Friday, November 28, 2014

Margret's Story

Credit goes to Gail Dooley for her creative contributions to Kudjip Hospital
When she first came to me, Margret complained of irregular vaginal bleeding. She was old enough (mid-40's) that my mind jumped to cervical cancer or DUB (Dysfunctional Uterine Bleeding) due to a fibroid, but she seemed otherwise healthy. She told me she had been married for almost two years, but had never had children - unusual for PNG, where most women are married off and start bearing children in their teens.

Here at Kudjip, one of the diagnostic tools I have come to dearly appreciate is the ultrasound machine. With much help from the other docs I have become very comfortable scanning our patients for a wide assortment of diagnoses which in the US might warrant a CT scan or MRI. At this point, I know what "normal" looks like and can identify the more common diseases (TB, liver/gall bladder disease, effusions, abscesses, etc), but much of the time I'm asking Bill or Mark (who's rooms are adjacent to the US room) to come help identify the mass or abnormality I've just found. In Margret's case, I placed the probe over her uterus looking for a fibroid (benign overgrowth in the uterine wall) or cancerous mass.

To be honest, the first thing I thought of when her uterus flashed into view was "that's a big worm". Something tiny was writhing around in her uterus, as you might expect a fish to flap around when pulled onto shore. Of course my logical mind immediately recognized the tiny wriggler as a fetus, but I still enjoyed a little mental laugh at my thought of parasitic invaders. I asked Mark to come have a look, since the fetus was small, and vaginal bleeding meant a threatened miscarriage. We measured the baby's head, and guessed him to be around 11-12 weeks, close to finishing the first trimester.

My heart broke a little as I thought about how to share this news with Margret. I would be providing her joy and hope to know she was pregnant for the first time, but then replacing that happiness with fear and anxiety in the knowledge that her situation didn't look promising. After sharing all this with her, I was amazed with Margret's reply. She said (translated) "I am happy with God's will, whatever comes." What a relief! She could have no better Comforter in this time.

 ~ Picture Intermission ~

(Left - gecko's in a HUGE flower     Right - the Highland sun)
(Left - butterfly birthmark!    Right - Cutest kid on the ward)

 ~ End of Intermission ~

When I saw Margret a week later, she told me there was still a little bleeding, but less than before. I hoped this meant her pregnancy was going in the right direction. After 5 minutes scanning the uterus for fetal movement, I asked Mark to join me again. He also couldn't find limb or heart movement, and we ended the visit with a prayer, asking for God's will, and for His healing peace. Margret would go home once again, to return in a week, or sooner if the baby miscarried on its own.

When she returned without having passed the fetus, we admitted Margret on medications to induce the process. The following morning we learned it had happened sometime during the night, but that she still needed some placental products cleaned out from her uterus. We prayed again with Margret, and Mark guided me through performing the minor procedure. This was only the second time I’d performed such a procedure, but being opposed to abortion, I experienced a lot of mixed emotions about the process – even though both times the baby had already died, and needed to be removed.

Thinking back on these events, I am struck with how Margret had waited patiently, endured the hard news and significant loss, and yet her Faith remained strong. We had prayed at every turn, and she gave me hope where I would have been at a loss. I believe this is one of the greatest strengths and responsibilities of the Body of Christ - to genuinely love and lift one another up - encouraging, serving, connecting in prayer, and admonishing one another to greater depths of relationship with God.

Ephesians 4:1-16
As a prisoner for the Lord, then, I urge you to live a life worthy of the calling you have received. Be completely humble and gentle; be patient, bearing with one another in love. Make every effort to keep the unity of the Spirit through the bond of peace. There is one body and one Spirit--just as you were called to one hope when you were called-- one Lord, one Faith, one Baptism; one God and Father of all, Who is over all and through all and in all. But to each one of us grace has been given as Christ apportioned it. It was He who gave some to be apostles, some to be prophets, some to be evangelists, and some to be pastors and teachers, to prepare God's people for works of service, so that the body of Christ may be built up until we all reach unity in the faith and in the knowledge of the Son of God and become mature, attaining to the whole measure of the fullness of Christ. Then we will no longer be infants, tossed back and forth by the waves, and blown here and there by every wind of teaching and by the cunning and craftiness of men in their deceitful scheming. Instead, speaking the Truth in love, we will in all things grow up into Him who is the Head, that is, Christ. From Him the whole body, joined and held together by every supporting ligament, grows and builds itself up in love, as each part does its work.

