Sunday, December 15, 2013

A funny, likely distorted sense of humor

Hats. People wear some funny ones, mostly passed down from a holiday. But they aren't wearing them for a holiday, they are actually wearing them for a hat. 
Thanks America for the costume!

I don't even know what caption to write. Go get em tiger.

Well, I thought this lady had on a hat, then I realized that it wasn't. 
Baby Santa. Thanks again America!
The old, distinguished man hats aren't like ours.
Santa Motorcycle Taxi. No extra charge. 

Okay, enough with the hats. Though they never cease to make me laugh. 

Next is hospital scenes.

Sometimes you just need a good soft place to rest. 

The taxi just at the hospital gate. Poor fellow in the trunk, as if it hasn't been a hard enough day. 

So, maybe you can't see this, but even though balancing a  huge mass of junk on the head and in the hand, she still has the skill to use her cell. And you thought you had talent. 

Never saw this in the sterilizing room in the US.

Wheres Waldo? I mean, where in the world is my scrub tech?

This isn't funny to me. It's a darn plague of flying insects - everywhere around the hospital.

And this is the kind of plague they like. Grasshoppers everywhere. They catch and eat. This is the storekeeper at the hospital showing me her bag of the ones she caught in the store. Including the ones that just came off of the toilet paper rolls that I bought. I told her she could have them. 

And then for road scenes.
These are a combo, the two are always found together. They know that nobody is going to pay attention to a silly "caution, sharp turn" or "low shoulder", so instead, they quantify how many people have died at this particular location. (Ici 10 morts=here 10 dead). I'll admit that this is dark humor, but I think these signs are funny cause they would never be culturally appropriate in the US. 

Sometimes you just know someone is a nice, warm person. Other times, they probably aren't. Bumper stickers state "Beware of BAD friends" and "SHUT UP, are you God?" x 2. Makes me want to beware of him.

And around the village
"Mbingo - Upper Old Peoples Club"
You are looking at the old peoples gardening spot just behind the sign, inside the "fence". I have no idea if there is actually a clubhouse.

And around town about an hour away

This gang of 4 or 5 police women are streetside high heel shoe shopping on their shift. Machine gun in tow on shoulder. I can't take authority seriously when they are buying stilletos. Really???

Monday, December 9, 2013

Health Care

Every 9 or 10 days I run out. Hand sanitizer is supposed to be provided by the hospital, so I go to get some more. For decades we have had evidence that clean hands by health providers saves lives, but most of the nurses and staff never clean their hands between patients. I must say this is probably partially due to the painful waste of time that acquisition of necessary cleaners can be. I stick my head in the pharmacy window, explaining that I need some more. “It is finished”, is the response. At first, I assume the obvious truth that such a statement means that there isn’t anymore. But during those extra few delayed moments, she adds a statement indicating that maybe there is more, but it isn’t in the pharmacy. So I ask, “where would it be?” The answer is “in the store”. The store is only 2 small cement buildings away, maybe 50 steps needed to get there. I can clearly see it from the window which I am looking in and from which she is looking out. However, in spite of the fact that multiple employees have come for a refill, no one has found it important to go see if there’s any in that building. So, I turn and head for it. There are three doors, I step in the only open one. “Is there any hand cleaner? The pharmacy says they are out.” “You’ll have to check next door”, is the response. I move toward the next door, but it is closed. I return to the other man stating that the door is closed, asking if I should go ahead in. He never looks toward me or acknowledges me, though he is aware that I am there and speaking to him. So, I leave and go back to the second door, push it open. I look over each of the shelves, seeing many items, but no hand cleaner. I return to the man, asking more loudly and in such a way to encourage a response, “do you know where it would be, I am not seeing it”. He finally looks at me and eases up from his seated position. He walks to the second door. Less than a second of glance inside the door brings a response, “I am sure, it must be finished”. I respond, “are you sure, or are you guessing?” He again says the same statement “I am sure, it must be finished”,  never looking within the room again, zero effort to try to find the item that I am seeking. I again respond, “Are you sure, or are you guessing?” Finally he realizes that I am not leaving until some effort is made to actually assess if the hand gel is there or not. He yells, in an obviously bothered tone, to a man walking on the sidewalk, “Is the hand gel finished?” The reply is that there is plenty. Within a few seconds, the new face is walking over carrying a whole box full of the gel. I take a whole large bottle, hoping to avoid this same scenario for at least a month. My tongue gently, yet untamed for the moment again speaks as I turn to the first man, “So, are you sure, or just guessing?”

It’s a foolish example intentionally. There are other examples within every area which are not so foolish and have direct patient effects. Stat labs still unresulted after 12 hours, no staff has checked on them but they are “not back”. Necessary medications were not given, arguments blame nursing staff, no pharmacy, no nursing staff again. None of it is charted, so who could know? Medical records “have not been found”, but it turns out they were never looked for. The patient was admitted, but no one looked at her all night, so they never noticed the complication or notified a doctor. No area that affects medical care is exempt. It is sort of depressing.

But I was riding down the road the other day and saw something interesting. The previously battered road was being repaved. Now, the typical way for road repair is to have some dusty man in torn pants, and an oversized, dirty shirt filling in the hole with dirt or gravel. As the drivers pass by the area where he has obviously been working and sweating during that day, they may give him a coin as his pay. But, this particular road repair was a world apart from that. It was the developed world apart. A French company had been hired to repair a large section of road. The employees working were all Cameroonian. The sight was not anything like a normal process in Africa though. Traffic was stopped in an orderly manner, giving me a good time to watch. Dumptruck after dumptruck of gravel came and went in an orderly fashion. As they dumped the rocks, immediately they were leveled out by the workers on the ground. No one was standing around, there were no extra people. On the other side of the road, an orderly system for grading the land was occurring. The whole process was like watching the inside of a watch – all of the parts were working together to make the clock tick. I had never seen anything so systematic and successful in my travels in West Africa. I wondered, how did they make this work so well? The existing systems did not support such effort, response, or effect. But what had been brought in as the standard within this company was working. The workers wanted work. If they didn’t want to do it within the standard put forth, there were hundreds more standing behind them who would be glad to. Hmm.

It made me wonder. Health care is certainly different. It requires more training and skill than basic manual labor. Developing a good system could not just be “dropped in”. However, how can one make a system that actually is effective within this setting. Is there a way to change the present system? Each missionary doctor comes with that expectation, that some part of the system will be improved as we pour our lives into it. But every one of us would say that the change we have made is much less than we had hoped. I am not foolish enough to believe that there is a place on earth where all frustrations cease and all problems are solved. But I must continue to believe that there is a better way, a more supportive system, for such change. I long to learn more about such a method. I want to see, is there a way to pour out a life where more is left when we finish than just our sweat which has dried invisibly into the ground we have toiled? I believe that whatever work we do should be done well, and that in doing so is a part of how God is glorified through His people. That we should implement systems that are sustainable within our communities and areas of influence. And that the people we serve with should be trained and empowered to carry on after we are gone. But all of that takes a better system than I have seen. Practically I don’t know how to do it. Yet, there is something inside me, determined and stubborn, that refuses to settle for less. I don’t want to see my patients unnecessarily at risk for generation after generation. I want to see life-change, and system-change, and method-change. Ultimately I want the health care that I provide to glorify God both in the present, and long after I’m gone. And that requires some plan for better care of patients and communities.

