Enough

I tried to share on facebook this morning about a little boy that had a very bad accident and came to our hospital. The image and message wouldn't upload, so I will share his whole story now.

John was playing outside like any typical 12 year old would, but was hit with a thrown stone. It caught him just under his ribs and he went home in pretty bad pain. Night before last he had severe pain and started vomiting so his parents decided to bring him to Kudjip.

On the way, John stopped breathing. He came to the emergency room not breathing and without a heartbeat. We thought John had died, but an ultrasound showed his heart was still pumping weakly, so Dr. Bill and I resuscitated him for 15 minutes in our emergency room. After being intubated, having CPR and getting adrenaline through an IV and blood started, John had his own pulse, a blood pressure and had some breathing - but Tiffini (a visiting PA student) and I took turns bagging him until the operating room was ready for him.

John before surgery

I got to perform surgery with Dr. Jim to explore what had happened to John. It turns out that this stone did quite a bit of damage. John had 2 lacerations to his liver and some of his intestine had perforated. We repaired the damage, and when he left the operating room John had a good blood pressure, was breathing on his own and had a very large incision newly closed along the length of his abdomen. It seemed like we did just enough.

Unfortunately, shortly after the surgery, John started breathing heavily, developed a fever and had a seizure. There may have been some damage during his resuscitation, but more likely the damage from his belly had already sent his body into a cascade of reaction called peritonitis. He died a few hours after surgery.

John's bed the day after his ultimately unsuccessful surgery

Today, the second of the twin babies that I performed a Csection for got very sick. It looked like she had neonatal sepsis (severe infection). This baby also has some underlying congenital anomalies (we think) and did not respond well to our treatments for her. Her twin brother is alive, healthy and doing very well. I wept with Betty, her mother, as we stopped ventilating her and let her pass on.

There were a couple of victories today, though. More than a couple I'm sure. One mother who had a placenta that was invasive into her uterus delivered at our hospital. She had severe bleeding after her delivery and Dr. Bill and I gave her blood transfusions, performed a small surgery to stop her bleeding, and stabilized her after the procedure. If she had delivered at home she would not have survived her delivery.

Two babies that I've been taking care of for two weeks were looking fantastic today. They are twins and both came with severe pneumonia and dehydration needing IV fluids and oxygen. Now, their lungs sound great, they are feeding well, off oxygen and going home.




My patient with diabetes, Anna, is doing much better. She has put on a little weight, has much more energy and is not having the vomiting and pain that brought her to us. As she prepared to leave the hospital, I got a quick photo with a fantastic smile that looked nothing like the frail girl that came to us just a week ago.

Anna ready to go home (I'll forgive the Chelsea jersey)

I wrote before that the blend of joy and grief rub against one another so frequently here. Over the past few weeks, I realize how terribly true that is. I consistently find myself thinking that we've done just enough for our patients here. It seems like we are in the nick of time to perform surgery, resuscitate a child or a baby, stop someone's infection or treat their heart failure. When one of our patients die, I find myself asking if we did enough. Did I know enough? Was I careful enough? Did we use enough of our resources and time for them? Do I care enough that they are gone?

I know now that the answer to each of those questions is no. If I am looking to myself to be 'enough' for the people here, I will invariably fall short. There is not enough of me for the great challenges here. Where, then, do I turn for hope? If the doctors and nurses, the staff and families that spend their time and energy in this place is not enough for these patients to live on, where is their hope? There is no natural hope. I would find it impossible not to trust God in a place like this without losing my mind to grief. If I didn't know that God's sovereignty was more than enough, I am sure I would despair. Amazingly, our hope (and because of that our peace) doesn't depend on the situations or circumstances we find ourselves in if we have something outside of us that we put it in.

I already wrote that I don't feel I have to explain the things that happen here, to justify why things are this way. I know that God is sovereign and that we simply find our roles to play, great or small, in how He chooses to work. Tonight Anna, Esther and I read about the Israelites in the Old Testament during a battle in the wilderness. When Moses, their leader, lifted his hands up they prevailed, when his arms came down they began to lose the battle. Moses' actual hands had very little to do with the battle. But as God's instrument, he was imperative to what God wanted to do for the Israelites. So much so that Moses had others alongside him that supported him when he was too weak to play his part alone. I am certainly no Moses, and I don't pretend to play a pivotal role in the things happening here as a visiting physician. But I recognize that I have a role to play, that my strength is not enough, that God is ultimately going to decide the outcome, and that the people around me are a large part of what successes I have in this place.

Thank you, again, to those of you that make it possible for us to be here with your support and your continued prayers.