Synopsis of a day

Today I rounded early, then went to the OR for a couple of cases lasting until almost lunch. Then Moumadou called to see if I wanted to go ride horses. I had a bunch of other things to do, but I went anyways. Moumadou is an 18 year old boy who keeps the horses around the hospital. His age is given away by the way he rides. I'll be running through the dirt and mud, and here he comes passing me by like a flash of lightning. Doesn't matter to him if its uphill or down, slippery or rocky, he is always wanting to go fast. Since he is usually a bit faster than me, and thus ahead of me, it leaves me splattered with dirt and mud from the top of my head the whole way down. It's okay though, I've always enjoyed dirt and mud. We went to a Fulani (a people group who mostly are associated with raising cattle) compound way up on a mountain. We went to greet and they invited us in. They always are kind to me, I think they are amused that I am a woman who can ride a horse. We were in a little square house with a smaller house on each side. We sat in the man's house, and each of the other houses was for one of his wives. They brought tea with milk from their cows, yams, and bread. I sat with the men and took the tea in a circle on the floor. They were so gracious and kind. It reminded me of so long ago when I spent time in Africa. That was the way that we took every meal, from the same plate sitting on hard dirt. Of course back then I didn't get to sit with the men. And in that culture we all had to drink from the same bowl. Being a girl and young put me right at the bottom of the totem pole, and having to drink from the bowl after everyone else had already drunk and left their spittle. Ugghh. Getting older has some perks. Thankfully they don't do that here. We visited probably too long, because the rains then began coming heavily. They offered for us to stay, but we moved along. So off we went into the mud back toward the hospital. It was the best mud splattering thus far on my clothes. I was really glad to get to go meet with that family. It was a bright spot in the day. The Fulani have always caught my attention. They often live far out from everyone else so that they can raise their cattle. Almost all of the are Muslim. They are often not concerned about education, so many do not send their children to school. It is neat to see how easy it seems to connect with them in spite of being worlds apart in many ways. Like I said, they're always impressed by a white woman who can ride, so that gives me a foot up I suppose. Who would have thought that God would use something like that to start relationships. I don't know what will come, but I love meeting them and getting to know them. I hope that I will be able to continue to build relationships, eventually connecting regarding eternal things. But for now, I guess horses will have to do.

Well after we got back, maternity immediately called. Back to the OR. And then to labor and delivery, again. Then finally back home. A patient at the hospital followed me home. That is always a bit sketchy. She wanted something, seemed like she was trying to get money to put minutes on her phone so she could call her family. I told her where to go at the hospital to get help. I was tired of being chased down by everyone at the hospital and just wanted time alone. People are always trying to get me to see just one more. Nurses always calling me to come see someone else. It wasn't that sending her away was wrong, but the spirit in which I sent her was one of not wanting to be bothered. As soon as she left I began thinking of how Jesus never was really bothered by people. Maybe He was tired, but He kept ministering to others. I then thought of how the Word talks of kindness to others, and how it states that sometimes people have even entertained angels without knowing it. I hoped she hadn't been one. Seems worse to turn away an angel than a person. Of course, that is exactly the point. I wished I had just let her use my phone. Not because I was truly changed into a giving heart, but so I didn't have to think of it anymore. I've been running her through my mind ever since. And yet I really am tired. It's been 5 weeks I think without a real day off from the hospital. I've had hours here and there, but not an actual day off.  How did Christ make his eyes see the eternal value of each person in the midst of the frustrations and weariness caused by desperate crowds and endless work?

Patients this week

I diagnosed my first case of meningitis in a pregnant patient this week. It was kind of obvious by her symptoms, but still I was happy that I knew what it was. As for what to do about it, I read that line by line out of a book to make sure I didn’t get anything wrong. I stuck a needle into her spinal column to get some fluid immediately to confirm the diagnosis. I was proud of myself for remembering how to do that. It wasn’t hard, but I don’t think I had done it since medical school. So, now she is lying in a little room by herself getting antibiotics for a week. She is far from better, but so many die from this by now. I think (and hope) that we got to her in time.

 I opened up another patient’s belly who had undergone a cesarean section a little time back. She was full of pus all in her abdomen. I’d never seen such after a C-section. I was so angry at the medical decisions that put her in this position. I was on fire inside at so many management errors that were made during her hospital course. But I went by this morning to see her and she had her new baby at her breast, resting in bed. Now, she’s not recovered yet, she still has pus draining out of the tube coming from her side, but when I saw her I stopped being consumed so much by anger. I began having hope for her healing and joy at the life she does have.

