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In truth, if we know how to look, we find evidence of human dignity all around us, in the valiant efforts ordinary people make to meet necessity, to combat adversity and disappointment, to provide for their children, to care for their parents, to help their neighbors, to serve their country. Life provides numerous hard occasions that call for endurance and equanimity, generosity and kindness, courage and self-command. Adversity sometimes brings out the best in a man, and often shows best what he is made of.

Leon Kass, “Life, Liberty, and the Defense of Dignity”

“…to those who by patience in well-doing seek for glory and honor and immortality, he will give eternal life…

Romans 2:7

I was privileged to be part of a patient story this past month that highlights the team nature of medical missions. Just before caring for this patient, I flew to our capital city, Port Moresby, for an emergency medicine training conference. While there, I talked with Freddie, a Papua New Guinean emergency physician from another province. We discussed caring for heart attack patients. The best care for a heart attack patient involves a cardiologist emergently inserting a stent into their blocked artery, thus restoring blood flow to the heart. In Papua New Guinea, there is only one place this procedure can be done. It is a plane flight away from Kudjip and not something most of my patients can afford. The next best treatment is a concoction of medicines: aspirin, clopidogrel, heparin, and a special medication called a thrombolytic, which attempts to dissolve the clot that is causing the heart attack.

As I talked with Freddie, I lamented that we did not have any thrombolytic medication at Kudjip. Our heart attack patients could not get the best, or even the second-best treatment. Freddie told me, “I know of a pharmacy here in Port Moresby where you can buy thrombolytics.” A couple of hours later, we had adventured through several hospitals and pharmacies, and Freddie helped me buy six doses of the thrombolytic medication. I took it home in a small cooler on the airplane when I flew back to Kudjip at the close of the emergency medicine conference.

The next week, I walked into the emergency room (ER) just as my colleague, Dr. Angeline, defibrillated a middle-aged man. Defibrillation is the TV show procedure (and real-life, too) where the doctor puts two paddles on the chest of a dead patient to deliver electricity. In the US, we don’t use paddles anymore (there are stickers that get attached to the chest to deliver the jolt), but here at Kudjip, we are old-school. It sort of makes me feel nostalgic, but that is a digression. Dr. Angeline shocked the dead patient, his arms shooting forward as the electricity coursed through his body. A faint smell of burnt flesh wafted through the air. Another colleague of mine, Dr. Daniel, helped Dr. Angeline continue the resuscitation (CPR, medications, bagging), and on the next pulse check, the patient had come back to life.

Defibrillation often does not work like the movies. If someone undergoes cardiac arrest in the hospital, there is only about a 1 in 4 chance they will live to be discharged. If it is out of hospital, the odds are about 1 in 10. I asked Dr. Angeline about the story of the heart attack patient: David had come to the ER with 2 hours of chest pain and was awake and talking when he arrived. Dr. Angeline did an ECG which showed a large heart attack, and then appropriately started David on multiple medications, including the thrombolytic I had purchased the week before. Seconds after receiving these medications, he went into ventricular fibrillation cardiac arrest because of his heart attack. She shocked him, did CPR, and two minutes later he came back to life.

 In our setting, it is far fewer than 1 in 4 cardiac arrest patients who survive to be discharged from the hospital. Far, far fewer. We don’t have an intensive care unit, and our efforts are often not directed towards resource-intensive critical care. David happened to be exceptional. After being shocked and brought back to life, he was confused and couldn’t talk. We briefly assisted his breathing, but then he started to breathe on his own, and began to roll around on the bed with his eyes closed. About twenty minutes later, he woke up and started talking with his family. I was in the ER at that time along with another of my colleagues, Dr. Matt. A large group of David’s family members encircled him, reaching out to hold him with their eyes full of tears. I was sitting at the ER desk with Dr. Matt when he told me, “Now is my chance to go share the gospel with him.” Dr. Matt went over and told David, “You were dead, but now God brought you back to life…” Dr. Matt prayed with David and showed him love and compassion. David was deeply moved.

