An Emergency

It was late May, and I planned to resupply, attend some meetings, and see what equipment and medicines we could access from USAID (they were still here continuing emergency assessments, looking at proposals, and arranging for distribution of medical supplies they had brought), as well as UNICEF and WHO. Almost immediately after returning to Kuwait City, I just didn’t feel well. A day or so later, I developed a fever, nausea, and abdominal pain, all signs of appendicitis. Although I had gone to the US embassy when I’d first arrived in Kuwait with the express purpose of developing an expat medical plan and had in fact created a list of satisfactory doctors, clinics, and hospitals, I wasn’t sure if I had insurance to cover any of it. Meanwhile, I attended the meetings, arranged for supplies, wrote reports, and wished whatever this was would go away. After two full days, when I couldn’t stand the pain and discomfort anymore, I quietly told Adam that I was going to the clinic “to be checked” before heading back to Iraq. He was busy and involved in mounds of work and barely heard me as I left the office.

I went to the clinic I’d chosen as part of my expat plan. “How much will it cost to see a surgeon?” I asked the receptionist.

“A surgeon? Cash?”

I nodded. The cost would be fifteen Kuwaiti dinars, about forty-five US dollars, not bad at all, but it would take most of my money.

I waited for only a few minutes before I was ushered into the surgeon’s office.

“What seems to be the problem?” he asked.

I told him that I believed I had appendicitis.

He raised his eyebrows and said, “Really?”

I told him about my background and my job here and just why I thought I had this. He examined my tense and tender abdomen and wanted to do some tests to confirm the diagnosis.

I asked him for the prices of the tests and said I wasn’t sure I could afford all of them. We negotiated the tests I’d have. He wanted liver function tests, and I said no; I agreed to a white blood count (to check for the degree of infection) and electrolytes (to determine my overall condition); he wanted to order a gallbladder study, and I said no, just an ultrasound. All in all, considering how I was directing my own care, he was very reasonable and very kind to me.

The tests confirmed the appendicitis, and he said, “We must admit you right away.”

I told him I wasn’t sure about insurance and that without it, I couldn’t pay for surgery. I told him I had to return to the IRC office and talk to Adam, and then I would come back.

The doctor, a middle-aged Syrian man with a soft voice and gentle manner, was reluctant to let me leave; he wasn’t sure I would return, and he didn’t want to let me go. “You must promise to return, otherwise, well . . .” He stroked his beard and bobbed his head. “Well, you know.”

I promised that I would return. He said he would take me to surgery that evening. I made him promise that if I felt fine after surgery, he would release me. I was sure that I would not need to stay in the hospital, that I would be fine and ready to leave right after surgery, and leaving would save money.

The surgeon smiled. He seemed to think otherwise.

I returned to the hotel and went to the IRC office, which was also Adam’s room. I walked in and sat down, resting my hands and my gaze on my lap. Adam looked up, his brow wrinkled. “What’s wrong?” he asked.

All of my control over the last days broke down and I started to cry, my shoulders shaking, my nose running, my fingers twitching. Adam came around his desk and knelt in front of me, taking my hands in his. “Tell me what it is. Please.”

In between my sobs, I told him. “I have appendicitis and need surgery and I have no money to pay for it.”

He smiled, his eyes dancing with relief. “Love, you have insurance with IRC. What’s all this fuss?” His smooth Australian accent made his words that much sweeter.

The sense of relief was overwhelming. I started to smile and then laugh, but that made the pain worse, which made me cry all the more. I wiped my nose, my eyes, and my mouth on my sleeve as Adam patiently explained that he would take care of it all. He would call the IRC office in New York—we were seven or eight hours ahead of them, so the office wasn’t open yet—and he would take care of everything.

“First,” he said, “we’ll get you back to the hospital. Tell me who you want New York to notify at home.”

“No one,” I said, my voice firm. I didn’t think it would be fair for my family, my sister, my friends, to know that I was undergoing emergency surgery in a place they still believed was backward and dirty. New York was understandably eager to notify someone. I understood how it was for them, but I couldn’t bear for my family to sit anxiously and helplessly so far away and imagine the worst. I promised Adam and New York that I would call home after surgery.

