Back to Reality

A dozen times a day I have become lost in the surreal awareness of being back at Kudjip Hospital. As though 5 years never happened, the same faces of hospital staff smile and laugh in passing, the same graphic odors and vivid images shock the senses, and Tok Pisin pours easily from my mouth from a source I didn’t know remained.  I have thought and dreamed of these images, scents, and faces thousands of times over the years - to be here now again is mind blowing, heart wrenching, and saturates a part of my soul Called to Serve here. I did not realize just how dry the well had become, but now my soul drinks deeply from these rich waters. So surreal is the experience at times, I have felt detached from reality - like I’m behind the camera of a documentary on Kudjip Hospital. Panning left we see a patient in the ER struggling to breath. Panning right, a bright lightbox on the wall illuminates xrays of broken bones. The camera zooms in at flies landing on a malnourished baby’s face, halfheartedly waved away by a thin tired woman. 

But then reality provides the pinch - “Dr Ted, please come, your patient is arresting.”

When we lived here 2014-2015, it took me about 3 months to get “used to” witnessing death. Now having one of my Peds Ward patients die the very first day back in hospital, the callous is not so hardened...and my heart cried out silently while the boy’s parents wailed over his lifeless form. His meningitis was bad before I ever took over his care. I’d even suspected he was brain dead that morning. But it doesn’t lessen the blow of a dead child underneath my stethoscope. I prayed with his parents for God to grant them peace. I filled out the death paperwork. I went back to outpatient clinic and put on a smile for the next patient. I held my children tight when I got home.

My first day of call was on my second day back in the hospital. This time at Kudjip, I do not have any responsibility for OB patients when I am on call, for which I am very grateful. My friend Dr Mark Crouch was covering OB Call, and he had just headed home for the day. After clinic ended, I went to the other wards to familiarize myself with patients that might need attention overnight, then I went to the ER. A trauma patient had just arrived - he was hit by a car and it was immediately apparent that his left lower leg was malformed. As I checked the rest of the boy’s body for injuries, another trauma patient was bustled into the ER by a group of men - unconscious, labored breathing, and bleeding from a large laceration across his face. This man was reportedly hit head-on by a bus while riding his bike. Patient 1 was stable, so all my attention went to Patient 2. My first thought on examining him - clearly head trauma, maybe pneumothorax, maybe internal organ damage and bleeding. My second thought - I need help! So I called Mark. He came, he saw, he stuck a needle into the guy’s chest - that didn’t help. So we called Surgery. Ends up his labored breathing wasn’t a collapsed lung, but all related to the head trauma, and our surgery team drilled two holes into his skull to relieve pressure. So yeah, managing traumas is traumatic, and I am SO very thankful to have experienced missionary docs here to back me up!

Day 3 on the Pediatric ward, I discharged a boy with a brain tumor, only to be replaced by another boy admitted with an abdominal tumor.  The child with a brain tumor needed a Head CT and a Neurosurgeon in order to survive - neither of which we have at Kudjip. If his family chooses, they will pay close to 1000 Kina to get the Head CT, then many thousands of Kina to get a brain surgeon to complete a risky procedure that may not actually resolve the problem. Between the exorbitant cost and poor prognosis, it is unlikely he will have any intervention, and his brain tumor will kill him. The other boy with the abdominal tumor, most likely a Lymphoma, is receiving a single dose of chemo here - if it helps, he will get more. If it does not help, with chemo options being VERY limited in PNG, his abdominal tumor will kill him. The apology and prayers I offer feel hollow and echo of routine. Then that hollow feeling sits in my stomach like a rock. 

On Thursday, I was greeted on the Peds ward with the news that Petrus had died a couple hours ago. I was shocked. This 11 year old boy with significant Congestive Heart Failure had been stable and communicative all week.  Yes, he was on oxygen and a bunch of CHF meds. Yes, his heart was barely functioning. But the report of “he was uncomfortable all night, then he arrested and died” seemed shallow. So many questions flooded my mind:  Why didn’t the nurse notify the Provider on call that he was worsening? Would it have mattered? Should I have done something different in his care? Would any intervention have changed the outcome? Probably not at this point. But did I adequately share the Gospel with him? No. I did not. I expected to have more time with him. Reminder of the day - tomorrow is not certain, take every opportunity to share the message of Jesus Christ. 

It is Friday, and this week has felt like a month. While I am wading slowly towards remembering how everything works here, frequently I get stuck and need direction. How do I cast that again? What’s the right combination of hypertension meds? Does this abdominal ultrasound look OK to you? Tomorrow is Saturday and I am on Call again. Please pray for God to supply me wisdom in providing the best care, to know when to ask for help, and to have discernment for investing time & prayer with those who need it. Thank you!!!