Tuesday, September 15, 2015

April 27, 2015 - Farewell to Uganda

A feeling of sad melancholy came over me and my eyes teared up as I looked out the window of a small Lear jet and saw a cluster of round huts with thatched roofs fade into the distance until they eventually disappeared beneath a layer of clouds. I couldn’t believe I was leaving Uganda this way. I felt fine. I was supposed to speak in church in just a few minutes. I didn’t want to leave a place and the people I loved after just 6 weeks. It couldn’t be…but it was!

 Our last views of Africa
April 27, 2015 - The Heart Attack & Our last day in Gulu

I woke up about 5 am on Sunday, April 27, 2015 with a severe pain in my sternum; or at least I thought it was my sternum. I thought it was the worst indigestion I’d ever experienced, but “if I just lay still it will go away” I thought. But it didn't go away, so I thought, “If I just sit up it’ll go away,” but it didn't. For the first time I thought just maybe I was having a heart attack.

But it didn’t feel like a heart attack; or at least what I thought a heart attack should feel like. I didn’t feel like bands were tightening around my chest so I couldn’t breathe. My left arm felt perfectly fine. I wasn’t sweating. I didn’t have any of the symptoms I thought I would have if it were a heart attack. It was not at all what I thought a heart attack would feel like. Not at the moment anyway. But just to be safe I thought I would call Elder Chabra, our mission medical director in Kampala.

Elder Chabra has the calmest way of dealing with patients and I had worked with him to help some of the young Elders who lived across from us with their medical ailments like boils and such. He never presented a sense of alarm when you talked to him and he was very reassuring. But I could tell from the tone of his voice that morning that whatever was happening was serious. When I told him my symptoms he just said, “Oh boy” in a tone that let me know he was concerned. Then he calmly asked, “Do you have any aspirin?” We did, so he said “Well take an aspirin and I’ll call back in 15 minutes” as calmly as if I just had a headache.


About that time I started to notice a tingling in my left arm and numbness in my hand. My legs started to feel shaky and I was sweating profusely. When Dr. Chabra called back and when the pain had not subsided he said, "You're having a heart attack and you need to get to the hospital right away. They won't know what to do when you get there so call me and I will tell them what to do."

Our house in Gulu. Eight Missionaries lived 50 feet from us in 2 similar houses.

With that I told Eileen to wake up the missionaries in our compound and tell them to come with oil to give me a blessing. Next I heard Eileen pounding so loudly on the metal door of the Elder’s houses. “What is taking so long?” I wondered as I wiped my face with a dirty shirt I grabbed from the laundry basket. My arm was growing more numb and I wasn’t sure my legs would get me to the missionaries’ truck. But soon I was surrounded by 8 young elders who prepared to give me a blessing.

Elder Barret, who was in his first area and fresh out of the Missionary Training Center did the anointing and his companion, Elder Lechiniment; who was be going home on the next transfer gave  the blessing. Oddly enough I never felt any fear and the thought that I might die never crossed my mind. I remember very clearly that he said I would “be able to return and finish the mission.” That was good enough for me! I never once thought my life was in peril. I had complete faith that a plane would arrive in the morning and take me to South Africa as planned. As the Elders left our house I could feel advancing numbness in my left arm and jaw. My legs were also becoming very shaky.

As I walked to the Zone Leaders' truck I wasn’t sure my legs would carry me the 30 feet or so that I had to cross  to reach the door of the vehicle.. By now my left arm was completely numb and my legs felt very wobbly. But I made it and when I pulled myself inside I said to Elder Wolfenstein, “Gulu Independent Hospital” and off we went.

We got to the hospital and the entry gate was closed. Elder Nyony jumped out; went through the unoccupied guard house; opened the gate and we drove in. He and Wolf found an old wheelchair and wheeled me into the Emergency Room. But it was Sunday. There was no doctor there. As luck would have it though, one doctor appeared on the scene. He was not scheduled to work but lucky for me his wife was having a baby at that same hour so he was there.

As Elder Chabra predicted, the doc didn't know what to for me. Yet even though Dr. Chabra is a Urologist he new exactly what to do and told the African doc exactly what to do over the phone---“Get 2 nitroglycerin tablets and administer them sublingually (miraculously the pain left immediately). Give him oxygen NOW. Do an ECG and tell me what the results are. Monitor his vitals and don't leave him alone.” There were probably some other things but as far as I was concerned the horrific pain stopped and that was my main concern. The numbness left my arm and I started to feel very normal. No pain. No fever. No vomiting. I felt fine! I wanted to go home and get ready to give my talk in church.

