Anna hardly had time to stop before Cuddy threw the door of the Defender open and jumped out, her legs falling out from under her as she hit mud instead of solid ground. Grabbing at the inside handle of her door, she used her upper arms and shoulders to yank herself upward and paused for a moment to steady herself before setting off toward the clinic. She ran up the stairs, her feet leaving pale reddish brown smudges on the wet concrete. She turned, nearly losing her footing again due to a puddle that had formed around the perimeter of the courtyard. Anna made it to the top of the stairs in time to see Cuddy go into Natalie's room. The younger woman followed her footsteps, walking in to look at Cuddy standing in an empty room. Anna put a hand on the doorframe, waiting for a moment before taking a hesitant step forward. Cuddy stood next to the bed, a fistful of bloody linens in her hand as she looked down as though the patient would reappear if she rustled the cotton enough.
Cuddy looked up at her. 'Where did they go?'
Anna had opened her mouth to say something when Adzoa quietly appeared at the door, water beading in her hair. She spoke demurely. 'Sister Anna.'
The look on Adzoa's face gave Cuddy a sinking feeling in her stomach. Any good mood developed by the heady since of victory she'd had upon diagnosing Kwame dissipated as quickly as the rain had on the breakneck drive back to the clinic.
'We're too late,' Anna hazarded, bending forward slightly in a hopeful attempt to have Adzoa give them more positive news.
Adzoa allowed the briefest of smiles to cross her lips then shook her head slowly. 'It's bad, sister, but Dr Chase has not left us.'
The question of whether this meant she had shuffled this mortal coil or was simply elsewhere still hung heavily in the air, something that Adzoa obviously felt before continuing.
'She had to be taken to Damongo.'
Anna breathed a sigh of relief and looked at Cuddy, who dropped the handful of linen and began to walk toward them.
'What happened, Adzoa?' Cuddy asked as she reached them. 'Why did they go to Damongo?'
The same grasslands and trees greeted them on their way to Damongo. Mud sloshed up from the tires and flicked upon the windows of the Defender as they went along. No other vehicles or people passed them the entire way - even the little villages they went past were barely awake after the rains, though people were starting to emerge from their huts to begin building fires to cook dinner.
Anna's right hand flexed and unflexed compulsively on the steering wheel as they turned off of the main road and into the town.
On both sides of the road, Damongo was waking up from the rains. Although it was rapidly approaching evening, salespeople in their little stalls were intent on making up for financial losses for the day and were therefore staging their goods once more to catch any possible sales from people who had emerged after the rain. They stopped to allow a goat to pass and Cuddy watched a saleswoman wearing a hijab slide a makeshift wooden bridge over the canal in front of her store. These canals were on both sides of the road - the rains had made them swell, washing away the refuse and stagnancy that had collected over the previous days.
Once the goat passed, it was still slow going, something which tugged at the strained fibers of their beings. Cuddy tried to focus on her surroundings rather than her nagging doubts about the future of Natalie Chase. There was a chop bar with people sitting and eating jollof rice. Next to that, a kente weaver was carefully hanging his colorful scarves from a panel of dowels, his fingers deftly removing small knots from the fringe at the end of one that was colored the red, green and yellow of the Ghanaian flag. Another couple of doors down, a seamstress had thrown open the doors to her shop and had sat down once more to crank along her machine as she worked on a kaba made of green and gold waxed cotton.
Cuddy only looked forward again when they passed one of the ubiquitous furniture shops that also sold stylish coffins, many of the outfitted in mirrors. Cuddy wasn't a fatalist, but it was never pleasant seeing your own visage on the receiving end of a coffin. Why a corpse needed to check itself in a mirror was a mystery to her and to House the first time they'd walked by one of these shops on the way to grab Fanta one night.
The setting sun cast the long shadow of a baobab tree across the road leading up to the hospital. Although the grounds for the hospital were rather large, the entry to the West Gonja Hospital was very low key. A single four-by-four sign with fading painted letters announced visiting hours. Anna pulled over to the left of the sign, parking the Defender and stepping out. Cuddy followed, watching Anna carefully step on the muddy ground before getting to a poorly paved area right at the main gate. They made their way to one of the sidewalks crossing campus, following the signs to the public health ward.
Their shoes were still wet but much less muddy by the time they reached the building. Under the eave of the building, a sister clad in all white stood behind a patient in a wheelchair. She nodded a hello to Anna and said something in soft Gonja. Anna nodded back and they entered the building.
