Christians need to understand that bearing the cross does not in the first place refer to the trials which we call crosses, but to the daily giving up of life, of dying to self, which must mark us as much as it did the Lord Jesus, which we need in times of prosperity almost more than adversity, and without which the fullness of the blessing of the cross cannot be disclosed to us.Andrew Murray
“Is it worth it?” Genae and I were recently asked that question. Has it been worth it to uproot our family and move them 8,130 miles from Eau Claire, Wisconsin to another world in Papua New Guinea? Is it worth the frequent sicknesses, missing of family, threats of violence, and daily “otherness” that comes with stepping into another culture?
I pondered that question as I went for a run this morning. I took solace in a few minutes of being alone. My soul was nurtured by the mountains and the rivers. My solitude was frequently interrupted, however, by cries of “Whiteskin!” every time I passed a village. The peals were followed by a gaggle of little ones on the road who ran alongside me barefoot, cackling and trying to touch my hand.
A few weeks ago, I had another memorable call shift. I walked into our labor and delivery ward as a nurse marched toward a room with a vacuum device. I stepped behind the curtain and found a mom who had been in the second stage of labor for several hours. She was having trouble because her baby was stuck. The baby’s head was lodged in her pelvis and not budging.
I tried to teach a medical student how to use a vacuum device to assist mom in delivering the baby. There was some movement, but the baby’s head remained trapped. I took over from the student to no avail. A minute later, in an ominous sign, the baby’s heart rate went from 140, to 170, to 80. We canceled our attempt and I called for an emergency cesarean section. As the OR staff prepared for the operation, I saw another mom who would need a C-section, too.
It was already looking like a busy call shift. I walked over to the operating room to do the first C-section, but a nurse stopped me and told me I that I needed to go to the emergency room. In a neighboring province, a helicopter had crashed with 6 people inside. The first two victims were just arriving in the ER.
Lord, help me. I can’t be in two places at once! I said a silent prayer and went to the ER to assess the situation. Thankfully, both patients were stable, and their trauma was not as bad as I had expected. I found my other colleague who was working that day. I let her know about the ER situation and I hurried off to the OR.
I arrived in the OR just as the team was ready. I asked them to check another fetal heart rate while I scrubbed in. They couldn’t hear any fetal heart tones. I worried we were too late and that I was about to deliver a dead baby. I prayed as I made the first incision and put everything in God’s hands. A few minutes later, I pulled out a little girl. I could immediately see that she was moving. My heart swelled with hope. A few seconds later, she had a vigorous cry. She was completely fine. Thank you, Lord. I prayed in gratitude as we closed the mother’s incision.
After the first C-section, I checked on my colleague in the ER. There were a handful of patients still to see, so I went to work. The patient I cared for next turned out to be a very special one.
I went to the bedside of a little 6-month-old named, “Blessed.” I glanced at her chart. She was febrile and had a high heart rate. I talked to her mom, who told me that Blessed had been sick with a fever and vomiting for a few days. Today, however, Blessed was no longer nursing and not responding.
I took a close look at Blessed. Her eyes were closed, but when I opened her eyelids, I could see twitching eye movements to the left. I looked at her hands. Every few seconds her right hand would briefly flex, as if she were trying to grab something. These subtle findings suggested that she was having continuous complex partial seizures. I wondered how many hours she had been seizing for.
A nurse then skillfully started an IV in Blessed’s hand. It is no easy feat to find a tiny vein in a tiny hand! With the IV in, we gave Blessed antibiotics, fluids, and medications to stop her seizures. Next, I slipped a small needle between the lumbar vertebrae in her back, in search of a minute space from which to collect a sample of spinal fluid. Soon, droplets of cerebrospinal fluid fell into a collection tube, like a leak from a slowly dripping faucet. Blessed’s seizures continued, so we started more medications. I sent the spinal fluid sample off to our lab and went to see more patients.
Thirty minutes later, our lab brought back the results from Blessed’s tests. Her spinal fluid had abundant gram-positive cocci, a type of bacteria, and thousands of white blood cells, her body’s attempt to stave off the intruding infection. Blessed had bacterial meningitis. An infection had started somewhere in her body, and then spread to the fluid surrounding her brain and spinal cord.
The mortality from bacterial meningitis is high. Especially in an infant who is already having continuous seizures from the infection. Sometimes, those who do survive are left with permanent brain injury. As I looked at this frail little six-month-old, who was still intermittently seizing, and saw her mom stooped over her, face creased with worry, my heart ached. Why, God, might this little one’s life be cut so short? Before admitting Blessed to our pediatric ward, I prayed for her. I took mom’s hand and explained how serious Blessed’s illness was and tried to prepare her for the worst.
I left the ER and went back to the OR to do another C-section. Everything went well. Time for lunch! I thought. As I walked down the dirt road in front of the hospital, a nurse stopped me. “Dr. Jake, a woman just arrived on D ward with a retained placenta. She delivered two 18-week twins at home who both died. The placenta did not come out, though, and she is bleeding.” Thoughts of lunch disappeared, and I followed the nurse to D ward.
