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.  

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. 

Normal Patient, Extraordinary Moments

It was the most normal of surgeries for me. An abdominal hysterectomy. Big fibroids distorting the uterus and causing heavy bleeding. Her story was all too common, not at all thrilling. She had lost significant amounts of blood from the menstrual flow, and her blood level was one third or one fourth the amount of normal. Each time she stood up, the dizziness came because she had lost too much to really sustain herself anymore. She had already received one bag of blood replacement, and two more were on the way. So, I gave her the options of medicines versus surgery, and she desired a hysterectomy to remove the offending uterus and permanently stop the bothersome flow of blood. The bleeding was too much to send her away, so I put her on the schedule for the next morning.

The case went well, no complications, no excitement. And just as I was closing up, I heard her crying, almost weeping. I leaned over the curtain that separates the body from the face, usually keeping the humanity veiled away from the surgical field. I asked, “Is she okay?”, wondering if she was feeling pain from the surgery. The response was rewarding. She was weeping for joy. She had just asked the anesthetist if the bleeding would ever return (which I did cover in my counseling, but she must have not completely understood). When he told her that she would never again have this problem, the tears began to flow. She heaved her chest as she gasped air in between sobs. And then she began to sing praises to the Lord. A sweet, sweet moment breaking through the ordinary clamps, knots, scissors, scalpel of routine surgery.

Just a half hour before, while I had my hands buried in her abdomen assessing the size and mobility of the distorted uterus, I had thought about how blessed I am to be able to operate. Blessed that people would trust me inside their bodies. Blessed that I’ve had training to provide good surgical skills. Blessed that God cares for my patients long after my hands have finished their work.

My contentment in my calling, and her delight in newly found relief from the heavy burden she bore mixed together in that operating room – swirling around in worship to the God who gives good gifts, and allows us to do the same. I’m grateful to be able to pour energy and life into another. And I’m grateful that He is the One who she praised and glorified. 

Afraid of the Weeping

Been in the room too many times when the cancer is diagnosed, when the baby is lost, when the marriage is over. Tears and snot running down faces too beautiful to be puffy from hopeless weeping. Daughters and sons, husbands, friends – the awkward moments leave silence and space between relationships. Who knows what to say?

Most often everyone steps back. The pain is uneasy, tense. Our comfort is at risk. This is a time for the pastor to step in. The family to step in. The doctor to step in. The counselor to step in. Someone else. Not us. We aren’t trained or prepared. They write whole books on how to deal with this stuff. We feel foolish. Can’t fix it, and that is what we want to be able to do.

I remember times of pain, some near, others long ago and forgotten by others.Sitting in a purple plaid chair in the hospital lobby, alone, tears streaming down my face. That day as he died, I knew what loss felt like. Another time, fear and pain consumed me. I was just a child, lying in the hospital bed alone. The medications given into my arm were supposed to make me better, but also had side effects of making me hallucinate, the terror was so real. Such confusion in the midst of hurting so badly. And then again, when their marriage broke down, so lonely, such despair. Whose was I? Not theirs, so hers? Or his? In heartbreak. In despair. A thousand times I have had reason to cry.

David cries out to God in the midst of his distress – “Reproach has broken my heart and I am so sick. And I looked for sympathy, but there was none, and for comforters, but I found none.” So sad to cry out, and hear no one answer.

Who hasn’t bled, who hasn’t cried, who hasn’t lost. Each member of the body of Christ has been through circumstances that have pain us, shaped us, sometimes scarred us. Each has some compassion to share, a shoulder to lend. But we don’t want to share or lend. When the uncomfortable times of grief, or pain, or confusion come we want to draw away. But maybe God has been training us just for that moment, to step in. To try, knowing we may fail. To offer silence, or words. Provision, or even only presence.

The Word says “Rejoice with those who rejoice, and weep with those who weep”, and later regarding the body of Christ, “And if one member suffers, all the members suffer with it; if one member is honored, all the members rejoice with it”. We were meant for this. It is part of our life together.

Christ left the example for us. He didn’t just find Himself in the midst of the needy, He went out to be among them. He stepped into the world of dust and filth. He saw the Samaritan woman at the well, thirsty and tired. But he met her not exalted as He deserved, but dirty, thirsty, and tired Himself. He multiplied bread for the multitudes, knowing hunger Himself. He took Judas’s foul kiss, feeling the knife in His back, stabbed by betrayal. He watched His mother weep, as her heart was broken. He cried out to the Father for relief on that dreadful day, feeling His abandonment for the first time. He looked in Peter’s eyes as the rooster crowed, knowing that his best friend had been too ashamed to claim Him. He bled. He cried. He lost. And because of this He understands our trials and our pain. He also understands our weaknesses, sympathizes with us, and provides mercy and grace for our times of need. We are to be His, imaging Him into the broken places and broken lives, not just the easy, comfortable situations. May we have boldness and compassion to walk toward those in pain rather than walk away. He has trained us through our own trials, for times such as these.

The Search For Aisha Kelly

The story began long before I arrived. A young couple looked at their premature newborn, 28 weeks of gestational age (way too early). The village elders, several old Fulani men, came and told the doctor, Dr Kelly, that they were just going to take the baby home. They had no hope for it. Against all cultural norms, she stood against them. She told them that no, they weren’t going to take the baby girl out of the hospital. She would not relent. Cultures collided – Muslim Fulanis and the Christian medical doctor were at odds. The doctor won, believing that there was hope for the small, frail life.

The child was eventually discharged from the hospital, healthy and normal. And she bore the name Aisha Kelly, the latter obviously in honor of the pediatrician who cared for her. Relationships were not only restored, but flourished. The whole village came to know of the tiny baby, and the strong-willed doctor.

