Sunday, September 16, 2018

PNG Independence Day

Today is the 43rd PNG Independence Day, it also marks the end of my 11th year of serving in PNG and the beginning of my 12th year of service here.  Everyone was out in their PNG colors for our church service on the lawn, where different groups shared a special song, and then Ben spoke on what Freedom really means in Christ.  It was a good morning and I am looking forward to see how God will work in my 12th year here.

Wednesday, August 22, 2018

We made it

A few months ago, Peter and his parents were outside my door because Peter was sick, he had significant swelling of the nodes in his neck and his blood counts were all wrong.  Tests revealed that he had Acute Lymphocytic Leukemia and so I had to have a difficult conversation with him and his parents about him having leukemia and our limited abilities to help him.  I outlined what we could offer and gave them the choice of trying treatment or not.  They elected to give it a try.

The last 3 months have been very difficult, more than I know they imagined.  Despite doing this for over 10 years, I just haven't figured out how to get a family/patient to really understand what I mean by cancer and chemotherapy.  In some ways it boils down to, if I do nothing, your son will die, if I try and help him with chemotherapy - there is a good chance he will die from the medicine that is trying to help him, and if he somehow survives the medicine that is trying to help him by almost killing him, then there is a very good chance that he will still die from the cancer, but just hopefully a year or more later.

When I set out to offer chemotherapy to a patient, I know I am not curing them of any cancer, but I hope and pray that I might be able to give them meaningful time with family and friends that otherwise would have been robbed by the cancer.  To many that is all they want too, that is what Peter and his parents wanted - more time.

Peter is the last of 5 boys and is loved by his parents, as evidenced by their biweekly visits to our hospital for the past 3 months, and their leaving his brothers with other family members so they can be closer to the hospital to look after Peter.  There was a point, where I thought the medicine was going to be too strong for his body and was going to rob him of a chance to have some more time on this ground, but thankfully he pulled through.  There were many conversations with his parents and him about their desire to keep going or to stop, but they hung in there.

We aren't done yet, but we have done weekly chemo for the past 3 months, and he been a trooper as he has lost his hair, had a port placed, cried with all the injections and blood draws, and yet when he sees me each week he smiles, which makes me smile.  He always asks for a rubber glove to take home so he can make a balloon with it - it is hard not to meet his request knowing what he faces each day.

Pray for him and his parents, as they once again are facing a period of decision, where they decide how much more treatment to do, if any.  We hope to know how his leukemia responds to the chemo after a month's time.  If we don't find much evidence of it, we will all be celebrating Peter's renewed time on this ground, and if we do, tears will be shed, knowing the time on this ground is not as long as we want it to be.

Thursday, August 16, 2018

Unmeasurable Disappointment

A 16 yo girl comes into my clinic room with the complaint that she hasn't had a period her whole life.  I asked her some questions and then examined her and then did an ultrasound.  The ultrasound showed that she did not have a uterus or ovary.  I asked another doctor to confirm this, before I broke the news to her, he confirmed it and so a conversation would like have liked to not have, was now about to happen.

I brought them back to my clinic room and started to try and explain that this young girl was never going to be able to have periods or have kids.  They kind of stared at me, and so I tried to phrase it a bit differently, they seemed to understand a bit more then, but I could tell it wasn't quite clicking, because they still seemed happy.  I then went and got an anatomy textbook to try and describe what is normal and what she had.  I think this did the trick, as the girl started crying when I explained it for the 3rd time, and the mom put her hand to her mouth.

For many in PNG, being married, being able to bear children for your husband and his family, are ways that a woman is valued, and are what many women hope to accomplish.  Unfortunately for some women, their inability to bear children might be a reason why her husband says he is going to take a 2nd or 3rd wife.  For this woman, it could be a reason why she may never get married.  Based on her reaction when she finally understood what I said, and the tears that flowed, her dreams were shatter with the news.

