And Then There were None OR The Gideon Experience

And Then There Were None

OR

The Gideon Experience

The LORD said to Gideon,“You have too many men for me to deliver Midian into their hands in order that Israel may not boast against me that her own strength has saved her, announce now to the people, ‘Anyone who trembles with fear may turn back and leave Mount Gilead.” So 22,000 men left, while 10,000 remained. But the LORD said to Gideon, “There are still too many men. Take them down to the water, and I will sift them for you there. If I say, ‘This one shall go with you,’ he shall go; but if I say, ‘This one shall not go with you,’ he shall not go.” So Gideon took the men down to the water. There the LORD told him, “Separate those who lap the water with their tongues like a dog from those who kneel down to drink.” Three hundred men lapped with their hands to their mouths. All the rest got down on their knees to drink. The LORD said to Gideon, “With the 300 men that lapped I will save you and give the Midianites into your hands. Let all the other men go, each to his own place.” So Gideon sent the rest of the Israelites to their tents but kept the 300, who took over the provisions and trumpets of the others. Now the camp of Midian lay below him in the valley. During that night the LORD said to Gideon, “Get up, go down against the camp, because I am going to give it into your hands.”

...Thus Midian was subdued before the Israelites and did not raise its head again. During Gideon’s lifetime, the land enjoyed peace forty years. 

Judges 7:2-9, 8:28

In the last month, our team here has had some major changes, and will continue to have some more in the next month. The Harvey family left for their one year home assignment in mid-June. Dr Harvey is the medical director of the hospital, and one among three physicians here (the other two being myself and Stephen Wegner). His wife Becky has done quite a bit of administrative tasks for the mission as well. With their leaving, there were a number of tasks to be divided up among the remaining team members. With this comes the stumbling of figuring out how to do tasks we’ve never done before, even with the instructions left us by the Harvey’s. Prior to this, Sarah, one of our long-term missionaries broke her arm back in March in a bike accident. She runs a leprosy program and is working on building a new center for them. Her fracture didn’t heal properly, and she left a few months ago to return to Canada for further surgery and physical therapy. The tasks she performs were largely assumed by some Congolese, but also by another missionary family, the Marshes. Our pharmacist finished her term here in May, and returned to the US, and thus we’ve taken on some of the tasks she had been doing. She continues to do some of the work from the US. 

This Tuesday, the Marsh family is returning to the US before their anticipated time due to a medical problem that we are not able to treat here. They were assuming a number of tasks previously done by Becky Harvey, as well as tasks done by Sarah, which now need to be reassigned to someone else. This last Wednesday we spent our team meeting defining the tasks that need to be done, and clarifying who is doing each task. I think we all felt the weight of additional responsibilities to an already full plate. Being as I will soon be the only missionary at the mission (the rest live on the hospital compound), I have assumed many of the responsibilities the Marshes were carrying. Thursday, we spent about 5 hours going over everything. Nonetheless, I don’t feel too very stressed about it yet. I think I have a peace about it from God that He’ll help me get things done. But I would appreciate your prayers that I have time and energy to get the monthly and weekly tasks done. They aren’t hard, but some just take time. 

For those of you who are worried that I’m the only missionary at the mission, don’t worry. There is another family here with whom I am very close, who are Congolese. They are my Congolese family, and are a great help to me here. There are still guards here 24/7 (not that it’s not safe, but they help deter theft and provide a buffer between me and people knocking at my door.) So I’m not alone, there is a truck here for me to use, and I’m only 3 miles from the hospital. And God is here.

In December, the Wegner family leaves for their 1 year home assignment, leaving me as the sole acting physician at the hospital. (There is an internist here, but her main focus right now is helping to open the Eye Center and care for her three young children. Two full time jobs in and of themselves.) God has blessed us with several volunteers who have expressed interest in coming in the months of January-June. This should help me unload some clinical responsibilities so that I’m able to do more administrative duties once Stephen is gone. Currently I am not sure who will become acting medical director in January. 

The Marsh family hopes to come back in September, should their funding allow it, to finish their term here. Sarah hopes to come back near September as well. Suzy, the pharmacist, is planning on returning for a month in August. So, we are not without hope. 

Is God doing this so that we know the hospital continues to function not because of our own doing but because of His power? Quite possibly. It certainly requires more faith and reliance on Him when it seems we can’t provide things for ourselves. (Though in reality it is God who provides all, we just think we provide for ourselves.) It certainly forces us to work together as a team, to ask for help, to communicate well so that we do not become angry, bitter, and resentful towards one another. Be praying for the former, so that the latter does not occur. 

Father's Day

I remember writing my post last year for Father’s Day. It’s hard to believe an entire year has gone by already. But, it has, and this time it’s only been 3 months since I’ve seen him last, instead of 6 months as it was before. 

