Friday, March 21, 2014

A Good Laugh

I found myself laughing a big, deep, belly laugh all by myself while lying in bed. I’d gotten a phone call and had been rolling in laughter until tears were squeezed out from my eyes. This story is not for the easily disgusted, it is indeed far too much information to put out there on a blog. But since folks sometimes accuse my blog of being a downer, I figured I’d share the twisted humor that delighted my soul.

Two background ideas were running in parallel. The first is that times are often very difficult at the hospital where I have worked for the past 1.5 years. Stress can be unimaginably high. In the midst of such, I have a few friends who live a little ways away who make it a point to care for my soul. There’s always a top bunk available, a fridge with food in it, and a house full of fellowship.

The second running storyline is that I have had terrible gastrointestinal upset for over two months. It must be some Africa-induced misery. I’ve taken all the antibiotics, antiparasitics, probiotics, etc that have been recommended in multiple courses, yet to no avail. Still I am rushing out of the OR for the nearest toilet all too regularly.

Earlier today I called to ask my friends what days they would be leaving to go out of town (as I know they are travelling soon). I was in a rush, so I got off the phone after just a couple of questions, finished what I was doing, and headed back to care for my patients. I never thought of it again. But they did. For hours they wondered if I was alright, if the day had been something awful, if I needed their support. That is just the kind of genuine, caring people that they are. Finally, hours later as I lay in bed, I got the call. “Do you need anything? The door is always open. We are here for you and can come get you if there is something wrong. You can come out of town with us if you need a break.”

I responded that today was actually a surprisingly good day, with excellent patient care and multiple episodes of encouragement. The person on the other end of the phone line was a friend of rare quality, who immediately brings a sense of comfort and familiarity beyond what most could in years of knowing them.  So, I just bluntly told her the real reason that I had called earlier. In the midst of one of my GI moments, I realized that I really needed to do something about all of this terrible diarrhea. The situation had gone on too long, and suddenly I realized my desperation. Enough was enough. This was ridiculous. I needed labs, and blood tests, and evaluations only available in the big city which was many hours away. Since I knew that they were travelling to an area where there was a major lab, I was considering getting them to take down a stool sample in a coffee can and a vial of blood for me so I could get a real diagnosis.  It had initially seemed like a brilliant idea. It didn’t seem awkward until I said it out loud.

The contrast of her concern for my well-being (now completely alleviated) and my true intentions was too much. I got totally tickled. We both began laughter too great to continue the conversation. It was the rolling type of laughter that could make one pee their pants, the type with risk of losing control, the type I usually only dare engage in with my sister. Well, during the intervening time since I had come up with this great idea and made that initial phone call, my doctor from home had recommended another regimen of antibiotics, so I had decided to hold off on the stool sample. Through my choking laughter I told her that she was relieved of the wierdness of poop transport duty. I was laughing too hard, we had to hang up the phone. And so then I just laid there in bed with alternating giggles, then full on obnoxious loud laughing bursts. Tears rolled, cheeks tired, abdominal muscles became sore. It was wonderful. I was reminded of how good God is to give moments of delight. As well as how good He is to give friends and fellowship of such caliber that could encourage and protect my heart, as well as be considered close enough for intimate requests of a much more embarrassing nature.

Tuesday, March 18, 2014

The Broken

Woman after woman comes into the exam room bringing her designated plastic sheet, folded neatly. She unfolds it, presses out the creases, and places it on the table. Then she follows the nurse’s instruction to sit atop the shiny plastic. The history takes a few minutes, telling her pattern of uncontrolled leaking. Sometimes stool, sometimes urine, sometimes both. Then the story takes fleshly, human form as we examine. By this point, often she is sitting in a pool of urine, it shifts and splatters on the plastic beneath her with every movement.

The line outside the door is filled with similar stories. One normal occurrence – getting pregnant and giving birth – and everything changed. Left life shattered, leaking, foul. Drip. Drip. Drip. Always cleaning but never able to be clean. Most have been left by husbands, rejected from society. The odor wafts strongly in and out with each patient. They knew that there was a problem, but never had the money to get it fixed. But thankfully, now they have heard of this opportunity for free treatment, and they have made the trip. Some from near, some from far. All ages – young, embarrassed teenagers with recent births sitting beside old, wrinkled women who have borne their shame for decades. Each with desperation, and each with hope.

