Uncategorized

The Field, Honor, CV, Vitoria, Madalena, Manuel…

With every death in our hospital, at least several weekly, I have the opportunity to reassess my attitude and effort on the behalf of those seeking my help and putting their trust in my care. There is a saying tossed around in sports that I think is applicable to life with Jesus. You will hear that a runner “left it all on the track”, or that a football/baseball player “left it all on the field”. I certainly hope that one doesn’t give his/her life to win a competition, though that is almost encouraged today, but I believe every Jesus-follower is called to “spend it all”, “leave it all out there” for those he/she claims to love, even when we are sick and/or tired…

.

A little extra effort, a little less sleep, a little more study… are constant challenges when one is committed to serving in this type of setting. There is great temptation to fortify otherwise healthy “boundaries” and build, instead, walls of self-protection and self-preservation. “Self-care” is a buzz-word today (even among Jesus’ disciples!) and puts emphasis squarely contrary to that of Jesus. We encourage looking inside, monitoring, caring for, and calibrating our personal health because “we can’t care for others if we aren’t ‘well’”. Sounds reasonable, doesn’t it? I haven’t found that passage… Jesus emphasized self-analysis, without self-focus, not for self-improvement and better personal health, but to see how/where we might more help those hurting and/or confused. He emphasized caring for, and thinking of, ourselves less while ramping up our concern and preoccupation for others. Taking up our cross and self-denial are not kingdom principles to better “me” but, rather, to direct attention to our glorious and living (and largely unknown) King and to improve the lives of those around us.

.

The church today, like our surrounding culture, is more enamored by the “fruit” of following Jesus than by Jesus Himself

.

With every death that occurs under my watch, I seek to honor the deceased by promising that I will learn all I can from their experience to prevent the same from happening to another.

.

Betsy and I have been home with CV for about five days. We’re both vaccinated and our disease course has been that of a strong “cold”, leaving us pretty exhausted, but thus far not experiencing the life-threatening form of the disease. I have stayed away from the hospital in order to prevent exposure to our severely vulnerable, sixty-plus inpatients and Laurel and Eduardo, with our hospital staff, have stepped up beautifully, shouldering the burden of patient care. Yesterday, however, a concerning obstetrics patient arrived and I was called in.

.

Vitoria (photo), a beautiful, stoic, 17y/o, first-time mom, arrived following three days of term labor at home, after a trip of several hours over dirt on the back of a motorbike, prompted by sudden cessation of her contractions.  Ultrasound revealed that her baby was still alive.  We used vacuum extraction to assist the baby’s final few centimeters of descent, but it wouldn’t budge.  After several position changes and repeated failed attempts with the vacuum, I performed a symphysiotomy, cutting through her anterior pelvic bone to widen the gap for the baby’s head, which was too large to fit through mom’s small pelvis.  It’s an antiquated procedure, useful in situations like this, where a Cesarean isn’t possible.  She took the painful procedure without a whimper, her pelvis opened a couple centimeters, the baby descended and delivered, but was pulseless and not breathing.  After about fifteen minutes of sloppy and slimy mouth-to-face resuscitation efforts, we pronounced the baby dead.  One of our assistants had to leave the room because she couldn’t witness all that was happening and nearly passed out.

.

During my resuscitation efforts on the baby, mom suffered tremendous post-partum hemorrhage, along with stool and urine flowing from her vagina.  Her placenta was tightly adhered to the uterine lining and needed peeled free, which we were able manage, over several minutes.  The profuse hemorrhaging continued, with fresh and flowing blood spilling onto the floor and all over us.  Vitoria had a fast, fleeting pulse and was in shock.  We roughly massaged her uterus to encourage contraction of her uterine muscles, gave her medication to contract the same, and stuffed a blanket into her uterus, in order to provide compression from the inside onto the uterine walls which seemed, by feel, to have suffered a tear.  After perhaps fifteen minutes, the bleeding seemed to slow.  She was not putting out urine and we discovered, via ultrasound, that my symphysiotomy had likely severed her urethra, which empties the bladder to the outside, a common complication from this procedure, as the urethra runs just inferior to the pubic bone which I had cut through.  It’s a complication one tries desperately to avoid as it can cause urinary retention (urine from bladder blocked on its exit), and is difficult to repair.  Her kidneys were swelling (hydronephrosis) and she was at risk for kidney failure because of urinary buildup and pressure.