I miss my dad. I miss his hugs, I miss his corny puns (if you don’t get them at first, don’t worry. It’s like the sun, it will dawn on you.)  I miss getting to talk to him regularly. I miss him coming down to my bedroom to say good morning or goodnight. In April, shortly after I returned from my visit home, I woke up to the sound of what sounded like my dad’s footsteps coming towards me. My first thought was, ‘my dad is coming to give me a hug and a kiss good morning’. Then I realized I was back in Africa and it would be over a year before I got to hug him again. I was SO disappointed. I cried. And I’m crying again as I write this. 

I know it was hard for my dad while I was at home this last time because he was so busy with tax season, and even busier than usual since his partner had just passed away. He usually left fairly early in the morning, and arrived home late in the evening, not leaving us a lot of time together. So, he made time for me by taking time out to eat lunch with me several times while I was home. I know it wasn’t much, but it was wonderful to get to spend some one-on-one time with my dad. 

Today, I hope to get to talk with him on Skype, to personally wish him a Happy Father’s Day. I know that if by chance we don’t get to talk, he still knows I love him very much, and I know he loves me and supports me, even though this work takes his little girl so very far from him. 

Thanks dad, for loving me so much!

Fellowship of the suffeRing

I started call on Friday. I had been enjoying two weeks of not being on call. Whatever did I do with my time? I rested as much as possible, in preparation for call. So far, this week of call has been one of the worst ever. 

It started with doing two wound debridements on Friday afternoon. One was for a 20 year old with a chronic wound on his leg that we grafted last November, and now almost done of that graft is left. I saw It back in January and prescribed some antibiotics as I think it is a tropical ulcer, and sometimes they respond to bactrim and ethambutol. He never got the ethambutol. I don’t know why. I continued to see him from time to time, but didn’t realize he was still getting dressings, and that his wound continued to get worse. Neither did the guy doing wound care have me see him or his wound, to give direction on what to do. I’m working on seeing wounds on a more regular basis, as I’ve found some people keep getting dressings even when their wound isn’t getting any better, and never see a doctor until it’s really late. Anyway, I had to do this massive debridement on him, and it stunk. I hope and pray his leg will heal, but there wasn’t alot of bleeding with the debridement, which isn’t a good sign. Neither does he really have much skin to be able to do another skin graft if his wound gets clean enough to do another, because he has already had two. Next I did a debridement on a lady with some form of chronic ulcer-I suspect she had an infection, but not sure how it all started. It stunk too. Then I got to go home for a little bit, saw the missionary kids art show, and returned home in time to eat a little something before being called back into the hospital.

Around 8pm, I was called to come in to assist with a vaginal breech delivery-there was one food in the vagina. It takes at least 1 hour to get a patient to the OR from the time a decision is made to do a surgery, if it’s not during normal weekday hours. Sometimes it’s difficult to get ahold of people, and you have to go find them, or send someone to go find them. So, when I found the patient just had one foot in the vagina, I decided to see if I could get the other one to come down. I did. The woman was able to push the baby out the rest of the way, but as is the risk with breech deliveries, the head got stuck on the cervix because it wasn’t quite dilated enough. By this time, there was impingement of the cord (it was compressed) and so the baby wasn’t getting much blood flow. I tried all I could to get the baby out-hyperextension of the neck, episiotomy to make more room for me to get my hands in, and attempted to cut the cervix as a last resort, but found it difficult to reach with the short scissors I had. We struggled and struggled. Her aunt yelled at her that she wasn’t doing enough and tried pushing on the fundus to help get the baby out. I yelled at her to stop. End of story, the baby died in the course of giving birth. Drenched in sweat, I went home, showered, and went to bed.

The next day, I was awoken by a phone call that there was a lady who was 4 months pregnant with placenta previa who was bleeding significantly. I rushed into the hospital but by the time I arrived, she had delivered a stillborn, still in the sac. According to the nurse it appeared the baby had been dead for a few days. I started rounding, and discovered the patient admitted by a colleague the day before for post-abortive endometritis had retained products of conception, which were now infected. She also complained of a lot of pain in her right buttock, where she received an injection at a different hospital a few days ago. I took her to the OR to perform a D&C, and ended up also doing an incision and drainage on a large abscess in her buttock (which smelled HORRIBLE, and the OR still smelled the next day. Not a lot of air circulation in there). 

I continued rounding and was asked to come evaluate a woman with abdominal pain. She’s in her sixty’s, I’d guess, and has a distended abdomen. It’s been that way for several months, getting worse. She’s losing weight, and has blood in her urine. On physical exam, her liver tip comes down to the level of her belly button, and her spleen does too. I did an ultrasound of her belly-large liver, spleen, and lots of masses in her abdomen-likely metastatic cancer. Oh fun, I love giving news like this to families. I explain to the family what I saw, what the likely diagnosis is, and that I had no way of treating it. It’s already very advanced, and I don’t know what the primary source is. And then they say ‘but what are you going to do to treat her?’. This invariably happens just after I’ve explained what I’m going to do for the patient, especially if there isn’t much I can do. It’s like they don’t accept that the white doctors don’t have any medicine to treat it. Or perhaps denial of the illness itself. I don’t know, but it’s tiring. So I explain again. And again. Finally, I think it starts to sink in.