At Margret's last visit to clinic, she gave me a beautiful handmade “bilum” (shoulder bag worn by all PNG’ians). A few of the more established doctors here have small collections of similarly gifted bilums adorning their walls. Maybe the novelty of receiving gifts has grown old to them...but it's new for me, and I love the bag, tassels and all! 
Do we not serve an awesome God?!

Monday, November 24, 2014

An Encounter with Paradise

I Chronicles 29:11
Yours, O LORD, is the greatness and the power
and the glory and the majesty and the splendor, 
for everything in heaven and earth is Yours. 
Yours, O LORD, is the Kingdom; 
You are exalted as head over all.

Stalking forward, our necks craned to the canopy above, we scanned the lush green limbs for any trace of movement – a flicker of shadow or rustle of leaf. The cool jungle at 8,585 feet is layered in a reddish fuzzy moss, which sparkles with dew wherever rays of light glance through the thick foliage. Brilliant flowers are backlit by every shade of green – the trees woven together with vines and draped with mossy green beards, dripping from the last rainfall. Our movement was near-silent as we treaded upon spongy layers of decay, and each breath was partly held in anticipation of sighting our quarry – the remarkable Birds of Paradise.

Our weekend adventure venue was Kumul Lodge, a rustic mountaintop camp ~90 minutes West of Kudjip, and proud host to many of the famous Birds of Paradise. Ironically, most of the BOP’s with whom we became acquainted over the weekend were observed from the comfort of a viewing deck off the main lodge. This deck overlooks a mossy platform at the jungle edge, which is conveniently supplied with fresh fruit scraps twice a day. Don’t worry, we also enjoyed quite a number of stealthy hikes along the jungle paths surrounding Kumil Lodge! 

On this particular adventure, our 15 passenger van was crammed with 12 missionaries – Bill and Marsha McCoy, the Dooley’s (Scott, Gail, Allison, Emma, Olivia), Kevin and Leslie Kerrington, Judy Ralph, Rachel “Babe of Paradise” Henderson, and yours truly. I had the pleasure of navigating the highland roadways – dodging potholes, climbing switchback slopes, and (sorry Marsha!) roller-coasting a few rolling hills. :-)  The views heading into the mountains were breathtaking!

Our accommodations at Kumul Lodge were quaint and comfortable – little thatch cabins all connected with covered walkways, and of special note !Electric Blankets! on each bed to beat the crisp night chill – talk about cozy! When we weren’t bird watching or bird walking, there were a variety of games played in the main lodge – my favorite of course being charades by firelight. Rachel brought her travel guitar and led the group in worship on two occasions – a perfect complement to witnessing such majestic creation.

Psalm 95:1‑7
Come, let us sing for joy to the LORD; let us shout aloud to the Rock of our salvation. Let us come before him with thanksgiving and extol him with music and song. For the LORD is the great God, the great King above all gods. In his hand are the depths of the earth, and the mountain peaks belong to him. The sea is his, for he made it, and his hands formed the dry land. Come, let us bow down in worship, let us kneel before the LORD our Maker; for he is our God and we are the people of his pasture, the flock under his care.
 Belford's Melidectes 

Papuan Lorikeet

Archbold's Bowerbird

Gerygone (left), Honeyeater (right)

Romans 1:20
For since the creation of the world God's invisible qualities - His eternal power and divine nature‑ have been clearly seen, being understood from what has been made, so that men are without excuse.

Regent Whistler (left), White-winged Robin (right)

 Brehm's Tiger-Parrot 
(male left, female right)

Ribbon-Tailed Astrapia 
(Female above, immature Male below)

Funny Story (pic below) - we saw one female Ribbon-tail chasing another, grab a hold of its tail by the beak, then suspend it for almost a full minute off the feeding ledge! Amazing!