.

Using a guide wire and ultrasound, I was able to snake the catheter through the deficit and into her bladder, freeing the obstruction and allowing urine flow to the outside, resolving the insult to her kidneys.  We typed her and her mother and found a match, and began giving Vitoria a unit of her mother’s blood.  After infusing the blood and a couple liters of saline, she remained conscious but still in shock.  Our visiting NP, Laurel, offered that her blood would match the patient’s rare type, so we extracted a unit from Laurel and transfused her blood into Vitoria, who continued to bleed, though at a slower rate.

.

We contacted our beautiful colleagues at CEML and MAF and arranged flight transport for her this morning, for emergent surgery to stem the hemorrhage and either repair or remove her uterus to save her life.

.

We have few uneventful deliveries in Cavango, as women only arrive after there is an apparent catastrophe.  This baby arrived to us with a beating heart, but didn’t survive our attempts to deliver her alive.  If I would have done the symphysiotomy immediately and without our attempts at vacuum extraction, she would have survived…  I must live with that and try to learn from it, for the sake of the next similar arrival. 

.

When we say, “Here I am, send me.”, our Father graciously accepts the measly loaves and fishes we offer Him and He sometimes uses our offering to help and provide for others, and sometimes…  As we partner with our Father in His care for these beautiful people, we often face circumstances that are difficult to comprehend and feel inadequate for the task.  The Wind blows where it will…  Perhaps Vitoria will survive to know Her Father, but we are called to be “mud and spit” in Jesus’ hands, to “lay it all on the field”, whether ill or tired, to honor and care for each as if they were our mom, sister, daughter, without regard to outcome, knowing that our Father calls each of us to live through often difficult-to-understand pain as He pursues intimacy/closeness with those He created with joy and deeply cherishes…

.

Madalena (photos) is a tough and leathery 70+ y/o woman who tripped on a small rock (there are thousands on the dirt around the simple houses in her village) and fell, breaking her right wrist (distal radius and ulna) and right hip (femoral neck). She hired a motorbike guy to drive her (seated!) about an hour (slowly) over perhaps the worst dirt “road” we know (roots, holes, rocks, ruts) to arrive in Cavango at the end of a day last week. She tolerated manipulation/reduction/splinting of her wrist with only an injection into the fracture site, without anesthesia (after traction in our Chinese finger splints), though she did sweat and scream a bit… The next day I offered her my cheek and invited her to return some of the pain I had inflicted on her! Madalena actually slept through the night, her ankle roped to our crude cinderblock-rope-rafters traction (photo) to keep her leg suspended to help immobilize her unstable hip (femur). She was transferred via MAF to CEML and will need surgery on both her wrist and hip, courtesy of many of you….

.

Little 10 y/o Manuel arrived with his father a couple weeks ago with his abdomen full of tumors, likely from a cancer I wrote about last time, called Burkitt’s Lymphoma.  I have two chemotherapeutic cancer agents currently in Cavango that can be used to treat this illness, but up-to-date protocols call for several more meds to improve likelihood of cancer remission.  The protocols also involve IV meds and I only have oral forms.  I spent hours searching for protocols that would allow me to treat him safely and effectively with only the two meds.  I found many protocols and studies from the past fifty years, all requiring more meds and/or a different form of the meds.  Some called for more modest dosing of the meds and others were more aggressive.  With the “gentler” protocols, it is less likely that the treatment will harm him, but the likelihood of cure is diminished, thus allowing the cancer to kill him.  With the more aggressive protocols, the treatment could kill/harm him but there is better likelihood that the cancer could be eradicated.  A couple studies in Malawi have seen 50% success, but not with exactly the meds I have.  I have no experience in treating this cancer with these limited tools.  I have sought counsel from friends in the US, and exhausted my ability to gain further information.  I have grown to love this beautiful little guy in just two weeks and I have a decision to make this week.  Please pray for me and for Manuel.