It wasn't long after that that I received a phone call from a Dr. Bruce Barton from South Africa. He told me I was going to be life flighted to South Africa for surgery. Bruce is the Area Medical Director over 23 African countries and he started asking questions. "Is there an airport in Gulu?" "Yes." "Is it a dirt runway or tarmac?" "I don't know." "Ok, I'll call you back." Surprisingly, after the pain stopped and I felt perfectly fine I thought we should just go back to our house. I was actually slightly embarrassed to have caused so much trouble.  I had no idea how serious this was.

There were phone calls back and forth between Gulu, Kampala and Johannesburg all day as Bruce worked to set up the life flight for early the next morning. Did the airport have a dirt runway or tarmac? Would international law require 3 pilots or just two? Was there an ambulance that could be standing by to get me from the hospital to the airport? Were there volunteer pilots, a doctor and nurse ready to go that night? 

I stayed in the ICU all night. I knew it must be the ICU because the large room with 3 antiquated hospital beds, a part of a baby incubator, a couple of oxygen machines and 1 old monitor for vital signs had a key in the door with a cardboard tag on it with letters in ball point pen, "ICU."

They put me on the newest of the old beds which I was grateful for, though I was a little disturbed by the dried blood on the sheet, presumably from the last occupant. But beggars can't be choosers I guess. Meantime my wife was sent home and instructed to pack all of our stuff and be ready to leave for South Africa by 7:30 am the next morning. We could only bring 14 kilograms on the flight and it was uncertain whether she would be flying with me or on a commercial flight the next day. Everything depended on how much fuel the plane would need to make the trip, how many pilots were required by international law and how much space there was in the plane. It was a stressful day for her for sure, having to get ready to leave; wanting to be at the hospital, never sure of my condition, having limited phone contact with each other, changing plans in the flight status through the day and night, etc.
Kickin' back in the ICU at Gulu Independent Hospital
I felt fine the entire day which was good because the level of care in the Intensive Care Unit was neither caring or intensive. At one point I felt the chest pain returning and a nurse came and gave me another nitroglycerin tablet. I last saw the doctor about noon after his baby was delivered. I asked him what all the numbers meant on the machines and he told me. That info came in handy that night as that was the extent of my care for the day. It didn't matter too much because I had people with me all day and evening. Five friends came to see me from the Gulu Branch. That was very nice. I appreciated them because I could see their clothes were damp from walking in the rain. It rained all afternoon and nobody goes on the street in the rain. In the evening Elder Oliphant from Zimbabwe was with me and he told me that Uganda was very backward compared to his country. But from 10 pm until 5:30 a.m. as far as I could tell I was the only person in the entire building.
Friends who walked in the rain to see me in the hospital
About 11 pm I noticed things were very quiet in the hospital and I hadn't seen a staff person for a few hours. I got curious so I unhooked myself from all the machines and went exploring. All the lights were on but I couldn’t find another soul in the entire building. Not a doctor, a nurse, a house keeper or anything. As far as I could tell I was all alone. I got a little scared so I started watching the machines much closer. 
Since I was now my own physician/nurse/whatever, I monitored my own vitals. I was a little scared so I was watching the machines much closer now My blood pressure was always in the normal range but my pulse became erratic and started dropping quickly. I was worried  but wasn't sure what to do. When my pulse got down to 49 beats/minute an alarm went off on the monitor but nobody came to my aid because nobody was there. My pulse kept dropping and I figured that 0 would be a very bad number to have so I had better do something. So I started slowly waving my arm as I laid on my side. Every time I raised my arm my pulse rate increased 1 beat per minute. So I continued to slowly raise and lower my arm until the rate got up to 60 bpm. When I stopped moving the red number in front of me would immediately start dropping..59, 58, 57, etc. about 1 number every 5 seconds.  I watched the monitor until the rate got down to 50 and I’d do the same thing again. After about 3 hours of this my pulse stabilized and I felt fine again.