How as a doctor do you help her, do you console her, do you share truth with her?  All the words that came to me seemed meaningless, seemed shallow, seemed pointless to verbalize.  I struggled to know what, if anything to say, but watching this girl cry in front of me, forced me to come up with something.  I thought of the song Even If by Mercy Me, which comes from the book of Daniel and the fiery furnace and says that we know that you God are able to take away whatever we are dealing with, but Even If you don't, we still will trust you and believe in you.  Not easy to grasp or to get to the point of accepting, but something that all of us at some point or another, will need to wrestle with, as struggles will come that don't go away.

Not sure if she understood what I was saying or if the words were just meaningless, but me thinking about it the reality that God can chose to change the situation of today, but doesn't always take it away, doesn't or can't change what I feel about Him.  So if it wasn't for her, it was a good reminder for me, that despite the hard things I see each day, despite the pain I see that doesn't go away, despite the prayers for healing that go up, and the sickness that still is there - It is well with my Soul and my Hope is in God alone.  Pray that she might find that understanding as well, as she wrestles with unmeasurable disappointment.

Saturday, August 11, 2018

Too many parts

I was in the delivery room the other night with a lady who wasn't making progress in her labor and so I asked our nurses to get her ready for a C-section.  As they were doing that, they asked me to see another woman in labor.  I checked on her and found her to be ready to push, and told them I would check back after I did the first C-section.

I did the first C-section with a PNG Rural Registrar, Cindy, and we delivered a healthy baby girl and then I went back to D ward to see how the 2nd patient was doing.  I found her pretty much unchanged, and decided she too needed a C-section.  Unlike the first patient and all the other C-sections I have done, this woman was different in that she had a colostomy from having an imperforate anus as a baby.  That means, she was born without a way to excrete her waste and so as a newborn, she had surgery to allow her to excrete her waste through a connection of her bowel and her abdominal wall.  Anytime someone has had surgery before, there is the concern for scar tissue which can make the anatomy a bit tricky to distinguish, and so I went into this C-section with a more heightened awareness and alertness.

As soon as I started to make my incision and go in, I found lots of scar tissue and wondered if I was in over my head.  It was after midnight at this point, and I didn't want to bring Sheryl, the surgeon, in if I didn't have to, but after struggling for about 15 minutes - I finally said to call Sheryl.  Sheryl got there and made quick work of getting us in, but once we got in, we found some other challenges that awaited.  Her uterus was adhered to the R side of her abdomen, and her bladder to the lower end of the uterus.  It was more than difficult to get the baby out, but thankfully after a lot of effort on Sheryl and I's part we managed to get the baby out, and thankfully he breathed quickly thereafter, he was going to be okay.

We now focused on sewing mom up and as we struggled with bleeders and exposure because of the adhesions, we didn't feel like this mom should be undergoing any more operations, or else she would be risking her life.  We talked to her about this and she agreed to have a tubal ligation, and so we started on that process after suturing the uterus closed.  Cindy made quick work of the Right fallopian tube, but when we went to find the Left one, we didn't see one.  Sheryl looked around and pulled out something, which initially we thought was a large ovarian cyst or mass, and instead determined was a 2nd uterus which had the Left Fallopian tube and ovary attached to it.  We think the uterus's were connected below the cervix and so we didn't enter in the 2nd one with our section.  Cindy tied off that tube and then as we were irrigating and making sure everything was okay, we located the appendix and found 2 of them.  We took both of them out too, as if she had appendicitis, no doctor would believe that she could get it again, we all only have 1, but in her that wouldn't be true.

So what started out as just a C-section turned into an operation on a woman with 2 uterus with separate ovaries and fallopian tubes and 2 appendices.  It was quite interesting for all of us involved and we all agreed that the next patient we see with a history of an imperforate anus, is going to have a surgeon schedule their C-section from the get go, instead of being surprised at midnight with these findings.