On the other side of the world, in the land that I would proudly call my home, there is a whole different battle for health care. One of which, as a doctor, I admit that I still do not understand well. It is also true, that I do not have some magic answer that would straighten out the whole, messy system. My world is much simpler, the baseline needs are much greater, and the resources to meet those needs are much less. Of all of the problems that the US has, the developing world has piles more. And there are fewer people committed to solving them. One isn’t more important than the other – I want my family cared for well there, just as I want someone else’s family cared for well here. We all certainly need wisdom in these times. Better systems are needed all over the world. How do we keep the patient a priority, while building an effective system to serve them? It turns out I am not the only one who doesn’t know. A whole army of healthcare thinkers can’t figure it out. There is no easy, obvious answer. May God grant us wisdom as we attempt to care for the people around us. We certainly need it.

Thursday, December 5, 2013

The small physician degraded, the Great Physician at work

I was called after liters of blood were already on the floor. Besides a dead baby being delivered and now lying in the baby warmer, now another complication with massive blood loss. I went through all the possibilities of how to treat her, and none slowed the bleeding. The only option left was to go to the operating room. It was a quick surgery without complications. Unfortunately, her uterus had to be removed in order to save her life. I thought that we were out of the woods. I was a little bit proud of myself, that now these complications don’t really get me too excited, not like when I first came out to work here. I’ve had an awful lot of “opportunities” and experiences of big cases for this one to get me flushed.

I went home for lunch. I hate to miss a meal. Just as I finished my soup the call came. Her incision was bleeding heavily. A moment later the phone rang again, now she was bleeding profusely from the vagina too. I knew it wasn’t a surgical issue, all the areas had been repaired well and were not having any bleeding issues only a short time before. I also was aware that such bleeding is much worse than something that can be stopped by surgery. See, sometimes when someone bleeds excessively, they run out of the particles in their blood that actually make the blood clot (yes, DIC for you medical folks). I knew that this was the case with her. Some blood had already been given, but she needed something more. She needed fresh blood to get her the substances that would make the bleeding stop. Really fresh blood. I asked the type, and of course mine would do.

So, off I went to the lab. I sat upright and squeezed my arm, watching the life-blood drain out of my arm. Finally the bag was filled. I knew that if I didn’t take it directly to her that delivery would be much slower. And I knew that every minute counted,  she really needed it immediately. I thought I could do it. I grabbed the blood and walked toward the ward.

The surgery ward lies uphill from the other walkways. In order to get up to it, there’s a sidewalk with a grade. Usually it’s no big deal. But there are times, like when you are emergently pushing a patient, that you realize it definitely has an incline. When you’re pushing that stretcher, you can feel the back of the thighs and butt really having to work to get up the hill. Well, that day, there was no stretcher, and no pushing. But by the time I reached the top I knew that something bad was about to happen. That incline got me. I hadn’t had anything to drink all day. And my body screamed at me that it wasn’t going to take dehydration, followed by the blood loss in the lab, followed by a brisk walk. It was over. Things started spinning and flashing. I saw one of the anesthesia students who is a friend walking by. I reached out a hand with the blood and said “take it to the ward”. Then I sat down, put my head between my knees, and tried to recover. At this point my autonomic nervous system decided to continue the craziness – was it passing out that was coming? No, vomiting…wait, diarrhea… one wave of possibilities followed the next. Even in my current status of degradation and confusion, I could imagine things getting worse and more de-humanizing. I hoped it would just be vomiting. One of the staff saw me and came by to see if I was okay. I could only say, “Get Doctor Keith”. He is the anesthesiologist, and a friend of mine, who I knew was there because he was also watching my bleeding patient. I never lifted my head, just said, “take me home”. He came and shuffled me into a wheelchair. I looked like I was dead. Normally I am one of the palest ones at the hospital (ha ha, like my joke?), but today was especially pale. As well, I was doubled over with my head between my knees, slumped in the wheelchair. Anytime I lifted my head things would start spinning again.

Being a doctor-patient with all the hospital watching was embarrassing. On and on we went, over speed bumps and gravel. I could hear people talking, but couldn’t see anyone with my head tucked down. Even without vision, I could feel them all watching me. Keith kept saying “She’s fine, I’ve just gotta get her home”. Finally I saw the grass passing beneath the wheelchair, and I knew that we were almost there. I heard Anna’s voice from inside the house. (She is one of my best friends here and works at my house one day a week, helping to prepare stuff to cook cause everything is really from scratch – like grind your own corn kind of scratch). I could tell she was a bit scared. I told her I was okay as I wobbled to the bedroom. Within four minutes, I could hear voices in my house. My initial thought was, “Why are their voices in my house? Intruders, and I am not even able to fend them off!” Then heads peaked around my bedroom door frame, and I saw that it was the clinic and maternity staff. They had let themselves in so they could catch any action. When they realized it was just me laying in the bed, unable to get up, they lost interest, said they hoped I felt better, and went back to the hospital. Forty-five minutes later after a good bit of water and a coke, I was pretty much back to normal. I headed to the hospital to check on the patient.

She stopped bleeding when my blood got into her. I’d like to say it was cause my blood was exceptional, however, it was really just God’s grace. She was even starting to make a little urine, which is a great sign that someone is having enough blood in their vascular system. I was cautiously delighted, at least she didn’t look like she was walking straight for death’s door anymore. She had turned the first corner.

I got the call at dinner that her condition was again deteriorating. The hope from earlier quickly began to dissipate. Now she was vomiting blood, and her belly was distending out. When I saw her, I knew that her condition was not just deterioration, she was standing at death’s door again. And this time there wasn’t really anything more I could do. All over the world, her condition would have a high mortality rate. Anywhere in the world, the doctors would have done the same thing and would be hoping that somehow she would turn around. But hope was dwindling. I talked with the family, letting them know that there was nothing that I could do to intervene. I told them that we would watch her, but that likely she would not make it. They understood. I left her there to die.

I thought of her each time I awakened in the night. Finally in the five o’clock hour I woke and reached for the phone. I wanted to see what time she had died. I asked about her, and they said that she had not died - she was still alive! I hung up the phone, praised the Lord, and jumped out of bed to do a little dance. It was no attractive, choreographed dance, but a soul thrilled, wild expression of delight. I was like a little kid jumping around. It was so exciting to hear, so beyond medical expectation, I couldn’t help it. The doctor turned into a four year old jumping and spinning around, giggling laughter and praise. Death was grabbing hold of her by big handfuls, in such a way that no medical intervention could help, and yet now ALIVE!!! I got it under control a bit, dressed and went to see her. From a beyond-treatment, miracle-hoping condition, to talking to me and asking if she could eat. I was so thrilled but cautious – I laughed and like an overbearing mother, then cautioned her - “no eating, no drinking, no moving, no nothing, just lie there and breathe”.

