Saturday, June 11, 2022

Worth fighting

 A woman presented to our hospital having seen a rush of fluid and vaginal bleeding after just five months of pregnancy.  An ultrasound scan revealed twin babies, perfectly formed, measuring about 17 weeks, but  without any of the protective fluid  in the womb needed for their growth.  Over the next couple of days, the bleeding continued and the fluid showed signs of infection.  Then the leading baby died.  The second one still had a heartbeat but no fluid, and mom's hemoglobin dropped two grams in two days.  I administered antibiotics and multiple medicines in an attempt to deliver the now deceased baby and her sister.  I felt the chances of their mother suffering a serious complication were too great.  But nothing worked.  Her body did not respond to the medications we gave and the time had come to remove her deceased baby and her terminally ill sister.  

My heart weighed heavier and heavier as I approached the task ahead of me.  I tried so hard to avoid it, but now I prepared to perform one the procedures I have come to abhor.  I have only been forced into it a handful of times, but each one is hauntingly painful.  I sensed myself bargaining.  Perhaps another emergent case would come up and derail this one.  Perhaps the surgery team wouldn't be ready in time and I would hand it off to the on-call doctor, who said she would be willing to complete it for me.  But in my heart, I knew the burden of my decision and that it should be my responsibility.  Mom understood and, having felt sicker each morning for the past three days, asked me to proceed.


"It's all wrong.  By rights we shouldn't even be here.  But we are."

Lord of the Rings

 

Anyone who has known me for more than a day or two probably knows that I am a Tolkien fan.  In the Lord of the Rings, Frodo and Sam undertake a perilous journey to rid the world of a great evil.  In doing so, Frodo nearly succumbs to despair.  Upon realizing that his own soul is changing because of the evil he sees and carries with him, he wants to give up.  But his companion Sam sees beauty and light on the other side of their present darkness.

 


Some months ago a young woman presented to the hospital with painful contractions after just seven months of pregnancy.  She delivered not one but three very low birth-weight babies ranging from 900 to 1,200 grams.  In our setting, these little ones faced almost impossible odds to survive.  In those early days I counseled mom with a desperate realism - that we would do everything we could for them, but I did not think they would live.  Each day I attempted to prepare her for the difficult road ahead and the likelihood that at least one, if not all, of her babies would die in the hospital.  When they all started losing weight, I began to dread rounding on those three babies cuddled together in their single warmer.  The smallest developed an infection and difficulty breathing.  When I moved to a different ward of the hospital I felt guiltily grateful that I might not have to be the one to pronounce them.  I nearly despaired.

"It's like in the great stories, Mr. Frodo - the ones that really mattered.  Full of darkness and danger they were.  And sometimes you didn't want to know the end, because how could the end be happy?  How could the world go back to the way it was when so much bad had happened?"

Some weeks later a colleague of mine shared a request in our prayer meeting for three small premature babies in the nursery - triplets that, despite being small and seemingly frail, appeared to be making a turnaround.  My heart was buoyed by the news.  But I have held more tightly to cautious and expectant hope rather than unrealistic optimism.  I remained downcast.

 


Some time later, I returned to our maternity ward.  After a glance over the charts of the twelve expectant mothers we were managing that day, I entered our nursery.  I could hear the hymns of the nearby church beginning the Sunday service.  The crowded room bustled with young mothers and their little treasures - changing clothes for the doctor's arrival while delicately navigating intravenous lines and oxygen tubing.  Several greetings of "moning" welcomed me and I collected papers, afraid that I might need to ruin many of those smiles with the day's news.

The first warmer I came to took my breath away.

Three healthy babies cuddled together wearing matching Sunday dresses.  A young mother and a new grandmother smiled at my surprise.  They were now the seasoned veterans of our nursery and could even be seen advising newer arrivals on how to look after their little ones.  As I perused their growth charts I grew more and more stunned.  Not only were they growing, but breastfeeding and approaching a healthy discharge home from the hospital!  As the hymns continued in the background, I enjoyed a silent and misty-eyed moment of reverent gratitude.   

 


 

"But in the end, it's only a passing thing, this shadow.  Even darkness must pass.  A new day will come.  And when the sun shines it will shine out the clearer.  Those are the stories that stayed with you, that meant something, even if you were too small to understand why."