 

I have a patient with HIV and tuberculosis on whom I recently delivered a baby emergently. She was so sick and had to be delivered in order to get the treatment that she needed for her disease. She was so sick that I had to do her cesarean section with her sitting up and with local anesthesia to help numb the surgical site because she couldn't have the usual type. The study I got on her heart had less than half of the work-ability that it should have had. She was gasping on admission, and had been ever since. Mothers in the US die from what she has going on in her heart, they have heart transplants and such due to it. Plus, then you add on AIDS and very active tuberculosis, and medically there’s just not much hope. But this morning I walked in to check on her and there she was, lying flat on her back (she has been unable to sleep for days due to difficulty catching her breath unless she is sitting upright), sleeping soundly. She still was breathing a bit fast, but she looked so peaceful and, well, I’m not sure how to describe it, better. Just last night I had given her a little card with a couple verses from Psalm 73 written on it-

Whom have I in heaven but You? And besides You, I desire nothing on earth.

My flesh and my heart may fail, But God is the strength of my heart and my portion forever.

I don’t know if she will even make it. She looks better for the moment, though the road ahead is likely a hard one. But I loved to see her resting there this morning. And I loved to see her smile when I awakened her, not smothering any more. Indeed, for her and for each of who follow after Him, our bodies and hearts may let us down, but God is our strength and forever our portion. 

Oddities

The funny things that are so different are scattered randomly through life here. Like, I helped push a patient from one ward to another the other day, and there were so many hills. My burning thighs felt like I was doing a massive exercise routine. Up one hill like huffing and puffing, and then down another holding the stretcher back. I wondered how far would it go if one of those stretchers got loose from the person who was supposed to be driving it during the downhill slopes? In US hospitals there are no slopes. Maybe a little bump or a slight little ramp, but elevators do all the hill climbing. Here, people do all the climbing. 

Another thing – we officially ran out of disposable surgical masks a week ago. So we went back to the MASH type green cloth ones. Everything takes a long time to dry here because it rains every day. They don’t have dryers, etc. The masks often have a funky mildew odor to them. So, this morning I went to go get one and there weren’t any in the bin. So sweet little spunky Judy, the circulating nurse, took me to show me where to find them. She then walked away with it. I followed and asked what she was doing. “Ironing it”, she said. Well, I don’t iron even for special occasions, so I didn’t get it. Ironing is just not one of my gifts. J  So I asked why. She said “Cause its wet. And to kill some bacterias”. I thought, “You just go ahead and iron it all you want then, kill all those bacterias”. I turned around and laughed as I walked off.  She ironed that mask for what must have been 5 minutes. I bet it was sterile, though still damp.

And then, there is death. Death usually isn’t funny. But this morning after rounds I walked past a taxi that was just getting ready to pull off down the road. “Taxi” doesn’t mean the same thing here that you may be used to. It means a 1970 or 1980 compact car that somehow got shipped over here to live out its final days. It also indicates enormous levels of pollution from the thick black smoke trailing behind the car. Anyhow, this little tiny blue Toyota hatchback had a well-made wooden coffin tied in under the hatch. About 2/3 of it was hanging out the back, with the back door tied onto the top of it. Well, unless that person was shoved down there wadded up at the bottom, it was way top-heavy out the back. Plus the whole car was bogged down with the load (in addition to the 6 people inside with their own loads). One little bump and that poor fellow hanging out the back was a goner. I guess he was already gone, but the thought of it just got me tickled on the walk home. I rushed to get my camera to take a discrete picture, but someone stopped me along the way, making me miss an awesome photo. I don’t care who you are, how holy, or serious, or sensitive, or whatever, you would have thought it was funny too. 