And she did. She kept breathing, and kept doing better and better and better. Day after day she improved. I did eventually even allow her to move and perform all other bodily functions. And then this afternoon I wrote on her chart, “D/C home”. I stepped over to the bed to tell her goodbye. Tapping her leg, I gently woke her up. I gave her the general instructions to call if there was fever or pus or worsening pain. And then I gave her a little glimpse from within my eyes. I told her that she had gotten so sick that I knew that there was nothing that I could do. Walking away from her was the first time that I just left a person in their bed to die. She had been beyond our medical capabilities. We gave her all we had, yet it was not enough. But God had been gracious, and had amazingly restored her health and life. She was the closest thing I’ve seen here to a medical miracle. Like God was just showing off His Great Physician skills. They were indeed great, beyond my capabilities and my mental grasp of possibilities. I am so thankful to watch Him move. I revel to know that He is indeed the one who controls all things, and that sometimes, beyond reason or expectation, He just chooses to save. Bless His name.

Tuesday, November 19, 2013

Two Girls, Two Days

It was different than any experience that I’d ever had in sports. I mean, it’s been a little while since I’ve broken out a volleyball, but I don’t remember all of that being part of the game. This game had kicking and hitting the ball, whichever was necessary to get it over the net. And within the players, it included hitting, kicking, wrestling, and biting. Thankfully, since it was my first time, they left me out of that part. The deaf kids were glad to have me there. We played and played. My arms were sore, but my heart was happy. Dinner time eventually came and the headmaster sent all the kids inside but one. She was a sweet-faced girl. Initially I had noticed that she was a bit less confident and a bit more shy. It seemed she wasn’t sure of her ability to hit the ball, and was a little embarrassed to try. She was the oldest girl out there. In fact, they told me that she was a graduate of the deaf school who had now integrated into mainstream school with a sign language translator. (As a side note, it is nice to be able to talk about someone right in front of them, and not be worried about if they can hear you.) I heard the headmaster brag on her, saying that she had found her courage to come out and play, as she was often too shy. Though she wanted to, she sometimes held back. After all the other kids had been sent away to dinner, it was only one teacher, the headmaster, and the two of us girls. I watched her confidence grow each time she successfully hit the ball into the air. She wasn’t scared anymore, she was accepted and having fun. At one point, the girl’s phone dropped to the ground as she ran. The headmaster picked it up and said, “Everyone’s got a phone now”, half-jokingly adding “even the deaf”. I said back to him that with texting the whole world is wide open to communicate,  whether or not you can hear. He added, that if they were taught to read and write, a whole other realm could be entered. “Empowerment!”- he reveled for a moment in the victory that he got to be a part of as the leader of the deaf school. I agreed, that it was a big victory, for each child a much wider world of possibilities. I didn’t think any more about it. Just kept hitting the ball back and forth til the darkness began to overtake us.

The next day I had three surgeries. The third was a girl just over 20 years of age. She was deaf and mute, and couldn’t read or write. She made some hand motions, but she didn’t know sign language, so no one understood. When she got excited and was really trying to make something known, she would make some vague noises. All the history came from her caregiver. The exam was not showing any real issues, but there had been a cyst on ultrasound. Based on the caregiver’s persistent claim of the patient’s pain, she had been set up for surgery. She came into the OR, obviously a bit nervous. I stayed by her side the whole time as we prepared for the surgery, intentionally giving her a face and hand that she could trust. The time came for the spinal to occur. I sort of got across through hand motions that someone was about to prick her in the back. My hands rested on her shoulder and leg, calming her, soothing her. She made it through, but tears were streaming down her face. The anesthesia had some issues, so we needed to test and see if she was numb. It became like torture for her. She was already scared. She couldn’t understand why we were pinching her. Her eyes became wild, scared, untrusting. Breathing increased. Sweat poured off of her skin. The medicine that was supposed to make her numb wasn’t working. Finally the anesthesia team agreed to put her to sleep, this was too much for her. She couldn’t understand or enter our world. My heart broke for her. The final tears dropped down her cheeks as the sleeping medicines took effect. This magic drug took away the need to trust, the need to understand, the need to communicate.

I thought of how different the two stories were. Both were born to the same kind of life. But the worlds have become very different. One had entered a world where she had gained confidence in herself little by little. She had integrated into a normal school, she had been willing to take one step in front of the other to slowly make her way in toward the volleyball net (even though a white stranger was on the other side of it). The other had no way to enter the world around her. Her value was no less, but the possibilities were drastically inferior. All the world was filled with unknown risk; fear and misunderstanding lurked everywhere. What set them apart now wasn’t some amazing healing or great medical advance. It was the persistent, day to day struggle that had occurred in a classroom, and in a deaf community. Someone had a vision to care and to make a difference in the lives of deaf children. Each girl represents what could have been. Different choices, different opportunities. Now very different lives.

May we, as God’s people learn to reach into the dark worlds, the quiet worlds, the shameful worlds. Those hauntedly isolated places where people dwell. For me, I need to learn to speak love and truth into lives which cannot hear. If only a hand could come along to lift someone out of a lonely place and draw them near. That is what has been done for us. He brought us out of the pit of sinking, miry clay. He brought us out of the sins and failures and weaknesses that were smothering our life, and He pulled us up and drew us close. He showed us a life of kindness, mercy, and grace. And it has made all the difference. May we look for opportunity to do the same. May we not pass by those who need us. Those who need Him.  

Monday, November 11, 2013

A Quiet Joy

I had been trying for a while. It seems like the kids need so much love. But it was awkward and I felt out of place. It kept burdening my heart, so I kept stepping down the path that led to the dorms and cafeteria building. But when I got there I didn’t know what to do. I would give a little wave and smile. Some of the kids would gather around, wondering what I was doing. But that was it. I didn’t know how to make in-roads with relational development. They couldn’t hear me. I couldn’t use sign language. We were only inches apart, but I didn’t know how to cross what seemed like such a wide barrier.

But I kept feeling that I should engage, that I should keep trying. One hundred and twenty kids, ranging from 5 to 20 years in age. Three house parents. Including staff at the deaf school, 9 total adults to pour into the hundreds of souls and lives. On the best and most intentional day, every child wouldn’t get attention, most wouldn’t get touched. Love spread so thin doesn’t even usually feel like love. If there were “the least of these” in my world, they were probably there in that school, there in those dorms. What if I could somehow, with a few hours a week, pour out just a little to let them know that someone cares, that God cares.

A midwife is here, one of the first volunteers that I have had within the Ob/Gyn department. She bubbles with excitement at everything. What are burdens to me, she waltzes into. People who are hard for me to connect with as their boss, I find her laughing with and enjoying. So, after church I asked if she wanted to go to the deaf school with me sometime in the afternoon. She was thrilled to agree.

We turned off of the dirt road to enter their silent world. At first it was the same old awkward – longing to communicate, wanting to engage. But then, I deciphered the invitation. Soccer (football) was being played somewhere. My sign language may not be good, but I could figure that out. I shook my head, excitedly. A quiet, but thrilled entourage of deaf children accompanied us down the path to the football field. Crowds more joined us there. The older boys were engaged in a football match. But swarms of younger children were hanging around on a small playground dotted with sparse, old jungle gym equipment.

