Saturday, April 27, 2013

Patient This Week

I walked into the room that serves as my clinic as the nurse called out for me to come help. As I turned the corner I saw the medical officer (someone who has completed medical school, but hasn’t done any further training). His face showed fear and uncertainty. He realized that an emergency was beginning, but wasn’t sure where to go from there. A young woman stood before him with blood gushing down her legs and pooling onto the floor. She had been to two hospitals over the past days, and was not treated at either – but now things were getting desperate. I asked some questions about her history,  I gave a few orders, put her in the wheelchair, and headed for the OR. As I had glanced at the ultrasound from an outside facility, I knew that she had a molar pregnancy (an abnormal pregnancy that is dangerous and doesn’t have an actual baby inside) and was now hemorrhaging. Her belly was big and full. She had thought all this time that it was just a normal baby. I told her that there was a chance that she could have to have a hysterectomy if the bleeding wasn’t able to be stopped. She begged to do as much as possible to allow her to have children in the future. She said she wanted to wait for her husband to come, but I told her that she would likely die by then, and that we had to act immediately. So, we found ourselves in the OR. Her blood pressures and pulse were sky high from complications related to this abnormal pregnancy. I asked the anesthetist to give some medications. I prayed and started.

She lost a couple of liters of blood over the next few minutes. We didn’t have the appropriate instruments for this type of procedure, but quickly and furiously I began to complete a D&C on her. Finally I could tell that we were starting to win. The blood was slowing down. The products from within the uterus had come out. Tissue and blood covered the floor. My hand was cramping as it clung to the instrument used for scraping inside her womb. Finally I knew that it was going to be okay, and freed my hand from the grasp for a minute.

The procedure was completed. I removed my gown and washed my boots. It all turned out alright, but it wasn’t the way it should have been done. We didn’t have the instruments, the labs. The pregnancy was too big, and the risks so high. But we made it. I called a doctor back in the US when the rush was over. The medical complications with the severe blood pressures and such were the first I had ever seen that were so advanced. The books would say to make sure you have a doctor available with significant experience managing such complications. Well, nope, I’m not that doctor, so I figured I better confirm with someone who was. The doctor answered the phone, at which time I realized that it was still night back at home. Sorry to bother you, and good early morning from Africa! I explained the situation and they graciously advised that there was nothing more to do than what I was already doing. I didn’t want to miss anything. And I just wanted somebody to hold my hand for a minute since the case was pretty complicated. Oh how thankful I was for someone to walk through it with me even from a continent away.

But really, it wasn’t just the doctor that held my hand and walked with me. The Lord provided for that woman. We didn’t have the things that we needed to really take care of her correctly. Her life was truly in danger. But only a few minutes later she was significantly improved, and at the start of a long road back to normal. Another time when we didn’t have enough, and ultimately we were not enough in ourselves, but God was gracious and brought a good outcome in spite of what we lacked. How often he does this. One lifetime is not enough to praise Him for His goodness. Over and over again I see it, trickling all around me in day to day circumstance. But it is bigger than I can even often realize – besides that trickle there is an overwhelming flood that is poured out onto mankind in general, and then specifically onto His children. He is indeed so very good.   

Friday, April 5, 2013


Ring, ring, ring, ring, ring. I was so tired of that noise. So many calls came in that night. I had to go in to the hospital to see two patients. One had been healthy just the day before, but now, in the middle of the night she was going downhill so fast. I treated her correctly, figured that there was nothing more for me to do, and moved on to the next one. The second ended up in maternity because she was pregnant, but really needed intervention from the general surgeons for a non-obstetric issue. So, I called them, waited for them, explained it all. And then finally back to bed. Ring, ring, ring, ring through the night. It all felt burdensome.

Then finally the morning came. Alarm went off (which I have set as a harp so that it is far more pleasant than that terrible phone ringing), I just reset it for later. I mean, they can’t really start the surgeries in my room without me, right? I got up with the second alarm. Ate a bite, dressed, then thought I would check email really quickly before going to the hospital. So, I logged on and saw an email from someone I love. I opened it up and read the story.

Even those we love often have big chunks of their lives that we have never known. She told me of how her mother died during the course of her own birth. She had always wondered what it would be like to know her, and always had some void without her. It said a few more things. I found myself getting a bit choked up as I thought about it. Then I thought to myself, “its way too early in the morning to have a tear welling up”, so I pulled it together, took a deep breath, and headed out for work.