"But I think, Mr. Frodo, I do understand.  I know now.  Folk in those stories had lots of chances of turning back, only they didn't.  They kept going.  Because they were holding on to something."

A decade ago we felt the distinct call of God to pursue caring for the least, the last, and the lost in the highlands of Papua New Guinea.  Over the years, my initial heroic optimism has matured into a persevering hope.  The enduring effects of our service here are evident in the children I see running around our village that I delivered, in the new doctors that I have taught, and in the grateful smiles of families I've cared for as we go to and from the market.  But every once in a while, a moment of miserable darkness threatens to to blot it out.  When another child dies, a mother loses her newborn, or the endless tribal violence fills our wards with casualties, I begin to wonder what I am holding onto.   In some of my most challenging call nights, I have thought it would be simplest and easiest to leave these daily battles to someone else.  

When I reflect on that call, I know now.  I am not called to great accomplishments and great victories.  Not even to be successful, though with God's grace we often are.  I am called to fight for what Christ fought for - God's redemption of this world through the rescue of individual hearts.  A contest filled with miracles, narrow escapes, blood, trials, deaths, and resurrection.  At times, the gravity of it escapes me - while at others I cannot escape it.  But in all times, I pray I would continue steadfastly in His hope.

"What are we holding onto, Sam?"

"That's there's some good in this world, Mr. Frodo.  And it's worth fighting for."

 



Thursday, February 3, 2022

Nearer

"So draw me nearer Lord
 Never let me go 
Closer to your heart 
Draw me nearer Lord"

Our midwife handed me a packet of papers to sign as I rounded in our nursery.  I knew what they were … I have signed so many.  Black-and-white reminders of tragedies recently played out in flesh and blood.  I set them to the side while I finished my work, planning to attend them later.

 



 

Before I could, I was summoned to delivery bed three where a first-time mother struggled to deliver her baby girl.  The nurses could no longer find heart tones with the hand-held Doppler and mom was getting tired - her pushes shortening and her face showing obvious exhaustion.

I applied a vacuum extractor to the baby’s head and told her, “Mama - mi pulim i no inap.  Yu pus i no inap.  Yumi wok-bung, em bai inap.”  On the next contraction a limp baby delivered into the bed with deeply stained amniotic fluid.  But she had a heartbeat.  We cleaned her airway and I set to work giving artificial breaths with a bag.  The mask was too big for this unexpectedly premature infant, but I started to see some movements in the chest.  All the while I awaited the telltale cry of new life … but it wouldn’t come.  I stared into that face, challenged in maintaining a good position of the over-large mask.  It stared back with a stunned and pale look.  I wondered to myself if this image would be a haunting reminder when I was forced to collects its black-and-white specter in a few days or if it might be a moment that I reflected on with privilege as a new life gained traction in our world.

After what felt like hours but was likely a few minutes, that little blank-faced baby started to gain color and grimace.  A few more breaths and the chest moved in and out on its own.  A weak cry finally escaped and I set the bag aside, still praying that I would see that face on rounds in the morning … “Just let this baby see a turn of the earth …”

 


 

I resumed caring for the patients in the ward and picked up the chart of a woman whose baby bilum rested next to her.  She looked like she was ready to leave, even though she had just had a cesarean delivery 3 days ago.  I inquired about her pain, her eating and walking.  “Na bebi i stap?”  A thin mist layered her eyes as she indicated the bag, “Em dai asde na mipela bai planim tude “.  Her deceased little one lay next to us, wrapped and shrouded - perhaps to conceal from the public motor vehicle driver that she was bringing a dead body in the car - to which there is a costly stigma attached.  “Mi sorri tru“. Had I paid more attention to those papers in the morning I would have known.  The chaplains visited them and prayed.  Next patient.


A few days ago I was really struggling with the experiences of my patients.  I actually kept a running list of those that I had to tell were dying.  In eight years I had never done that before and I don’t know why I did at the time, but I brought it home, recalled their faces through prayers, and felt better.  

The next day in clinic I watched the back of one of my HIV patients.  He had contracted the virus at birth 11 years ago and he left my room having just been told alongside his grandmother that the virus had weakened his heart and that he likely wouldn’t see his next birthday.  I felt a surge of helplessness. I want to be honest with my patients. I want them to understand what the road ahead looks like - and where it ends (in this world).  I give so much bad news. I wondered if what I do made any difference.


