The Big Meeting

First things first. I'm always going to change names in my stories. People in PNG read blogs. There is a PNG Gossip Newsletter that finds and distributes links to interesting blogs about PNG. The last thing I want to do is to further compromise the privacy of people who are already hurting. I'll change other facts, too to help obscure their identity. The core facts of my stories will always be true, but many of the details will be flat out lies! There, I've confessed in advance.

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So, with that in mind.... Maria and John. Yeah, Maria and John.

They've been married just a few months. Within a couple of months of their marriage Maria began to be ill. She felt weak, had frequent nausea, and lost weight. By about 5 months into the marriage John began to worry that Maria had AIDS. It's a testament to his faith in her that he assumed that in order for her to have it, he had to be HIV positive. So instead of suggesting that she be tested, he went and had himself tested, and was quite relieved to be negative. He let the matter drop.

A few months later, as she was getting worse, he went and repeated the test. Still negative. Finally, just a few weeks ago, he took her to a hospital in a province near ours. Among the many tests that they did there was an HIV test, which was positive. By then her symptoms included confusion. Her mother was with her there, and for reasons that I don't understand, took her, and they slipped out of the hospital and ran away back to Maria's home village. Perhaps the mother underestimated the depth of John's commitment to Maria, and was afraid that he would take some reprisal.

Within a few days, her family began to recognize how ill she was (although only her mother knew about the positive HIV test), and brought her here to Nazarene Hospital. John has relatives who work here, and was actually staying here with them, but it was a day or two until he found out that she'd been admitted. In her evaluation here, the HIV status was confirmed. John was tested yet again, and was again negative.

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John's dilemma was that when Maria's male relatives finally found out the situation, they would assume (as he himself had) that he was the one who had infected her, and would attack and possibly even kill him. He wanted someone in a position of authority (you'll be surprised to learn that he was thinking of me!) to be the one to inform them that she has AIDS, and at the same time explain to them that he was HIV-negative. Because of the advanced state of her AIDS, it is in fact likely that she contracted HIV long before she met John.

So, as Maria herself was now too confused to give informed consent herself, I felt it was John's right to grant me permission to tell the family. I discussed it with some of my colleagues, and decided that that was indeed the best way to proceed. He would ring her family and ask them to come to the hospital Saturday morning because the doctor needed to talk to them about Maria.

Saturday morning I went to do ward rounds with a sense of dread. I knew that it could be a difficult and even tense meeting. I had mixed emotions when I got to the ward and discovered that Maria and her mother had again run away! But a couple of hours later I learned that the family had tracked them down near the provincial border. They were probably heading back to the first hospital. The meeting was now rescheduled for John's relative's back yard.

I was surprised at some of the people who were there. There were several other people from the station who were related in some way. John's relatives had invited Pastor Robert from the nearby Nazarene church. He opened the meeting in prayer, and then turned it over to me. It wasn't an easy task. It was hard to know what to say at all, but then I had to say it in my second language, and the more nervous I get, the worse my Pidgin gets.

I stated the facts as simply as I could. Then I stated that I was no longer speaking as the doctor, but as a friend. I talked about the fact that not one of us there was without the need for forgiveness. We've all done wrong, and God has either forgiven us, or is ready and willing to do so. I said that just as past actions (especially Maria's) have affected present circumstances, our actions now would affect our lives into the future for better or for worse. I turned to Maria's family and stated that they must have seen some good in John if they had allowed their daughter to marry him. There were nods of agreement. I turned to John's family and stated that they must have seen good in Maria to allow one of their young men to marry her. Again, the nods.
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"Those things have not changed," I said, "they are still there. This hasn't changed them." Again there were nods all around. "These young people will need the support of both families if they are to get through this and strengthen their marriage. Anger or fighting won't help them. Only your love and support will help." I asked for the privilege of praying with them, and asked God to direct and guide them all.

I looked up to see a security guard from the hospital who had obviously been sent to summon me back there. I explained that I had to get back and excused myself. On my way I passed near Maria's dad, whose eyes met mine. I could only imagine the flood of emotions that were going through his heart. Sorrow for his daughter. A sense of betrayal. Anger. He offered me his hand, and shook mine warmly.