The day was filled with many normal things clamoring for attention. But in the late afternoon, something worse than normal caught my gaze. I looked at a patient, and then glanced at her chart. She was very thin, but swollen all over. Her chart registered a blood pressure within stroke range. The note of referral from the day before said similarly high pressures. It had taken her a day to get to the hospital to be seen. I knew she was too early to deliver, but I knew that she was very sick and that I would have no other choice. So, I did what I have been trained to do. IV’s, drugs, labs, catheters, ultrasounds – all orders were set in motion. I gave three doses of medications to bring down the blood pressures, to no avail. Finally, with the fourth dose, came a small but hopeful decline. I stood outside of the pharmacy asking for meds. The reply was that the store was locked. I couldn’t understand why one person would be the only one with a key. So I got mad. I told them to go to the person’s house and get the key, get security, or do whatever it takes to get me that medicine from behind the locked door. He called, but there was no answer. He began to reply, “see it is just unfortunate…” I couldn’t hold back from cutting him off, “I don’t care about fortune, I care about Labetalol” (the medicine I needed). Every fifteen minutes the alarm on my phone would go off, I would call maternity to ask for pressures and give orders. I hardly ever worry about patients, but I knew that she had a good chance of death. And I knew that if I couldn’t get the medications that she needed, I would have to transfer her to another distant facility where she and the baby would both be likely to die.

The medications were finally obtained. The blood pressures had begun to come down. Specific instructions were given to the nurses. I changed the alarm settings on my phone from 15 minutes to midnight. I prayed and fell asleep.

The most interesting thing to me about this patient is not her sickness, for I have seen that many times. But it is the way she got inside me, the way that I was awakened to be poured out. I try to always provide the best care that I know, but she was different. When I looked at her, I still had the words ringing in my heart that I had read in the email the morning of the day that she arrived. I saw in her the story of that lovely woman from home, who had lost her mother so many years before and still had the void inside her. I thought of her as the ultrasound was done, as I prayed with the patient, as I stood at that pharmacy demanding their help.  Calls every 15 minutes weren’t burdensome to me this time. I wanted to make sure that this momma was there to take care of her baby. The story that was told to me came just at the right time to make a difference in my attitude, and to give passion to my care. It came just at the right time to remind me how great the value is for every one woman and one child.  

Thursday, April 4, 2013

Welcome Home

I’ve had some days filled with frustrations and troubles. And once in a while I have gotten a day off in the midst of those stressful times. But if I stay at the hospital, I usually end up still feeling attached to it. So, one day I found a place to run. On this side of the nearest city, up a steep, rutted dirt road, tucked away I found a refuge. Inside was like no house I’ve ever been in. Everyone was welcome, all the time. A wonderful, genuine couple and their daughters lived there. But then, it wasn’t just their genetically proven family. Girls with dreams for education that their culture wouldn’t sustain lived and studied online school there. Two more young missionary women stayed long term. And then there are the short term folks passing through. Cultures, tribes, races all intertwined in conversation. Together it is a strange and warm patch-work quilt.

Every weekend a slumber party naturally occurs. Visitors are welcome, bunk beds are full, mattresses pulled out onto the floor. So many young women. I was almost certainly the oldest, at 30 years, while those in their teens to 20s filled the place, finding relaxation and rest. I’ve never seen such people who are so graciously open to the wandering passer-by.

I met the family when one of them showed up to be seen in my clinic. Soon following, I began getting the text message that “pizza and movie night is Friday if you want to come” on a weekly basis. As often as Friday would come, so would the sleepover. I couldn’t go too often, but once in a while I would make it down. Kneading dough for pizza, arranging the toppings, everyone adding something to the preparation, until everything was ready. Then the movie, and as I longed for sleep, another movie. Then pull out the futon and fall asleep. Those have been strange nights for me, reminding me of youthfulness, filled with tiredness and refreshment of late nights and good company.

I don’t think I have ever met more freely hospitable people. I will always be grateful for their giving me a place for renewal. Tonight, as I remember how gracious that family has been, I pray for them in their sadness. The mother found ultimate rest in the Savior that she has served. As she has welcomed others so many times, now she has been welcomed home. 

Then the righteous will answer Him, “Lord…when did we see You a stranger and invite You in..?” The King will answer and say to them, “Truly I say to you, to the extent that you did it to one of these brothers of Mine, even the least of them, you did it to me”.

The Ride

She walked into the OR in the dingy hospital gown and flip flops that are provided. She had prepared herself mentally for the hysterectomy, thankful that all the heavy bleeding would be done. She took that big step up to lift herself onto the table as directed. And then whoo-hooo! – the table started moving from side to side in a deep wobble. Patience, the skinny little scrub tech, dove forward to grab her, but it was too late. Off the other side of the bed she tumbled. She had been tossed, but thankfully, not injured. Heart rate was quite high, confidence in the medical system was quite low. Seems that somehow a bolt had come loose overnight. Usually there is a little jiggle in the table, it makes a small movement when pressure is applied from one side or the other. One leg of it always sits on the bottom of the heel of a flip flop to keep it more level and less mobile. But something changed dramatically overnight. The table now took on much more personality, the type of personality found in the bull-riding portion of a rodeo. I couldn’t help but to reflect on the similarities. I later tried to explain how bull-riding was a “sport” in the US. As I went through the descriptors of such an activity, I realized how foolish it sounded to do something like this intentionally. Indeed the more I talked, the more stupid it seemed even to me.