I reassured Adam that I would be okay, that there was nothing for him to do at the hospital, and that I would have the doctor call him. I returned alone to the hospital, where I was admitted and sedated and given intravenous antibiotics. I slept for the first time in days. Through a haze, I heard someone say that Adam was calling. The doctor spoke to him, and later I was transferred to the main hospital for surgery. I didn’t get to see much of the hospital, but it seemed clean and modern to my drugged eyes.

The nurses took my jewelry, but I wouldn’t let them take the metal cuff bracelet that had been given to me in Afghanistan almost one year earlier. I had promised never to remove it. The nurses were determined to get it off, but I told them it didn’t come off. Finally they relented and covered it with gauze and tape. They took my clothes and gave me a paper hospital gown. I hadn’t a smidge of dignity left, but by then I didn’t care.

I was given another sedative and wheeled into the operating room. I hadn’t seen the surgeon in several hours, so I was relieved to see him lean over and reassure me that I would be fine. “Hello, hello, my dear. Everything will be alright,” he said.

The anesthesiologist came in, and I heard him, through my heavy haze of drugs, order anesthesia doses that I thought were far too much for someone my size. An oxygen mask was placed over my face; I tried to remove it, but my wrists had been secured.

I tried to speak, to say, “No, that dose is too high for me.” I wanted to say, “Take off the sheet, see for yourself.” But I couldn’t get the words out; I didn’t feel panicked or afraid, and that is the last thing I remember.

Next thing I knew, someone was waking me, and I felt like hell. I was in pain, I was vomiting, my head felt as though it would explode, and they were making me move from the OR stretcher to a bed. I had been wheeled to a room where Jen was waiting for me. I had never felt worse in my life, and I told her she should just go back to the hotel. All I wanted was pain medicine and something to stop the vomiting. God, I had never been so sick.

I was in a bed, but I slept fitfully; I was tangled up in the IV (intravenous) tubing, my paper gown was torn, my skin was stuck to the plastic sheet I was lying on, I was vomiting into a small basin, the room was pitch black, I was alone, and for the second time that day, I cried, but softly this time and only to myself. Although there were nurses here, in this part of the world, family members were expected to stay and take care of the patient; I had sent Jen home, so I was on my own. In the middle of the night, I had to pee desperately. I was unable to sit upright, so I slid sideways out of bed and literally crawled to the bathroom, dragging my IV pole.

For the first time in my life, I was grateful for a squat latrine toilet; there was no way I could get myself fully upright to sit. I was not grateful though for the lack of towels, soap, and even paper towels. (I learned the next day that families were expected to provide those.) I crawled back to bed and slowed down the rate of my IV (which would slow the rate at which fluids were delivered to my bloodstream and kidneys and would decrease urination) so I wouldn’t have to go through that miserable ordeal again.

The next morning, the surgeon returned on rounds and gave me a knowing smile as he asked how I felt. I had been vomiting all night; I was sweaty and still stuck to the sheets. I was in pain from my head to my abdomen, which throbbed with every move I made.

“Never felt better,” I said. “When can I leave?”

He looked very serious as he reminded me that I still required IV hydration and medicines, not to mention that I would have to stop vomiting and actually eat before discharge would even be considered. I could try drinking water later, he said, if my vomiting had stopped. He increased the IV drip rate before leaving my room.

The nursing staff here didn’t come around in the morning with fresh towels and soap and clean hospital gowns. I had no family here to do that, so I asked for a bar of soap and paper towels and crawled back to the bathroom to try to wash up. Doubled over, trying to use the soap and then dry off with paper towels was too much work to ever be worth it. I peered at the mirror and was startled by my own reflection, my greasy, slicked-down hair, my ghostly-pale, shiny skin, and the bruises on my face, probably from intubation, I assumed, and the array of bruises covering my arms, abdomen, and hips. Surgery sure was rough business in Kuwait. I crawled back to bed, no longer caring that I was dirty; it was too hard to get clean here.

Later in the morning, Jen returned, laptop in hand, to spend the day by my side. I hadn’t even known her just a few weeks earlier, and already she’d been a loyal friend. How could I ever thank her? Well, for starters, I knew she had work to do before she left for New York the following day, and although she professed that she could get it done sitting here next to me, the truth of it was she couldn’t, and so once again, sadly, I told her that it really was okay to go. She brought me flowers and arranged them in a tall glass of water. “From IRC,” she said as she kissed my sweaty brow and wished me a swift recovery.

