Sometimes, I think that I am a bit wimpy, or that I am just seeking attention when I feel sad. I often have to be reminded and assured that I really have been through some rough times, and it is ok to grieve and mourn. I have seen a lot of death the past few years. I have even experienced it myself once, and nearly a second time last month. Everyone in the world goes through cycles of loss and grief, the richest, the poorest, the most religious and the atheist. This is a fallen world, so no one is immune to pain. But Afghanistan seems like a constant season of loss… It never ends.

This entry will be about the last month. I still need to blog about my evacuation and all that happened in India, but that will have to wait for another day.

I woke up on October the 4^th about 2:30 in the morning in terrible pain. I had been working with the Kuchis (a nomadic Pashtun people of Afghanistan and Pakistan), helping them with a sewing project, and as we celebrated the end of the project the week before, I had eaten a rather large bowl of homemade yogurt… they use whatever water they can get for mixing the yogurt, and of course the milk is not pasteurized, so I just thought I had picked up some nasty bug that would take a couple of days to get over. I began taking Xifaxin (an antibiotic that works on in the intestines) and some anti spasmodic medications for pain. Neither really helped, the pain just continued to worsen, and my temperature began to go up and my body began to hurt so badly I didn’t want to move… the pain very much resembled the pain I had just before I became septic two years ago, so I decided I would go to the doctor the next morning. There is a really nice German clinic here, very expensive, but clean and well stocked with a laboratory and different diagnostic machines.

I finally got in to see the doctor, who was a very sweet German lady. She did an abdominal exam and took blood and got a stool sample. When she did the abdominal exam, she said that she feared I probably had appendicitis, but wasn’t sure. I sat in the waiting room for the results and when they came, she said that the blood test didn’t indicate appendicitis, so she wrote a prescription for anti-parasites (which I had tested positive for), and told me to come back the next day to get the results of the test for Typhoid. That evening, I called my friend Dr. Jerry, and he said to not take pain medication just in case my appendix ruptured anyway, so that it wouldn’t mask any symptoms. That was hard. The pain was so bad, that it felt like I had surgery with no pain medication. I couldn’t even touch my side.

The next morning, we got a security alert that the German clinic was being watched, and that the threat was specifically against Americans going to the clinic. We all got together to figure out what to do, and we decided I would go in disguise. I put on a burka, and one of my local drivers from my office got a taxi and pretended to be my brother. We, of course, got lost on the way to the clinic, so we ended up driving for an hour over terrible roads that resembled the moon more than a real road. In the clinic, the doctor took me in right away and told me I had Typhoid and that I should go straight home and sleep, but that I couldn’t start taking the antibiotics until I had finished the parasite medicine (10 days later). (In hindsight, I am so glad that I started right away, or I may have died of infection.) I asked her about the pain in my side and could she please give me something for it, so she gave me an anti-inflammatory. I called Dr. Jerry again that night and he said that he didn’t think I had typhoid… I thought he meant I wasn’t sick enough… what he really meant was that I was too sick… He also told me it was ok to go ahead and start taking the antibiotics, so I did. After a few days, I started to feel a bit better, but still as weak as a kitten.

In the middle of the treatment, we had to move house… very difficult to do on your best day in Afghanistan. Some sweet women from my NGO came and helped me pack up my kitchen and a few other cabinets around the house that I hadn’t gotten to. We got to the new house, and I began to unpack, lifting heavy boxes, trying to get things in order, all the time I still had this pain in my side and was very weak. I would unpack one thing and then have to take a nap. I was starting to feel pretty discouraged and useless, but since I wasn’t as bad as before, I just figured it would take a long time to get over the infection.

People kept telling me I was looking better, I finished the medicine and kept thinking that I must be better, and just still weak. But everytime I looked in the mirror, I saw a weird looking pasty white thing. Finally, one day (two weeks after it had all started) I called Dr. Jerry again and told him I was still just worn out, and still had a terrible pain in my side. So, he said I should come to Cure hospital and get an ultrasound to see what may be going on. I said I would think about it, and maybe go the next day. Because of the moving and having been sick for two weeks, I was really behind and trying to get caught up at work.