 Island Thrush (Left), Blue-capped Ifrita (Right)

 Brown Sicklebill

Splendid Fruit Dove 
(sadly, found dead)

Matthew 6:25-34
“Therefore I tell you, do not worry about your life, what you will eat or drink; or about your body, what you will wear. Is not life more important than food, and the body more important than clothes? Look at the birds of the air; they do not sow or reap or store away in barns, and yet your heavenly Father feeds them. Are you not much more valuable than they? Who of you by worrying can add a single hour to his life? And why do you worry about clothes? See how the lilies of the field grow. They do not labor or spin. Yet I tell you that not even Solomon in all his splendor was dressed like one of these. If that is how God clothes the grass of the field, which is here today and tomorrow is thrown into the fire, will he not much more clothe you, O you of little faith? So do not worry, saying, 'What shall we eat?' or 'What shall we drink?' or 'What shall we wear?' For the pagans run after all these things, and your heavenly Father knows that you need them. But seek first His kingdom and his righteousness, and all these things will be given to you as well. Therefore do not worry about tomorrow, for tomorrow will worry about itself.”

Tuesday, November 18, 2014

Long Gone

I have continued to face death on a regular basis, each instance unique in source and circumstance, but never less tragic. A recent example occurred well after midnight (I was on Call), when I was asked to come help a boy in the Pediatric ward who had stopped breathing. I arrived within a minute and found the staff pumping air into his lungs, but it was unclear if they had done any chest compressions. He didn’t have a pulse, and appeared lifeless. 

While starting chest compressions, reading the boy’s chart (possible diagnoses of both pneumonia and gastroenteritis), and teaching the nurse how to effectively give breaths through the mask, I learned that the boy (named Isaiah) had stopped breathing 15 minutes before the nurses had called me. My heart sank. The chance of getting him back was slim to none. I ordered STAT Epinephrine, but the dose had to wait a minute for the medication to be found, and another minute for me to decipher the miniscule writing on the snap-top vial to calculate the appropriate concentration/dosage. In the US, shocking the heart is another life-saving tool, but I had no such option for the boy. We took turns performing chest compressions and bagging air into his chest, but even with Epinephrine on board, Isaiah’s pulse never returned. 

When I finally approved stopping CPR, the words “I’m so sorry” quietly edged their way out, and the boy’s father folded into sobs beside me. I placed my arms around him, squeezing him tight, letting him just weep, and whispered my sorry over and over. The lifeless boy in front of me, maybe 4 years old, was handsome and well-muscled. I envisioned him playing and smiling, as I see every day with the local kids, and I tried to imagine the memories of him flooding his father’s mind. I asked if everyone would be OK praying, and a small gathering formed around Isaiah’s bed – his parents, the nurses, and even the parents of neighboring patients. We thanked God for the boy’s life, and for welcoming him Home. We asked for the family to have peace in their grief, and for all present to trust Jesus in and through life’s hardships.

~ ~ ~ ~ ~ ~ ~ ~

The clinic day was coming to a close, and being Friday, I'd been watching the clock. Just one or two more patients and I'd have a refreshing walk home in the cool rain. For the last couple hours, I'd been hearing loud cracks of lightening, their peals of thunder rolling across the valley. One of my last patients had taken me into the ER to finish some paperwork. It seemed a little busier than usual, the ER nurses and a couple other docs entrenched at various beds, sterile gloves bloodied in varied procedures - draining pus, stitching a laceration, setting a broken leg.

As I busied myself with paperwork, I heard the front ER doors bang open, followed closely by five men carrying a teenage boy. He was limp in their arms, and one man was careful to lay his head down gently on the triage bed. I didn't jump in right away, my first thought being maybe he'd had a seizure. Within a few seconds, I'd turned around again to see the nurse starting chest compressions. This wasn't good. I joined her, and couldn't find a pulse. Taking over chest compressions, I asked for someone/anyone to find a face mask and get breaths going. An older PNG man hovered close beside me, his flannel shirt steaming with rain and sweat, probably the boy's father or uncle. "What happened?!" I asked him. "Lightening on the mountain" was his reply.