A few of us cared for David while he was in the hospital. His chest pain resolved, he had no further cardiac arrest events, and four days later I had the privilege of discharging him from the hospital. He had no signs of heart failure or ongoing illness. He was one of the few patients we care for who could afford to travel to the capital, and he was planning to fly down the next day to see a cardiologist and undergo a heart catheterization. He told me, “Thank you – thank all of you – so much for being here and for saving my life. I am grateful to be alive. I am grateful to God.” I thought of our hospital’s motto, “We treat, Jesus heals.”

David’s story deeply impacted me. It highlights the beautiful team nature of medical missions. Freddie helped me find thrombolytics. The money to purchase the medicine came from our supporters in the United States. Dr. Angeline and Dr. Daniel cared for David when he died and resuscitated him with excellence. Dr. Matt encouraged me profoundly by putting first gospel of Christ’s love and sharing this with David; a poignant reminder that physical death is not our greatest enemy. And woe if I forget the myriad nurses, cleaning staff, chaplains, and administrators, who cared for David in the hospital, stocked our pharmacy, and ensured we had a functioning defibrillator in his time of need. Great works come from great teams.

While David’s story strengthens me, death is tangible here every day. The next week, I was in the ER on a busy weekend call shift. Kennedy, one of our pediatric nurses, hurried into the ER, “Dr. Jake, there is a patient coding on the pediatric ward and we need you to come.” Kennedy handed me the chart of a 12-year-old girl. The admitting diagnosis said, “Cardiac arrhythmia, pericardial irritation, pericardial effusion.” I ran through a few scenarios in my mind and decided that I wanted to bring an ultrasound and a defibrillator to the code. In the US, myriad defibrillators are located in every hospital ward and place of patient care. At Kudjip, we have one. It is a behemoth that lives in the ER on an old wooden cart. It is not portable. It sits in the ER to help save patients like David.

But this was a 12-year-old girl, and I wanted to have everything I could to possibly save her life. I asked Kennedy to grab the ultrasound, and I started to wheel the defibrillator out of the ER. There is rough concrete ramp that leads from the ER to the pediatric ward. The defibrillator and cart shook like an earthquake as I tried to push the small rusty wheels over the uneven terrain. A drawer fell off the cart in my haste and clattered to the ground with a bang, like the pained thudding of my heart as I felt inadequate to respond to this emergency.

A few seconds later I was in the pediatric ward. I looked over to where a nurse was doing CPR on a small child. My breath caught. I knew this girl. Rachel was a beautiful 12-year-old I had seen in clinic 8 weeks before for chest pain and shortness of breath. She had looked great. Normal vital signs, smiling, and shy. I had done an ultrasound and found a small to moderate pericardial effusion (fluid around the heart). In our setting that is usually TB, so I started her on TB medications and expected her to recover. I had seen her come and go from clinic several times over the following week, always with a radiant smile, giggling with her older sister, and being escorted by her mom. I didn’t know she was in the hospital.

As CPR continued, I hooked Rachel to the defibrillator’s monitor. I tried not to look at her pale face. At the next pulse check, I checked her rhythm and an ultrasound. She was in asystole, a rhythm which does not respond to defibrillation (here is where the TV shows are wrong). Her ultrasound showed only a trace pericardial effusion and no cardiac tamponade. But her heart was huge, globally dilated, and perfectly still. Her disease had destroyed her heart. I knew there was no hope, but we continued CPR and gave resuscitative medications. A few minutes later I told Rachel’s mom and sister, “I am so sorry. Rachel has died.” Tears filled my eyes. My shoulders slumped. She was a special patient. 

I don’t know why Rachel died. Her heart was enormous and dilated on ultrasound, a big change from what I had seen 8 weeks before. She likely had myocarditis that resulted in a dilated cardiomyopathy. Whether this was caused by TB or another infectious disease I don’t know; we don’t have any special tests for evaluating myocarditis here. Having a defibrillator on the pediatric ward would not have saved her life. But as I walked out of the ward and collected the drawer that had fallen out of the defibrillator cart, I was sad and angry. “Why are there more defibrillators in the Eau Claire, Wisconsin YMCA than we have for a hospital that cares for half a million people?” I think, mostly, I was grieved about losing Rachel, but I wanted to be angry. Angry at injustice. Angry at sickness. Angry that beautiful 12-year-old girls suddenly die. Angry that I would never see her smile in clinic again.