Guttural noises and rapid hand signs kept coming. But I helplessly shrugged my shoulders over and over indicating that I didn’t understand. I spelled out my name in the alphabet, and then spelled out doctor, then imaged a big pregnant belly followed by a downward sign indicating a baby coming out. Name and role, that was about the best I could get across. But then – lighbulb!!! I remembered that on my hip was clipped the i-phone that someone had given me. I grasped it, and began to type. “How many children? Girls? Boys?” The oldest girl, who had been most engaging in trying to communicate, typed back “120 - 70 boys, 50 girls”. She typed her name. On and on and on we went. Then I typed, “I want to learn, tell me the names of these”, and showed pictures of animals. The children delighted to teach the signs - zebras, giraffes, lions, cheetahs (though they thought that was a tiger and so I just went with it), elephants – my hands learned to say their names. Then it was time to play. I wrapped my skirt between my legs and twisted up to the pull up bar. Swung up and hung by my legs, no hands. It was the most impressive that I could still accomplish from childhood without checking my health and disability insurance policies first. The children copied. Shelly (the midwife) climbed the dilapidated jungle gym. She, and it, became so covered with children that she disappeared in and under the piles of faces. Finally I saw unveiled what I knew was there. The need for and delight in adult attention and engagement. And somewhere deeper – my soul saw a glimpse in their eyes, and I felt it in my heart - hope. Hope for relationships. Hope for the future. Hope that my love might make a difference in these kids.

I brought back out the iphone as the sky became dusky and the night threatened to set in. “Good to meet everyone! I am excited to come see everyone again.” I left with a happy heart and new dreams. Too many dreams – Christmas party, Easter party, next weekend, Bible stories, cooking classes… I had to reel it back in. One day at a time. Relationships just started. But I’m super excited to dream of this new place to pour life out. Such great needs unleashed. Their need for love, my need to love. This could be the start of something wonderful.

Friday, November 1, 2013

The Other Side of the Continent

I pretended that it was vacation. The thrill of a new place with old friends. It didn't matter that the real reason was revolving around training for work. It took 2 days of a journey before I even would arrive. A long bus ride into the city the day before the flight. Night  in a guesthouse, then off to the airport.

I was leaving the frustrations behind. Well, at least the usual ones. I awoke at the guesthouse the morning before the flight feeling freedom all around me. The recurrent tune beautifully resounded from a bird in the courtyard. I wished that I could write down the way that the melody kept coming. But the tune and note, mixed with the alternate language of the bird, made it impossible. I was grateful. Grateful for time to consider such things. Grateful to have been woken by it. I turned over and grabbed the Word, read another song, this time in my own language from the Psalmist. Then on to words of wisdom of Solomon.

The rest ended, I packed the few things that lay scattered back into my luggage. The driver would come any minute. I'd better go once more to get rid of all the water that I had been drinking before the airport. Once you make it to the airport, the restrooms there are anything but "restful". My personally developed system becomes - roll up my pant legs to avoid tainting from the urine which coats the floor when I pull them down. Take a big breath just before entry, hoping I don't have to inhale the inevitable stench that constantly lingers inside, then rush in, balance above the toilet, while the heaviness of my carryon threatens to pull me to the side - no forward - an awkward shuffle and balance. All that while keeping the breath held. Oh yes, such a situation must be avoided. So, one last time before I leave the guesthouse.

I'm only there in the hotel bathroom for 25 seconds or so, during which of course, the driver arrives. In that brief time, he has knocked twice, and rung the bell 4 times. I thought the frustrations had all been left behind at the hospital, but he reminded me that they were still there inside me, lurking and waiting for a moment of expression. I rolled my eyes and ran out from the toilet, hands wet from a rushed drying trial. I grabbed the bag and off we went.

The airport was- well, it was the Douala airport. Hopefully no one reading this will have to know the implications of that any more than described in the "bathroom" section above. It's no fun, no pleasure. But, then came a previously unknown perk. In addition to my ticket, she handed me a slip for the Kenya Airways lounge. I found myself sitting in a cushy chair, thankful for whatever course of reasoning or mistake had obtained my entrance, wondering if all the food on the counter was free. Finally, the gentleman came and asked if I would like anything. I crunched the green apple in delight. Not only the delightfulness of the sweet-sour bite, but the knowing that it was free, unmerited, and undeserved. It was greatly appreciated.

Finally, out of the life of luxury, and into the plane. Across Africa, excitement rising in my spirit. The meeting was to last most of the week, but a few of us were meeting a few days early. Where we live there isn't anything to remind one of the National Geographic scenes representing Africa. So, we wanted to go on safari. And we did. Gazelles leaping, elephants crashing through the trees, long-necked giraffes giving birth to wobbly-legged offspring, lions tearing through flesh while eating their kill. It was definitely not our typical day in Africa. Not only amazing things to see, but great company with friends. It was strange to think of how many would call this "real Africa", when what each of us was trying to get away from - endless pursuit of death, unending stench of rot and disease, unending tears of pain - was what we would call the reality of Africa. Just for a few days, it was nice to think that National Geographic was presenting the real picture.

Then the actual meeting. No one wants to read all the details of that, though it actually was pretty useful. But everything is better when mixed with some goofy, yet like-minded members of the body of Christ. And any meeting is also better when there's a deep, long bathtub filled with steaming water waiting on you in the room. Oh, and  a candle lit, with flame dancing, just to feel fancy. And a refreshing (though embarrassingly slow) run every morning through the trails weaving through the woods. And cheese. And ice cream. And meat. Even smores. Oh, delights so often unobtainable, so much more precious because they are often far beyond our grasp.

I've wondered many times over the restful, fun days - why is it so easy to see God's blessing and seemingly glorify Him more when situations are conducive? Why is it so easy to have joy in times of ease? Why, when the days get stressful and the risks get higher, do I feel the weight and frustration well up inside? A small twinge hits me reminding of how I don't meet my own expectations, certainly not His... And then I am reminded that God is making and molding us through it all. Sometimes He keeps us in the wilderness. Sometimes He takes us to a place of rest. He tries us, brings us through difficulties, and then we look back, seeing that indeed we have developed some evidence of perseverance and some change in character. But He is making us, developing us - we are in process. It isn't something that has been completed, it is very much in the making. His glory will be seen as we are more and more transformed. We aren't now, as we will be. We are in His process. Not always through gentle,soothing massage, more often hammer and chisel - beaten with pressure to transform into something He delights in. But in His hands to make, and to re-create. I love His hands. But it is in the times of refreshing that I tend to remember that they are His hands, doing His will. That is how He refreshes me most. I am reminded.
Newborn giraffe (so newborn that placenta still inside mom)

Elephant Family

Mom and Baby Lions

Sunday, October 13, 2013

Complications: A Continuation of the Last Story

She kept getting better. But it seems medicine, and it’s providers, kept fighting against her. Two days after surgery I noticed her leg was swollen. I knew that she had a clot in it. I looked at the chart, making sure that I had not forgotten to write for the medicine meant to prevent this particular complication. No, the order was there. As well, another order was right above it, written by the surgery team, which ordered the exact same medicine. Written twice, but never given. I called the nurse, and no, that medicine hadn’t been given. “It must have been overlooked”, they answered as if it were no big deal. But it was a really big deal to me. They continued explaining, “maybe the chart was moved by one of your colleagues”, and “we have been very busy”. Finally the gasket blew (it isn’t always that firmly attached anyhow, and this episode of apathy flipped it off). I explained heatedly that I didn’t care about any of the excuses, what I cared about was if my patient got her medicines. I emphasized that she could die from this. And how I wrote those orders to prevent stuff like this. And again said that the least important thing to me is the excuses that keep coming. That explanation probably did very little to encourage my relationships with nursing, but I lacked the strength to hold it back.