Several hours later I passed by the house where the meeting had been held, and saw Maria's family at the road loading into the truck that they had come in, while still visiting with John's family. I saw no blood, wound or bandages, so I was happy! They all greeted me cheerfully, but it just wasn't a good time to ask about details of the rest of the meeting. Later I talked to one of John's relatives, who told me that it had gone very well. There had been hours of speeches, of course, but in the end they all agreed to help and support this young couple. Later yet, I learned that a few days before, John had prayed to recommit his life to Jesus.
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Please pray with me for John and Maria. God knows their real names! He knows the pain in their hearts. He knows the pain and frustration of their families. Please pray that Maria will be consistent with medical treatment, which will probably involve the use of anti-retroviral drugs. Pray that she will follow John's lead in committing her life to Jesus. And pray for me, Bill, Jim, Susan, Scott, Erin, and the soon-to-come Rebecca and Stephanie as we battle on against AIDS, violence, and the countless other consequences of sin and evil in the world. Pray the the Great Physician would give us strength, wisdom, good judgment and the stretching of limited resources.

Yours and His,
Andy

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Photos
1 A sunset seen from near Konduk
2 A flower of some kind. Photo by Sam Bennett
3 A wedding, not John and Maria's. The couple are kneeling, surrounded by a large wreath of flowers that has a lot of the same symbolism as a wedding ring, but also symbolizes the prayers of their families which will continue to surround.

Ok, the last 2 photos look a little silly and out of place, but really they fit in nicely. They are three of my fellow doctors here that I request prayer for in the last paragraph.

4 The always-dignified Dr. Bill McCoy, holding treasure.
5 To introduce my soon-to-be-newest colleague, Dr. Rebecca Wallace, seen here dressed as Strawberry Shortcake during a Harvest party on her visit last year. She will be arriving soon. She will be coming as a post-residency fellow, like Dr. Erin Meier (shown here on the right in a costume that I don't recall), who is one year into her two-year fellowship.

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Faces of C-Ward

Inspired by Dr. Erin Meier's nice collection of photos of patients from her ward, I decided to do one of faces from my ward. Trouble is, her patients (being kids) are cuter than mine. But the folks in C-Ward have their own special appeal. I'll add in a couple of patients who aren't actually on my ward, but I want to tell you about them and show you any way. Three of these are victims from last Tuesday's MVA. The man with the facial injuries, and the little girl with the hand injury were the main focus of my attention that afternoon.

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Going Home

Not us. We are home. Well, at one of our homes.

I'm talking about the folk from last week's MVA (motor vehicle accident). I am still amazed that none of them were more seriously hurt. The last of the ones that we admitted to medical ward (they would usually all go to surgical, but there were just too many) went home this morning, with plans for a 1-week follow-up. I haven't checked on the little girl with the bad forearm injury, but I'll look in on her in the next day or two and report how she and her mom are doing.

I really recommend Erin Meier's blog. She does a way better job than any of the rest of us at keeping up. Sometimes you will learn more about Judy and me there than here! Check out the "Faces of the Pediatric Ward" that she posted a few days ago. (Sometimes it's just fun to make links.)

By the way, we sure enjoy it when you leave comments. On some of the recent posts I've added an extra-big COMMENTS link, but they all at least have the little "0 COMMENTS" link in tiny font at the bottom. Click on any of those to comment, and please sign your message.

A Night in Paradise (Part 3)

You'll remember that I originally wrote this just over a week ago. Here's the rest of the story.

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Dave went to his apartment for a water bottle, and I found a few peanuts in my locker (I always keep some there). We sat and visited for a few minutes, feasting on peanuts and water while we waited for the crew to get everything ready, then went down and did the operation. Again, it went well. This time, there was no dread ring of the phone at the end of the case. At about 4:30 we went to Labor, just to check, then made our way home.

I ate a bowl of cornflakes, then crawled into bed a little after 5. But the story doesn't end there.

The local custom here is that the doc on call Friday night will come in on Saturday morning to round on his or her own ward, leaving the rest to the doctor who is coming on call for the weekend. Judy knew that she had to wake me. It was pretty hard to get out of that warm bed at 7:45. For some reason, I didn't make it to the hospital until nearly 9. Judy had been out jogging, and told me that something was going on at the ER, but she couldn't really tell what.