Now, a year later, Dr Kelly was going to the village to see the child. This seems like a simple concept, but the practicalities were more involved. It is best to travel with a second person, especially as a single woman in the developing world. So, she needed somebody to accompany her. I didn’t know the language, or the location, but I was somebody. So, the plan was made, and off we went.

We walked half an hour to the edge of the nearest town. Two motos (mopeds) were arranged as she bargained on the price. The ideal moto driver is a bit older and a bit fatter, as this generally indicates a lower testosterone level and safer ride. The last key is to pick one with a helmet on, since at least he appears to have some concern for safety. Mine had no helmet, was young, and skinny. But, such it was, so I just prayed as I put on the helmet I had brought and jumped on. As light raindrops fell, we were off. Further and further from town, down dusty dirt roads, out into the bush we went. Dust particles covered us, even grinding between my teeth.

The cell phone for the family we were visiting wasn’t working, nor had we actual directions to where they lived, and lastly, the family name couldn’t be recalled. We only knew the name of the nearest village. But we were determined. The family is from a aforementioned tribe called the Fulani, cow herders who previously were completely nomadic. The group that we were going to see has two camps, hours apart. We were hoping that they would be at the one near the village that we were heading toward.

We arrived at the village market. Most of the villagers didn’t speak French, so we wandered around until we found a man who did. Then the three of us wandered around more, initially in what appeared to be an aimless fashion. Within an hour, though, we had found an elder from the Fulani tribe, who spoke neither French, nor the predominant local language. He was one of the men who had come to the hospital, demanding the child a year ago. Immediately upon seeing Dr Kelly, he smiled and laughed as he rushed to greet her. She had won his respect over the intervening time. There were four languages that were being translated amidst all the people in order to figure out where to go to find the husband, wife, and little girl. Finally, after much ado and the formation of an entourage of translators mixed with moto drivers, we were again off.

A few miles down the road, and off the path, to where the path narrowed. I could tell we were getting close. There were several women bearing large loads atop their heads, with fewer clothes, more skin, and dense brightly colored beads. The decorations seemed to grow heavier and heavier with each subsequent woman, signs of beauty and prosperity, shiny glimmers covering necks, chests, ears, wrists, and ankles. Their appearance showed that they were obviously Fulani. Finally, the motos stopped, though there was no trail, or obvious camp. We began walking through the bush until we saw the small domed houses, covered in plastic tarping. These structures even have the appearance of the nomadic, temporal lifestyle, easily picked up and carried off to whatever place is next necessary for the grazing of the cattle.

Finally, we had found them. The grandmother came out, with little Aisha Kelly wrapped on her back. Another family’s child also peered out at us, obviously stricken with some condition limiting his mobility, nearly crippling him. Then came the young father and mother. I watched the mutual delight of Dr Kelly and the family. The little girl locked my eyes, at first scared of the white skin, but intrigued as well. Again translation ensued through many people, the long task of communication.

It turned out that the wife was pregnant again, which allowed for encouraging her to come to the clinic for care. Any woman who has had a prior preterm baby is at risk for having a similar outcome, and needs to be watched carefully and given some special medicines to try to prevent a repeat of the prior early delivery. So, Dr Kelly pushed me forward, indicating that I was the mom-baby doctor, and she needed to see me. I was glad that I was there, as she would be much more likely to actually come for and accept care within an established relationship.

We enjoyed the time, took some photos, and eventually said goodbye, mounting the motos again and heading back out the path to eat more dust. Furthering relationships here almost always requires a bit of adventure, stepping out into the unknown, risking something. But I suppose that life worth living requires those things. Life lived today. 

A typical fulani house

They are taught not to smile in pictures, it isn't that they were scared to death of Kelly

Mom and little Kelly

Worth Running For

I finished with the lady in clinic. Her problem list included high blood pressure, thyroid disease, obesity, and medication exposures that can cause damage to a developing baby. Ugghh. High risk pregnancies are difficult to manage even in the developed world with fancy tests and monitoring. Here, “high risk” just brings a sigh and a sense of helplessness. Too weighty for limited resource settings. I headed off to the house to grab some lunch, glad to have closed her chart for the moment.

I was about 2/3 finished with my bowl of macaroni noodles when I heard the noise. Like a circus clown horn, with a high pitched honk-honk. I had heard rumors of such a horn, and was sad that I hadn’t ever heard it here. So, I jumped up from the table, leaving my fork in my lunch bowl, and ran for it. The only problem was that the hospital compound is on a circle. As I approached the road it hit me that if I went the wrong way, I may miss it all together. So, I just started yelling “Fan Milk? Fan Milk? Fan Milk?” There was no reply, sadly.

I saw one of the missionaries heading across the grass. “Mr Teusink! Have you seen the Fan Milk man?” To my delight, he directed me in the way. A few moments later, I rounded the corner of a house, and found him. There he was, looking glorious, the ice cream man. He rides his bicycle around tooting the little horn on the handlebar, selling ice cream in little sachets. I put in my order. “Five?”, he questioned. My reply “I’m hungry” as I smiled and rubbed my belly for emphasis. I smiled as I walked away, carrying my bag of goodies.

Finishing my bowl of room temperature noodles, I grasped one of the cold plastic bags, tore the corner off with my teeth, and squished all the ice cream up through the little hole. Delightful. A new, and wonderful addition to my life. The ice cream man might become one of the more important men in my life. He definitely brought joy to my day. In those few moments, I went from sigh of helplessness in the face of medical problems, to sigh of satisfaction and happiness. Ice cream makes my heart beat fast in delight.

Phone rings, it’s a retained placenta. So, I’m off. But I’ve been refreshed, ready for the next thing. Thank God for life’s small pleasures amidst normal needs and tasks of life.