As the names on my list stacked up and the myriad ailments reminded me of my inabilities, I actually began to dread each pleasant smile entering my clinic door.

But there was one I could not avoid.

I wrote about my experience at Sengapi, one of our rural health centers, at the end of last year.  One of our nursing officers there was expecting a baby at the time. About a month after our team left, I received a phone call from her husband.  His crackled voice and our short conversation told me Melissa needed to be at Kudjip.  She had developed pronounced swelling and headaches in her eighth month of pregnancy.  She managed to get a medical evacuation flight out  but Issac couldn’t join her because Covid restrictions meant that only patients were allowed to travel on evacuation flights now - no guardians.  When she got to Kudjip she seemed alright, but quickly worsened over the next few days.  We needed to deliver her baby early.  Her husband tried to make it, but the rivers were flooded and he couldn’t cross them.  Her surgery went well and a vigorous baby girl went back to the ward while we finished.  When I went to check on her, a hooded figure was already next to her baby cot holding her hand.  There was Isaac.  A new father beaming down on his little girl.  MAF had managed an early flight and brought him in the morning hours while we were operating.  


 

Melissa and her baby had a few ups-and-downs for a couple weeks.  But over time and with prayer they did well.


I have never been able to untangle the great mystery of Gods grace.  I have seen and felt that it is infinite and that He spreads it far and wide.  Yet somehow none is wasted.  As though our world's separation from his perfect and peaceful presence means that a profound Grace, even limitless, is simply sufficient.  Abundant and extravagant but not wasteful.  When I watch my patient leave the room with an hourglass hanging over their days I wonder how I can see the next one in any way that shares that Grace.  Yet somehow it works.  Hearts are changed and touched - mine most of all.  Not because I have solutions.  Not because I am a miracle worker but often because I am not.  


In the next few days, our new mother and her baby girl stayed in the hospital.  The nurses dutifully checked on both of them - making sure they were doing well and that this new life was gaining the foothold it would need.  As I put my signature on their papers to leave, I reflected on the great redemption of those moments I spent looking into that apparently lifeless face.  It would be tempting to pat myself on the back.  We did well, it is true.  But we were just vessels of a greater intention.  A Grace given that I could not create or bestow - merely share.

 


"In your nearness I take shelter.

Where you are is where I'm home.

 I have need of only one thing - 

To be here before your throne"

 

As I enter our nursery I am reminded of God's presence.  All entrants must remove their shoes and wash their hands, like approaching a temple.  I go back and forth performing my doctor duties as mothers watch anxiously.  The room has a sacred quality for me because it is a place in which the most vulnerable are tended.  It draws me nearer to Him even when the end result may be a tragic reminder that His redemption is not yet full in our world.

And although I may struggle to see or feel it at times, at others all it takes is a small spark in a dark place to change the entire landscape. 

Perhaps that Grace can bring out bright blooms - even in a garden still fighting the weeds.

 


 

Thursday, December 23, 2021

The Brightest Light


“Years of silence

Waiting on a king

They thought they knew who you would be”

- Behold, Plumb 

 

 

On a crisp morning that heralded the oncoming rainy season, I briefly checked in on the nursery then left our new resident, Spencer, to conclude while I went to the Emergency Room.  Several patients needed attention: a skull fracture, a case of terminal cirrhosis, one of my young HIV patients with heart failure, and a young woman with a ruptured ectopic pregnancy – among others.  I finished a procedure and told the operating room to prepare for the ectopic pregnancy patient before heading back to the maternity ward to check on Spencer.  As I went, Dr. Laura approached me, “There’s a baby that was just born and isn’t doing well – can you come see if there’s more we can do?”

 

I arrived and saw a baby that appeared lifeless being given artificial breaths by Spencer while staff scrambled to grab suction and oxygen.  I made a brief correction the bag-mask technique and checked for a pulse.  An exhausted young mother, Maria, took it in as we scrambled to save her little one.



How many times have I been in that place – walking into an apparent darkness, hoping for signs of life, but unsure of what to expect.  Anticipating the worst yet hoping for a miracle.

