Saturday, May 9, 2020

Love Wins

One of the hardest things for me here is seeing sick patients get sicker or die despite our best efforts because we do not have first world scans, labs, or specialists. Every day I care for sick people who have wildly impressive findings on exam for which I can not give a definitive diagnosis. Is the paralysis from a brain tumor, tuberculoma, abscess, or stroke? Is the dilated heart from a congenital heart defect, past/current infection, or lung disease? Is the joint problem infectious, autoimmune, or simply overuse injury? Without all the fancy tools of first world medicine, I am left with the quality and competency of my physical exam skills, my interpretation of ultrasound and xray, and a few basics labs. More importantly, I have decades of medical missionary experience in my colleagues, who I riddle with 1,000 questions a day to ensure I give the best possible care to each patient. But even then, many patients are left without a clear diagnosis and treatment plan. Common things being common, we start with the meds that will most likely help, and if it doesn’t work, we switch gears until we’re out of options.

This past week I have been caring for a little girl named Lapina on A ward. She presented with 10 days of fevers alone, no cough or focal pain or any other obvious clue as to the cause - but she was pretty sick, so I admitted her on a strong IV antibiotic (Rocephin). Labs and xrays and ultrasound didn’t help, and by the third day of admission with persistent spiking fever, I added a second antibiotic (Ciprofloxacin) to treat Typhoid, as we see that present oddly at times. Two days later with ongoing fever, I consulted my friend Dr. Mark Crouch, who had a look over everything and suggested another antibiotic choice (Azithromycin) to treat Leptospirosis (an uncommon zoonotic infection from standing water sources - which I'd never seen/diagnosed before but for which my dog back home has been vaccinated against). Did we have a highly specialized lab test to confirm the diagnosis? Nope. Did the fevers go away after just the first dose of Azithro? Yup. Kudos to Crouch. Whether her illness was due to Leptospirosis or some other atypical infection, we will never know. More importantly, unlike quite a few patients whose dance with polypharmacy doesn’t end well, Lapina is doing better now, for which we can give thanks to God.

I also noticed this week the stark juxtaposition of two other A ward patients, both with meningitis, but with entirely different outcomes. The first is Friel, a toddler with TB infecting his brain, who has been my longest admitted patient (since mid-March). Despite our best efforts he has battled with breakthrough seizures and fevers while on many medications for TB and other possible infections. I suspect some (if not all) of his seizure activity, altered mental status, and generalized weakness is due to a brain injury incurred early in his TB meningitis. At the same time, along with his exceptionally dedicated and Jesus-loving mother, I prayerfully hold onto the hope that the TB meds are making steady progress eradicating the infection from his brain, and Friel will someday soon return to being a happy healthy boy.

Right next to Friel on A ward is a 2 month old baby who does not yet have a name. Of note, it is a common practice here to delay the naming of infants until they are old enough to more likely survive. This baby was admitted with Pneumococcal meningitis causing seizures and altered mental status. Of note, this kind of bacterial infection is prevented in our first world babies by routine PREVNAR vaccines. This patient’s specific diagnosis was made because we did a spinal tap and one of our lab technicians saw the Strep Pneumo bacteria under a microscope. We placed the baby on appropriate antibiotics, and I prayed he would not sustain the same meningitis brain injury that I fear Friel has had. Within just a few days, all symptoms resolved, and Baby NoName was back to his bubbly breastfeeding self, who I ended up discharging home yesterday.

The expression of bleak sadness worn by Friel’s mother as I discharged their happy healthy neighbors caught my attention, and I snapped a picture of each mother-child pair. Life isn’t fair. It’s not fair!!!

We don’t get to pick and choose the pain and trials life throws at us. We are in fact guaranteed that with every living breath, we are under attack. The world is dark and vicious - all of creation broken by the weight of sin, and it tugs at our hearts to choose wicked, selfish, fearful places to hide from the storm. The army of darkness surrounds us at every moment seeking to invade, blind, and destroy. The enemy wants nothing more than to turn our attention away from the Truth.

But every day I walk into the Pediatric Ward, I am greeted by the beaming smile of Friel’s mother, who has some new Christian literature strewn across their bed. Despite all the pain, the frustration, the sadness — she walks in the Hope and Peace of Jesus Christ. The great tidal wave of this world’s darkness is held at bay by the Light of Truth - the victory is already won.

No matter what darkness you face, my dear reader, remember this Truth. Turn your attention to Jesus, and He will supply you with every strength needed to prevail!

Love, The Henderson’s

P.S. My heartfelt thanks to all you Mommas out there pouring your heart and soul into your children and husbands. I am awed daily by the exhausting lengths to which my dear Rachel goes to juggle countless tasks and hold us all together at the same time. We husbands and children can not fully understand your sacrifice, but our brimming hearts and daily strength are mighty proof of your love. Thank you!!!

1 comment:

  1. What an incredible article brother, rich with love and wisdom. Thank you for all you're doing there PNG and the sacrifices your family is making to do it. God bless you.
    Praying for you and your family!