With our ordeal of last night now fully behind fully us, at least from the perspective of being stranded and needing rescue, we still needed to get back to Karatu and out of the Ngorongoro Conservation Area. Samwel, the driver/ranger/clinical officer (a man of many talents) who had been one of our rescuers last night, had told us that he wanted to leave the safari lodge by 8:00 am as he would be driving us back to FAME and then returning to Ndutu, a pretty hefty drive on some very rough roads.

I had been so exhausted last night, as I’m sure everyone was, that I had fallen immediately asleep, but wished that I had several more hours to spend in bed rather than having to get up early. At least it was for a good cause, though, as the breakfast bar at the Ndutu Safari Lodge was truly awesome, and I think most of us made excellent use of the omelette station. Once finished with breakfast, we all headed back to the rooms to grab our stuff and bring it out to the reception area where it was then carted to the parking lot to pack into the bed of Samwel’s truck. Vitalis would be staying as he would need to find someone with a tractor who could pull Turtle out of the muck, then get the clutch repaired and drive home.

I was once again put into the front seat of the truck, but this time Saidi sat in the back with Ashley, Laura, and Theandra, as it was too unsafe for anyone to ride in the bed of the truck on the main road past Oldupai and on to the crater. It was a pretty tight fit for them and I heard lots of strategizing being discussed as far as ways to fit everyone in, though I can’t confirm if any of these really did work since I had been sitting comfortably up front and feeling just a bit guilty (though not enough to have switched seats with anyone). Samwel once again sped along the roads at the very same pace as he had the night before, though we thankfully didn’t encounter any bull elephants this morning. The ride was most uneventful, including our passage through the Lodoare Gate that morning with papers indicating we had paid only through yesterday, and without the vehicle in which we had started. On any other occasion, this situation would have required hours of negotiation to have gotten through, but it was readily apparent that our arrival to the gate had been anticipated with instructions to let us through with little hassle.

We arrived at FAME by around 11:00 am with Samwell driving us directly to the Raynes House to unload all our baggage, and for everyone to breath a huge sigh of relief, and perhaps especially me given the ultimate responsibility I had to get everyone home safely. Though we were all now home and each in one piece, the episode wasn’t truly over as everyone would need to process the events that had taken place each in their own way, and that might take time. In our absence this morning, Dr. Anne had elected see any neurology patients that showed up for clinic along with our translators/clinical officers for they had now worked with us for over a month, so they would be able to put their training with the neurologic exam to practical use. Thankfully, it hadn’t been overly busy, and she was able to deal with all the patients which was certainly a testament to the fact that we have been working together for so many years. She is truly our boots on the ground in our absence.

I decided to change and head directly over to clinic to see what was going on, though had anticipated that the others would take some time to fully collect their thoughts before heading over, and besides, it would soon be time for lunch, and they could simply come over after eating. On my arrival to clinic, though, I was informed there was a 70-year-old gentleman with a history of hypertension and renal dysfunction who had presented the day before after developing a severe headache, vomiting, and then loosing consciousness. His history was most concerning for a hemorrhage and, sure enough, he had a very large right intraparenchymal hemorrhage with midline shift and developing hydrocephalus.

His CT scan from the night before (the one pictured) had been taken on admission and was, to say the least, very concerning. His GCS (Glasgow Coma Scale) was 7 at that time, and I was told that it was closer to 4 this morning. That’s about as low as you can get on that score, but his family was insisting that he be transferred to another medical facility for treatment – evacuating the hemorrhage would not be beneficial for the patient, and the only real consideration would be to put in an EVD (extra ventricular drain) that would help with the hydrocephalus to some degree, but would do nothing to alleviate the significant neurologic deficits that he had. In essence, we could perhaps prevent his death but would in no way prevent the fact that he would be entirely dependent on others for all his needs in the future even if he managed to survive.

The patient was Maasai from the Ngorongoro Conservation Area and his son had accompanied him to FAME, but there were also other family members who were involved in the decision-making including elders from his village who were pushing for him to be transferred to Arusha or Moshi. I had asked the residents to see the patient and their report was that he was unresponsive, and his pupils were sluggish and dilated, which told us that he was already in the process of dying and making it utterly hopeless to even consider transferring him for further treatment as there was a very strong likelihood that he would not have survived the transport.

It was now late afternoon/evening which would mean that any transfer would now take place in a good deal of darkness, making the trip risky as driving a night here is very dangerous and should only be undertaken if it’s absolutely necessary. In this case, making the drive to Moshi, or even Arusha, would put other’s lives in danger which was not a risk worth taking considering the horrible prognosis. I offered to speak with the son and another family member so that I could explain to them that any of our efforts to save him at this time were futile and that we should do our best to keep him comfortable and to allow him to pass away with dignity. We stepped out of the hustle and bustle of the ward into a utility closet close by where I offered to show him and another family member the images from the CT scan of his father that had been taken the night before.

I would have had the same discussion at home, and I was hopeful that I could get the point across to the son that his father had suffered a catastrophic injury from which he would not survive in any manner that his father would have wanted, and that it was really not up to any of us at that moment to decide otherwise. I let everything sink in with some long moments of silence and allowed Dr. Gabriel to speak to the son in Swahili as this was really not an exercise in convincing anyone, but rather a time to let the family come to their own conclusions. In the end, thankfully, the son realized what was best for his father, and agreed for us to keep him comfortable and not to escalate his care. They had already readied the ambulance to bring him to Moshi, a three-hour drive on treacherous roads made even more so in the dark, and I was relieved that no one would be placed in harm’s way for a journey that in the end would not change the inevitable.

Our afternoon of patients was otherwise very slow that day, a combination of the fact that the weather had been rainy overnight and everyone knowing that we had been delayed by our adventure in the Serengeti. We had actually been invited to have dinner last night (when we were instead hiking in the dark in the mud and water of Ndutu) at Asha’s home but had obviously been unable to attend. Asha had been the head of housekeeping at FAME since the very beginning, but perhaps more importantly, she is Abdulhamid’s aunt and had been incredibly grateful for everything I had done for her nephew in the past. Abdulhamid was a medical student at Muhimbili University when I first met him while on break from school, and he volunteered at FAME to help us in the neuro clinic over the next several years whenever he could. I had also arranged for Abdulhamid to come to Penn for a month observorship while he was in medical school given his keen interest in neurology and his burgeoning skills in medicine. It was an incredible opportunity for him, though as is always the case, the experience for the residents who had already worked with him in Tanzania, as well as those who hadn’t, along with the medical students, was perhaps even more rewarding to them. These bidirectional learning experiences provide far more than anyone could ever imagine.

Asha totally understood about having to delay our dinner, and even though we were all still exhausted from our ordeal the night before, she had prepared our dinner, and it was essential for us to get there to enjoy what she had made for us out of her appreciation for our coming to Tanzania. Visiting someone’s home for dinner such as this honors them with our presence, and though it has always felt odd to me as I’ve felt honored for them to have me, I’ve come to realize this distinction over the years and have always done my best to accept these invitations for what it means to our hosts. In essence, for them to be able to “pay back” for the fact that we have come to their country to volunteer our services is what honors them. It is these simple acts that are often overlooked and can mean so very much.

Though our dinner was very simple and very Tanzanian, it was delicious just the same, and we are thrilled to be there. I can’t remember how many of these dinners I’ve been to in the places I’ve gone to volunteer (Karatu, Dar es Salaam, Mali, and Vietnam), but I can say that each and everyone have had the same effect on me. I have been forever grateful to have had these opportunities, and they have meant the world to me.