  Once finished rounding, I then was presented with a patient who complained of right thigh swelling for one year, then for the last three months, pus has been coming out a site in his thigh where someone from a clinic lanced it. Now, for at least the last month, when he’s walked on his leg, he says it feels like his femur is broken. Noting how his upper thigh is rotated differently than his distal thigh, kneed, and foot, I believe him. So I took him to the OR to drain the pus out of his thigh, but got interrupted before I could start (but after the nurse had given ketamine, unfortunately).

Before I had started, the OB nurse called to say a woman 30 weeks pregnant came in for evaluation. Her water broke yesterday at home and she’s now having contractions. And there’s a foot in the vagina. Nice.  So I debate between trying for a c/s and letting her deliver vaginally (though there is higher risks, but the baby is small, so might be ok). I call in the team to do a cesarian, but can’t get ahold of people. I end up sending someone to find them. In the meantime, I planned to drain the pus out of the guy’s thigh, but was interrupted by the OB nurse calling to say the patient wanted to push. So I take off to maternity, get there in time to help deliver the infant. This time, the right foot came out first, but the left food stayed up by her head as she delivered. I was able to sweep it down. I was trying to sweep the arms down (Williams Obstetrics and all other books make it sound so easy. Liars.), and was successful with the first one, but as I was ‘sweeping’ the other one down, I felt a snap. I broke the humerus. Great. Thank the Lord, the head didn’t get stuck this time. I took the baby to the warmer and started rescusitation. She still had a heart beat when she delivered, and it was a relatively short time for the delivery itself. She wasn’t breathing at first, and so I used the ambu-bag to give her some air and oxygen. (I will say I’m proud the nurses got the right things out ahead of time for the delivery, except for connecting the ambu bag to the oxygen concentrator. But still, the fact that they had it out is a good thing. And both the incubator  and the warmer turned on.) She started breathing, but required oxygen, and was still mildly hypoxic. I used an adult cannula to create a little more pressure for her (they tend to fill the nose, creating a sort of CPAP). She stabilized, I started antibiotics, I swathed her arm across her chest to stabilize the fracture, and put her in the incubator. 

I then returned to the OR, drained the pus that was there, and am sure he has a fracture by the way his leg bends abnormally in the middle of his thigh. The question is if he has osteomyelitis or a sequestrium that needs to be drained. Will have to get an xray on Tuesday. For now, he’s getting antibiotics. 

Sunday morning, I am awakened by a phone call from the OB nurse that the preemie’s oxygen saturation is low-30%. I’m trying to verify that the concentrator is working and all tubing connected properly (as that is a common cause of hypoxia while ‘on oxygen’ at our hospital) when she tells me ‘now there is no heartbeat’. Perhaps there was no heartbeat for a minute or two, and that’s why the kid was hypoxic. Not sure exactly what happened-if there was an apneic spell, or bradycardia due to prematurity, or something else. I gave the baby caffeine (in the form of instant coffee) the night before to decrease risk of such spells, but it doesn’t eliminate them completely.  So we lost another preemie.

I arrive to do rounds this (Sunday) morning. The lady I worked on the day before is now afebrile, awake, and talking a little. Looking a little better. Praise the Lord. But now there’s a 13 year old with right lower quadrant pain. She is moody and doesn’t respond to questions, but sometimes flops around like a fish on the bed. So I suspect her pain may be more ‘supratentorial’ than in her abdomen. I do an ultrasound and don’t see the appendix, or any mass in her pelvis. So she’s on antibiotics and treatment for malaria, as she had a test done elsewhere that was positive. While evaluating her, a 20 year old girl is brought in from a town about 45 minutes away. She drank caustic soda (lye) in an effort to commit suicide. Sounds like she drank a significant amount. She started vomiting blood, and her lungs are all junky sounding from a pneumonitis. She became hypoxic so we had to start oxygen. She has a high risk of death. 

I leave the ‘ER’ area and sit down outside the church and cry. Angry about the two babies deaths. Angry over this girl drinking caustic soda because of something her dad said to her, who now might die a painful, horrible death. Tired, and hurting because of the suffering of these four women I’ve cared for in the last few days. 

A colleague of mine sat down next to me and was praying for me. As he stood up to leave, he said the Lord told him I’m ‘enjoying the fellowship of the suffering’. I’ll tell you what, it’s not so enjoyable. But it makes me more empathetic, and it brings me closer to God. So I guess it’s not so bad.