Glories stream

Robert walked along the stony roads of Jiwaka some weeks ago, unaware that his life was about to change forever.  A bulldozer worked to clear large trees in preparation for a re-working of the road not far from our home.  One tree snapped violently in half and spun out of control, striking Robert directly across the side of the head.  He lost consciousness briefly and friends brought him to the emergency room at Kudjip.

After concluding a difficult post-partum hemorrhage management in our maternity ward, a nurse summoned me to the ER where Robert's injuries quickly threatened his airway and his life.  One look and I knew that even with aggressive surgery he could die.  I phoned my incredible friend and colleague Dr. Ben Radcliffe and we quickly took Robert to the operating theatre.

Fifteen minutes into the procedure we knew Robert was in big trouble.  After creating a new airway that bypassed his injuries through his neck, the difficult work of stopping the bleeding and re-creating facial structures for Robert began.  After two hours of work, Dr. Ben placed some stabilizing arch bars across his mandible and left large balloons and packs in his nose to slow the blood loss while we prayed for his head injury to stabilize before more definitive treatment could be pursued on another day.  I found his brother waiting outside under the night sky and gave him the heavy news.  As I bundled some things away in my clinic room and prepared to go home, I said a special prayer for Robert - one like so many I have uttered in the corridors of the hospital during those long call nights. 

 

 

 

Our family just returned from what has become my favorite Christmas tradition.

Each year the missionaries of Kudjip visit the hospital on Christmas Eve to bring carols, the nativity story, and small gifts to those in our community who are too sick to be in their homes to celebrate Christ's birth.  Each year brings tears to my eyes.

I miss the cold weather and the occasional white-morning Christmases in the U.S. but if I could choose one sensation to replace them, it would be the consistent blend of joy and gratitude that I feel during these special times with family and my patients.

 

 

As we shared Christmas presents with the suffering of the PNG highlands, a tender moment interrupted me.

After our songs and reading of the Christmas story, a seemingly new Robert smiled and spoke clearly of his gratitude to God in sparing his life as I saw him shaking hands with Dr. Ben.  Tears immediately came to my eyes as I recalled the thin, softly muttered prayer in the dark some weeks ago.  I took Robert's hand in mine and managed to choke out a "Merry Christmas."  I wasn't sure if I'd seen a more glorious sight.

Our efforts in Kudjip go far beyond medicine.  The lives of our friends and neighbors rub, and sometimes grate, against ours in ways that force us to bring God's patience, grace, forgiveness, and love to and through challenging times of ministry.  The times our mission family can share in a Christmas party or a Christmas outreach build connections that allow our friendships to transcend the difficulties of bringing health and hope to a hurting place.

And the hallowed halls and wards of the hospital become much more than just a place to practice medicine.  They have changed into a sort of home.  Not in the sense that I live in them - but, in a way, the sacred work and vulnerable people that they hold now live in me.  Sometimes I feel it strongly during times that my family can join the ministry there.  But many times I feel it most in darkened halls, whispering last resort prayers to a God that has shown himself willing to embrace the darkness of our world by joining us, dying for us, and lending His strength to us in pursuing His redemption for all people.

 

Glories stream from Heaven afar

Heavenly hosts sing Hallelujah

Christ the savior is born

JJ Heller

More Gladness

 

“There is a far kingdom, aways from here -

Beyond the storm and the sea”

 

The Gray Havens

 

 

I completed writing the note for what felt like the hundredth patient for the day – and I hadn’t even finished rounds yet.  As I did so, a sinking feeling came over me and I went looking for the newborn I had delivered about twelve hours prior.  The nurses couldn’t tell me where he was, and I didn’t see any paperwork.  The ghost-like appearance of his skin when I did the cesarean section the night before filled my mind and brought a too-familiar premonition to my heart. 

 

I went to the nurses desk in search of paperwork – resigning myself to the sense that my operation of the night before had failed to save the little one I held so briefly on its way into the world.  Unable to locate the forms needing my signature, I decided to start in on my maternity rounds and return later to complete them.  

 

 

 

 

This was the first of our furloughs in which I did not pursue any locums work and it afforded additional time for friends, family, rest, relaxing, a trip to Canada, and some teaching at the In His Image residency.  Many things that filled my cup.

 

But I am glad to return to the care of my highlands community back at Kudjip since our stay in the US this summer. 

 

As I round most mornings, faces with bright smiles alternate with mothers just waking with the morning sun as I make my way through the hospital.  Some I need to disturb for an exam, others I let sleep while I review vital signs, lab results, nurse notations, or the reports of medical students.

 

But in recent days some great challenges threatened to overwhelm me.

 

 

 

 

A woman came to Kudjip to deliver her baby in the safety of our maternity unit, but the child was born with a significant congenital defect.  Though I attempted to provide the treatments I knew could help, the baby got weaker over the next several days and eventually passed away.

As I walked away from the family, I glanced into a delivery room and saw the face of another mother I had been caring for smiling at me.  I instinctively smiled back – but as I walked on, a heaviness descended as I reflected on who she was.