The boy's chest was cool and clammy under my hands, his body rocking limply with each compression. I didn't see any obvious burns where the lightening might have entered/exited his body - apart from his GCS of zero, he had a healthy teenage physique. After a minute or two, he still had no heartbeat or spontaneous breaths. Resuming CPR, I asked for more information, specifically how long ago he had been struck. Every answer from the surrounding men was different, but even the shortest report was over 30 minutes. He had been at the top of a nearby mountain, and he had been carried, then driven, to our ER. I realized then that not a single thing I did would bring him back - he was long gone. I asked a nurse to get Dr Bill - knowing he would be able to confirm my assessment. More importantly, I was sure Bill would know the right way to tell the family, who were waiting pensively around the bed, and at the door.

Veteran in every respect, Dr Bill McCoy swept in on the scene, assessing and taking in every detail (as he does), and I gave him a brief report of the relevent information. He checked the light reflex of the boy's pupils, and shook his head. "It's been too long. I'm sorry." So after a brief five minutes of CPR, we stopped. Even if we had somehow restarted his heart, his brain had already gone far too long without oxygen.

Uncle Bill turned to the father figure standing beside the boy and reiterated the futility of any further intervention. The man refused the notion, and indicated that we must continue with our CPR to bring him back. I was glad (for the 100th time that day) that Bill, and the great blessing of all his experience, was present. I'm sure that if I was alone, even knowing the futility, I would have extended the hope of all present with many more minutes of CPR, intubation, and medications. The fact remained - the boy had died somewhere out on that mountain, a terrible truth which required the sure resolution and empathy of Dr Bill.

Agony broke over the countenance of the man, and he threw himself on the boy, his own wailing cry echoed in crescendo by two, then six, then countless men and women in and around the ER. Silent, I was out of place among them, and retreated from the scene respectfully.

The perfect vitality of youth had been ripped in a split second from the boy by a seemingly random event of nature. Can we shake it off, saying he was just in the wrong place at the wrong time? ...or do we demand of God why He would allow such a painful burden to fall upon the family? 

Mourners gathered outside the ER
~ ~ ~ ~ ~ ~ ~ ~

Not two days later, I was on call and was asked to come to the ER for a young man without a pulse. Two clarifying questions later, I realized he was in fact dead, and the nurses needed me to come proclaim his death for all the family present.

The ER doors were crowded with people, some peering, some wailing, and two young men were lying in the road, crying, making gravel angels beside where I parked. The small gathering parted for the white skin doctor, and I found the inside of the ER just as crowded with spectators and mourners.

He was the only person occupying an ER bed, surrounded by sobbing figures - one women wiping her head and face with his feet. I went to his side, placed my stethoscope over his still heart, and held a single finger to my lips, for which all but a few went silent. No beat, no breath, pupils widely dilated and fixed - I shook my head and offered "Sorry" to those meeting my gaze.

In the prime of his life, he had walked off the Rugby field and then collapsed, never to awaken. Had he sustained some fatal injury? Did his heart simply give out? Did he needlessly later die in the hour spent at a small local clinic? Sadly, I have begun to learn only some questions are worth investigating.

As an odd punctuation to the grief of the moment, I noticed a young man purposefully approach the deceased, then abruptly swing a round house kick at an older man standing bedside. The young man's face was etched with grief and anger as he followed quickly with a hay maker right, shouting his accusations for all to hear. Having been first to notice the assault, my instant response was shouting !HEY! a couple times while stepping in to stop the attack. Common sense caught up with me quickly however, and I pulled up short of the ensuing tussle. There were already security personnel in the ER, and they readily elbowed their way in, separating the two, and threw the younger man outside. Pastor John and the nursing staff were also present, and were quick to remind all present of the heavy fees and penalties exacted upon those who fight on Hospital property. Whether or not the young man's explosive anger was directed justly, it's hard to imagine what feelings I would have in the face of losing a brother.

~ ~ ~ ~ ~ ~ ~ ~

Young lives lost, unexpectedly, is not something I'm used to yet. I'm sure I could fill up this Blog with any of the happy encounters I enjoy every day, but somehow the tragic ones call me to write and share. If you are moved to pray for these hurting people, or for this hospital and all the staff desperately trying to heal broken bodies and lost spirits, then perhaps the Lord is working in these words. Thank you, as ever, for reading and so sharing in this experience. 

Two verses come to mind. The first is Job's prayer following complete ruin of his life, the second is from Romans 8, declaring our hope in future redemption.

