Serving in Brokenness

This has been a week with dramatic ups and downs. Many weeks we’ve experienced here have had their uplifting and depressing moments but this week has been an intense one…and it’s only Wednesday. Over the weekend, Steph started having a few legitimate contractions. With her history of rapid and premature deliveries, we decided to cancel my plans to be gone for the week. (I was supposed to be traveling across Kenya to attend Medical Officer intern interviews at four different schools.) I was disappointed that I couldn’t go out and meet my potential future MO interns but was also glad to remain close to Steph and the kids. Staying at Tenwek has also given me a chance to get a lot of projects done.

Over the past several weeks, I’ve been immersed in Ebola preparedness for Tenwek along with other members of our Ebola preparedness task force. The extra time here allowed me to make significant progress on obtaining important supplies for our preparedness plan. I also had the opportunity to present our overall disaster preparedness plan for Tenwek to about another 100 staff members. (We have just released a new disaster preparedness manual and plan to test it with several small scale drills in the next couple months followed by a larger live hospital wide drill in January. These types of drills have never been done here before but are very important. Tenwek’s location and reputation have made it the referral center for mass casualty events in the past and there is a high likelihood of similar events occurring in the future.) These things alone have made for a very busy week, but then there is the clinical side of things.

 

The week has already been full of complicated outpatient consults and difficult inpatient cases. So far there have been perplexing outpatient cases such as the post-partum woman with >6L of ascites and a questionable large ovarian cyst, another young woman with a three year history of sudden onset leg weakness followed by one year of partial arm weakness, and the young boy with an unusual chest x-ray and persistent chest symptoms despite seemingly appropriate treatment. These are just a few of the consults I’ve already had this week.

 

Casualty has presented plenty of unique challenges as well. We’ve had severe trauma cases, complicated medical cases, and have seen some pretty sick kids. Yesterday morning started with a severe poisoning case. In brief, it was a young man who ingested a legitimate organophosphate as a means of suicide. (Many times the “poison” they take is another form of an insecticide but the true organophosphates can be the most severe.) The ingestion occurred at 4 am, he was taken to a neighboring hospital and was transferred to us in a comatose state around 9 am. He was a classic OPP ingestion (just imagine fluids oozing from every orifice). The other facility had place a tube through his nose into his stomach to drain the poison and wash out his stomach but when I went to intubate him, I found the tube was actually in his lungs instead. After removing that tube, securing an airway and providing the antidotes to the poison, he still remained in critical condition. We struggled to keep his oxygen levels anywhere close to normal and his lungs showed pretty severe damage. These findings plus the nature of his poisoning give him a very grim prognosis.

 

Today we had another tragic transfer. We were told we would receive a young woman in her early twenties with severe post-partum bleeding. She was also comatose from hemorrhagic shock but was receiving a blood tranfusion. The other hospital is only about 20 minutes away but it took about 90 minutes of waiting before she finally arrived. I could see on the faces of those who had transported her that things were not going well. They reported that they had to start bagging her during the transport. A quick evaluation showed that her heart had stopped at some point during the transport and she was dead. This case was particularly frustrating because we felt like if we had received her sooner, we may have been able to intervene and save this new mama.

 

Last night I was on call and at around 1 am, I was paged for a young woman with symptoms consistent with heart failure. She had some fluid around her heart and perhaps had some valve issues. At that time she seemed fairly stable and was admitted for further testing in the morning. (Sadly, I was emergently called to the ICU this morning and found that she was in cardiac arrest. After several cycles, and no response, we said goodbye to another patient who was far too young to die.)

 

After receiving that call overnight, I grabbed my iPad to read some emails and catch up on the world according to Facebook. What I read crushed me. I saw a frantic post by one of our friends from our sending church stating that their youngest child (only 17 months old) was unresponsive after drowning in their pond. Steph was semi-awake from my pager going off so I informed her so she could be praying as well. Not long after this, I read an updated post that made me feel as if I had been physically sucker punched. “He’s gone!!!” In an instant the emotions I had experienced exactly 19 months earlier rushed over me like uncontrollable floodwaters. I know, at least to some degree, what pain they are feeling. I can identify with the brokenness that they (and the families of our patients) are feeling.

 

Almost everyday here, we witness brokenness. Families fall apart; hopes and dreams are shattered; people are broken. I don’t fully understand why God allows us to experience so much brokenness in our lives. I understand that this is not how things were meant to be and I know that this is not how they will always be. I also know that there are plenty examples of brokenness and how it can be used in the Bible. I think one of the patterns that we see is that God is able to more clearly reveal Himself to us when all false pretenses of self-sufficiency and independence are removed. Moses is a revered Biblical figure for what he allowed God to accomplish through him. But his character is that of a broken man. Not only was Moses “slow of speech and tongue” (many believe he may have had a severe speech impediment), but he was also a murderer. He was also a bit of a coward.  (Remember how he pleaded for someone else to go? Hence why Aaron accompanied him.) He also lacked confidence as he feared that the leaders of Israel wouldn’t believe what he had to say. He was a broken man with a shady past but God used him to silence the oppressive Egyptians that were enslaving his people and he ultimately led the Israelites to freedom. (For more details on Moses and his story, see the book of Exodus.) Job is perhaps the ultimate human example of a broken man. He lost every earthly possession, his servants, all his children and even his health. His friends and wife even began to turn on him. Yet through his brokenness, God was able to reveal His might, power and authority, not just for those during Job’s time but also to everyone who has read his story since then.