Days later that hope is mixed with fear as she walks to the operating room door. Her longing for continence, for normalcy stirs within to overcome the anxiety as she lifts herself onto the operative bed. Spinal is placed for anesthesia, legs flexed back into the gynecology stirrups. And the repair is begun.

My surgery skills are enough for the easier ones. On those, I operate while an experienced fistula surgeon assists. But many are beyond me. Those are scarred, fibrotic fistulae, in difficult to reach places, with much higher risk for failure after the procedure. On these patients I assist while an extensively experienced surgeon operates. I watch their hands perform from the creativity of their imagination, combined with years of training and experience. For a moment, I occasionally am jealous, wishing that I had the same level of skill. But after a second passes I return to the reality that life doesn’t work that way. We all start novice, and time brings us expertise as our hair grays. I focus again to learn from the experts, watching their thoughts work themselves out with the throw of each stitch. Some time later, she rolls on the stretcher back to the fistula ward, with hopes of being a new woman, a restored woman.

The next morning we pass by to see each woman. “Dry” is translated by the nurse, though often the patient’s smile needs no translation. Sometimes there is disappointment, but most often cautious joy. Sometimes overwhelming, unrestrained joy. It is amazing to see the soul stirring in a woman whose body has been restored to what it was meant to be.

A picture of renewal. We all need renewal, restoration. We all need Something beyond us to make us who we were meant to be. For most of us, we hide behind our own strengths, masking our weaknesses, insecurities, and failures. We feign wholeness, pushing brokenness out of sight into the recesses of our minds and flesh. Sometimes we even buy into the idea that we are okay. We are good. We have forced self-discipline, we’ve grasped success, we’ve made something of ourselves. But all it takes is one phone call, one doctor’s visit, one screech of metal on metal, and our fragility is exposed fully, laid bare and open. A deep cut from the normal occurrences of life, and we are left hemorrhaging, empty. Suddenly our awareness of our lack of sufficiency becomes acute. Sometimes that is what it takes to break our fa├žade. To realize that our deepest needs are beyond our ability to supply. We all need restoration deeply in our souls. And thankfully, God offers us that. Through Christ, He has made a way to be renewed, made right. What we could not be with all our effort, He has made us – sufficient and whole.

These women, with brokenness unable to be hidden from the harsh eyes of the world, are finding healing. They have called out for help, and help has come. We delight to see their once known, then lost, now restored body with all its function. Theirs is easy to see. How I long for the rest of us to have eyes opened to know our brokenness, to realize our desperation, to call out for the One who offers help. The tears of the saints for generation after generation have been for restoration of the brokenness around us. A restoration better than intact flesh or function, rather one of the individual man to the God who made him. I praise Him for being a God who restores. And I am thankful that He allows us to be instruments of restoration in His hand. 

Another Airplane

Since the first time I heard of it, obstetric fistula had peaked my interest and stirred my heart. The condition occurs after a long, difficult labor which causes damage to the urinary system or bowels. Women then leak urine or stool from the damage incurred during labor and delivery. It is crippling for a woman and affects every area of her life. I've tried time and time again to get involved in more training during my time in Africa. And at last it worked out for me to go to a fistula camp.

I got on the plane and was off to Uganda. I arrived at the Catholic hospital which was the site for the fistula work. It's nice to work with a bunch of nuns, mostly because names aren't an issue - you can just call everyone "Sister" and it works. For someone like me, who is terribly bad with remembering names and faces (basically just can't remember people), it was a great perk. I was definitely the trainee among the physicians there. Other well established fistula surgeons had come from Great Britain and other parts of Africa to take part.

Word had been spread for weeks over the radio, and women had responded from hours and hours away to come for help. It was a good time for me professionally as I was able to learn techniques and get feedback from other doctors. I have been working alone for a good while now, and I really miss having other people within my field to bounce ideas off or or to get advice from. It was also refreshing to be in a different environment than usual and to see how other hospitals work.