 


 

The heart sounded out at about a hundred beats a minute – a reassuring sign.  The fluid around the baby had been deeply stained indicating distress during the labor.  Spencer continued bagging while I assembled the laryngoscope to open the passage into the baby’s voice box.  I handed him the instrument and he quickly visualized the vocal cords, suctioning some secretions away from them, just as the baby began to pick up its own breathing.  After a few minutes of coordinated efforts, the baby’s breathing improved and we cut the umbilical cord to take him into our nursery where he would receive all five interventions we had to offer.

 


 

 

“So we pray we ask and seek

When the answers don’t come easily

And when they’re not what we expect

Help us to trust you even then.”

 

 

Roughly two thousand years ago, a young woman labored with her first child.  The circumstances surrounding his birth were incredible and, to many around her, unbelievable.  What seemed to others a mark of darkness, she cherished as hope in a miracle.  One that would change the entire world. 

 

When the moment came, did the delivery go smoothly?  Not much else in their journey had.  I imagine hours of intense pain, focus, anxiety, anticipation, and fear.  Did he cry right away or were there moments of doubt and concern – awaiting those first and all-important breaths?  But those breaths came - and the life that arose out of them marched an undeniable path through history and brought long-awaited redemption.

 

So often I forget that what we see in the daily miracle of childbirth here was once lived out in a Divine way centuries ago.  Advent helps to remind me.  That the Creator would choose this path to enter our world – enjoying and enduring the full human experience so that we would have a personal God who knows us.  The brightest light, born in a familiar and common darkness.

 

 


 

Over some days, Maria’s baby experienced seizures and side-effects from the medicines we used to control them.  His young mother dutifully attended to him – changing him, cleaning him, praying over him, and showing an impressively calm resolve through eyes that betrayed a simmering doubt.  But she trusted us – and the weight of that trust sits with me even now.

 

Five days into his life, he stopped having seizures and began to drink the small amounts we offered.  Over the next three days, we were able to remove the various tubes administering our treatments and send him to his mother’s bed.  Soon after, she placed him into a string bilum and took him home,  walking her newborn through the crowded marketplace like so many others - with those around her oblivious to the living miracle she held.

 

“Unlikely joy

anticipated hope

Give us your peace

Undeserved love

Such relentless grace

You are our king”

 

 

Thursday, November 18, 2021

Higher and deeper


 “I could just sit and wait for all Your goodness, hope to feel Your presence.

I could just stay right where I am and hope to feel You, hope to feel something again”

-All Sons & Daughters

 

 

The daily healings and hope at Kudjip have flavored the last eight years well.  Some of the challenges of life in the highlands have become character-building inconveniences.  The patients’ struggles have tempered my na├»ve ambitions.  In a way, what once seemed exotic has become a bit routine.  So, I looked forward to getting into some of the last places on Earth with a team that included our newest OB/Gyn doctor, her husband, and one of our maintenance staff.

 


As the MAF Caravan started circling I thought, “Where are we going?”  I had been captivated looking into the unfolding valleys of jungle, but I certainly didn’t notice anywhere that looked like a place to land an airplane.  On the second loop, it appeared in front of us – a level and well-cut stretch of ground with a few tin-roof buildings on either side.  We were in Sengapi – perhaps one of the most remote health centers in the world.

 

 

“I could hold on to who I am and never let You change me from the inside.

I could be safe here in Your arms and never leave home, never let these walls down”

 

On the first night I under-estimated the change in altitude.  I woke up a few times, clicked on my solar lantern, piled on more clothes or blankets, and tossed and turned my way to dawn.

 

 


 

We began our days with devotions and teaching while waiting for patients to come down from the surrounding ridges.

 

 


 

A young man hiked over the hills and arrived mid-afternoon looking weak and uncomfortable.  Once the rag over his arm was removed, it was obvious why.  A small sore in his finger grew into an impressive abscess of his hand and forearm over some days.  With a high temperature, high heart rate and slightly low blood pressure it was clear the infection quickly overwhelmed his bloodstream.  We gave him IV fluids and antibiotics and prepared him for a minor surgery to drain the infection.  (Thankfully I had packed a few vials of light anesthetic with me).  After a relatively quick procedure, we admitted him he did well. 




