Fastest Service in Egypt? Organ Removal

Despite the rather preoccupying pain in my side, a droll thought occurred to me as I waited outside the As-Salaam Hospital emergency room: I had actually had an easier time communicating with the staff here in Cairo than with the heavily African-American staff at the Brooklyn Hospital Center right down my block in Fort Greene last year. To be fair, my visit to the latter had been for sudden loss of hearing in one ear, which may have had an effect; but linguistic comparisons aside, As-Salaam Hospital looked all-around cleaner and less chaotic then the zoo at the BHC. I tentatively relaxed.

Then my summoned boyfriend Aaron wheeled in, looking much more worried than I had yet allowed myself to get. He had originally guessed that the odd pain in my side might be appendicitis, and had no doubt been working himself up about it all morning while I stubbornly prepared to have a normal day at class. A stop by the university clinic had however revealed that such was not to be:

“So it might be appendicitis?”
The doctor shuffled papers and blinked at me with the lackadaisical expression that was to define my day of seeking diagnosis.
“Well . . . either it is an appendicitis . . . or it is something else.”
“So I should go to the hospital.”
“Yes . . . you will go to As-Salaam Hospital, in Mohandisin. A very good hospital.”
“Okay . . . and um, when should I go?”
“Oh . . . right away, of course . . . But do not worry!”

So it seems the Egyptian tradition of sugar-coating, the culture of ma‘lesh (meaning both “Sorry about that” and “No big deal”) extends even to the realm of medical emergencies. Perhaps it is very American of me to want to hear a suitable degree of urgency in the voices of my caretakers, but I found this persistent nonchalance quite unnerving.

Of course Aaron’s presence in the waiting room shattered the outer defenses I had summoned up in my solitude. I crumpled into his shoulder and sniffled. Fortunately, we didn’t have too much time for boo-hooing because they called my name almost immediately.

A skinny, mustached doctor offered us chairs and, gathering that we were American, began questioning me in clipped, business-like English. I didn’t protest; this was no time to show off. He then became the second of what turned out to be many medical employees who needed to press down on the sensitive spot on my abdomen just to make sure it really hurt. In this and in all following check-ups, there was no ritual donning of hospital robe; indeed, there was no removal of clothing at all. When I moved to pull down my skirt he nipped it in the bud: “Ah ah ah! That won’t be necessary.”

Still making no certain proposals as to what might be causing the pain in my side, the doctor dismissed us to get a blood test, which required another hour’s wait, and revealed nothing. Befuddled, the doctor called in his senior (both in age and mustache growth). Taking a more jovial approach to his foreign charge, Doctor Number Two (Bushy Mustache) addressed me in Arabic. When I responded, First Doctor (Skinny Mustache) did a double take.

“But . . . you speak Arabic?”
“Well, yes, I just . . . I’m not at my best today,” I accompanied this excuse with a broad gesture that I hoped would express my general state of disrepair.
“Lovely! Let’s speak Arabic then,” tinkled Bushy Mustache, and escorted me to the bed to run the same series of pokes and questions, now bil-'arabiyya. As I responded in kind, Skinny Mustache quipped to Aaron that I spoke Arabic better than English. It may indeed have seemed so, since somehow speaking about such personal things as your insides can be easier when concentrating on relaying it in code. Bushy Mustache decided that I needed an ultrasound, although I had sworn before Skinny Mustache’s doubtful eyes that I was not pregnant or suffering from any venereal diseases.

The giggling gatekeeper of the ultrasound room let us in after another hour’s excruciating wait, throughout which she provided mild entertainment by flirting with a lone older man, also ostensibly "waiting" although for no apparent reason. The ulstrasound medic did not see fit to remove any of my clothing for the ultrasound either; instead, his young female assistant pulled back both shirt and skirt as far as possible without revealing anything PG-13, then tucked a white towel modestly around my waist. Woe betide the loose woman who dares to show her panties during her ultrasound! Not here at As-Salaam.