 

There is a lot that I don’t know or understand about brokenness and suffering. But there are a few things that I do know. Brokenness and pain are not meaningless. (I think again of the Shane & Shane song, “Though You Slay Me” that I posted last year.) In fact, I would even say that brokenness, suffering and weakness are gifts. While they are painful gifts to receive, they are gifts nonetheless. They are certainly not gifts that anyone would ever ask for, but in our weakness and brokenness we are allowed to see and experience God in deeper and more intimate ways. When we are broken, we seek God more earnestly and He is often better able to use us. Sometimes God even uses our brokenness to bless or heal others. This is something that Steph and I have experienced on many occasions since Hannah’s death. We have already begun to see some of the harvest from the seeds that pain planted in our lives. Since letting Hannah go to her forever home, we’ve planted many of seeds of love and hope. Our tears have watered them and we’ve witnessed seedlings sprout out from the ashes of lose. We still hope that far more seeds will be planted and we hope for a far greater harvest to come from Hannah’s short life and the pain we have been left with. I truly believe that in the end when everything is made right again, that we may find that the fruits of brokenness and weakness may be much sweeter than the more “virtuous” or desired gifts that we often seek after and desire.

 

So for now we, like so many others, remain broken. But in our brokenness we will continue to serve. I don’t know what the results will be. I don’t know what impact our service will or won’t have. I just know that this is our calling; to serve the One who gave everything He had so that we could be reunited with Him and look back at a meaningful (and hopefully plentiful) harvest.

 

 

 

“We’re not necessarily doubting that God will do the best for us, we are wondering how painful the best will turn out to be.” C.S. Lewis

 

 

Update: The young man who took poison has been making a miraculous recovery. His vent settings are being weaned and he has been increasingly awake and alert on the vent. When I visited him yesterday (Wednesday) he was responding appropriately and signaling that he wanted water. He even agreed to have his picture taken and was able to wave. We hope to extubate him today. As one of my clinical officers said, “This is proof that while we treat, it is Jesus that heals.” There is no doubt in my mind!

 

The music kick I’ve been on lately has been Jason Gray.  He has an amazing story and uses the gift of music to minister to many.  You’d never know it by listening to his music but he has a pretty severe speech impediment of stuttering.  Yet in his brokenness he serves.  There are a lot of his songs that I would recommend but these ones seemed appropriate right now.

“Even This Will Be Made Beautiful”

…All the broken promises
Every loss of innocence
Every dream that was stillborn
Every “I don’t love you anymore”
Every wound, and each regret
Every sickness, all of death
In every heart, to every hurt
Love will have the final word

Even this will be made beautiful
Even this will be made beautiful
Scatter the ashes on the wind
Everything will be born again
In His time, in His hands
Beautiful…

“Love Will Have The Final Word”

…When the place that broke inside you will not mend
And you wander in the dark without a friend
When the night goes on and on
Remember when it all goes wrong
That this is how we know it’s not the end

Of all the things I’ve ever heard
Let me remember when it hurts
That love will have the final word
As long as God is on His throne
I am carried by the hope
That love will have the final word

Sorrow may close the chapter
But the story will end with laughter
Cause the worst thing is never the last thing
No, the last thing will be the best thing

Of all the things I’ve ever heard
Let me remember when it hurts
That love will have the final word
As long as God is on His throne
I am carried by the hope
That love will have the final word…

Prayer requests:

-Pray for the Dubas family as they mourn the loss of their precious little one. Pray that God’s presence would be an ever-present reality and that they would find true comfort from the only one that can provide it. Services are planned for this weekend.

-Pray for Tenwek as we push ahead with Ebola preparedness. We hope to never see a patient with this disease but we must be ready to protect our staff and treat our patients if it does surface here. Another physician and I hope to travel to the U.S. to participate in the CDC course so we can maximize the safety of our preparedness efforts with our limited resources.

-Pray for us as we prepare to welcome Joshua. We have no misconceptions about this being easy. I am sure that there will be times with recurrent and raw pain. We pray that joy will overshadow those times and that we will always remember that we have an amazing family reunion to look forward to.

-Pray for Tenwek as we prepare to graduate our Clinical Officer interns next month and as we work out plans for our new CO interns as well as our MO interns.

-Continue to pray for our patients and their families. May we be a strong witness of the one who truly heals.

 

Joshua’s Ultrasound