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When I got there, I heard that Dr. Erin Meier (click to see her blog--I'll bet there will be a story there by now) was swamped in the ER with 9 victims of a motor vehicle accident. I did rounds on my ward (Adult Medicine), checked on the patients from last night, and caught up with Erin, who filled me in on the MVA. She mentioned that a lot of off-duty nurses and nursing students had rushed in to help with the work. Before I could go home, I had promised to do something for the friend of a friend, which I did in my exam room in the Outpatient Department, next door to the ER. No sooner had I started than one of the ER nurses called me to come and help them. One of the victims of teh MVA had stopped breathing, and had no heartbeat. I went to check on him and made a brief attempt to get a breathing tube into him, but quickly concluded that he was now beyond my help.

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So now I'm home, sitting at my computer reliving the night. I'm thinking of that young woman, who wanted so much to be a mom, and of that little life, ended before it really started. I'm thinking of those two healthy babies, now sleeping contentedly by their moms on the maternity ward. I'm wondering about that young man who died in the ER--I don't even know if he has a wife or kids. I'm thinking of the thousands of people who would have no health care without Kudjip Hospital. Kudjip Hospital is me. Kudjip Hospital is Dr. Erin, and Dr. Bill, and Dr. Scott, and Dr. Susan, and Dr. Jim, and the dozens of volunteer doctors and medical students who come here each year. Kudjip Hospital is those OR nurses and anesthetists who just say, “That's alright, we'll do it.” It's the ER nurses, trying to save lives threatened by violence, alcohol and bad roads. It's the labor ward nurses and aides staying long after their shift is over. But it's also you, praying and giving to keep us going.

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Judy has gone to take a group of people up the river so that they can float back down on inner tubes. When I came in, the dogs told me that they love me unconditionally. My nice new coffee maker (a "going away" gift from Sam) is gurgling, and emitting the smell of brewing coffee. I don't know if I'll make it through day without a nap.

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Photos:
1 Kudjip Nazarene Hospital
2 Dr. Susan Myers and Dr. Scott Dooley discussing a patient
3 Dr. Jim Radcliffe on the ward
4 A scenery shot to remind you what a beautiful place this is

Couldn't Count Them

As you know by now, the last story I wrote to post here got pretty long, and I decided to break it up. In a future episode of that story you will learn of a 9-victim MVA (motor vehicle accident) that occurred early Saturday morning. I was only involved in the care of those folks tangentially; Erin Meier did most of it all herself. Well, this past Tuesday afternoon we had another multiple-victim MVA. They were literally (and I only use that word literally) filing into the ER. We don't know how many there were. Before the last of them arrived, we had moved the first ones off to other areas. The first victims arrived at about 2:30; Scott Dooley and I took care of them while Erin saw all the regular outpatient department patients. We all worked until between 6:00 and 6:30. Visiting surgeon Salim Wahab took the most seriously injured patient to the operating room that day, and two others the next.

Surprisingly, there were no fatalities. Most of the injuries were abrasions (scrapes) and avulsions (skin or other tissue being torn away) from sliding down the pavement at high speed after being thrown out of a vehicle. One little girl and her mom both had parts of their wrists torn away, but neither will likely lose their hand. Many had "road burns" on their faces, trunks and arms. Two had skull fractures, but have not had serious neurological problems. Several had serious facial lacerations.

Andy

A Night in Paradise (Part 2)

In the previous episode we learned.... Well, just scroll down and read it for yourself.

I gave her some medicine in her IV to strengthen her contractions, and she was able to push the baby down the birth canal. But when it got to the point that the head would deliver all progress stopped. The head was firmly stuck at the outlet of the uterus. This is the reason that we try hard to never do a vaginal delivery for a first-time mom with a baby in breach position. If a mom has successfully delivered vaginally in the past, it is highly likely that she can safely deliver a breach. But with first-time moms like this one, you just don't know, and occasionally the head can get stuck. With a live baby this is a disaster, usually resulting in the death of the baby.