Add caption
Well, 2 tables later, it seemed that all of them were broken. So, since no easy replacement could be found, we had to call in help to fix it. The help was definitely qualified. The Australian anesthesiologist took his position lying, kneeling, bending, straining, lifting, etc to knock the table back into shape. His face crinkled up with a mean look as he pushed and pulled against the metal pieces. Above him stood the vascular surgeon serving in more of a verbal role as supervisor and counselor. Finally, after much ado, it was back to only a gentle rocking from side to side.

The patient came for a second try. She used much more caution as she climbed on it this time, testing before allowing it to bear any weight. The scrub tech too, was more careful. She actually moved away from the bed. It must have come to her mind that the patient was almost twice her weight, so she was no longer willing to risk the catch. The bed had its little wiggle, then held steady, and we were ready to begin. Rodeo over. But it was sort of fun while it lasted. A much more entertaining way to start the day.

Scrub tech moves away from patient thinking
 "sorry, you are on your own lady"

Patient safely, and securely on bed

This one has no real connection to the story,
I just enjoyed the American flag painted on each
toenail. I got very patriotic for a minute. 

Tuesday, April 2, 2013

What are you doing?

Someone recently asked me what I was doing here, what was the purpose and plan. People are working all over the world, from hometowns to foreign soils, for all sorts of reasons. For the work here, there certainly is an aspect of service to those in need. That service involves caring for bodies because there are souls which, for the moment, are inseparably linked with those bodies. So, part of day to day life is serving and treating patients. As the door opens and closes, changing from one patient to the next, the need changes. Some come with hope, others with despair. Within this little portion of the world, in a relatively small span of time, I hope to be able to enter in to the moments and engage patients at the point of their need.

But also, part of the goal is to train others to serve better, with more appropriate skill and care. Practically, there are women dying throughout the developing world because there are not skilled providers to care for them. Pregnancy and birth are the most dangerous times in life for the large majority of women scattered beneath the span of the sky. Local caregivers need to be trained to give better medical care to those who come to them seeking help. Part of what I do is to provide some oversight of care in order to teach midwives and improve healthcare given within our setting.

Ultimately, all of what we do is aimed toward making the gospel clearly seen (and heard). We say that God loved the world so much that He served and gave. We hope that as we serve, we bring the perspective to others that makes Christ known.

However, the dreams are not accomplished in a moment. Change is slow and often frustrating. Improvements in healthcare are limited by so many things. Personal struggles often leave me not reflecting Christ well. Sometimes I wonder if change will ever come – both to the work itself and to the shaping of my own heart.

But I do see the faithfulness of God in His working here. I see that He is still drawing people to Himself. And, as always, He is using the frailness of humanity to reveal the greatest needs of the human heart – the need for Him. Sickness and poverty and despair all point that there must be something better to put hope in besides what the world alone can offer. Even the strongest of flesh will let you down. The cries of the heart long for the One they were created for, and when they cry, He is faithful to answer. 


Easter is celebrated here with a “sunrise” service. Now, why that would be the name, I have no idea. It starts at 4 am, a couple of hours before the sun peeks out. Everything American in me wants to cry out and petition for a second service at the later time. But, no, its 4 am to about 8 am. So, I set my alarm for 3:15, but then calculated how long I thought I would need and snuck in an extra 3 minutes, so make that 3:18. I woke up on my own at 5, realizing within a few moments that I had set the alarm for pm, instead of am. So, I threw some clothes on, grabbed my umbrella, and rushed out into the drizzling rain. The mile and a half walk was slick mud from the frequent showers. That, combined with darkness was a set up for brown splatters all along my skirt. But then I heard the drums ahead, and my attention turned to catching up. The church gathers far from the church building, at one of the chaplain’s houses. Then all together, they begin a long walk through the community, beating drums and waving branches in the air. It is like a call to celebration of the resurrection. I can imagine that people who don’t go to church probably don’t appreciate it, but it actually was kind of fun. I finally caught up with the others and slowed my pace down to a crawl, following in the crowd behind the drummers. Women and girls at the front of the crowd waved branches, leading the others along. We made it to the church building, where the service continued. It was definitely a worship experience to be remembered.

Then, since church was over so early in the morning, all the missionaries met for brunch. Cinnamon rolls and casseroles, everyone filled their plates. Children moved from the eating toward the Easter egg hunt. As the egg hunt finished, I could hear a nap calling to me, so I answered the call. It was a delightful rest. In the evening I met with some friends for dinner. We had the best American feast that we could come up with in the midst of West Africa. It was like being at Grandma’s house back in the old days – barbequed chicken, fried okra, roasted potatoes, sautéed vegetables, and then some mango-peach cobbler to top it off. Mmmm. So many reasons to love Easter!

Such wonderful things to fill a day of celebration, and the best of all we continue to rejoice in - He is risen. He is risen indeed. Praise His name!