In spite of her setback, she started getting better. I had one of the medicine doctors seeing her to make sure her blood clot was being managed correctly. Better and better and better. She always smiled, and it delighted me to finally see her condition catching up with her attitude. She was actually getting better. I transferred her medical care to other doctors to manage her clotting issues and her chemotherapy treatments.  I couldn’t really let her go though, I thought of her every day, so found myself going by to make sure she was hanging in there, or to have a quick word of prayer with her.

I got the final pathology back. It was a cancer that is rare, but can be very aggressive. In fact, it was the one I was hoping most against. I went to tell her. I had to make her understand. Medical terms would be lost, so I went with a more accurate description – “I was hoping it would be a type that we could really squash dead, but it is a type that is much harder to kill, and even with the treatment, it could come back”. I told her about the medicines she was going to be taking. How they were cruel to the body, but how she had to hold on, even through the hard times. Looking at her little frail body, I was surprised to hear her so excited to fight against it. And so she did. Made it through the first round of chemo weak but vibrant, and smiling as always.

About a week passed. Just a few days after she was readmitted for more chemo, I got a call from her brother. He said she was not breathing well and was confused, and that he couldn’t find a doctor. I hung up and called the medical doctor at the hospital to please go and see her. Soon it was clear. Her issues had been “lost” on the readmission. The new doctor didn’t know her well. No one was following her issues. The medicine to treat the blood clot had been forgotten. She died the next morning of a clot that moved to the lung.

I had poured my heart out into her. I cared too much. She loved it when I came to see her. She loved that I would walk through it, and hope through it with her. I loved to watch her get better. But caring wasn’t enough. It seemed that it was an avoidable death, a greater tragedy than when a loss couldn’t have been prevented. Too many things had gone wrong one after the other, leading to the loss of life. I was discouraged and frustrated. And just plain sad.

It is a hard reminder that my best is not enough. That medicine isn’t enough. Out here we need better training, better management, a better system. Our resources, including both human resources and medical resources, are stretched too thin. In fact, for most of the society here such loss of life is accepted as normal. It is not the exception. All those things really are issues. But if they were fixed, it still wouldn’t be enough. It still couldn’t make sense of the madness of circumstances that we pass through. It couldn’t make sense of our losses.

But my patient seemed to make sense of life, at least to me. In spite of her circumstance, I never saw a bad attitude. She never complained, though she certainly had reason. There was no feeling sorry for herself. In the midst of great pain, she pushed through with a smile. Over one hurdle, over another, she just kept climbing. While I was frustrated and tired from fighting on her behalf, she was just resting and trusting that God would care for her. She did want the medical care, she wanted help, but she knew that it wasn’t ultimate. She could rest in Him.

Too often I cannot rest. I am too busy fighting. I fight on behalf of my patients. I push to make the staff provide better care. I fight for the injustices I see all around. Sometimes I work as though I am holding up everything around me. Frustrations abound because I carry more than I am meant to. My grasp is a bit too tight. One day I will know better how and what to fight. One day I will know better how to rest in Him.

For this time, in spite of the struggles and frustrations, I have lost the battle on her behalf. Yet still she rests, now more completely than she ever has.

Wednesday, October 2, 2013

The Kindness of God in the Bitterness of Cancer

The greed of cancer. Taking position and strength from places it should never have gone. Invading bodily fields it was never given a right to enter. Growing and stealing from other organs without any regard to their welfare. 

Stupid cancer. 

Her belly had grown beyond the size of practically any that I had ever seen. It grew far beyond her pregnancy expectations. There was indeed a living child within. But it was getting squished and pushed more and more as the tumor grew. Eventually the child came, early, but healthy. However, the abdomen was still massive, as if many babies still rested inside.

She was a young woman, younger than me, pregnant with her fifth child. A doctor had seen the tumor in an ultrasound during the middle of pregnancy. Then, it was 7 inches in size. He stapled the report in her little booklet. But he never told her. After she delivered, she waited, wondering what was happening. There had been no change in the size of her belly even though the baby had come out. Six more weeks past. Her abdomen bulged beneath her ribs, hugely swollen, now many times it’s earlier size. The rest of her frame was like that of a refugee, frail and thin, making the protruding belly even more strangely alien. She began to have difficulty breathing, and came to our hospital for management. I was consulted since she was postpartum, at which time I found the ultrasound showing that not very long ago it was only a large, but reasonable sized mass from one of her ovaries. In only a short time, it had flourished, and now was overtaking the rest of her.

I made a plan, knowing that I was in over my head. If there were a specialist, I would have sent her to them. But there was none. The head general surgeon said that he agreed with the proposed surgery, and so we teamed up against the disease riddling the patients frail frame. The next day, too weak to move alone, she wrapped her arms around my neck as I helped to lift her off of the stretcher and onto the operating room table. Without the surgery, she would have been dead in a matter of days to weeks. With the surgery.. I couldn't know. Hope and fear were in my heart. Hope that though she obviously had an advanced cancer, that it would show itself to be a type that was treatable with chemotherapy. Fear, because decision making and surgical care for her were beyond my level of training. 

Two hours later, we closed up the abdomen. The length of the incision was almost like a jacket's zipper, running the full length from just below the chest to the pubic bone. Approximately 30 pounds of tumor had been rolled out of her abdomen, into my arms, and then dumped into a large bucket. As much other residual disease as possible had been dissected, adding to the final total weight.

She went to the ward. I went home. She uneasily rested. I worried. I prayed.

Next morning, she smiled. Finally she was able to breathe. By the next day she was walking with the assistance of a walker. She continued to improve. A set-back would come, but she would struggle through it. Better days kept coming.

I wish I could say that we were out of the woods. But we aren’t done yet. She could still die from this disease that has taken hold of her. It is likely an aggressive type. She has a long road ahead. I have done all that I can do surgically. Now she needs chemotherapy. I’ve transferred her to the care of another doctor for the drugs that she needs to help fight the cancer. Now, as her doctor, and as one who practices under the supervision of the Great Physician,  it is time to once again ask for the help of my Supervisor. He has guided us this far, and is still at work. But now my hands are done, I personally have nothing more that I can offer. It is time to kneel. Because He still has plenty that He can do. I pray that inside her – from every crevice that has a cancer cell attempting to gain ground to the deepest depths of her soul – He will work to restore all that is broken. Please pray with me. He loves to hear you pray, and He often moves His hands to heal in response to your requests. May He be glorified through this one frail, sweet woman’s life - for as long as He gives her to live. May she know the kindness of God, even in the midst of the trials and bitterness of cancer. 

Saturday, September 21, 2013

Generations and Restoration

Her diagnosis preceded her exam. The odor of urine made me want to turn away to get a clear breath. But her sweet smile and nervous eyes drew me in and I welcomed her into my exam room. I knew that she had a fistula – a condition where women get damage to their bladder and vagina during labor, and then leak urine continually thereafter. Now I had to find out how she got it, and figure out if I could fix it. Most women in the developing world get such problems through prolonged labor and delivery. Most are having their first baby, and lose it in the process of delivering. But that wasn’t really the course that led to the steady stream of urine running onto the floor.