 

The community had gathered on the lawn outside the clinic.  “Isaac, what topic do you want me to talk about?”  “Coronavirus – they are scared.”  I gave a brief overview of the virus and the importance of the vaccination, then opened it up for questions.  A local leader stood up: “We are just bush people, and we don’t know about this, but we have heard a lot of things about it.”  He went on to inquire about several of the common misconceptions surrounding the vaccine.  They were right off the pages of FaceBook … likely propagated into the remote areas of Papua New Guinea through simple word-of-mouth by unwitting individuals, susceptible to assuming that anything they read on a smartphone must be smart.

Afterward, our health staff took the lead by receiving their COVID jabs and several community leaders came forward wanting to be immunized as well.

 

“And I will be yours, Lord – I will be yours for all my life.

So let your mercy light the path before me.”

 


 

 

At the far end of the clinic building was the gently but appropriately used 4-bed inpatient ward.  A woman slept there but stayed outside most of the time – because of a personal preference or to minimize odor, I don’t know.  She had noticed abnormal bleeding and presented to Sengapi where she was presumed to be anemic from a pelvic mass.  Fearing the worst, the nurses there asked her to await our team, assuming we could provide some answers.

 

Using some new and impressively portable ultrasound technology, we were able to confirm that she had a cancerous mass in her uterus.  In an ideal situation, this could be removed surgically.  Because of the delay in diagnosis, the tumor had now spread and involved other internal organs – meaning surgery would cause her great pain and fail to cure her.  We broke the news to her and her husband, prayed with them, and entrusted her ongoing care to the staff and local pastor.

 

 


 

About a dozen ladies had queued to see Dr. Laura.  I’m certain that for each of them it was the first “well-woman exam” they ever received.  Laura was able to bring a new device for treating cervical pre-cancers.  She discovered some worrying lesions and saved five lives by being able to provide instant therapy – likely preventing the devastating scenario that our patient in the ward now suffered from.

 

“But You have called me higher – You have called me deeper.

And I will go where you will lead me, Lord.”

 

We had already packed our bags, knowing that we were departing that day but unsure of the exact time due to a heavy but quickly lifting fog.  I had a devotion prepared to share with the staff that I looked forward to.  As I walked up the airstrip to get a better signal, my phone rang.  The MAF operations director greeted me warmly, “the plane should be overhead in a few minutes.”  As if on cue, the sound of an engine crept over the ridge in front of me.  We collected our bags, loaded the plane, said farewells and in what felt like a bit of a whirlwind I was back in the air heading home to Kudjip.

 

 



 

Now as I walk down the corridors of the hospital, I see faces around me in a slightly different light.  What journey led them to us?  Now those little hand-written scraps of “referral letters” from outlying aid posts carry a new gravitas.

 

Jesus said, “to the end of the earth” - and I think He meant it.  I admit I am guilty of thinking I am already there sometimes.  But I suspect my tendency is to redefine His phrase.  “I did my bit.  I am already in a tough place.  The ends of the earth are coming to me anyway.  The work I am doing is sending others there.”  All very legitimate points - but positions to be held and scrutinized in fear and trembling.  Am I, too, willing to go higher and deeper if I am called there?  I pray that I can let His mercy light that path before me.

 

 

Sunday, October 24, 2021

Broken and scattered

“All these pieces broken and scattered

In mercy gathered, mended and whole.

Empty-handed but not forsaken,

I’ve been set free”

-Broken Vessels

 

I regretfully collected some papers from the Surgery office.  They contained the records of a boy we will call Will that I had cared for last week … a boy whose family was now grieving over his under-sized grave in the north of our valley.


Will presented to the emergency room with a distended abdomen and vomiting.  The family said he had been like that for over a week.  With the health system (including Kudjip) getting derailed by a wave of COVID in recent weeks, this was the first chance they had to seek care for him.  Though he was awake, it was obvious that he struggled to remain so.  On our pediatrics ward, our nurses were placing a tube into his stomach to drain the contents there and giving intravenous fluids to support his circulation.  Blood tests and an X-ray revealed an intestinal blockage and, surprisingly, a pneumothorax - probably from an infection eroding into his chest wall.