Tuberculosis Ward Lessons

Had to go to TB ward today and see a patient. This one was really sick. And the room was little and cramped with no real ventilation. It already made me feel claustrophobic, and then since she was a super sick immunocompromised TB patient, I started to concentrate on my breathing the whole time and it made me feel like I might pass out. We don’t have special respirator masks here. Actually we are out of all masks except the cloth ones we use in the OR. Anyhow, I didn’t have a mask on. So, it probably doesn’t make any sense, but I thought to myself that if I just breathed shallowly maybe the TB would just get in my nostrils or the very top of my upper respiratory tract and then be able to be blown out when I got back outside. Well, at least that thought gave me some comfort while I was in the room, even though it is pretty dumb. So there she was breathing about 60 times per minute, and since I was trying to breathe really shallowly I was probably just beneath her rate. I was praying the whole time, “Lord please don’t let my TB test convert to positive”. As I left that hazy dark room and came out into the light, I realized how weird my perspective had just been. I laughed at how consumed I had been by my breathing, like I was in a modified lamaze class or something. And I remembered how going where God has called us takes us often to very uncomfortable places. I regained perspective that He had called me to go in there and care for that poor woman. I was overtaken for a moment by thoughts related to my own mortality, but ultimately He has already numbered all of my days. I don’t want to be foolish and risk unnecessary exposures, etc. I am not advocating that. And yet, I am glad that God doesn’t sit up in heaven consumed by what we are consumed by. What a small and useless God would He be if He were looking down, biting his fingernails, wondering if I would get TB, not knowing what to do if I did. But that isn’t our God. He is not consumed by these facts, indeed He is consuming. He is bigger, fiercer, stronger, more dangerous, more passionate, more loving, more full of kindness than anything that we can imagine. And when circumstances are beyond our understanding and we fear that they have gone beyond His control, we remember that He is sovereign and able to be trusted even then. So of course He can be trusted in the TB ward. Stop breathing funny, thinking you can keep those particles in your nostrils, silly child.

People along the way

 I could eat beans and rice everyday. I love them. So, I started eating them daily. I didn't have time to cook much, so I'd make a big pot on Sunday for all week. The first week was black beans, second one was lentils. And I am always a thankful eater, so I was fine. I never went hungry. But I never wanted enough to get full either. And then came Anna. At first I thought I didn't want her. And I knew I didn't need her. A few weeks ago I felt obliged to have her come, but now I will never let her go. She only comes one day a week. But that is the best one. She opens the curtains on the windows and lets the light shine in. Seems like that is what she does in life too. I walk in and see her there and the light inside me starts shining. Maybe she just acts like we are friends because she is working in my house, but I don't think so. She's probably the closest thing I have to a real friend. If I come home for lunch there she is, cooking something amazing. And then I smack her on the butt as I leave to go back to work and dart away out the door before she can reach out to hit me. I yell, "bye ma!" as I run out. She just laughs. And then when I get home at night she is gone, but the windows are still open and the kitchen is clean and something smells good. She has left her mark, though she has moved on for the day. It must be something similar to what it would be like to have a good 1950s wife. Come home, and there's dinner waiting for you, and a clean quiet house. A few weeks back I was wondering how much weight I had lost. Now I am trying to budget my meals to avoid obesity from Anna's cooking. She's someone I never knew I wanted or needed, until she came along.

Another person I have met along the way and found interesting is an old man. I use the term old honestly, and yet somehow generously. He's in his eighties, but he seems much younger. His story in it's entirety is beyond my telling, but I'll encourage you with a few pieces. He lost  the woman who had been the love of his life 10 or 12 years ago. When his wife passed on before him, he entered deep depression. God brought Him out of that dark place,  and He made it clear that he was to go and do medical mission work. Since then he has been all over the world serving. Not like a week here, or a week there, but months at a time for I believe almost forty trips. Without regard to the safety of location, he goes where there is need. He is such a cute old fellow, you want to just kiss him on his bald head and tell him that you are proud of him. He wonders why God waited until he was 70 to really show Himself to him. At the same time he understands that it took going through the deepest valley that he has ever known to really be broken and open to the Lord. It is encouraging to me to see a deeply seasoned, deeply wrinkled man following the Lord with all of his heart. He is going for it, at more than 80 years old. God changed his whole idea of life, took away all his prior hopes of retirement, and gave him something infinitely better. He made Himself known. And a broken and needy heart found it's every desire fulfilled and satisfied.

I thank the Lord for people like these as I go through life everyday. I see the difference they make, in big ways and small ways. As they provide for others and pour their lives out, they are touching those around them. I think of your stories too, those who have walked through many days with me, those who pray for me, those who give to make the work that I am doing right now possible. And I thank the Lord for you too. So many of you have made my days brighter and happier. Many have lived admirable lives worth trying to replicate. I would encourage you all to live this life well. You've got huge chances to make a difference to those around you. Thanks for making a difference in my life. 