No one wrote down how long she was in labor, or anything about her labor course in the little book she handed me. Her story seemed to indicate that it wasn’t too terribly long. Nor was there anything written about the C-section that was performed. They never really told her any of that either. So, it seems that though she labored, she wasn’t able to deliver normally. But surgery was done and a healthy baby was the end result. That is all I knew. But ever since the surgery a couple weeks ago, she had a stream of urine leaking down her legs. I performed the exam and saw that it was quite extensive, but appeared related to surgery rather than specifically a long, abnormal labor. 

She asked if her father could come in to hear the counseling. In came a smiling, joyful man. He was beaming with hope. It was as if the grin couldn’t leave his face. A few teeth missing and one short black one, his continual smile showed his excitement. He said that he was so glad that someone could help. He said that he brought me something. I didn’t really understand what he was getting at when he said that part though. It was only after they had left the clinic that the nurse brought the lettuce and scallions and celery – special things that most people don’t grow, as a gift for the certain success that he envisioned. He wasn’t a rich man, he was a farmer. As I stood there talking with the two of them,  I had to tell him what the expected hospital charges would be. The prices are only a fraction of what most hospitals in the country charge, but still can be significant for the patients and their families. I expected the usual, “doctor, it is too high, can you reduce it?” that I hear from so many patients. Instead, I heard, “no matter what it costs, I will pay it. She is my daughter”. It almost made me tear up to hear him. As if he would plant every vegetable, till every inch of soil, sell at every market, whatever it took, to see her healthy again.

Her eyes, his smile. They were creeping in on me. They were becoming more human than usual. She was somebody’s baby. In her arms, she carried her own firstborn, their next generation. She was ashamed of her condition and in obvious need. She was void of dreams for the moment, except for the great dream of being normal again. He was densely filled with optimistic anticipation.

It was refreshing to see such a father’s love. Here was his daughter with a newborn baby. There was no man around who had helped conceive this recent birth. Now there were complications and responsibility. It wasn’t as fun anymore. I asked her dad when I saw him a bit later if the father of the newborn baby was still around. His answer, still smiling, was “He has escaped. Now I am the father.” The only man in her life right now, was the one who had been in her life since day number one. He still stood steadfastly in her time of need, willing to do anything that could help return her to health again. He wasn’t rigid and austere like many fathers, he was loving and kind, willing to pour out himself, no matter the cost. If he hadn’t been like that before, her need had exposed his love.

But it wasn’t just refreshing. It was a bit burdensome. He looked at me with eyes filled up with hope. He brought vegetables in anticipation of some great outcome. I felt the weight of it. When people lift you so high, you’ve got a long way to fall. What if surgery failed? What if I couldn’t fix it? What if when they left, I had let down their hopes? I don’t like to hold people’s big dreams. I don’t want the chance to disappoint them.

So, I took it before my kind and gracious Father. The one who has poured Himself out for me. The One who has sacrificed greatly for me. The One whose love for me has been clearly exposed through the work of Christ. I asked Him for help and wisdom. I told him of my inadequacies, but He already knew them. I told him of my anxiety, but He already knew it. And though the weight of hope and expectation made me uncomfortable, I was reminded that He was big enough to bear it. So then I just rested and waited for the proper time to do the job that He has given me to do.

Surgery day came a little while later. She was the last patient for the day. She hadn’t eaten all day, and it was late in the afternoon. There was no complaining, though the wait had been long and she dripped urine all around her as she sat. As she waited on the wooden bench in the entry area of the operating room, her family brought the newborn baby to breastfeed periodically. She waited, and waited, and waited. Finally her time arrived. My neighbor, a general surgeon, assisted me during the procedure. There was plenty of scarring inside, with everything matted together that should be clearly separate. As I dissected the layers free, it became clear that the prior C-section had been improperly performed. The cut was too low, actually below the uterus. And then the bladder had been directly sewn into the vaginal incision. “Surgical misadventure” was the cause of her condition. We opened and explored, took apart and put together. We added an extra layer to keep the structures separate to try to avoid recurrence of the fistula. And then we closed it all up.

Post-operatively she did well. An ideal patient. She slept on dry sheets for the first time since her prior surgery. She sat on a dry skirt. The lack of normality now made “normal” feel extraordinary. She felt so good that she asked to go home on the second day after the procedure. There they went, she with the now brightened eyes and urinary catheter in tow, and he with that same big, bright smile.

She walked away a bright, young woman – not the nervous, embarrassed, malodorous girl from just a few weeks before. God allowed us to take part in restoring her wholeness. And I loved to see her bloom. Praise His name for restoration – body and soul.  

Tuesday, September 3, 2013

where heaven and earth collide

We all want to see where heaven and earth collide. I pray sometimes for the miraculous to occur in the lives of my patients. I wait, expectantly watching to see what will come. There are difficult times, when I am fighting with all my strength to save a life in a complicated surgery, or in a horrible delivery, I find myself crying out aloud for Him to make something amazing happen to bring resolution to the emergency. I, too, long to see great revelations of the unseen hand of God.

Humans always have yearned for such. Those circumstances are often rare, that is one reason why they are so exciting. There were some times when the miraculous seemed more common, such as during the earthly ministry of Christ, or during the early church. Still, even in the days of Christ, when He was doing awesome things which had never been seen before, they asked Him to perform more miracles to prove Himself. With God standing among them, they still apparently wanted more amazement than healing of the sick and raising the dead. Heaven and earth were wrapped up in His frame, yet, it wasn’t enough for most. But there were some, who saw divinity beneath the human skin. And as their eyes were opened, their hearts were changed. Other miracles were happening, but the greatest ones were unseen in the souls of men.

I remember when it happened for me. I had grown up in a church, but there was no substance to it for me. But that night as I sat alone and saw the lines of cocaine on the table behind me, and my friends wasted in empty pleasure around me – He opened my eyes to more. I realized that everyone around me was going down a path of destruction and hopelessness. And I didn’t want to walk any further down it with them. I wanted a Savior. I had never wanted that before. I had wanted a ride to heaven, avoidance of hell, and some “genie” type help along the way, however I didn’t want anybody with actual authority over my life. But in the external haze and beginning of internal clarity, I began to understand that if God really was legitimate, that He was worth a life lived.

I started to realize that all the things of earth weren’t what they had promised to be, and that the neglected things of heaven were more than I had ever imagined. It was as if I had never had eyes to see before, as if the world around me were new. I grew to understand the work of Christ – how literally heaven and earth came together in Him to bridge a gap between the two. I had heard about the work of Christ thousands of times, but it never became real to me until then. His sacrifice for my acceptance, His payment for my debt. Love so far reaching was almost unbelievable. But amazingly true.

I still want to see great and glorious things. Miracles and wonders, divine aid and assistance…but sometimes I forget that the greatest works of God are being wrought in the hearts of men. That is what I want to see more than anything else – hearts that come to see the unseen God and are changed by Him. The God who became seen as Christ, walked the earth, died to save the people on it, and then left the Spirit as a guide. He brought salvation and grace to the sinful who had no possibility of obtaining it on their own. Justification was brought to us through Christ, who died undeservingly, appeasing the wrath of God that we should have borne.  Only God could make heaven and earth collide with a plan so full of love and mercy, and yet satisfying justice. Only God. 