When I had to go to the bathroom I just shut the machines off, disconnected myself and went to the closest restroom to the ICU. In fact I was just headed back to the ICU when the life flight crew arrived in their blue jump suits and carrying all sorts of equipment under their arms. I said, "You must be the life flight team." They were shocked and said, "Are you the patient? What are you doing up walking around?" "I had to go to the bathroom" I told them.

The Flight to South Africa--In just minutes they had me back on my back, hooked up to their ECG machine, a saline drip, checking my vitals, etc. After doing all of that they put me on a stretcher and wheeled me to an old beat up old ambulance and we headed for the airport. I remember the flight nurse taking one look at the vehicle and asking, “Is this the ambulance?” with a tone of surprise. And just before we left the Dr. made an executive decision----Eileen would fly with me, even though it meant he had to sit on an uncomfortable jump seat for the entire 7 hour flight.
Volunteer Doctor sits on a jump seat behind me for 7 hours
The flying hospital was pretty crowded.

I had tears in my eyes as the plane gained elevation and I knew I was leaving a place I had come to love behind. We landed briefly in Entebbe to refuel the jet and for Eileen to take care of passport control and customs. By the afternoon I was safely in Johannesburg where I was loaded into a modern ambulance and taken to Milpark Hospital with its world famous cardiac unit.

I was taken to a world class hospital for cardiac care

The Ugly Nurse--I wish I could say I passed the night comfortably at Milpark waiting for an angiogram early on the morning of April 29, but nothing could be further from the truth. I was placed in the “theater” which was a big ward with 10 beds. Each bed had a nurse covering each patient with a chair and table at the foot of each bed. Every nurse had a huge sheet of paper to use for charting. All of the nurses were black and all of the patients were white, which seemed very odd. But I learned that apartheid is not completely dead in South Africa.

I had not urinated since before the flight team arrived in Gulu but nobody seemed to notice or care. Eventually I started to become uncomfortable. I asked for a urinal and my grumpy nurse brought me a big plastic bedpan. I tried to sit on it but I honestly don’t know how people can use those things so I set it aside and asked for a urinal. “Just relax” the nurse says. “But I have to pee.” She gives me some pain medication and goes back to doing nothing. By now I am in pain and ask for a urinal again. “Just relax, you’ll be fine.” “I can’t relax I have to pee.” I am watching the clock and it’s 10 pm. I last urinated about 9 a.m. in Gulu. I try to relax but before long I am writhing in pain and never taking my eyes off the clock figuring the angiogram will probably be about 7 a.m. About 11:00 I ask again for a urinal and tell the nurse I haven’t had my prostate medication for two days. Reluctantly she brings me a urinal but by then I can’t get more than a few drops out and the pain gets worse.

The nurse leaves my bedside and goes to another part of the room to chit chat with another nurse. She plants herself there and turns her back to me. I am thinking all sorts of bad thoughts about this woman as she ignores me completely.

By this time most of the patients in the theater are looking at me and the young nurses and the patients are concerned, but my nurse just gives me a couple more pills and keeps saying “Just relax.” I can’t figure this out. Is she doing this because I’m white and she can? I start to have all sorts of racist questions go through my mind because I am wondering if there is some cultural thing going on that I don’t understand? Why is she torturing me.

About 1 a.m. as I am writhing and groaning in pain, Patrick in the bed across from me is becoming increasingly upset because the nurse left me alone for about half an hour when she went to that side table and just chatted with the other nurse while I suffered. When she finally came back to my bed Patrick blurts out, “Why don’t you do something to help him?” At last I had an ally.

The nurse turned and looked at Patrick who was a heart patient from Rwanda. She turned at looked at him. Then without a word she went somewhere. When she came back she had a syringe which she stuck into my I.V. line and injected some form of liquid into it. “This will help you relax” was all she said and walked away. Almost immediately I could see she was right. My pain subsided and I started to relax. Then I quickly position my plastic urinal and wonder of wonders, miracle of miracles, I started to pee! I am so relieved! Liquid just flowed continuously into the bottle and before long I did relax and fell asleep. When I awoke I was being taken for my angiogram. My big ugly nurse was gone and my night of torture was over, but unfortunately because of her lack of concern I now had a distended bladder which caused me problems later on. But right then I didn’t care and I fell back to sleep as they wheeled me away.
Meeting My Doctor--The next time I woke up the angiogram was over and my cardio thoracic surgeon was standing by my bed. Dr. Essop was his name and I liked him right off. He told me what happened with the angiogram and asked if I wanted to see my heart. I still felt no pain, no fever, etc. so when he put the sonogram thing on my chest I expected to see a perfectly normal heart. What a surprise!