To our partial relief, the ultrasound revealed nothing decisive as to the source of the pain. However, we were not yet free: leave from the ultrasound wing was only granted upon receipt of ones “official” folder of internal photographs. We had seen multiple exemplars painstakingly assembled by Giggles and her ever-shifting Girl Crew; although as far as we could tell this task consisted only in a bit of cut and paste, the artistes performed it with evident pomp and relish. My file was no exception. Giggles laid out her implements (photos, scissors, gluestick) one at a time, chattering away all the while with the omnipresent Lone Dude. Snip, snip. I felt each unskillful clip as if nicking away at my now very besotted nerves. Snip, snip. My appendix is going to explode! Let me do the arts and crafts for the love of Allah!

Oblivious to my mounting ire, Giggles abandoned the task entirely to exchange travel agent numbers with Loner. Rather than stop the conversation to expedite this process, the blithe pair continued their banter, such that the digits botched and piecemeal in its midst required multiple repetitions. I watched the glue dry on the back of one of my pictures. With the slowness of a sleepy or perhaps disabled child, the charged receptionist resumed her snipping, noticed the dried glue, and in bewilderment laid her work aside once again, just in time to intercept a phone call (“Izayyak? Winta izayyak? Al-humdu-lillah, al humdu-lillah, izayyak inta, ‘amal eh? Al-humdu-lillah, kwoyiss . . .” and variations thereof, forever).

Just when my will to restrain myself from ripping the photographs away from their incompetent captor had dwindled almost to nothing, the final piece appeared: a printout from the ultrasound medic, which apparently had been the hold-up all along. Oops. Sorry I hated you, Giggles. We made good our escape.

Back downstairs with my new photo album, we still had no conclusive evidence of what might have gone wrong in my lower right abdomen.
“In this case,” mused Bushy Mustache with a whimsical smile, “I suppose we cannot rule out appendicitis.”
“So it is appendicitis.”
“Well . . . probably . . .”
“And what does that mean? I need surgery? When? Here?” By this point I was finally in tears, surrounded by the quizzical faces of B. Mustache’s team.
“Hmmm, yes. Do not worry. Why are you worrying? Do not cry.”

Still smiling pleasantly to himself, Bushy Mustache began dialing up surgeons’ numbers. Each contact triggered the obligatory litany of greetings, queries after children and wives, a few inside jokes, and ended on a ma‘lesh, sorry, no can do. But somewhere in this light-hearted chattering Bushy found his man, and sent me off to be admitted.

“You must not worry,” he implored me once more. “He will do a lathroscopy, an exploratory surgery to see if the appendix is really the problem. If it is, we take it out, khalass!”

And if it isn’t? “Exploratory” surgery? I have never before had any kind of surgery, much less an ambiguous reconnaissance mission of my still mysteriously embroiled organs.

Fortunately, I was so glad to be done waiting that I didn’t really care. One Egyptian surgery, coming up. In the meantime, I discovered that my otherwise impeccable hospital room had no toilet paper.

***

Nasim Gerges, my surgeon, strode in flanked with assistants (admirers? minstrels? there were a lot of them). Tall, clean-shaven, and clad in a black button-up shirt, his presence demanded confidence and credibility. Upon a brusque reprise of the now-familiar jabs to the abdomen, he declared that indeed I was suffering from acute appendicitis and must be operated upon at once. He swept from the room with an order that I must not eat or drink. Someone handed me a hospital robe and told me to suit up.

All systems finally appeared to be “go,” but by this point the director of my Arabic program and my friend Justin had arrived, and much fretting and catching up ensued. After a whole day of waiting around, I had at last slowed my nerves to a less excitable pace. However, someone behind the scenes must have turned the green light on the As-Salaam staff, because suddenly we were the obstruction to progress. The nurse who had given me my robe and cap poked his head into our room for the third time, only to find me still in street clothes gabbing with my visitors.

“Yella! We’re ready!”

Wow, I guess he’s serious. I donned the hospital robe with characteristic lack of skill and hoisted myself onto the waiting mobile bed.

Perhaps the responsibles at As-Salaam Hospital had not bothered to measure the actual width of their hallways and elevators before ordering the wheely beds, because we had quite a rugged ride to the operating room. A fellow at once tall and roly-poly had gotten the job as transporter, and he navigated my unwieldy vehicle as well as he could. After each big bump he would grunt or ask if I was okay, then interrupt himself to intone, “Bismillah alrahman alrahiiiiim” whenever we passed through a doorway. I could not decide whether I found this reassuring. Once we were on less treacherous ground, he began to chat down to me with warm, fatherly interest.