Wednesday, August 21, 2013

The Psalmist's Sieve

The Christian life is not a life to be only contemplated, it is a life to be lived. What does that look like? Lived in the midst of joy, delight, suffering and sorrow, with a thousand frustrations along the way. Sometimes I think, usually only upon reaching the end of myself, how I need to reframe my thoughts to align with God’s plans and purposes. He isn’t sitting in Heaven frustrated, irritated, and with vision blurry from anger. And yet, where I am right now, there is injustice, poverty, oppression, apathy, disease, pride, and death. The stench of those foul odors waft through life here every day.

Too often, though, we find ourselves fighting against them with a very human strength. Unfortunately, disease and sorrow and poverty are winning. There are times when we can alleviate a small drop of them, but one drop isn’t even noticed when it is removed from the sea. Our frustrations will have only mountains more to add to their burdens, unless we learn to let go a bit. When I say “let go”, I don’t mean become lazy or apathetic. I mean filter properly.

It is God who allows us to make a small difference, to bring a brighter moment to someone’s day, a smile to their face, restoration in the midst of decay. And it is God who, for now, allows the vast majority of those dark evils to remain. Even after healing, the body still heads toward death. Even great joys will have times of sorrow to follow.

Big things, little things, they start to build up and wear us down. The frustrations of living as a plain, normal human. Just like for you. The kids don’t quiet down to give you a moment to avoid the snap of your temper. Your spouse doesn’t even try to see it your way. The neighbor’s dog poops in your yard, not once, but every single day. You get overlooked at work, while others get acknowledged and don’t even deserve it. Your relationships are falling apart. He died. She died. They left. Don’t have enough to make the bills. On and on.

This is real life. And yet, in the middle of it, there is real hope. In every joy and sorrow, I want to grasp them each up and run to the Lord with them. Like the Psalmists, pouring out their hopes, praises, losses, pains to the God who truly does care. Those men had a perspective of God that was big enough for them to take their troubles to, kind enough to be willing to help bear them. They knew Him as the only one great enough to worship, and the one worthy of continual praise. So they brought Him their greatest and worst moments, and left them there for Him to make sense of. He is the filter that I want to sieve through as well. Too often, instead I run to someone who can listen to me vent, knowing that they will be on my side. Then I can have the feeling that they understand. There is validity in that sometimes. But they aren’t my comfort, or shelter, or peace, or shield – God is. And He certainly understands better – not only my situation, but how it fits in His bigger plan.  I want to learn how to run much more quickly to Him. To give Him the burdens that are bigger than me, the sorrows that can overwhelm me, and the praise that flows from inside me, and let Him sort out the details. He is big enough to manage all of that.

Monday, August 5, 2013

The Splash

I knew that she was HIV positive before I started her surgery. I’d seen her multiple times for significant other problems related to her pregnancy. She was kind, and smiled sweetly each time she came to see me. But this last time was different. She was bleeding too much and I knew that a C-section would be needed urgently. I put on my routine  garb –hat, glasses, mask, plastic gown, then cloth gown, followed by double layers of gloves. I moved quickly, as the situation required. The placenta was sitting beneath where I had to cut the uterus to get inside to where the baby was, so I had to cut through the placenta. This added a little bit of extra bloodiness to the routine operation. As I finally got inside where I needed to be, I stretched my hands to make room to get the baby out. The tissues started to move against the force of my hands, and the amniotic fluid rushed out. In that moment a mixture of blood and amniotic fluid gushed at my head, hit my hat, mask, and glasses, went behind them, and ran all down the side of my face. I tasted the slightly salty (unfortunately previously known) taste of the fluid as it even soaked through my mask. There was nothing else to do but get the baby out quickly. Meanwhile, the fluid had also gotten all over my assistant and the anesthesia staff too, and they had immediately left the room to clean up. So, I found myself alone, with no one to hand the baby off to at the baby warmer. I was yelling for someone to come in and clean off my face, but it was multiple minutes before anyone arrived.

Finally a replacement anesthestist arrived at the head of the bed. He cleaned my face with rubbing alcohol. I told him that I needed to rinse out my eye. A moment later the bore of a needle was aimed at my left eyeball. I usually think it is a bit ridiculous to be scared by a needle, but this one was looking huge! It was equivalent to looking down the barrel of a shotgun pointed at your head. It was like a centimeter away and the more I looked at it, the bigger it got. I thought the guy was going to pierce my eye with it. I instinctively began to back away. He saw my deep distrust. He told me to be still and started to squirt sterile saline forcefully into my eye. I’d never exactly had an eye rinse like that one. It was scary. He finished a couple syringes full and then I finished up the surgery. 

After the case, I rinsed it more myself in the sink, grabbed the medications that are recommended for HIV exposure, and then went home to take a shower. Yuck. But the yuckiness was just beginning. I took the necessary pills upon arrival to my house. They were quite large, what in my family we would describe as “horse pills”. Almost immediately after taking them I felt some uncomfortable nausea. I figured if I just waited, it would go away. Nope, that wasn’t an accurate assumption. My compassion rapidly began to grow for those on such medications permanently. The nausea was constant, initially only relieved when I fell asleep at night. In addition, frequent diarrhea left me nervous to leave the house. I felt bloated up like one of the dead frogs that I used to find in the swimming pool. Disgusting, that is how it felt, disgusting. I spoke to others who had to be on the medications before for similar exposure related risk reductions, and they all said it had been awful. Most had stopped the medications after only a day or two because they felt so bad that they couldn’t leave the house.

I knew that my true risk for contracting the disease from the eye splash was really low, but each time I thought of stopping the meds I considered how stupid I’d feel if I were that rare person who contracted the virus and it could have been avoided. So, I kept on. I never really felt motivated by fear, just by a desire to do what seemed to be the responsible thing for my health. I did consider the obvious, of course, that it would sure stink to get that infection. But a moment later, the less obvious, but completely certain reality set in – that God can manage any “complication” that my life ever brings. That includes every single sickness and injury and pain and loss. I don’t have to live in dread of something bad happening. I don’t have to live with fear of losing control over part of my life. All I have to do is live for the glory of God. It is so comforting to know that He can handle all of the details from there. Now that doesn’t mean that I understand what He does with all of it, but I know that He can be trusted with whatever comes. And that is good enough.

Practically, I am very thankful, as I have now finished those terrible medicines. All my labs are fine, with negative test results for HIV. And I have once again been reminded that being in God’s hands is the safest place to ever be, regardless of circumstance. 

Thursday, August 1, 2013

Abdominal Pregnancy

Abdominal pregnancy. It's a very rare event that happens when the baby grows inside the abdomen, where all the guts and such are, instead of inside the uterus, where it should reside. It was one of those thoughts that always made my heart beat fast. What would it be like? Would the baby just hop out at me when I cut into the belly wall? The theory of coming across that obstetric rarity had always been sort of fearfully exciting. But as I stood there alone with the knife in my hand, there was no sense of excitement or adventure. There was only a very real sense that this patient could die in the next few minutes. She is alive right now, and she may be dead before she gets off the table. But there was no other choice.