The floors of the hospital were tile rather than the poured concrete of the clinic. The ceiling was pristine, painted white with humming fluorescent bulbs running down the backbone of it. The walls were two-toned like most walls in Ghana were wont to be - this one was a Sahara brown to the tops of the doors then white to match the ceiling the rest of the way up. No one was directly in the hallway but their footsteps brought House to the doorway of a room down the hallway. He locked eyes with Cuddy before stepping back into the room.
'Why don't you go talk to Dr House and I'll go find the charge nurse?' Anna said, stopping suddenly.
Cuddy looked at her with uncertainty, but nodded. 'Okay.'
Without waiting to look back at her, Cuddy continued forward, reaching the door to the room and standing to look at the two beds. House sat on the edge of one looking across at Natalie, who was supine on the other. Cuddy sat beside him, her eyes drifting from the hub of the IV in his arm along the tubing and to a glass bottle of fluids that hung from the pole on his right side.
'I might have overdone it a little,' he offered in a tired voice. 'The last couple of hours involved a shitload of running and medical interventions, something the malaria was not fond of.'
'Your leg probably wasn't fond of it, either,' she hazarded, lightly rubbing his thigh.
'One of the good sisters morphined me up when she started my fluids, so I'm feeling pretty good right now,' he said, before motioning to Natalie. 'Chase, on the other hand...'
Cuddy slowly laced her fingers through his, both of them looking across to the other woman. Although she's feigned partial wellness for the last day, it was now completely apparently that nothing about her was even vaguely healthy. The warm glow of the setting sun filtering through the windows accentuated the bronzed hue of her skin. A plastic endotracheal tube was inserted down her windpipe, flesh-coloured tape looping from her right jaw, around the tube and back to her right jaw once more. With each forced air breath, the tube condensated, a tiny winter's day taking place in the space between her bronchial trunk and the joint where the ventilator hooked into the tube. Cuddy stood and walked over to her, taking her hand to look at the bruised skin and dusky fingernails. She furrowed her brow as she laid the hand back down, looking at her own hand and rubbing her fingers together to feel the salty texture that she'd pulled off of Natalie's skin.
'Uremic frost,' House confirmed. 'She's in renal failure.'
'It's not dengue fever,' Cuddy finally remembered to mention.
'I know,' he said, allowing her to continue.
'It's leptospirosis,' she said. 'Rats were nesting in the water bowls at the Mante house. If she put ungloved hands in contaminated water and happened to have a few little cuts, she's be open for infection. One of their sons has it.'
'It was leptospirosis,' House replied. 'Now we're dealing with full-blown Weil's disease.'
She turned around to face him. 'House, what happened when we were gone?'
'Oxygenation issues,' he started. 'On auscultation, I noted some fine crackles in the bases of her lungs. We gave her some IV prednisone and increased her oxygen, but it didn't help. She started coughing frank blood then just stopped breathing.'
Cuddy reached up to Natalie's face and rubbed some dried blood from her cheek with the pad of her thumb.
'We needed the ventilator, so we had to bring her here,' he continued. 'The chest x-ray showed inferior bilateral infiltrates.'
House just nodded before laying back and situating himself in the bed, one arm behind his head as he looked up at the ceiling.
Cuddy watched him until he was comfortable then turned her attention back on the patient. Natalie's other symptoms were now glaringly obvious considering the confirmed diagnosis. Cuddy moved her hand from around Natalie's cheek and up to her left eye to slowly open it. The deep jaundice of both her skin and her highly icteric sclera spoke of outrageous hyperbilirubinemia, an indicator of acute liver failure and possible necrosis. The bruising on her arms and petechiae Cuddy noted on her uncovered leg showed thrombocytopenia. The far-too-regular rhythm of breathing afforded to her by the ventilator confirmed respiratory failure.
'I should have caught it at the fever with conjunctival hyperemia,' he said. 'It would have given us time to get her down to Kumasi.'
'Weil's is treatable,' Cuddy said, looking to him for confirmation. 'This can be treated.'
'Two weeks of Rocephin,' House said as he continued to look up at the ceiling. 'But with the widespread hemorrhage...'
The rest went unsaid.
A/N: Well hello there. I think that I've finally found the impetus to complete this! Since the last update, I graduated nursing school and have been working as a cancer research nurse for the last two years. I have the very cool job of administering first-in-man drugs to patients. My clinic's all happy in the pants because so many of our abstracts were accepted for presentation to ASCO, good times. But yes, I've been overloading myself with CEs for my OCN examination, so I figured for the love of god, maybe I can finally finish this. HERE'S TO ACCOMPLISHMENT.