, briefly, you wonder why but not for long.

Up a flight of stairs a young woman who is a nurse or receptionist takes you almost immediately back into an exam room where there’s a scale and a table. She weighs your son, puts a mercurial thermometer under your son’s arm, and asks about his name and age. Suddenly an older women, her graying hair done up formally in a bun, comes in the room, she’s got a stethoscope and you realize this is the doctor. She listens to his heart, asks some questions about how long he’s been here, what we’ve been doing, when the symptoms started. She has him stick out his tongue, which is white; he’s been complaining of cold sores since we’ve got here, and this seems the key to everything for the doctor. Though he doesn’t have a sore throat or overly swollen glands, there’s an infection here, she’s sure, and writes us a prescription. Someone asks about malaria; she says this isn’t malaria, not severe enough, and that western children are so well inoculated, there’s little to be concerned about, but if we want to get a blood test, she’s amenable to it.

I’m so assured by this grandmotherly presence that my mental ship seems instantly righted, and I feel sure we don’t need a blood test, feel embarrassed that we paranoid westerners have come here seeking one, but my sister-in-law nurse reminds me that this is what we came here for.

Back in the first building, we grab a sterile plastic syringe in a bag and take it up a flight of stairs where we find the phlebotomist who looks surprised to see us in a sort of open cubicle. Carrying what looks like two old metal tea pots, he takes us to an open area and seats us at a dirty table with wooden benches. When he ties off my son’s bicep with a rubber band and begins swabbing his arm, Micah tightens up. I try to encourage him by reminding him of the “strong and courageous” line and tell him to look away. He settles enough for the phlebotomist to be successful on the first try, who in a moment he disappears with the vial.

We wait ten minutes, then the Lao nurse seeks out the results. When she returns ten minutes later, she and grandma seek out the doctor to read it; I send the American nurse along with them to make sure I get an English translation of events. When they return, they have a printout that is entirely recognizable with categories such as RBC, WBC, and HGB; the American nurse looks through them, all of them reassuringly normal with WBC “a little elevated”; there’s the infection.

All that’s left to do is get prescriptions at a window in the first building, but now there’s some debate: the first prescription, we’re told is the Lao version of Tylenol; the second is Amoxicillin, but we’ve already got Z-Pac along, a short, powerful dose of antibiotic we were directed to bring along in case of emergency, and the question is whether we can allow one antibiotic to stand in for another. Collectively, the two nurses and one physical therapist decide we can, so we pick up several packets of something like pedialyte to try to ensure our kids are getting enough fluids and electrolytes.

This feels entirely recognizable, entirely familiar, and reassuring in the way that a scientific worldview is reassuring: by taking you through a baseline process—hypothesis, experiment, and computer printout with recognizable terms from a larger medical community that I trust are accurate enough to ensure that what is wrong with my son can be taken care of with the magic pills we’ve taken along.

We leave the hospital in under an hour, out 43,000 kip for the doctor’s visit and blood test: about $5.33. Suddenly, Lao medicine seems more progressive than what I’m used to.

But what’s truly comic is my western paranoia, the feeling of homesickness that becomes overwhelming in a hotel room in a foreign country when one of my children is sick, and the fact that we already carry all the drugs we need in our backpack. And yet at the merest sign that our layers of insurance aren’t working, I’m ready to pack up and head back home, distrustful of medical professionals in Laos and feeling a different reality press in on me.

Perhaps that’s the most valuable thing here: for a good portion of the world, when a fever presses in on a child that you can do nothing about, when there is no help, when your reality changes forever by loss, you realize that you inhabit a world that is not friendly, that is not safe, that you are powerless in the face of. It’s no wonder that fate predominates in most places in the world, while self-will carries the day in the west. 

Still, I'm thankful for medicine the world over, for people who care and can use their knowledge for healing and blessing.  In the dark of night, I’m glad for my son’s scriptural reassurance and for the ability to cry out in fear and anxiety to a God whom I know heard my cry, even if he chuckled, perhaps, at what in the light of day looks a lot like paranoia.  That's also a major difference:  the light of day.