I had called the surgeon on call with a fury of need and hope in the moments before scrubbing in to begin the case. But his phone wasn’t passing through. I had notified security to go to his house to get him, but he hadn’t come yet. I took a moment to pray my usual prayer for wisdom and skill and set my mind to act. I began to open the belly wall and found what I knew was a couple of cell layers away from disaster. I asked the anesthetist at the head of the table to call the surgeon one more time. I prayed that he would answer, and he did.  I waited, thankful that someone experienced with such possible complications was going to stand on the other side of the bed. He scrubbed in a few minutes later, and after seeing the mass, said that he had never seen something like this. If the mood were different I would have chuckled, since I was banking on his prior experience. The entire abdominal area was covered by the placenta, bearing its huge vessels boastfully before our eyes. If we got into those, the bleeding may not be controllable. The mass was attached to bowel from what we could initially see, and who knew what it was attached to beneath the superficial area of our vision. We found an area that seemed a bit thinner than the placental bed and opened it there. A gush of blood and fluid flooded out. I grabbed the baby’s feet and delivered it through the small incision that I had made. As we cleared all of the residual blood and debris, I noticed the importance of the exact area where we had entered. One inch higher and we would have injured the intestines, one inch lower and we would have been in the bloody placental bed. Indeed, God had guided our hands, just as I had prayed. After we could examine inside, it was clear that the possibility for catastrophe was even larger than we had known. The placenta had implanted itself in the large intestine, bladder, abdominal wall, and the kidney. How it spread to involve all of those organs was almost incomprehensible. But it certainly did. Removing it would endanger her life within minutes, so we packed some sponges inside to hold pressure and closed the belly up.

A day and a half later we opened her back up to remove the sponges. The surgery went well. She was in pain afterward, but overall was beginning to improve. I counseled her each morning on what the experts from the States had recommended for her further care. I prayed for her at night as I knelt on my bed. Last night as I prayed for her, all I could think about was making sure that she understood the Gospel. I determined to make sure to talk to her about it in the morning. But morning came and I again told her more about her condition and the treatment needed. She has so many possible complications and she had questions about each. I got lost in the medicine. It was evening as I read my Bible that I remembered that the one thing that I had set out to do for the day had been forgotten. I had covered the medical scene, but I had forgotten to make known the Gospel. Huh? I mean, am I a missionary doctor or what? Well, it turns out that I’m the very same doctor that I’ve been all along. How could I forget to mention the One I adore? Well, sometimes I get caught up in medical care and forget that something bigger needs to be addressed. It’s deep down in her eyes, past her figure, beyond her smile or frown, unseen and yet very real. Medical need is important, don’t get me wrong. The compassion to a patient through hands on care adds legitimacy to the claim that they actually are loved and cared for, that they have worth. But there is one weighty thing, and comparatively, the rest is feather light. And that is the truth of God’s love, poured out to us through the life and death of Christ. We call it the Gospel.

We all are sometimes carried away. Sometimes it’s by important things. Sometimes by just wasted time. We lose our focus and forget our purpose. We walk through hours, and days, and weeks like that. But people need to know that there is a God who loves them and who cares about what they are going through.

So, I walked back up there tonight to tell her about the goodness of the Lord. I’m no orator. I’m clumsy and stumble over my words sometimes. But I just started to tell her that God loved her enough to send His Son to make a way for her to be right in her relationship with Him. And that He cares about what she is going through now. The bad pregnancy, the possible complications, the treatments. He loves her, and He cares. I want her to rest tonight reminded of His great love for her in the midst of uncertain circumstances.

To those who read this, I want to remind you of His great love. All of life seems uncertain, but the Gospel allows us to rest in Him. He loves you and He cares. 

Tuesday, July 30, 2013

Complication after complication

I went for a walk with a few of the short term volunteers up the mountain behind the hospital. A good chance to get away from the cares of the hospital. Nope, nevermind. Way up on top of the mountain path, I got called by the midwife about a patient who I had seen earlier in the morning on rounds. She was complicated, her water had been broken for seven days before she came to the hospital, thus she had begun to have a severe infection in the uterus. I had been treating her with antibiotics. As well, she had preeclampsia, a problem of high blood pressure which can become very dangerous, eventually lead to seizures. I gave the nurse some orders, telling her to deliver the baby. The mom wasn’t having contractions any more, but the baby was sitting there ready to come. A few minutes afterward, my phone rang again. The midwife hadn’t followed my instructions, in fact she had gone home. The next shift had just arrived, and there was only confusion. I could tell that things were going from bad to worse. The preeclampsia was getting worse, the fetal status was getting worse, the communication was getting worse. I tried again to make them understand that they needed to proceed with delivery. I began realizing that the chance for a poor outcome was going up exponentially as I heard the panic in the voice on the other line. I made sure both mom and baby were stable for the moment, and told them to just monitor them and wait. I would be back within 45 minutes. I told the hiking group that I would have to leave them, and headed back. A few minutes later, I saw a rare moped riding along the slippery, rocky mountain trail. It seemed like a God-send. Only rarely do they they ride so far up there to take someone home who lives out in the bush, since the path is terrible. I waved him down. It took a minute to bargain him down to a reasonable price, but then I hopped on the back and off we.

Bumpety, bumpety, bump over the rocks, slipping into the ruts of the path we rode (or slid in many places) down the mountain. The waft of alcohol occasionally passed from the driver’s breath to where I could smell it even riding behind. I held on tightly to the bar behind my seat. I came up with a theoretical plan, that if the bike should begin to fall due to the rough terrain or the inebriated driver, that instead of trying to put my foot down and catch us (as seemed natural), I would spread my feet and catch myself, to let the motorcycle pass in front of me before it fell, leaving me behind and safe. Sometimes I make a “just in case plan”, thankfully, I rarely end up using it.  Too many of those prior motorcycle drivers (and riders) have passed through the orthopedic ward and now hop around with crutches on their one leg.

We made it back in a fraction of the time that it would have usually taken me on foot. I walked into the maternity ward and checked the patient. The mother was lethargic from the medicine that she was on to prevent seizures. We lifted her onto the delivery table. Then I grabbed the gloves and checked everything out. Things were not as had been reported, and they were even a bit worse. I described to the mother that I needed her to push with all of her heart. I applied a vacuum device to help pull the baby out. A few minutes later, out came a floppy and tired baby, barely able to breathe. The resuscitation began on the other side of the room. Meanwhile, I knew that the mother had many risk factors that could cause her to bleed after delivery. And she certainly did. I was almost up to my elbow inside her trying to arrest the bleeding. As I worked deep within her, it felt as if she was on fire with heat from the infection inside her womb. I glanced at the baby, knowing that it too was doing poorly because of being exposed to the infection for too long. The bleeding continued as I returned my eyes to focus on the mother. Medications were coming, but seemed to take so long to get drawn up and unwrapped and such. Finally, the bleeding slowed and I knew that we were going to be okay.

After I wrote a note in the chart, I headed back to the house. My hiking shoes had blood splattered all on them. My arms were tired. My passions were tired. So many problems, both with the patient and with the management of the patient. Another close call, too close. Another sick mom and sick baby. There are so many women and babies at risk, and so many opportunities for poor outcomes. But almost each time, earlier recognition and intervention could give a better outcome. I sometimes blame the staff. I sometimes get so frustrated. I know that it could be so much better. I am praying that God will engage the hearts of the staff to desire to learn more and care deeply. But I am thanking Him that in spite of our failures and lack, He often provides for us anyways.  There were so many other routes that could have ended their story. One complication seemed to pile on the next. But tomorrow, a healthy mom and baby are going home together. Thankfully, this is the story that they get to own.