Job 1:20-22
At this, Job got up and tore his robe and shaved his head. Then he fell to the ground in worship and said: "Naked I came from my mother's womb, and naked I will depart. The LORD gave and the LORD has taken away; may the name of the LORD be praised." In all this, Job did not sin by charging God with wrongdoing.
Romans 8:18-25
I consider that our present sufferings are not worth comparing with the glory that will be revealed in us. The creation waits in eager expectation for the sons of God to be revealed. For the creation was subjected to frustration, not by its own choice, but by the will of the one who subjected it, in hope that the creation itself will be liberated from its bondage to decay and brought into the glorious freedom of the children of God. We know that the whole creation has been groaning as in the pains of childbirth right up to the present time. Not only so, but we ourselves, who have the firstfruits of the Spirit, groan inwardly as we wait eagerly for our adoption as sons, the redemption of our bodies. For in this hope we were saved. But hope that is seen is no hope at all. Who hopes for what he already has? But if we hope for what we do not yet have, we wait for it patiently.

~ ~ ~ ~ ~ ~ ~ ~

My mother recently sent me the Serenity Prayer, which I have reflected on - I hope you also will ponder its powerful Truth.

God grant me the serenity 
to accept the things I cannot change;
courage to change the things I can; 
and wisdom to know the difference.

Living one day at a time; 
Enjoying one moment at a time; 
Accepting hardships as the pathway to peace;

Taking, as He did, this sinful world as it is, 
not as I would have it; 
Trusting that He will make all things right 
if I surrender to His Will; 

That I may be reasonably happy in this life 
and supremely happy with Him Forever in the next.

Sunday, November 16, 2014

On-Station Adventures...

Since my last post was about some exploring we did off-station…I thought I would write and share about some adventuring that we’ve done on the station.

The station is about half a mile across, with the hospital at the center, 2 trails going down to the river, and one road headed out to the front gate which leads to the highway. For fun, and to get my out-of-breath-self back into shape, Teddy and I have been going for a run around/across the station a few times each week. Sometimes we run across the station, make a stop at the weight room, and then run back….and other times, we run along the canal for the hydro dam and loop back up to the station. There is also a tennis/basketball court near our house which we take advantage of sometimes…Teddy much more than me.   : )

Last weekend, we got to do something that we had REALLY been looking forward to….tubing on the canal! There are about 10 inner-tubes in the mailroom fully inflated at all times, ready to be taken out on the water. The canal is about a mile long and has water from the reservoir rushing through it in a race to the building that houses the turbines, which provide power for the station. Every time Teddy and I have walked or run along the canal, we have dreamed about the opportunity to fly through this cement-lined waterway on tubes. Last weekend, our chance had finally come. We invited two other docs from the hospital, Jaryl and Imelda, to join us. We carried our tubes all the way across the station, down to the canal, and all the way to the dam, where our journey would begin. It was a blast! The water was moving fairly quickly and we were all laughs and smiles along the way…except for the places where we had to lay down as flat as possible to fit under the walkway bridges. I was paranoid about getting ANY water in my mouth…it’s not exactly clean…so when I would catch myself laughing with my mouth open, I would quickly close it and hope that no parasite-infested droplets made their way into my body. We did the trip two times and all came away from the excursion unharmed and healthy. : ) We are looking forward to our next tubing adventure, which we hope will be out on the big river!

Teddy and I feel truly blessed to live in such a beautiful place while we are doing His work! What an amazing God we serve….who provides ALL our needs…even the opportunity for outdoor recreation!

~~~~~~~~~~~~~~  Running Trail  ~~~~~~~~~~~~~~~
Pikinini (children) playing on the trail

My attempt to keep up with Teddy...he tolerates my slow pace well!

Stop to take a breath...and a picture

~~~~~~~~~~~ Tubing Adventure on the Canal ~~~~~~~~~~~

Brave explorers about to set off...

The resevoir...a popular swimming place for locals

The dam....also a popular place to sunbathe...
...even though it's not allowed...  : )

Preparing to embark

Teddy enjoying the ride
Mel and Jaryl 
Kiddos along the way enjoying the show!

We had lots of cheers!
Jaryl & Teddy catching some waves
Coming around the home-stretch...

Mel and me trying to stay still long enough to snap a pic!

Jaryl going under one of the many bridges

Canal selfie!