I ran today for the first time. I started off going up Mbingo Hill on the road in front of the hospital. We may call it a hill, but it may as well have been Pike’s Peak. I thought I was going to die from exhaustion, so after no one was near enough to see me I turned around and headed back down that hill. I saw a little dirt road and decided to take it. I usually sing as I run. It ain’t pretty, but it is worship. To listen to music and not sing is a form of torture for me. I always find running as a time to worship. Years ago I used to want so badly to lift my hands in praise, but then would get embarrassed because I’d notice folks looking at me. I’d turn it into a stretching maneuver so they’d quit watching me as I ran down the road or exercised at the gym. They probably thought I had a cramp or something. If people thought I was crazy at home, they surely do here. I’m the only white woman in running shorts (though the most missionary-like ones I own), bird legs swishing past the shuffling feet of the people coming and going from market, hands raised, and singing between huffs and puffs with the worship songs ringing in my ears from my ipod. The most fun part of today’s run though was when two little boys started running right behind me. So, of course I felt that a challenge was beginning and I couldn’t let those little squirts win. I mustered all my energy to stay just a couple steps ahead as we ran over rocks and muddy ruts. I noticed as I ran that I had the biggest goofiest smile on my face from those kids. I miss playing the way children play. I’ve always been a kid inside. I understand when a child wants to play what that means. Adults always want to know, “what do you want to play?”, there has to be some object to the play. Kids just want to play.

So enough about play, don’t worry, I am working plenty. My schedule usually begins at with rounds on labor and deliver. Then gynecology. Some days I have clinic, with a few emergency surgeries often thrown in the mix. Others I have scheduled gynecology cases and then head over to clinic whenever they are done. I take call each night for obstetric concerns, but the surgery residents are on first call if one of the patients has to go to surgery. Then I am on backup call for them. That means that though I get called frequently, I don’t always have to go in every night. This week has been much improved from the last couple. For some reason the lines in clinic haven’t been as long. I’ve been less consumed by the frequent frustrations. Patients have been doing well and I’ve enjoyed the relationships with them. Surgical outcomes have been good. Some interactions with staff have still been fruitless, but I feel like there is hope for change (where sometimes I don’t have much of that hope). As an update, the really sick patient that I asked for prayer for improved and went home. Amazing how God can heal a body when we don’t have much to offer. I sincerely thanked God last night that I was able to be here. That was not the first “thank You”, but the first sincere one. 

Running hard

I rounded at the hospital, then crossed over into what seemed to be another realm. A Fulani man brought me a horse, saddled (with a wooden saddle) and ready. One of the doctors here accompanied me as well on his own horse. The two speeds they apparently prefer are stop and run. My horse didn't want to run at first, but the Fulani said that I should beat him. He was right behind my horse when he said that, and immediately after, the horse began an all out run. I didn't beat him, so maybe he whacked him. Whatever he did worked. We were off. We ran through brush and mud. Up steep slick roads that I sometimes have trouble getting up on my own. Four feet sure are more steady than two. Between green hills and crossing rivers, alongside bulls and cowherders. When the rain came, it made it even more like the old west or somewhere, running fast with rain slapping you in the face. It was so refreshing.

Initially when we began running I kept feeling my left hand reaching around the front. I knew immediately why it went there. When I am at home I sometimes take my niece riding. I ride on a bareback pad and don't have stirrups, etc. The only thing I have is a loop in the front. So, my niece sits in front of me, and whenever we start to run, I wrap her up to steady her and hold on tight to that loop with my left arm to keep her safe. She loves to ride with me. She's never afraid. In fact, the first time I ever took her, I thought, "This is going to be a boring, slow day." I put her on with me and decided to just take off at a gallop to see how she would like it. "Yee-haw", she yelled. So, I figured we were good and have been running as hard as the horse will go ever since. Well, anyhow, my hand kept reaching for that loop. It reminded me of her, and I wished she were on the front with me. I thought of how she and my mother (who is always with us when we go ride) would have loved the sights we saw today. It wasn't really a sad moment, but reflective on those so far away.

Sometimes I walk through the paths He has led me down in my mind. I love to tell myself the stories of His faithfulness, like the children of Israel reflecting on where He brought them from. But stories like the one above leave me once in a while reflecting on the recent things, more importantly, the ones, He has asked me to pass by. I've thought of my grandmother who worries all the time. She asked me if I could stay and not come. But only because she loves me and thinks that my safety is equivalent to my good. I thought of the children who will likely forget much of the joy of our lives together thus far. I have considered my family, my friends, loves of all different types. But then I always think of the Lord. He is better than the best this world has to offer. Better than friends, sisters, mothers, fathers. Delightful loves they are. And yet no wonder that He can call us to Himself without apologizing for the joys that He asks us to pass by along the way. For He is far better. He deserves affections that not any other thing or person in this world is worthy of. What that looks like will differ in each life, even in different phases of life. And yet the principle will always remain. His people exist for His glory, which sounds very small and insignificant to many men. But to those who are His, we find our greatest delight in him, and our greatest desire His glorification. 

