Wednesday, May 21, 2014

Worst Call Ever

"It seemed good to me also, having had perfect understanding of all things, to write to you an orderly account, most excellent Theophilus"  Luke 1:3

 I doubt this scripture gets much attention in missionary newsletters and blogs.  However, after the incredible encouragement sent our way in the past couple of days following Esther's Facebook post on Monday, I think an orderly account of the previous day might be helpful.  Forgive some of the medical terminology.

On Sunday I had what entailed my worst call here.  Two babies, one child and three adults died.  I may have made a poor decision on our obstetrics ward which resulted in a baby dying.  I didn't get much rest or sleep and had a few moments in which to eat.

0730 - Called to Pediatric ward, child in respiratory arrest, intubate, instruct nurses to bag child
0800 - Medical ward, start rounds
0900 - Begin rounds in Obstetrics ward
0930 - Back to Pediatric ward to remove breathing tube from neurologically deceased child, comfort family
1000 - Finish Obstetric ward rounds, resuscitate newborn born without pulse and not breathing
1030 - Go to emergency room and see several patients
1100 - Home for a late breakfast
1300 - Back to Obstetric ward, post-op mother apneic, respirate her while giving naloxone, she recovers, another mother with severe pre-eclampsia is now complete, see more patient in ER
1500 - Called back to Obstetric ward, first time mom now pushing for two hours with little progress, internally debate performing a CSection
1600 - Mom doing a little better, head coming down with contractions
1615 - Apply vacuum, not able to doppler fetal heart tones, deliver baby which is not breathing
1620 - Fail intubation attempt for baby, bag-mask and continue resuscitation
1635 - Intubation successful, CPR and medicines to baby by breathing tube
1700 - Baby not responding, now without pulse and not breathing, discontinue efforts
1730 - Inform mother, then sedate her for complicated third degree laceration repair
1800 - Called back to nursery, initially resuscitated newborn now having seizures, give medication
1830 - See several patients in ER
2000 - Home for a late dinner, make a cryptic comment about a terrible day of call on Facebook
2200 - Order stat blood type on mother in Obstetric ward who is pale and tachycardic
0000 - Call from ER, MVA with multiple passengers, seven injured patients in ER
0010 - Arrive in ER, one patient dies, 6 others to see
0020 - Complete ABC (airway-breathing-circulation) assessments of 6 patients, three stable, two with poor respiratory status, one near circulatory collapse and flail chest
0030 - Second load of patients arrive from MVA, 3 died at the scene, now three more arrive injured totaling 9 injured in the ER
0040 - Lab, Xray and Surgery support arrive
0045 - Ultrasound exam unstable patients, two with free fluid in abdomen
0100 - Place chest tube in crashing patient, intubate, perform CPR and resuscitation without success while surgery resident places chest tube in another critically injured patient
0130 - Reduce hip dislocation
0200 - One patient with splenic injury and free fluid in the abdomen transferred to surgery ward, one patient with fracture spine and paralysis below waist transferred to surgery ward, one patient with head injury and hip reduction admitted to my ward, one patient with pneumothorax and head injury transferred to surgery ward, one patient with head injury and fracture left arm admitted to my ward.
0430 - Home to "sleep"
0600 - Notified that initially resuscitated baby is now not breathing on their own
0630 - Baby dies
0700 - Wake up to conclude worst call ever

 Getting tired of these

Amazingly, the following day I expected to feel both tired and emotionally burned.  Perhaps the Lord divinely allowed me to meet a visiting nursing student named Jonathan.  Jonathan served as a combat medic in Afghanistan, and though I still felt our trauma patients made for a difficult night, I thought to myself, "Imagine trying to care for these people while taking enemy fire."  I stifled any complaints while Jonathan and I spent the day together.

"The work of righteousness will be peace, and the effect of righteousness, quietness and assurance forever"  Isaiah 32:17

As I reflected on my day, this verse hit home.  I am amazed as I work and serve in other cultures at the univesality of people's need for these three things: quietness, assurance and peace.

Near the end of my fourth year of medical school I experienced an episode of depression.  Thankfully it hasn't returned.  However, I remember a very poignant message given at my church during that time about God's goodness.  

The Bible talks about God's goodness at length, but I struggle sometimes to accept it.  Yet during the darkest time of my life, I resolved to trust in God's goodness no matter my circumstance.  What follows is a natural progression.  If I know that God is good, I can trust Him, and if I can trust Him, I can have peace in any situation - even if the outcome seems catastrophic.

After my day of call, I'm tempted to question God.  Why do I see all of these people die here?  Why couldn't I do more to save them?   Why should I go back to see more of the same suffering every day?

But I realize that every one of my questions revolves around me.  My skills, my efforts, my intention and my heart are not enough.  But when yielded to the certainty of God's goodness, I know that He will guide the outcomes.  And though the outcomes aren't what I like, His goodness doesn't change.

This gives me peace, assurance and quietness.

Thank you to all those that prayed for and sent encouragement to me, my family, my patients and our enduring work here during this recent difficult time.


  1. Keep up the good work man. If it seems hard, that's because it is, but it doesn't mean you're not doing good, it may mean you're doing better.

  2. Thanks for running the race. I pray God sends encouragement and refreshment in some way. Keeping running brother.