I slept fitfully through the morning, buzzed the nurses to say that I hadn’t vomited, and asked for a pitcher of water. I drank small sips; I dreaded the thought of dragging myself to the bathroom again.

Adam came in later, smiling. “God, I hate hospitals,” he said, passing me a small package wrapped in old newspaper. I slipped my finger under the corner and began to unwrap it. “I’m really awful at presents, but I wanted to get you something,” he said as I pulled the paper away.

He was grinning proudly, his fingers restlessly tapping the bedside table. It was the first time I’d seen him without a cigarette clutched between his fingers and a cup of steaming coffee at his lips.

I pulled off the last of the paper, and there, nestled within, was a line of plastic-wrapped dried fish. I started to laugh just as he began to explain. “I didn’t know what to get, and then I saw these and thought, ‘Ahh protein! Sick people always need protein.’”

That only made me laugh harder, which made the pain worse. He passed me his mobile phone and said, “Call home, I’m going out for a cigarette.”

I called home, shared scant details, and said I was fine.

“So you’ll be coming home?”

That was the first inkling I’d had that anyone might think I should go home; my only thoughts had been about when I could get back to Iraq.

“No,” I answered, “I still have work to do here.”

“They’ll let you stay?”

“Sure, I’m fine.” I was anxious to end the conversation. “Tell everyone I’m fine and I’ll call soon, okay?” I hung up and waited for Adam to return.

He walked in, more relaxed but now reeking of smoke. “All set?” he asked.

“I think I can leave here later today or tomorrow if all goes well. When are we going back to Iraq?”

“Even if you’re discharged from the hospital tomorrow, which I doubt, I don’t know about Iraq. What does the doctor say?”

“That won’t be a problem,” I said.

He raised a brow. “Make sure to ask for a permission to return to work note,” he said. Adam stayed for a bit longer, his fingers fidgeting, eager for another smoke. To his great relief, I said I wanted to rest and he should go back to work. What I wanted was to be alone, to curl up into a sweaty ball and sleep.

Later that day, I told the nurses I was able to drink water and I would try to eat. I assumed my first meal, which would be dinner, would be something light and simple, like broth or Jell-O. Dinnertime came, and an aide arrived with my tray, sliding it onto the small bedside table before leaving. I wiggled around in bed and managed to lift the cover from the tray. There, on a white plastic dinner plate, lay the full carcass of a shiny gray fish, one eye staring up at me. I started to laugh—more protein—and I laughed harder still. My abdomen burned with the pain of it. I finally replaced the tray cover over the still-staring fish and told the nurse later I had eaten. No one questioned me.

I slept on and off, sweating more, my hair matted to my forehead, my skin stuck to the plastic sheet. Occasionally I crawled to the bathroom and then back to bed for another restless night.

Morning dawned and rounds started, but only a junior doctor appeared. I asked about discharge and getting a return to work note. He said I shouldn’t return to work, and certainly not in Iraq. But I was determined to get back there—I had work to finish, programs to implement, a manager to hire, too much to leave undone or hope that someone else would do later. I had worked too hard to let it lie idle or simply languish and be lost in the myriad of other work that was being done. I’d had an appendectomy, not brain surgery. I was going back, but I knew I couldn’t argue the point here.

“Well then,” I said, “how about a back to work note for when I go home?”

“We can manage that,” he replied easily.

The senior doctor came later, and he, too, said that heading back over the border to work in Iraq was out of the question. “Too dirty,” he added for emphasis.

I thought, but never said, that I was plenty dirty here. I said I still needed that back to work note, knowing full well that he wouldn’t write out that I could not return to Iraq. He allowed me to dictate what I needed on the note, no mention of restrictions or comments on where or how I worked. I was discharged later that day. Adam picked me up and deposited me at the rooming house, where I slid into a warm bath and then slept, finally clean, for fourteen hours. I woke refreshed and hungry. I had bread and hot instant coffee for breakfast. Nothing could have tasted better.

Well, maybe pizza and a glass of wine.