 

A colleague had evaluated her almost two weeks ago when she came to the hospital concerned about not feeling her baby move for some time.  We discovered that her little one had died in-utero and counseled and prayed for her.  But her ordeal stretched on as we struggled to effectively deliver her– hoping to avoid an operation that would result in a painful and prolonged recovery for a now-deceased child.

 

Having just had her baby, her smile conveyed gratitude that, after many attempts over several days, she did not need to have surgery.  I, too, was relieved and grateful.  Yet I pondered on that smile for some time – wondering in what kind of world a mother delivering a dead baby brings her a comfort and a smile?  Shouldn’t the world - shouldn’t I - expect better than that?

 

 

 

 

The Voyage of the Dawn Treader has always been my favorite book in the Chronicles of Narnia. Two of the Pevensie children along with Eustace and the honorable Reepicheep make a journey to the very end of the world.  There they behold an amazing thing: Aslan’s country.  Beautiful beyond description but muted a bit when gazed upon through a standing wave of the sea.  Though they do not enter his realm, the sight remains with them for the rest of their lives.  Lewis describes Lucy reflecting on that glimpse of it years later –

 

““It would break your heart.”

“Why,” said I, “was it so sad?”

“Sad? No!,” said Lucy.”

 

 

 

 

My blog entries have thinned out in their frequency down the years.  I have asked myself if I am getting calloused, or no longer moved by the suffering that often overwhelms our highland community in Papua New Guinea.

   

Have I given up on the redemption that I have heard about?  I spend so much of my time in a place where loss feels like the norm, outside of that restored kingdom, and it makes me wonder if I will ever see it.

 

 I went on with my rounds, anticipating a bit of a hollow day.

 

In bed number one, a young woman, whose face I remembered well, slept peacefully under pain medication, while a dutiful grandmother held a beautiful baby against her breast – delightfully filling himself with a first-ever meal.  That ghostly child from the night before.  Tears rimmed my eyes as I went through the rest of my ward rounds moving from patient to patient in a glad mist.

 

 

 

 

 

“There is a far kingdom on the other side of the glass

And by a faint light we see.

Still there is more gladness longing for the sight,

Than to behold, or be filled by, anything.”

 

 

After so many years of depending on God’s sovereignty in the face of my many failures, and successes, here I felt like I learned something new in that moment.  I had been given a glimpse into that restored world.  Seen, as ever, through a veil and a haze.  Yet real enough to provide more than the grace and strength to just continue – enough to receive gladness.  And I feel it during both the great privileges and the great burdens. 

 

That it is more filling to simply stand on a threshold, occasionally peering into God’s redemption, than to pursue anything else.

 

 

“I would rather be a gatekeeper in the house of the Lord 

than live the good life in the land of the wicked”

 

Psalm 84:10 (NASV)

 

 

 

 

 

Strength Indeed Small

 

I entered my clinic room after rounding on about twenty patients in our medical ward.  I felt the draw of returning to perform a lumbar puncture and ultrasound examinations but stopped by my office to pick up some things I would need.  A small stack of papers awaited me, left by our medical records officer – death certificates needing my signature.

 

With several of our doctors out on furlough, I have been working in our nursery in addition to my medical ward rounds the past few weeks.  It has been a while since I’ve consistently been there and I don’t think I’m exaggerating to say its busier than I think we’ve ever seen it.  Mothers and babies cluster close together in a room designed to trap their body heat and warm the little lives under our care.  IV poles drip fluids into tiny veins, a cylinder leaks out small amounts of supplement oxygen through split tubing into frail lungs, medicines are prepared in insulin syringes to accommodate the miniscule volumes about to be administered, a nurse dutifully prepares charts, and a missionary doctor scans the room hoping to see all the faces he encountered yesterday.  But some are nearly always missing, their short lives momentarily recalled in a day or two when I sign that stack of papers. 

 

I hear the savior say,

“They strength indeed is small.

Child of weakness watch and pray.

Find in Me, thine all in all.”

 

A baby I will call Anna delivered prematurely to an unmarried University student two months ago.  After a few weeks of tending this little one, her mother returned to school, leaving the child’s grandmother as her sole custodian.  Routinely, I asked if the baby was breastfeeding and was told, “Nogat – mama I go bek lo skul pinis.  Em mi yet tasol.”  “No – her mother is gone.  It’s just me now.”

 

We discussed the proper way to prepare formula for this premature baby, being careful to make sure the water and equipment was clean.  I asked if there were any women in the family who could breastfeed the baby.  No – but grandma was determined that she could prepare and give the feeds properly.

 

I moved on to my other tiny patients, their small lungs using every bit of their energy to take their next breaths, and I feared that their strength would give out.  All I can do is watch and pray.

 

 

 

 

 

In the next bassinet I pause before asking mom to accompany me to a more secluded part of the ward.