I could see the heart plainly and it was obvious I had a major problem. The lower chamber was expanding and contracting normally at a pretty good clip. But the upper chamber was moving about half the speed and looked like a bear lumbering through the woods. Then he told me I would need double bypass surgery. Because I was already on a blood thinner he told Eileen it would be messy but he could do it.

That’s all I remember until I woke up in the recovery room. I was groggy and when I looked down I saw 5 tubes coming out of my body and I noticed I had another tube down my throat. But I didn’t care because I didn’t have to pee and ugly nurse was nowhere around. I went straight back to sleep and slept all that day and most of the next I think. At least I don’t remember anything.
I pretty much just slept the first days after surgery.

The next thing I remember is seeing Dr. Essop in my room with two nurses. He said, “They’re going to remove the tube from your throat and the drains from your lungs and the one from your heart. I looked again at the tubes coming out of my chest and side. Not a pretty sight. But I wasn’t in pain.

As they removed the tube from my throat I wanted to remember what that was like because I couldn’t really swallow but it wasn’t irritating. As one nurse started to remove the tube I could feel it coming out, all the way from my stomach, up through my chest and finally out of my mouth. It felt like it must be caked with crud so I kept my eyes closed the whole time. I didn’t want to see it.

The drains came out very smoothly. Then I drifted off to sleep again.

Discharged at last--After 6 days I was discharged to stay at the Barton’s flat. I was so glad to get out of the hospital though I was still very weak and slept most of the time. But less than 24 hours later the hospital called Dr. Barton to tell him my blood test showed I had an infection that could only be treated intravenously and to get me back to the hospital immediately. And in less than an hour a missionary couple picked Eileen and I up and took me back to Milpark for 6 of the most boring days one can imagine. They said it was too risky to treat me as an outpatient so I stayed there and tried to endure the most awful food imaginable. Eileen and I would go down to the coffee shop and get a milk shake or piece of cake that was delicious. Every day when they brought the menu I checked the same items each day, which were the few things edible---scrambled eggs, oatmeal, juice, yogurt, rice.
Too weak to walk much but being outside was nice.  
With the help of other senior missionaries Eileen got to do a few fun things.
Eileen in front of the Johannesburg Temple
The Phone Call--I was discharged on a Friday. On Saturday I got a call from Dr. Barton. “You’ll be going home tomorrow or Monday at the latest. You’ll be getting a call from Elder Egan who is arranging your flight.” I was stunned. Just the thought of having to fly such a distance in the condition I was in was overwhelming. I had walked around the block but had to rest half way. I wasn’t excited. Soon Elder Egan called, “I have your itinerary ready. You’ll be leaving tomorrow and will fly to Joplin, Missouri. “We can’t fly to Joplin, our house is rented out in Kansas. We have to fly to San Antonio to stay with our son,” I came back. “I’ll call you back,” he said and hung up. A few hours later he called with the revised itinerary. We would leave Sunday night. I was not physically ready to make the trip and neither of us was emotionally ready to leave Africa. But we had no choice and no control over anything once again.

The Trip Home--We arrived at the airport in plenty of time for our flight but had to get all of our belongings through security and to our gate which was a very long ways away. It was all I could do to make the distance, trying to walk, wheel a carry on back and carry my computer bag. By the time we got to our gate I was completely worn out. We hadn’t even found a seat when we heard on the loudspeaker, “Would passenger Ferguson please come to the counter?” We thought for sure there was some sort of big problem. As we approached the counter the agent said, “Dr. Barton just called and he has upgraded your tickets to first class.” That was such a relief because the first leg of our flight was 16 hours from Johannesburg, South Africa to Atlanta. Just the thought of flying in coach with other people in the same row, crawling over me to get to the bathroom sapped my energy. As it was we both had nice seats that folded back into a bed and nobody would be crawling over anyone to get to the lavatory. I was able to sleep much of the way and watch movies in reasonable comfort. We requested wheelchairs a wheelchair for me in Atlanta and Dallas which made the transfer and flight much easier.

I was so happy to get to San Antonio but I was exhausted. I went straight to bed and slept for 12 hours. The next day I started my slow and painful recovery period.

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