i spent the afternoon in the ER of ethiopia’s largest public hospital, teaching, learning in equal measure. the last hours, i leaned my elbow on the nursing station, and watched blood drip.
drop. drop. drop.
i learned to watch in sudan, where the wind was so hot, blood would clot in the tube before it could drain into a person’s arm. today, it rolled in a line towards a young, shaking man even with his black skin, he was pale as a ghost. that’s where the saying comes from, i’m sure. not some gauzy vision of a spectre at the top of the stairs, but the pale lips of the newly dead.
drop. drop. drooop.
a drip dangled. i walked to his bed, rolled the tube between my fingers, took a syringe and flushed the iv. it flowed again. his mother nodded.
the students and nurses were busy with other things. a little girl, 14, from days away, vibrated at 160 beats per minute. with each throb of her overlarge heart, her whole body quivered. you could see her shake from across the room. a few beds over, a man bitten by a dog one month earlier, foamed. despite being dehydrated, he gagged when we offered a bottle of water, pushed it away. hydrophobia. rabies. fatal. to my left, a woman sagged in a chair. she saw me notice her, half-smiled, let her eyes roll back into her head until they were only whites. maybe she thought she was saved. i checked her heart rate. normal. i moved back to the desk.
a young doctor, an american, in addis for a month to learn how to do this type of medicine, where minutes matter and you’ve none of the stuff, joined me, surveyed the people circling to the sick.
“how the hell do you know when to leave?” she muttered under her breath, then joined me in watching the drips.
teaching is not delivering held knowledge to a student for whom it is new. It is showing her to fall fully into questions that have no bottom, that point at a truth to which you can never fully arrive, that always live just there, forever shifting, beyond your finger.
how do you help others without hurting yourself?
that was her question. mine too. i don’t have the full answer, but i know how to start. you hurt yourself, and don’t help others. try to care for people, before you learn to care for yourself, figure you’ll learn it along the way, that if you save someone, maybe you’ll get saved too. you go through the motions for a couple of years, but in the end, you get beaten down, touch burnout, or worse, bitterness.
then, somehow, grace. you find the right teacher, the right question to ask, and you learn that first, to help others, you must help yourself. not to the last piece of pie, but on a deeper level. then you see that helping others and hurting yourself is as flawed an equation as trying to help others while robbing them blind. you understand that you’re part of a process that wants you, as much as anyone, to be whole.
something gathers us together, repairs us as we are pulled apart, binds us together and to all living things. you can call it soul, or god, or nature, but there’s no separate piece, just infinite, peripheralized shifting shapes spread among the stars and made of them, pushing fearlessly, inexorably towards some new place of previously unfound release, like plants from bright black soil, reaching as far we can.
in the deep questions about how to do that, we taste freedom. so too in the deep practice of pursing the deliverance of another person’s suffering as ardently as our own. i’m not sure it’s a law, like gravity, or just a rule that gives me a way to live, but it seems to me that none of us can fully abide in that peace until all of us arrive. why would you want to be there all alone anyway? what kind of celebration is that?
the drips stopped. the blood was done. a nurse went to find a second unit. the ER was quieter. many of the young doctors had gone home, most of the family members, save for those with the sickest patients. nurses moved from bed to bed, doing their endless work, patching up the broken, bleeding bits of humanity that wash through places like this.
a second unit came. i showed a nurse to watch the drops when she could, told the night duty doctor i would call in a couple of hours.
“let’s go,” i said to the american. together we walked down the hill, quiet, thoughtful, wondering if that boy would live the night, whether staying through the second unit would help, but we needed to eat, and we needed to sleep, because tomorrow would be full too, and the tomorrow after that. (read more)
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James Maskalyk is an emergency doctor at an inner-city hospital, and an award winning teacher at the University of Toronto where he directs a program that works with Ethiopian partners to train East Africa’s first emergency physicians. He has worked for Medecins Sans Frontieres/Doctors Without Borders as both a journalist and physician. He was their first official blogger, and from it, published the international bestseller “Six Months in Sudan.” He is working on his second book. Meet James at Wanderlust Whistler for his Speakeasy “How to Help Others Without Hurting Yourself.“