So I had my first Botswana hospital experience. I suppose it was only a matter of time.

After all, I headed to the Emergency Room in Pakistan only a month after moving there in 2009. This time I made it almost two years in Botswana before being forced to navigate the bureaucracy, fluorescent glare, unknown medical infrastructure and curious medley of bedside manners that compose an ER in a foreign country.

I had so many chances to avoid the encounter.

TUESDAY: It started as a faint throbbing behind my eyes, as if I had been peering at my laptop too long in the dark (which is almost certainly the case).

WEDNESDAY: I made a series of good decisions including calling in sick to work to soothe what I now believe were the beginnings of my first migraine headache.

THURSDAY: I got too cocky. With no headache in evidence, I plunged full speed back into my normal work, gym, social and home schedule. I was punished for it around midnight when a wave of the worst pain I have encountered since childbirth hit me and I could do nothing but stumble around the bedroom howling, hoping not to wake Lila.

FRIDAY: Did I learn my lesson? I did not. I am a complete stranger to migraines so I didn’t realize they can retreat and wait in the shadows, gathering strength to pounce again. By Friday afternoon I felt so good I got back on the computer, skyped with a friend and her brand new baby, watched House with Drew and merrily ate a buffet of migraine-triggering foods all day including cheese, chocolate and onions.

SATURDAY: I paid for my sins. The beast came back and there would be no sneaking away this time. By noon I was in agony. It hurt to move, it hurt not to move. The throbbing was so bad I felt like someone had put my head in a metal vice and was shaking it around. I tried to lie down and do breathing exercises, but the fear that the headache was something bad–something dangerous for the baby–made it hard to concentrate. I had googled “severe headache pregnancy” earlier and all the stuff that came up immediately was about preeclampsia, a fairly serious condition that can lead to something life-threatening for both mother and baby, and which usually requires an induction if the baby is far enough along (at just shy of 28 weeks, ours wasn’t).

I splashed lavender oil on both temples, Drew got me a bag of ice cubes to put at the back of my neck, and I got in bed and tried to stop moaning. It made Tuesday’s headache look like a spa vacation.

I laid on the pillow and thought of my friend who had just gone through a few intense hours to birth her baby girl on the other side of the world in Colombia. I thought of another friend whose daughter is due at the end of this month, on the West Coast of the U.S. I thought of the little boy in my belly who is scheduled to be born in Africa just a few months from now. I could feel him moving every so often, each little flutter or kick helping to reassure me that he was fine. A giant plastic bag of baby clothes I picked up last week at a German woman’s yard sale lay at the foot of the bed: tiny t-shirts and onesies, outfits with bears on them and little suspenders and a tiny soft cap. I started thinking, truly thinking in the darkness of the room, what if something happened to my baby.

By 4:00 pm I was sending desperate text messages to our nanny to come to the house and take care of Lila so Drew could drive me to the hospital. I shakily put on a pair of yoga pants, flip-flops and a flimsy eye mask that I got for free on an Emirates flight sometime in the last decade to brave the harsh Botswana sun en route, each bump on the road a small agony.

The Emergency Room wasn’t so bad. We went to one of Gaborone’s private hospitals, which is as similar to Botswana’s public hospitals as the ladies’ room at Nordstroms is to an outhouse in a muddy field. So I can’t tell you what the “real” experience of a normal hospital would be like in this country: the kind that 70% of the people have no choice but to use. I’ve heard that at a public hospital you have to be prepared to wait all day (and maybe night) to be seen, whereas my wait on Saturday was zero minutes. This was probably also because of my protruding belly and how jumpy everyone gets when a pregnant woman appears to be in pain.

I shuffled up to Labor and Delivery first to get the baby checked out, with only Drew’s arm at my elbow and a series of beeps and swooshing door sounds to guide me there, my eye mask and its aged elastic band slipping but intact.

My blood pressure was normal, so we could take preeclampsia off the table, which we did with a sigh of relief. Then we went in the next room to do the ultrasound, or the “scan” as they call them here. The doctor warned me that the gel for my stomach would go on very cold. I lay on the crinkly white sheet and didn’t care: my eyes fixed on a black screen waiting for it to flicker to life. It did, and the baby could be seen beautifully: he was moving and turning, legs stretching out over his face, perfectly formed feet in a ballet with arms and head and lips. My placenta had grown to the right height (it was a little low last time) and the baby was fine, was flourishing. I was so happy to see him.

After a day and a half more of pain, I was fine too. The headache finally released its grip with the help of two very powerful massages i.e. torture sessions on my back and neck to work out some muscle knots (I actually passed out during the first massage for a few seconds), and a shot of Demerol in the hip at the ER to get me past the worst of the wave. (The real migraine medicine normally used is, unsurprisingly, not suitable for pregnant women.)

Being pain-free after days of intense pain feels like a tropical island with thick substantial sandbars shoring up delicate wisps of foliage that sway in the wind. It is like seeing daylight for the first time. Soon after the migraine broke, I sat in a daze and stared at the side view of my fingernails, realizing all of a sudden that they were beautiful: each one curving from a smooth bed of pink into a soft white pointed tip. The angles of the human fingernail are lyrical and graceful, and I had never noticed before.

It is so easy to focus on the logistics and hassles of life. Lately I have had a lot of thoughts like “Pretty soon it’s going to be much harder to go out to lunch with the whole family,” and “Pretty soon there will be no more late game nights out at Alex & Brianna’s,” and “I can’t believe I have to get intimate with my breast pump again soon”…fleeting thoughts that aren’t exactly complaints but just acknowledgements of freedoms lost, the different rhythms and routines that a new baby inevitably brings, not all of them pleasant. I value my freedom fiercely, but I also cannot bear to see my child unhappy or in even mild discomfort, so having a new baby is a high maintenance situation for me. I am excited to meet our little boy, but a lot of the swirl in my head lately has been about all the to-dos that go with his arrival: moving to South Africa for two months from Botswana, expediting an American passport from the consulate, getting a birth certificate, transporting our dog across the border, navigating a foreign hospital for labor and delivery, hiring a doula, hypnobirthing classes, the rental house in Cape Town, juggling the work schedule, getting Lila ready for a brother, dividing up responsibilities for night care, the fact that all our baby stuff is locked up in my family’s garage in California, finding a decent carseat in South Africa, etc etc etc.

But the pain of the headache crystallized everything in an instant: the important thing was only that my baby was safe and I was fine. All the other stuff was immediately revealed as unimportant crap that will get figured out one way or another, or not.

As a final note, I am now 3-for-3 in Emergency Room visits in the last three places I have lived: Gaborone, Santa Barbara, and Islamabad. This is not a streak I am super excited about.