Sunday, June 15, 2014

The Barrenness of Seventeen

This all started over a month ago. She was pregnant at seventeen. Scared and unprepared, she looked for a way out. Traditional medicines were taken for a month trying to provoke an abortion. Finally, she had gone to another facility and gotten a D&C procedure to scrape out the little life. And for reasons unknown to me, a second D&C was done the next day. Unfortunately the results of those procedures included complications all too common in the developing world.

All of that happened before she came to me. She moaned and then gasped as I touched her abdomen. It wasn’t just tender along the uterus, it was tender everywhere. I knew that the prior procedure had likely caused a hole in the uterus. And I knew that there was likely infection taking hold inside. I counseled her that there was a true possibility that I could even have to take out her uterus, leaving her barren. But she was in such pain, she just nodded. I counseled the family as well.

During the operation I sent word out to the father and mother that indeed, the majority of the uterus was rotten. It had to be removed. They understood. “Clamp”, “tie”, “suture”, “cut”, again and again until the malodorous, dead organ was out. I closed her up and continued antibiotics.

The next day I sat on the edge of the bed and counseled her again. She nodded, eyes glazed over, barely listening. I told her that we would talk more specifically when she came to see me in the clinic. I counseled the family again. Each day she made progress, and finally I sent her home with follow up a few days later.

She was doing amazingly well on her return. Too well. There was no somber spirit, no sense of sadness. I needed to counsel her again. She was either in denial, or she hadn’t listened at all.

This time she started to weep. Her head bowed low. Her tears ran down her cheeks. Everything changed in that instant. She finally understood. She hadn’t before, and though her family had known, they didn’t tell her. The fact that she otherwise would have died was no consolation. Her life changed in those fleeting moments as she sat in that straight backed wooden chair. The carefree youthfulness of her seventeen years became shackled by the adult understanding of a barren life. She realized then that huge parts of her adulthood and womanhood, had been taken away. Her moans were heard in the adjacent rooms as she heaved, rocking forward and back.

Finally her breathing slowed toward normal and her tears dropped to only one by one rather than the prior river’s flow. I told her that her pain was real, and there was loss, but that her value had not changed. A conversation too often repeated with patients struggling with infertility of all types, women stuck in a culture that says they no longer have any value. It didn’t make it all okay. It didn’t make her leave with a smile. It didn’t take the pain away. She was overwhelmed by the thoughts of what her life would and would not be. New fears and insecurities were already taking hold. The depths of her tear-filled eyes laid her soul bare before me.

Mistakes made, consequences realized, naivety lost – all of it too real. Bitter truths. “Valuable, God says that you have worth and value, and none of that has changed”, it was the one truth that had the ability to resonate deep in the darkness of her soul. It is the one truth that can carry her now and through a lifetime. 

A little Bible study for a Sunday post

Amos. One may ask, why in the world read in the obscure book of Amos??? But I love to read the old words, see the way God has worked from times past. No one can pin Him down as to what He will do next, or presume that because once He acted in such a way, He always must. For He is God, infinitely greater in imagination, wisdom, and knowledge. But sometimes I like to see the things He does over and over, the themes that always seem to return. Through those age old texts, He still guides and instructs.

Amos was just a normal shepherd. He had no social standing, or religious authority. He was just a simple guy, doing a simple job, living a simple life. Until God gave him words to say, elevating normal flesh to the mouth of God. His prophecies were hard for the nations surrounding Israel, they had been evil, and judgment was coming. And come it eventually would. But more interesting, and pertinent to the church today, seem to be his words toward Israel.

Specifically he addressed neglect of the poor, direct abuse of the poor, and the pursuit of injustice. The Israel that he addressed was then a wealthy, place, full of people reclining at ease. Satisfied in their religious practice, they sought God only partially, and with an impure heart. He was not their everything, but had become small to them. Amos reminded them of His greatness “He who made the Pleiades and Orion and changes deep darkness into morning, who also darkens day into night, who calls for the waters of the sea and pours them out on the surface of the earth, the Lord is His name…” The simpleness and greatness of morning and evening, the steady stars, the seasonal rains – all made and changed by Him. But they had forgotten. Their lips spoke of Him, but life showed that their hearts were far from Him. “You impose heavy rent on the poor and exact a tribute of grain from them…For I know that your transgressions are many and your sins are great, you who distress the righteous and accept bribes and turn aside the poor in the gate…”

Their perceived themselves as dressed in robes, but really they were dressed in rags. They self-righteously envisioned how good they would look when they would one day stand before the Lord, as if He should be so glad to have the honor of meeting them. But harsh words awaited them. “Alas, you who are longing for the day of the Lord, for what purpose will the day of the Lord be to you? It will be darkness and not light; as when a man flees from a lion and a bear meets him, or goes home, leans his hand against the wall and a snake bites him. Will not the day of the Lord be darkness instead of light, even gloom with no brightness in it?” He goes on to say that he has come to despise and reject their sacrifices and offerings, for their hearts are wicked when they offer such things to Him. Instead, He desires that “justice roll down like waters and righteousness like an ever-flowing stream”. Real faith wasn’t going to live turning a blind eye. He didn’t want vain words, or monotonous service, He wanted hearts devoted, lives changed.

The people were like mahogany veneer, overlying pressed board. External service looked good, but beneath was cheap, self-centered religion. I wonder how much of religion today fits that same analogy. Filling the visible roles necessary to find acceptance within the church, and yet really being all about our own wants, desires, and pleasures. We cast away thoughts of the poor, walk a shady line of righteousness that appears acceptable, and turn a blind eye to injustice. Faith is spoken of, but lives never show the change that real faith inevitably brings. We say that we care about what God cares about, but our lives are quite revealing otherwise. What a sad delusion to say to ourselves, “Oh, we long for the day of the Lord…” only to realize that justice on that day will surprisingly be unfavorable to many.