To those who walk these roads for Him, whatever that looks like for where He has placed you now, I would encourage you to run hard. He is worthy of a life lived.

Reviewing the Week

                I made a difference a time or two this week. Felt like a few things went right. Even in one difficult surgery where there was a complication, my initial response was the thought to call someone to help, to stand beside me, to make me feel more secure. But then after the uncertainty of the first few moments, I found myself overcome by the understanding and skill that are what is supposed to be the outcome of all the training I have had. I knew how to fix it, knew what I should do. In the states, you would have called someone, if only so that you could cover your own liability. But not here. You just put into practice the theory you once learned and fix what’s broken. It’s satisfying.

                But there are still a thousand things that I didn’t learn, or never really got secure in. Sometimes, as a new practitioner, I will get confused as to where to go during a case. And it makes it worse, because I am working with general surgery residents who I am supposed to be teaching. I want to give a clear, replicable method, but often I don’t yet have a certain way that I am in the habit of doing things. As well, since general surgery is a five year program, some of these guys have had more training than I have. And that training is on exactly the type of complicated, weird cases that they have here, not tame, benign cases. So, all of it adds up to make me a bit insecure in my skills sometimes, especially as I am trying to explain to someone why I am doing something a certain way. It can lead to frustration on my part. But in time, I will continue to learn both how to use my skills more effectively as well as how to teach others along the way.

                Other frustrations abound as well. I work with the nursing staff, and it draws my mind to compare them to “my” nursing staff from before. I really loved working with them. They made my days brighter, even the bad ones. If you’ve gotta be at the hospital 80 or so hours a week, you want to be with them. What other nurses in the wee hours of the morning when we were all weary, would let me lay my head in their lap and play with my hair or rub my back. Most of you who read this and work in healthcare might think, “um, that doesn’t happen on my unit”. Well, you’re right, it doesn’t. That’s because my unit was the best. Even recently, with the loss of one of my nurses, I have wished I could be there. Wished I could love them from closer. But that’s not where I am.

Anytime you start working with new staff it can be difficult. There is no trust on either side. Sometimes it feels like I am being undermined or manipulated. Sometimes I think they call me in the night to ask a silly question just for kicks. They must know I often can’t fall back to sleep and are just doing it for meanness. Of course I know that isn’t true, but in the night while I am lying there during what seems like eternity wishing I could fall asleep, it seems like it could be.

This week we had a poor outcome with a maternity case. The nurse said as soon as she presented with a possible abnormality noted at the ultrasound department that we should just go back for a cesarean section. He said that would be the only way we could feel like we were helping her. But as a doctor, I don’t usually treat our feelings. I make medical decisions based on facts. I didn’t think taking a 29 week baby out without being pretty darn sure what the indication was would be right. I mean, the likelihood that it would die from prematurity if I did an emergency cesarean section was almost 100% here. I wasn’t sure. So I said no, I needed to confirm what was going on first. Well, it’s hard to see if a baby is in trouble or not with no devices for monitoring. The monitoring strip hasn’t worked since long before I got here. Neither has the ultrasound on maternity. I am not very good with that funky fetoscope from the old days, and couldn’t get a heartbeat on the baby. Thought it may just be me. So I said to go bring an ultrasound from the ultrasound room which is waaaay on the other side of the hospital. It came, and by that time the baby was dead. So then that led me to multiple other hard decisions as to how to deliver the baby. I felt that nurse looking at me, condemning my decision to wait initially for the operation. I could almost hear him saying, “that death isn’t on my hands, it’s on hers”.  But the decisions are so complex, and the resources with which to make them so much more limited. Maybe that nurse was right, I don’t know. But ultimately we can’t save everyone. The best of my decisions will sometimes still end up with a poor outcome. And whether it’s because of my decision or not, I need grace from others, and help from them too. We all do. I want to learn to love the staff around me and work with them for the good of our patients and ultimately that God may be glorified through us as we image Him while we provide care.

So, to those who read this who pray for me based on the stories I tell, please pray for relationships with those I work alongside here will be fruitful. Not just workable and manageable for getting through the day, but really good. I need discernment to know what is worth fighting for and what should just be let go. And please pray that I will continue to grow in my skill and abilities. And to put some feet onto that one, if you know of anyone who could come teach me more advanced gynecologic surgery skills, ask them if they would be willing to come for a trip. It is a great place to make a difference by coming to help. But better and more importantly, a place where skills taught can be replicated as we use them and teach them to the surgeons in training who will go from here to provide care all around West Africa.