“Amrikiyya! Wi tikkalammi il-‘arabiyya!”
“Yes, I am trying to learn Arabic.”
“You live in Egypt then? How long have you been here? Almost six months! Well my dear, you must go out, must see Egypt! Egypt is beautiful! What have you seen in Egypt?”

One would almost think he was reproaching me for wasting my time in this boring old hospital when such marvels awaited. I began telling him about my trip to Luxor and Aswan to reassure him, but he had worked himself into high fervor and cut me off.

“Ah, Luxor! Wonderful, isn’t it wonderful? But there is so much more! Hurry, you must get out and see Egypt!”

I tried to express enthusiasm and promise to fulfill this vague task from my prostrate position on the bed, now being wheeled into the operating room proper. My escort’s jolly face was joined by a team of others, peering down and murmuring until they realized I could understand.

“An American who speaks Arabic! I don’t believe it!”
“And look at her, what are the men supposed to do with her around? She’s zay al-amar, lovely as the full moon!”

Since I had not eaten all day, was suffering from an unprecedented pain in my side and was dressed all in white, this traditional idiom had probably never been truer of me. I gave my admirers a wan smile. Still exclaiming and gossiping about their exotic patient, they transferred me onto the operating bed and began to examine my abdomen. A robust, grandfatherly fellow, introduced to me as Sharif, fingered my navel piercing.

“Eh da, what is this? This needs to come out.”

I began trying to unscrew it, and explained that I had never tried to remove it before. Members of the surgery team took turns leaning in to peer at this latest evidence of American oddity. I joked sheepishly that it had been a sort of eighteen-year-old rebellion thing. Well, now it was rebelling against us. Sharif boomed that I should relax, he would give it a try. He brandished his thick fingers and began twisting.

The crowds were starting to turn on my raciest piece of jewelry. The surgery needed to begin; this little thing wasn’t expensive, was it? Couldn’t we just cut it off? But Sharif, now deaf to them in his determination, renewed his efforts. When at last he held the little bugger aloft, I fear his colleagues did not empathize with his sense of triumph.

“Ha HA! Who got it out? Sharif got it out! Miss Anna, I expect you’ll be needing me when the time comes to put it back in! Either way, look: she’s got the incision already for us in the right place!”

I laughed and liked Sharif a whole lot. The next thing I remember they were showing me my appendix.
“They put it in a kohsery container!” I heard someone guffawing. Figures.

This is koshery, a popular Egyptian streetfood that comes in a distinctive plastic bowl.
While many disagree, I think that an infected appendix thrown in this putrid mix may even constitute and improvement.

Back upstairs in my room, I tried through a haze of drugs to assure a full room of well-wishers that I felt great, then (rather stupidly) to wrestle past Aaron to get a drink of still-forbidden water. Then they were gone and I was left starring in my first but strangely familiar hospital-room scene. Dripping I.V.; iodine-stained-sheets; fading in and out. You know, Bushy Mustache was right: what was I so worried about? Maybe Egypt isn’t so different. They seem to have figured out surgery, anyway; nothing to turn one’s nose up at.

Throughout the night, a veritable gaggle of adolescent-looking nurses filed through my patchy consciousness, changing my IV bags and asking me how I was doing. Then suddenly, two of them doubled up to oust me from my bed so they could change it. I could barely move. They shoved me into a chair and proceeded to turn the bed-making into a doozy of a brainteaser. Then they urged me to use the bathroom, a trip that I pointed out with a mute gesture to my arm would require unhooking the I.V. After some whispered conferring, one of them unscrewed the tube strapped to my vein. I watched with some interest as blood began immediately to spurt from the opening. After a few more moments’ flutter and argument, my ladies-in-waiting stanched the flow and I hobbled wordless into the bathroom.

Moments later, one of them bustled in and proceeded to fiddle with my arm tube again and tie a clean hospital robe on me before I could rise from the toilet. Throughout these exchanges I made a futile intra-lingual sounds of surprise and objection, but I didn’t really seek to protest. The Egyptian health care system had gotten me this far, after all; I may as well see it through to the end.

But as those bickering youngsters jerked my bleeding arm back and forth, I couldn’t help but surmise that the folks down at As-Salaam Hospital have some details to iron out. I hope they do; I may just want to come back next time I need a shotgun surgery.