The book of Amos goes on to tell that even though justice would come and would be painful, God was eventually going to purify and draw people closer to Him. Restoration and redemption would be accomplished, and would be amazing. It is a common theme through the scriptures. The world is messed up, it will feel the repercussions of the paths chosen, but there is yet a plan for something better to come. God will not stop pursuing His children, even through the brokenness they have created.

Another theme found here, and recurring through so many other parts of scripture, is how God over and over again directly correlates the honest and transparency of our relationship with Him to the way that we care for those in need among us. If our eyes are blind to the orphans, widows, poor, suffering, etc, it could be that we are really blind to the desires of God. Just as later when asked, what are the greatest commandments, Christ would answer “Love the Lord your God with all your heart and with all your soul and with all your mind. This is the great and foremost commandment. The second is like it, you shall love your neighbor as yourself. On these two commandments depend the whole Law and the Prophets.” This even includes the prophet Amos, speaking so long before Christ about the truths of loving those around us. For Gods people, to be made right with God would mean also to be made right with others. To just turn away from the needs of people around us is an indicator that our hearts have probably not been truly inclined toward God.

It is incredible to me to know more of the story. How often the themes repeat, the same story and lessons at different times in history. Things veiled and seen only dimly by the prophets of old, now made much clearer by Christ. Redemption has been completed. And yet the gracious character of God is still made known again and again, even as His people fail time after time. As the church, may we have eyes to look on the accounts of old and have a clearer view of the God we serve. I hope that we can learn the hard lessons through the lives of others, have our eyes opened through their stories. Too sad it is to waste the years, only to look back and realize that our affections were wrongly placed, our energies thrown into foolish pursuits, our lives poured out for things that don’t matter. May our hearts be always inclined toward Him. And as we serve Him, may others see the greatness of His love and compassion, even in the midst of a broken world.  

Tuesday, June 3, 2014

Fighting for health, and knowing God's hand in the midst of it all

I knew that something wasn’t right when I heard her story. She had been taking malaria treatment at home, and the sickness should have been better. The treatment she had gotten was almost always effective. But still, she was sick. We put her in the hospital and put her on IV medicines to make sure that she received all that she needed.

But she got worse. She started vomiting, and contractions started. Labs were drawn as she was prepared for a repeat C-section. Her twins were delivered safely. But her labs came back, showing that something was terribly wrong. But what it was didn’t seem to fit in any typical specific diagnosis. She was destroying her own blood cells, and her kidneys and liver weren’t working well. This type of pregnancy-induced disease can always be dangerous, but her type was worse than normal because it was much different and more complicated. I drew more labs to rule out rare disorders, hoping to find a medical diagnosis that she could fully fit.

The day after surgery, she started having trouble breathing. People like her are at risk for this. Suddenly they go from feeling relatively okay to drowning from the water filling their lungs – we call it “flash pulmonary edema”. I had already restricted her IV fluids to less than what is normal to avoid something like this. But she was so sick, and even minimal fluid went straight to her lungs and tipped her over into respiratory distress. If the fluid got any worse, she wouldn’t be able to breathe. No breathing, no living. I knew what to do, and I quickly and urgently gave orders. Sweat pooled in the notch at the bottom of her neck. She leaned forward, muscles straining for every breath. There was only one way to help, I had to get the fluid out. The only way for that to happen was to make her urinate. Her kidneys were going to have to make urine, make a lot of it, and make it quickly. But they were damaged already by her disease process. I wasn’t sure if they would be able to do what I was going to ask them for. I pushed medicines into the IV line, knowing that the next several minutes would tell me if her kidneys were still functioning enough to get the fluid out. I watched her urine bag. The kidneys rose to the occasion and began filling the bag with clear, beautiful urine. I delighted to see it coming. An hour later, there were only a few beads of sweat on her brow. A victory won, but the war ravaging her body was far from over.

There were fevers starting too. This seemed like a separate problem. Fevers should mean infection, but it seemed there was no infection to be found. I knew that they weren’t from her recent malaria after a day or two of continued treatment. But blood tests, urine tests, x-rays, ultrasounds – nothing was showing where the infection was coming from. Antibiotics were started. Fevers continued. Finally, the only thing left was to assume that she had an infected blood clot within her pelvis somewhere. I couldn’t see it on ultrasound, but I knew it must be there. It is sort of a last-ditch diagnosis, when everything else has been considered. So, I started her on blood thinners as treatment to break up the clot.

I waited, and doctored, and prayed, and hoped. By this point she had required five units of blood (since her body was killing off her own blood cells, we had to replace them with transfusions). The blood would drip in, but by the next day, the blood level would have fallen again. Finally, the blood level remained steady overnight. Her other labs also began to move in the right direction, indicating that the multiple organ systems which previously were struggling were heading toward normal functioning again. And lastly, the fevers finally stopped. We turned the corner.

She held her babies in her arms today as I signed her discharge paperwork. I realized that every day that I had come to sit on the edge of her bed I had come to like her more. I had become more invested. I had been the one in charge, working to save her life. I had been the one trying every morning to figure out how to manage her to restore health. But I wasn’t the one who could actually make her better. Sometimes women just like her don’t turn the corner. No matter what we do - not with the best care, not in America, and certainly not in Africa. I don’t know why one and not another. I only know to ask for wisdom and guidance as I practice medicine, and know that He is able to be trusted with the outcomes. So as she left and I said “Thank the Lord for two healthy babies and a healthy mom”, I didn’t say it lightly. He holds it all together, and I see that is His hand doing so. Mine are too small, too human. I am grateful for the work that they have been given to do, but alone they are not enough. Indeed, thank the Lord for two healthy babies and a healthy mom. He has again provided.