When I walked into the room, it was obvious that woman, who I’ll call Rosalyn, was critically-ill. Her heart rate was 140 and her oxygen saturation was 55%. She was still bleeding from the retained placenta. I looked at a woman in a green and red dress as she swayed on the delivery bed. A dazed look filled her eyes. It was a puzzling clinical picture. Why is her oxygen so low? A retained placenta should not cause low oxygen. Does she have a blood clot? Is her hypoxia secondary to shock? Does she have a collapsed lung? I reviewed the labs our nurse had drawn: her hemoglobin was 6, her platelet count was 40, and her WBC was 1. Further, her HIV test was positive.
I asked for an emergency blood transfusion. We started oxygen, fluids, and antibiotics. I pulled over an ultrasound to evaluate for a blood clot or a collapsed lung, neither of which she appeared to have. Even with all the oxygen we could give, her oxygen saturation would not creep above 75%. With the blood running, I pondered what to do about the retained placenta. Typically, I would sedate the patient and then manually remove the placenta by hand or using instruments in a dilatation and curettage procedure (D and C). However, as I looked at this confused and hypoxic woman, I thought there was a high likelihood that my sedating her for a procedure would kill her. I prayed, and decided to see how the D and C went without sedation.
Thankfully, much of the placenta was sitting just inside the cervix, and I was able to remove it without too much trouble. I then did a curettage of the uterus to ensure all pieces of the placenta were removed; this is painful, but Rosalyn was so ill that she didn’t seem to be conscious of any pain.
A few minutes later, Rosalyn’s heart rate went to between 180 and 200. There is no way she is going to live. I thought to myself. I talked to the patient’s sister, who told me that Rosalyn had three young children at home. How would they do without their mother? I got an ECG and a CXR, which confirmed that she had a severe pneumonia and acute respiratory distress syndrome (ARDS), possibly secondary to something called PCP pneumonia, a type of infection seen predominantly in AIDS patients. The pieces of the clinical puzzle were coming together. But, unmedicated AIDS, oxygen saturation of 55%, heart rate of nearly 200, and pancytopenia – I thought it was 95% likely that Rosalyn would die in the next 24 hours. I prayed for her, and then prepared her and our nurse for what seemed medically inevitable.
During the following several weeks, I cared for Blessed, the 6th month old with meningitis, every day on our pediatric ward. I talked to her mom, who told me that she had tried to get pregnant for years and had not been able to. She had many miscarriages and infertility until she finally gave birth to this little girl, whom she named, “Blessed.” For several days, Blessed continued to have seizures and was essentially unresponsive. We supported her little body with fluids, antibiotics, oxygen, and medications to prevent seizures. I prayed for her and with her mother multiple times.
After a few days, Blessed woke up. After a few more days, her seizures slowed down. After a week, she started to nurse again. Every day, Blessed made a little bit of progress, and I became more and more hopeful. Finally, after 3 weeks in the hospital, she was completely seizure free, meningitis free, and I couldn’t tell she had ever been sick. I took a picture with her, her mother, and her auntie the day she left the hospital. Her mother gave permission to share her story. “Blessed.” What a fitting name.
During Blessed’s final week in the hospital, I wondered how Rosalyn was doing. I no longer cared for her after that initial call shift, but I remember hearing that she was still alive a couple of days after I had admitted her. How is she now? I wondered. Did she miraculously make it through?
One morning, after rounds, I headed over to the medical ward where, if she was still alive, she would likely be admitted. I didn’t know if I would recognize her, but then I thought to pull out my phone. I took a picture that first day I cared for her, and I assumed that, like most patients here, she would probably still be in the same clothes a week or two later.
I wandered up and down the beds, and then finally spotted her green and red dress. She was sitting up in bed, smiling and eating a banana. She was off oxygen and all IV medications. I could only recognize her by her dress; she looked nothing like the barely-clinging-to-life woman I had seen two weeks before. I reviewed the chart, just to be sure. She had made an astounding recovery from the brink of death. She had normal vital signs, was now on treatment for HIV, and was preparing for discharge. She would go back home to her three children. She beamed at me and shook my hand, though I doubt she recognized me from that first day.
“Is it worth it?” Life here has its ups and downs. If I evaluate our time based on how I am feeling and how I am doing, I don’t always know how to answer that question. But when I think of a mother who is caressing her precious six-month-old, it is worth it. When I think of a woman who stands on the edge of death, and then goes home to love and care for her three children, it is worth it. When I think of baby that gets a shot at life, instead of dying inside her mother’s body, it is worth it. When I reflect on how God has worked in and through us, for His glory, it is worth it. It is worth it to be part of a team of doctors, nurses, and staff, that every day are making a real difference in the lives of others. It is worth it, and we are Blessed.
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