Thursday, August 9, 2018

Poison Beans strike again

After many months of not seeing anyone who had eaten poisonous beans, we had a few cases in the past month.  Bill was the one who took care of both of them in the ER, and despite the histories not quite fitting with what we typically see or find or expect, when the patients weren't responding to other treatments, he tried our Cyanide Antidote for Poisonous Beans and we got some healthy happy kids and adults when it was all over.

Thankfully, we haven't seen more of it, thankfully people seem to know that there are beans that you should be eating and beans you shouldn't be eating.  Thankfully, we have the medicine to treat the kids or adults who come in after having eaten the wrong beans.  Thankfully the medicine, the antidote works, and people go home as if nothing happened, just like this kid and his mom.

Saturday, August 4, 2018

Breaking Bad News

When I called out for the next patient, a dad got up carrying his son, his wife trailing behind him. When they got into my room dad sat down, still holding his son, and his wife kneeled beside them.  When I asked what was wrong, they said they had recently gotten medicine for their son’s diarrhea, which is now improved, but now he has some sores in his mouth.  As I asked more questions, everything seemed to be okay, and just looking at the kid he looked okay. 

As I started to get closer to examine him, dad mentioned that his hair wasn’t really growing too well.  He still had quite a bit, but it was an unusual thing to say.  The kid easily opened his mouth and I found his mouth was coated by a white film.  While it can be usual for kids to get thrush (a yeast infection of the mouth), especially after taking antibiotics – it usually happens in younger kids and it doesn’t usually coat the mouth this bad.  I was worried about HIV, but the kid looked pretty well and the parents didn’t look sick.  I asked mom and dad if they had any illnesses and they said no, and when I asked about HIV they said they hadn’t been tested, but not that they were aware of. Since they looked healthy, I started to think of what else could cause this extensive film of his mouth. 
Not John, but a patient doing well and happy to be better

I asked the parents if it was okay to do an HIV test, just to make sure and they said sure.  About an hour passed, and they were outside my door again with the result.  Dad still holding his son, mom handing me the result and his clinic book.  While I was certainly hoping the result would be different, I wasn’t exactly shocked when it came back positive.

Like I have done many times, I now had to break the news to this patient and his family that he had HIV.  You never know what the reaction is going to be when you break bad news, but I wasn’t expecting this.  Mom just put her head down and started sobbing.  Dad squeezed his son even harder, saying words I can’t repeat.  They were obviously devastated. 

There have been times when I have had to explain what HIV is, this family obviously knew, and their reaction seemed to be more than just the news, but grieving over everything they all were potentially losing.  Initially, I didn’t know how to respond.  What could I say to a family who seemed to think their life was over?  I told them I was sorry.  I wasn’t sure that telling them about the medicine that we have to treat HIV would be helpful at this time, so I didn’t say anything.  I gave them time, explained how we would be with them through their process, and then I asked if we could pray. 

I struggled to compose myself, mom still sobbing, dad still holding his son tightly, but I prayed for them and their son and the journey ahead of them.  While the encounter was probably less than 10 minutes, it was still very moving to me.  To see the love, the grief, and the loss of planned tomorrows isn’t something that PNGians usually share.  Pray for John and his parents in the days, weeks and years ahead.  Pray that they can continue to find strength and hope in the middle of the valley they are facing, pray for a comfort that only the Lord can give to be upon them in this battle. 

Sunday, July 29, 2018

Kids Movie Night

My sister recently sent me the movie Ferdinand, telling me that the kids here might like it.  I talked to some of the parents and there were very few of our MKs who had seen the movie, so I thought maybe we should have a movie night.  I recruited 3 other adults, and we hosted all 21 MKs (minus Charley), feeding them pizza, popcorn, raw veggies and cookies, and enjoyed an evening of Ferdinand, and the parents an evening without their kids.  We had a toy area set up for those kids who might not watch the whole movie and managed to keep most of the kids entertained by something throughout the evening.  I think it was a success for everyone, and was thankful for the 3 others (Pamela, Sheryl and Jonathon) who helped to look after those who needed a little bit more attention, and for the bigger kids who also were a great help.