Dr. Ben came to the hospital promptly when he detected the concern in my voice.  We both have children about Will's age.  A drainage tube placed in the chest removed foul-smelling fluid and a significant amount of air.  We placed tubes about everywhere we could - to relieve his struggling body and to monitor the effects of our treatments.  He never really improved and less than a day later he died in spite of our efforts.

 



I went into the nursery and discovered that a premature baby I had been caring for had also passed away overnight, not unexpectedly.  Susan's first twin had died last week, suffering from ailments all-to-common for tiny babies in this setting and her second baby had deteriorated over time.  I looked over the other dozen babies under my care - all improving, all feeding, all growing, some going home to grateful and relieved families.


After finishing rounds in the nursery and pediatric wards I met our resident, Dr. Sheila, in the operating room for a cesarean section.  Maggie's baby was “sotwin” and couldn’t tolerate her labor.  Although she was only 8 months pregnant, we felt her little one had a good chance to do well if delivered.  Dr. Sheila performed the majority of the procedure as I assisted, and a vigorous little boy went to his “bubu” (grandmother) while we closed Margret’s incision and her anesthetic wore off.


Not long after, we were asked to see Anna - a fifth-time mother who had presented the day before with some mild contractions and edema.  A scan revealed twin babies nearly term but with the second one “slip-across” or in transverse lie.  Her blood pressures were severely elevated, a dangerous condition called pre-eclampsia.  Blood tests showed that her kidney function suffered as well which could jeopardize her ability to receive the resuscitation and medications she needed or to tolerate surgery.  We debated the best way to manage her and decided that we could attempt a vaginal delivery.  When the moment came, she did well.  Our midwife delivered the first baby, I guided the second baby into a good position and Dr. Sheila broke water and delivered a second small but vigorous baby girl.


Before leaving the hospital for dinner, I went to our COVID ward to follow-up on Wendy.  Wendy has worked at our hospital for about thirty years.  Her presence on station is a mainstay of our community.  In recent years she has struggled with some health problems.  She was one of the first to receive our COVID immunizations when they became available earlier this year.  Six days ago when I saw her in the emergency room with shortness of breath I was worried.  Testing confirmed that she had contracted COVID in the midst of our current spike in cases, likely from the delta variant.  While she looked good for a couple days, she later de-compensated at home and was promptly brought to our emergency department.  I had heard a reassuring update from Dr. Erin - but wanted to see how Wendy was doing today.  When I arrived my concern rose immediately.  Wendy was struggling - to breathe, to speak, to sit and to recognize those around her.  We changed out concentrators (recently mended by our amazing maintenance team), adjusted flow rates, added a couple of medicines.  Esther, the kids and some of our extended missionary family gathered on the porch outside our COVID ward and prayed together.  Wendy’s daughter, another of our nurses and also suffering from COVID, joined us in lifting up this faithful servant into the hands of God.  I know that whatever comes next is beyond me.





“You take our failure, You take our weakness,

You set your treasure in jars of clay.

So take this heart, Lord - I’ll be your vessel -

The world to see Your life in me”


During our recent furlough one of the most common questions I got went something like, “How can you do that?  It must be so difficult to see that kind of suffering.”  Some will ask “How can we help you in that?”

 

There is a renewed interest in caring for the spiritual and emotional health of missionaries in difficult situations and I think it is important.  The thoughts, prayers, words and deeds of our supporters give a palpable strength to our ongoing efforts here.  In attempting to be whole and healthy to best serve others I have heard something like, “You can’t pour from an empty cup.”

That is certainly true and I have had to be deliberate in setting aside times of rest, rejuvenation and fun to maintain myself and my family in this environment.


But I have also grown to appreciate the workings of the Holy Spirit in spite of my own weakness.

 

There are times when I am just empty-handed.  A jar of clay with pieces cracking off and scattering.

But there is a treasure in there: God’s heart for a broken world, which awaits its redemption through the groaning of the lost and dying.

   

Perhaps, sometimes, my job is not to gather the pieces but to let the glow of that treasure spill out the cracks.  Maybe my tears can be redeemed when joined with the heartaches of the vulnerable and desperate around me.  As I read the Gospels, it seems that those places are precisely where Jesus brought his mercy - mending and making His children whole.

 

“I can see You now -

I can see the love in Your eyes,

Laying Yourself down

Raising up the broken to life”