The last few weeks have felt heavy. I have not been very patient with my patients or felt a lot of love in caring for them. I have felt homesick. Our family was beyond blessed to have my dad, Bob, visit us in January. It was a rich, wonderful, and beautiful time. But when he left, I felt his loss and a longing for home. I miss him. I miss our friends and many of the things we used to do as a family in the US. Some days, I am tired of living inside a square mile compound, even if it is majestic. It is like an incredible gallery inside a museum. There is beauty and meaning everywhere, but sometimes I want to go to a different room.

As I ponder these thoughts, however, I am reminded of why God brought us here. The real purpose of life is to know God, become like Jesus, and love people the way he did. All of the other trappings of life are secondary. God has given our family a special opportunity here in Papua New Guinea to be “patient in well-doing.” We have a slower pace of being. The good and bad things of life are brought into sharper relief. Our hearts can zero-in on the truth that loving God and becoming people of love is what matters most. We are encouraged by a community that amazes us, by resilient families who have been “patient in well-doing” for years and years as they serve here in love. 

May you, dear reader, be encouraged, too. This path of patience in well-doing is open to you. You carry your unique burdens, your individual stress, your particular brand of anxiety. Your life may be frenetic, confusing, disappointing, or dull. But no matter your finances, no matter your health, no matter your job, no matter your unique admixture of burdens, be encouraged and assured that the marrow and greatest work of life is open to you: to know God, to know his love, and to be the hands and hearts that sow his love into the world.

My soul! Rest happy in thy low estate,
Nor hope, nor wish, to be esteemed or great,

To take the impression of a will divine,

Be that thy glory, and those riches thine.

Confess him righteous in his just decrees,

Love what he loves, and let his pleasure please;

Die daily, from the touch of sin recede;

Then thou hast crowned him, and he reigns indeed.

William Cowper and Madam Guion

Prayer Requests:

As always, our family covets your prayers, your comments, and your feedback! We love to know what is going on in your lives and how we can pray for you, too! Please don’t be shy about commenting on or sharing this blog if it was meaningful to you. We would be grateful for your prayers in several areas:

• Praising God for the life-giving visit of my father, Bob, and his smooth travels.
• Praising God for David’s life being saved after cardiac arrest, and that his story would impact many with God’s compassion.
• That our family would be “patient in well-doing”. That we would focus daily on growing in love for those God places in our path.
• For Rachel’s mother and sister as they grieve her death.
• For our hospital to build capacity in compassionately caring for the sick here at Kudjip. I am working on obtaining more monitors for the hospital and would love to obtain defibrillators for all of our wards. Pray that God would open the right doors and provide the right connections for this to happen.
• Pray for Dr. Ben and our other hospital leaders, who are stretched thin with medical care and many administrative projects attempting to expand our caring capacity.

Medical Potpurri:

For all of my medical friends, here is a snapshot of just a few of the hundreds of patients I have been able to care for this last month:

A baby with a cerebral abscess and meningitis that we diagnosed by trans-cranial ultrasound (credit to Dr. Dave Lean), and who had the abscess drained by our surgeon (Dr. Ben). I see bacterial meningitis here multiple times every week. In the absence of having a CT scan, trans-cranial ultrasound can be useful when the fontanelle is still open!

The first vaginal breech delivery I have done here! The baby is doing great.

Young children often present here with horrible osteomyelitis (bone infection) from untreated skin and muscle infections. The X-ray and photo are from different patients. The infected tibia bone has literally eroded through the skin of this poor girl. I see probably 5 osteomyelitis patients each week.

A young boy I diagnosed with horrible rheumatic heart disease. He had rheumatic fever 6 years ago and now has terrible mitral stenosis and cardiomyopathy. He needs a valve surgery, which is almost impossible to get here in Papua New Guinea. In the US he would likely get a heart transplant.

Placenta previa on ultrasound (from L to R, baby’s head, placenta blocking the cervix, cervix/bladder). A patient came into the ER 36 weeks pregnant with severe vaginal bleeding. I was able to save her life and her baby’s life with an emergent cesarean section!

Solia Deo gloria,

Morris Family