 

“I have tried everything to help your baby but nothing’s working.  You’ve been a long way from home for two months.  I’m worried about your family.  Yesterday, you asked if you could just take your baby home and give her to God.  I agree.  This illness cannot be cured.”

 

She thanked me for my care, took my hands, heard my prayer of surrender, and bundled her baby into a string bag hung over her head to begin a long journey into a remote corner of our province – most likely to begin preparations for a burial.

 

Lord now indeed I find

Thy pow'r and Thine alone

Can change a leper's spots

And melt the heart of stone

 

When I set out upon this entry, I planned to draw parallels between Christ’s triumphant resurrection and a miraculous story of recovery.  I began to write the story of how Anna’s baby returned having gained weight, when I received the phone call from the emergency room.  “Dokta, mipela I gat wanpela boi na ka I bampim em.”  A young boy we will call Norman was crossing the highway after getting dropped off near his home from Sunday Lotu when a large truck struck him.  Thrown across the ground, bystanders quickly rushed him to the Kudjip emergency room.  The next two hours I spent administering sedating drugs to alleviate the agitation from my patient’s severe head injury while cleaning and stitching multiple lacerations, reducing and splinting his femur fracture, and providing breathing support for his pulmonary contusion.  After stabilizing him to the best of my ability, I took the hands of his parents in our crowded emergency room on Easter Sunday and prayed that God might join the work of our medicines and treatments in healing him while giving peace to the hearts of his parents.

 

 

I do not preach many sermons.  I do not plant churches, though the work of our hospital has started several them.  But I have found a unique niche in meeting some of the great physical needs of our community while attempting to bring Christ’s love to bear on my patients.  I have seen many of them embrace His salvation and I pray and hope that they will help bring the change to this country that is desperately needed.

 

About two weeks ago I entered the emergency room and examined the first chart handed to me by the nurse in charge.  A young woman we will call Lucy on bed six had delivered her baby at Kudjip ten days prior, but now suffered from fevers and weakness.  Upon discharge she and her infant had been given a supply of anti-retroviral medications for HIV.

Her blood pressure hovered at about 80 millimeters of mercury, her pulse around 120 beats per minute, she breathed at nearly sixty times a minute, and she drifted in and out of consciousness.  No guardian stood by.  Staff and I scrambled for oxygen, IV access, and powerful antibiotics while I retrieved the ultrasound machine, worried about a postpartum infection.  As I concluded the scan, her mother and newborn child arrived at the bedside having just obtained her mandatory health book from our check-in clerk.  As I quickly transferred her back to our maternity unit, we obtained a chest X-ray that revealed a profound pneumonia in her lungs.  I could not "quick-fix" this with surgery and I was convinced that she would die, leaving her grandmother to tend another PNG highlands orphan.

I explained the situation to this sweet woman, every inch of 4-foot-10, cradling her grand-daughter in a bag over her shoulders.  Her eyes misted as she considered the severity of the situation and she asked, "The baby is hungry - can she still feed?"  I suggested that her mother was unlikely to be able to produce breast-milk and we would provide supplements for a while, but yes, she could still attempt to join baby and mother for a while.  I left the ward, along with one of our new missionary doctors, catching the image of a frail but dedicated grandmother latching her new grand-baby onto her daughter's lifeless form. 

 

 

As I enter my tenth year serving in the highlands of Papua New Guinea, I field more and more consults from my fellow doctors: seeking advice on how to evaluate certain cases, manage specific conditions, or even just to navigate the myriad challenges that buffet a physician tasked with a burden that should be shared among more colleagues.  In ten years, I have gained a little knowledge, some experience, and many scars.  I supposed one would think ten years serving in this ministry would make an “expert.”  Yet so many times my strength is small compared to the needs around me.  Like those little ones completely dependent on the few interventions that we can provide, I feel somewhat helpless.  

 

 

 

But I know that I don’t need great strength.  In fact, Paul writes that God’s strength is most manifest in my weakness.  I can and should invest my life into God’s call for the care of the sick and hurting.  But all of it depends on Him.  My watching and praying allows Him to show Himself strong.

And when before the throne

I stand in Him complete

"Jesus died my soul to save"

My lips shall still repeat.

Over the next two days, Lucy lay almost motionless connected to IV fluids, oxygen, a urinary catheter, and at times to her new daughter - dutifully placed there by a loving "bubu."  And then she started to speak in sentences, eat and drink, and even sit up on her own power.  A few days more and she was cradling her new baby lovingly to her breast, bathing her, then allowing her to nap in the ward looked after by our nurses while she went outside to see the sun a bit - resurrected to a new life with her child.

 

Today Christians all over the world celebrate that Jesus rose out of his grave to defeat sin and death.  He is risen indeed.  Though our world still hurts from the bondage of the Fall, He now rules and reigns with His Father.  His strength heals broken bodies, cares for newborn babies, and changes hearts and souls.

 

Jesus paid it all

All to Him I owe

Sin had left a crimson stain

He washed it white as snow