On the way back out of the country I got to stay over for a bit in the big city. I have become much more easily entertained over the time I've spent in Africa, and was delighted to get to just go to the grocery store and look through all the merchandise. So many options. I love to gaze down all the bright, shiny aisles. Next, I had the luxury of going to a swimming pool where I swam until my fingers and toes were all shriveled up and water was stuck way down deep in my ears. And lastly, one of the greatest and most treasured opportunities was getting to spend some time with other Christians who I met along the way. What a delight to meet people who love the Lord and are willing to follow after Him wherever He leads. They are dotted across nations, tribes, and tongues spanning the globe. All with one great affection and purpose, Christ and His glorification.

Thanks to those of you who have given financially, you've made it possible for me to take this trip and begin learning more techniques that can help the women who I serve. And thanks of course to each who prays for me in my work here. I couldn't make it without you. 

Sunday, March 2, 2014

House Call

I walked the rocky path up that steep hill. My lungs restrained me, as my feet tried to hurry. I wondered if this was wise. I had my emergency supplies tucked in the bag on my shoulder, along with my lunch (hate skipping meals). It was something I hadn’t done before, so I was a little nervous, and a little excited.

She had said she desired to deliver at home. She knew the risks, and she knew what she wanted. I reluctantly told her that if I wasn’t in another operation or busy in clinic that I would come and deliver her there. So, I finished up two hysterectomies just before the phone rang. The contractions were getting stronger.

I arrived up the big hill, short of breath, and was grateful to find that she was already well into labor. I balanced in my mind the ease and carefree doula approach and the well drilled medical training. If everything went well it was going to be awesome. If things didn’t, it had potential to be awful. I listened for the baby’s heart beat from time to time. Again, a bit awkwardly, I told her that if she wanted anything specific, to just let me know. I would be checking in on her and the baby, and if she wanted me to help any other way, or if anything changed, she would need to tell me. Thankfully, she was content to labor quietly, no drama, no overly specific plan.

I waited. Ate my lunch. Listened to the heart beat. Waited some more. Prayed for mom and baby. Waited. Listened. Small talk. Waited.

After a couple of hours, the forces inside culminated into the deep urge to push. She was completely in control. I guided the head out, then the body. The baby’s lungs filled with air and she strong cries began. She was beautiful (besides slippery and a bit bloody, of course - the norm for all newborns). I breathed a sigh of relief, all had gone well.

I was glad it hadn’t been a long labor. Patience isn’t my strong point. All of obstetrics, of course, has a lot of waiting involved, but the constancy of midwifery-type one on one care is different. I have always appreciated and respected it. A doctor is often more pointedly intentional about the times and interactions with patients. We always are there when the patient needs us, we enter in and bring a trustworthy set of values and skills. But a midwife is there regardless of distinct need, she is a provider, but more relational as a companion and friend. I felt like a strange mix of both, sitting in another person’s home, my tools spread out on the sterile towel beside the bed.

I can say I like both parts. In training, I used to enjoy slower nights on labor and delivery that would allow for more patient interaction than the usual rapid pace rushing from one room to another. Partnering with a patient in labor takes a soothing, calm spirit, only a bit of thrill after a long while of support. There’s something special about the delivery room provider’s relationship as they walk the patient through the pain. I’ve always liked near the end, when their eyes are searching, scared, wild – and then they meet with your eyes, settle there, and find a place to trust and focus.

But then there are the times when everything doesn’t go quite right. And then I’m glad that I’m a doctor in a hospital. All of the sudden, there is the rush of an emergent delivery. The call needing immediate help. The bed rolls quickly, the IV runs, the instruments fly into place. In a few minutes, it is all over. The emergency has been managed.

As enjoyable as a normal birth is, there is something trained up inside me that must prepare for those emergencies. I am not able to enjoy the tranquil, doula experience like many. My right hand is now meant to hold a blade, to cut in case of emergency. My mind is remembering where I have set the medications to treat hemorrhage – just in case. Lists of risk factors for numerous emergent possibilities run through my thoughts.  I am enjoying the awe of new life, but not lost in it. Making their moments special means that I protect them by preparing, even while they don’t know it.

But after the blood, and cries – when life is established and the baby’s lips are firmly latched onto mother’s breast. Then. Then, whether complicated or uncomplicated, I can embrace fully the amazement of what has happened. I can see that what God has made is indeed wonderful. I can protect life, but I can’t give it. What a wonder. I sure am glad that He lets me be part of it.