Dianne Drake - The Doctor's Courageous Bride

“Something like that. He has the right symptoms, especially the paralysis below the waist. But he’s latent.” Latent TB, meaning he tested positive for exposure to the disease but didn’t have the actual disease. “And I couldn’t find any significant case history of Pott’s in latent TB.”

“Well, you’re right about that. You don’t normally see Pott’s in latent,” Solange replied. Then she deferred to Paul. “Sorry. I shouldn’t be stepping in here. I’m just the visitor.”

“The visitor who’s welcome to step in any place, any time she wishes,” Paul said, gesturing for Allain and Solange to follow him to the small, two-bed room where the patient, Agwe Bourg, was snoozing quietly in bed. “We don’t really have any kind of a medical hierarchy here so, by all means, step in, comment, offer opinion, order tests. It’s all welcome.”

“Why do I get the feeling that I’m working?” Solange asked, laughing.

“Because Paul’s like that. He just sneaks it in on you. And watch your pockets, Doctor. He’s been known to pick a few of those on occasion.”

“You left out the part where I make you think it was your idea to have your pockets picked,” Paul added, opening the door and walking straight to the bedside of Agwe Bourg, a man, probably in his mid-thirties, who had a wife and seven children depending on this diagnosis. “So in spite of Mr Bourg’s being latent, why would you suspect Pott’s, Dr Sebastian?” Paul asked, keeping his voice low so not to disturb his patient.

“Like I said, he has the latent diagnosis, which puts him close to the disease. Maybe not right on it, but definitely close. And he does have the other symptoms—paralysis, general malaise.” He drew in a deep breath, then let it out slowly through his mask. “But it’s not Pott’s. At least, that’s my gut instinct.”

Paul nodded, but said nothing, so Allain continued. “He’s in the right age category, though, so that’s not a rule-out.” Often, diseases that were difficult to diagnose were given a final diagnosis by ruling out other conditions and symptoms. Rule out enough factors, then take a good hard look at what was left.

Paul nodded again, looking down at Agwe Bourg. “Fever?”

“Yes,” Allain said.

“Weight loss?”

Allain nodded. “He says he has no appetite, and we haven’t been able to get him to eat a thing.”

“Cold abscess?” Solange asked, pulling up a chair to sit next to Agwe. An abscess, cold to the touch, was almost always present in Pott’s.

“No. I’ve checked him twice, and so far he’s negative for a cold abscess. That doesn’t mean it won’t develop, but Mr Bourg has been ill for a couple of weeks now, according to his wife, so it’s not likely to appear at this point.”

“That’s good,” Solange said, taking hold of Agwe Bourg’s hand. “Standing over a patient, looking down at him, is so impersonal. I like being on their level. It makes for a better rapport.” Gently, she gave the man’s hand a squeeze, then watched as he squeezed back. “Good muscle tone. Good reflexes. Do either of you have a stethoscope?”

Paul pulled one from his pocket and handed it to her. She listened to Agwe’s breath sounds for a moment, then handed the stethoscope back. “Clear lungs.” She looked at Agwe. “Do you have a cough?”

He shrugged to indicate he didn’t understand. So Solange repeated the question in Creole—the language spoken by most of the rurals. On Kijé, the languages were a mixed bag. Broken English, Creole, and, among the uppercrust, French.

“OK, no,” Agwe said.

“Do you think the TB might be going active?” Allain asked, totally captivated by Solange’s gentle bedside manner.

Paul noticed that the younger doctor had barely taken a breath as he watched Solange check Mr Bourg. It was such a subtle lesson she was teaching. One about eliminating the impersonal tone in medical practice and making the patient feel cared for. A chair at the side of the bed, a squeeze of the hand…these were such simple little things that mattered so much. With all the haste and hurry around his hospital, Paul thought about how often the simple things were overlooked, and he admired Solange for remembering. Somehow, she would always manage them no matter how rushed she was, and he admired that even more.

“His TB going active is a possibility,” Solange said. “It can do that, depending upon certain factors—more exposure to the active disease, other physical illnesses or weaknesses. But I think Mr Bourg is doing fine. Probably suffering from some kind of secondary infection outside Pott’s, if I’m not mistaken. Because when I took his hand, he shifted in the bed and moved his legs. Just a little, mind you, but I saw movement.” Her eyes crinkled a smile at Paul over the top of her mask. “You did, too, didn’t you?”

Paul nodded, his eyes smiling back. “So I think we’re all in agreement now that’s it’s probably not Pott’s disease, and Mr Bourg is one lucky man because of it. But we’ll still need some blood tests to rule it out.”

Solaina bent forward to speak to Agwe, to which he responded by pulling down his mask and giving her a great big grin, revealing a mouth full of rotten brown teeth. Friendly, but infected. And there it was. An uncomplicated thing now. “There, Doctors, is the source of our initial infection, I believe. Our patient here said he’s been pulling out his own teeth.”

Paul looked down at Solange over the top of his mask, and the instant their eyes met, the look they shared confirmed a diagnosis for Agwe Bourg. “Osteomyelitis,” they said at the same time.

“Told you it wasn’t quacking like a duck,” Allain chimed in. “And if it’s osteomyelitis, the pain’s probably so bad that Mr Bourg just quit moving to avoid it. So I guess he yanked his infected tooth and the infection spread.”

“When you don’t have a dentist, that’s what you do. And, personally, I’ve always hated the dentist,” Solange commented, shuddering. “But pulling your own teeth…I think I’d rather cut myself open and remove my own appendix, without anesthesia, over pulling out my teeth.”

“Well, I’m pretty good at removing an appendix, if you ever have a need,” Allain said, already bending over Agwe with a penlight and peering into his mouth. “And from the looks of things in here, I’d guess I’m about to get good with dental extractions, because we’ve got at least three potential sources for infection festering away right now.” Dental infections were often the cause of serious, even fatal, illnesses that resulted from harmful bacteria escaping into the bloodstream. When they lodged in the heart, which was common, it was called bacterial endocarditis, and out here, more often than not, it was fatal. And when they lodged in the bone, it was called osteomyelitis, and could be fatal if not treated, but if caught it was treatable. Today was Agwe Bourg’s lucky day. He was treatable.

“Allain’s the enthusiastic kind,” Paul commented. “He’ll take on anything.”

“Especially eight straight hours of sleep,” Allain called after them as Paul and Solange left the tiny room. “If anybody’s interested in giving them to me.”

“He’s a good doctor,” Paul said once Allain was out of earshot. “Young, a little unorthodox, enthusiastic, and great instincts. I’m glad Frère Léon found him.”

“Another one?”

Paul nodded. “Like I said, he’s a tricky devil.”

Solange laid her hand on Paul’s arm and gave him a gentle squeeze. “With or without Frère Léon, this is a nice hospital, Paul. If I weren’t already involved up in the mountains, I’d be honored to work here.”

“And I would be honored to have you work here.” He glanced down at her hand on his arm, and drew in a sharp breath. Another one of the simple things Solange did, and he could feel the sparks of it all the way down to his toes.