At the office that morning, my local coworker kept telling me the pain was just left over because I had been sick for so long, etc… finally one of my foreign coworkers said that she would go to Cure with me that afternoon, and decided she would get herself checked out at the same time. So, we got into the car and took the hour long surface of the Moon road to Cure. By the time we arrived, I was in so much pain that I wanted to just lie down in the road and sleep forever.

I saw the doctor and for the first time, I felt that someone actually realized I was sick. I had a high fever (I didn’t even realize it!), and he had felt a mass in my abdomen. I went through all of the tests again… blood, stool, etc… but this time, I had an ultrasound. My appendix had ruptured, probably two weeks before when I had first felt the pain. The lab guy came out with an amazed look on his face and said “you are really sick, you must have diarrhea. You have SO much bacteria!” Yeah, no kidding…

So the surgeon saw me and said I needed to be admitted right away for IV antibiotics and surgery the next morning. It was a bit overwhelming. I have been in a third world hospital before and I didn’t want to repeat the experience. I talked with Dr. Jerry who told me the American surgeon was out of the country so the Afghan would have to operate on me. It was all so fast, I didn’t know what to do. I sat down and called my mom and all of my bosses from my Ngo and in the States. Then there was this sudden flurry of phone calls about insurance and evacuation and I was hooked up to antibiotics which were making me feel really sick, and I was given a pillow that smelled like the bathroom (which smelled so bad, that I retched every time I went in). It was just a bunch of fiberfill stuffed into a pillowcase. I wish I wasn’t so fastidious, but every time I moved and smelled the pillow, I could only imagine the ick that may be on it, and I retched. I finally asked for someone to bring my pillow from home. Dr. Jerry kept coming in to check on me, and he called another doctor who had seen the Afghan surgeon actually do surgery and said that he was the best in Afghanistan. That wasn’t really that comforting to me, since I had seen so many bad doctors here, it seemed that to be the best here really didn’t take that much effort.

On one side, if I were evacuated, the abscess that held the infection in one place may have ruptured on the plane on the way. On the other hand if something happened after surgery, it would have been much more difficult to move me… I finally gave in and told them all to just make the decision for me.

As soon as I was admitted, my friend, Lizzie, jumped into the car and came to spend the night with me in the hospital. That was such a blessing. I was told this week that I am stoic. I find that funny because I feel so emotional, but I think that I keep it buried sometimes, and I guess I did that with the fear. I was terrified, but I was afraid to tell anyone. I’ve had so many terrible labels put on me in my life and the past few years, it seems the one that stuck was weak and needy. I don’t think that I am either of those, but I was so afraid to appear that way. You know, emergency surgery is just that, you are NOT expecting it, so I had nothing with me, and I was dirty. Thankfully, Lizzie brought me some soap so I was able to take a quick shower that night.

I didn’t sleep much that night. I was still really sick, and in pain, so I mostly just tossed and turned. But since I had gotten sick a couple of weeks before, somehow every night had been full of terribly freaky dreams. That night was no different. The few minutes that I actually did sleep were filled with crazy dreams. It could have been either the fever or the metronidazole (one of the drugs).

The next morning, the surgeon came in and told me he was ready. But the insurance company was still trying to decide on whether to evac me or not, and they needed to talk with him first. It was crazy. Finally I was wheeled out to the OR. Lizzie came as far as they allowed her. I had Dr. Jerrry’s promise that I would be given pain medicine after the surgery, so that helped me face it. But as I saw the OR, my heart froze… It looked, well, not like an American OR. I laid down on the table and the anesthesiologist asked if I had any problems with anesthesia before. I told him nausea and he asked what he should do about that. I told him to give me some phenergan (great for nausea, but also helps pain medication work better). He said he wouldn’t give that to me… I wondered why he even asked… I asked him if he would give me pain medicine when it was over and he said he would give me tramadol, to which I replied that I was allergic, and he said then we will just give you diclofenac (an anti-inflammatory like ibuprofen). As they got me ready, I asked if I could keep my knees bent until they started, because my back hurt, and though he said yes, a nurse came by and grabbed my foot and yanked it out from under me with no warning, which not just hurt my back, but my poor stomach was wrenched as well. The doctor told him to stop so I was able to put my foot back. About that time, Lizzie snuck in and told me that there were two men in the waiting room waiting to put me on a plane to evacuate me as soon as surgery was over. I thought that was crazy and if they were gonna do that, they should just go ahead and take me before the surgery! I am glad that she told me because if I had woken up on a plane, I would have really freaked out!