It was hard work, but after about 10 minutes of trying, the head delivered, deeply tearing the side of the birth canal in the process. While this was going on, the nurses told me about the woman in labor in the next bed. She was also having her first baby, but despite strong contractions for several hours, she was not making progress toward delivery. When I could get away, I evaluated her, and realized that she needed a cesarean. Fortunately, the crew had not left after my first call, so I informed them that there would be an operation after all. They waited patiently for me while I sewed up the torn birth canal on the first mom. It was well after midnight when I turned over the last bit of suturing to the Labor ward staff. The evening shift, who should have gone home at 11 PM were still there helping to finish up. I hurried to the OR while Dave went to the ER to evaluate a psychotic young woman.

The operation went well, but as we finished, the phone rang. When the phone rings in the OR late at night, it almost means that there is something else for the doctor to do. In this case it was the nurse on the labor ward, informing me that the patient that we had tried so hard to induce all day long, had gone into active labor, but was not making progress. When I could get away, Dave and I went to Labor to evaluate her. It was clear that the only prudent thing to do was to take her to the OR for a cesarean. I went back to the OR to inform the crew of my decision. As usual, they were supportive and patient. The only comment I heard was, "That's alright. We'll do it."

(To be continued...)

Photo

It's not me, and it's not a cesarean, but it's an operation in our OR, so it will serve to illustrate the story.

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A Night in Paradise (Part 1)

This was written Saturday, 20 September. It got pretty long, so I decided to break it into 3 parts. Then our internet went out, so I was unable to post it until today.

Not that I'm complaining. No, not me! After all, it really is a privilege to serve the people of the highlands, to do my best to bring a measure of comfort and healing. Sometimes my best isn't enough. Sometimes it's hard work.

In fairness, most nights on call aren't nearly as bad as this one. But if you are inclined to pity me, go right ahead. I'll take what pity I can get.

The night started calmly enough. Dave is a visiting medical student from England, and he was on call with me as "back-up." There was one patient in the labor ward that we had been trying to induce all day, and we had some discussion about how we'd manage her, but finally decided to give up, stop the meds, and resume the efforts in the morning.

I was very sleepy, and quite uncharacteristically decided to go to bed early, confident that Dave could handle the routine questions that might come up through the night. I'd been in bed for 15 minutes when he called to say that there was a patient in the ER with a spear wound to his chest. Knowing that such a wound could be anything from trivial to life-threatening, I told him I'd meet him there and hoofed it to the hospital. This particular "wound" turned out to be at the trivial end of that spectrum. I don't think that the chest cavity was even penetrated at all. And to make matters worse for my attitude, he had driven past 2 hospitals that could have easily treated him on his way here.

Leaving Dave to finish that, I headed home. Just as I was walking away, the ER nurse called out to me that they had phoned from the labor ward, and there was a mother in labor with a cord prolapse. When the umbilical cord comes down into the birth canal ahead of the baby, it can be squeezed to the point of cutting off blood circulation to the baby, and can quickly cause the baby's death. I hurried to the labor ward, and Dave arrived a few moments after I did.

The staff were already doing the basic things that might save the baby's life. The labor ward was chaotic, as it so often is. As I examined the birth canal, I found that there was a weak pulse in the cord, and that the baby was in breach presentation, the legs and bottom coming first. This is actually less often lethal than when the head is tight in the pelvis, compressing the cord. I asked one nurse to call the operating room crew for an emergency cesarean section while another was starting an IV. I was doing my best to push the baby back up into the uterus so that it would not compress it's own umbilical cord.

But over the next couple of minutes we found that the baby's heart beat first weakened further, then stopped. What a helpless feeling to be there while this baby died, just out of my reach. Even if the OR crew had already been there, and if we had run straight to the OR and done a cesarean as fast as I know how to do it, it would have been far too late. It was already too late. All I could do was to try to get the little body delivered without harming the mom. It was with a very heavy heart that I explained this to this young woman and her mom.

(To be continued...)

Photos

1. Dr. Scott Dooley, visiting with Dave Scott, visiting medical student from England

2. A grauitous photo of an exotic-looking tripical flower

3. When everything goes right in the labor ward, this is what we end up with.

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