Finally, the anesthesiologist started giving me sleepy drugs. I have always found surgery to be a bit weird. Suddenly everything is black, then suddenly as if no time had passed, you are awake and in pain. I was in terrible pain! And, I couldn’t breathe. I felt like my throat was swollen and I was in so much pain I couldn’t cough or even try to clear my throat. I felt panicked, and I couldn’t do anything. I tried to tell the doctor and he said I was ok. But I didn’t feel ok. He finally gave me a shot of diclofenac. I don’t know how long I lay there. It felt like an eternity. I was so afraid I would die and it was so painful. When I had sepsis two years before, though I was in a lot of pain and it took a lot of effort to breathe, it wasn’t so scary. I felt like I was just slipping into the arms of God. This time though, I was struggling to breathe and it was so painful. I didn’t know how long it would last, and when I would finally just quit.

At some point, they finally began to wheel me back to my room. Lizzie was right outside of the OR, and she grabbed my hand as soon as she could. All I could do was keep saying, “Jesus help me!” I asked for pain meds, but the anes just said, well you are allergic to Tramadol. I said give me something else, and he said I gave you diclofenac (can I say that is like taking a half a Tylenol for a migraine). When we got to my room, Dr. Jerry was there. I was still struggling to breathe, and he told them to give me some morphine. The Anes said that I didn’t need it because I had already had diclofenac. Jerry said, “she is in pain, give it to her” “She is fine” said the anes, “give her morphine and don’t wait” said Jerry with his arms folded, and as I heard later, with the look of murder on his face. Finally I was given 5 mg. Also the ward doctor told the nurses to give me more anytime I asked for it. I didn’t ask a lot, because… obviously… I have a pretty high pain tolerance. But every time I asked, I had to fight for it. The nurses kept telling me I would get addicted, and I argued that I was a nurse and knew the research, and how most people recover more quickly if their pain is controlled, and that if you are really in pain, you don’t get addicted, etc… finally I stopped arguing and just said that I didn’t care if I got addicted, just give it to me!

Lizzie gave me a washcloth soaked in clean water to breathe through and finally it became a little easier to breathe. Over the next few days, people from all over the NGO community came to stay with me. Though the nurses were all professional, they were all Pashtun men and it was obvious that they liked to touch my soft white skin. They also seems to love giving me shots in my hip… Thankfully, I was never left alone with any of them. I had a huge hole in my right side, with a tube hanging out, and I kept retching and vomiting, but everyone just kept with me! I have been told that people who are receiving chemo therapy get so nauseated that they begin to vomit when they just see the nurse bringing in the IV bag. That is how I became every time the nurse brought in the metronidazole bottle. I would just see it and begin to retch. I ended up taking metronidazole for 25 days in October. I am not sure I will ever be able to take it again. Even when I got home from the hospital, in a mix of our bathroom smelling so bad, taking the metronidazole, and the nasty drainage from my wound, I continued to retch and vomit for about a week. If you have ever had open abdominal surgery, you know how painful that is.

I am now much better, besides a bought of kidney stones last week, my side feels a lot better, though I still have a rash and itchiness from a tape allergy. Also, every place I had a shot of diclofenac, both hips and my left thigh still hurt and all around the sites is numb, I wonder if that will every go away, and my IV sites are still really sore.

But I wonder… just before I went into septic shock, though I had had chills and fever the day before (something you can’t really fake), the head nurse on duty had ordered the other nurses not to check on me. She thought I was crazy and faking… I would have died if a teammate hadn’t come to visit and found me unconscious with a 107 degree fever. This time, I walked around for two weeks white as a sheet, weak as a kitten and in terrible pain, and no one really noticed how bad it was… Am I really that stoic, or do I complain so much that people think I am crying wolf?

Also, last time death seemed so easy, this time it was painful and scary… I don’t think I can do this again…

If I had known how bad it would be waking up, and how hard that first night would be, I would have chosen evacuation. Such wonderful things have happened because I didn’t evacuate, and many of my relationships with local people have grown deeper, because I experienced a little of what they experience. I would like to say that it is so worth it, and that I would do it all over again. But maybe I really am weak and needy. If you told me I would have to do it again… even knowing the good outcomes, I think I would still choose to evacuate.

I’m so sorry.