Sunday, 25 December 2011

Hong Kong

OK, these upcoming blogs are loooooooong overdue.  About 3 months so.  I need to get back into the swing of things!  Tomorrow I leave for my next district tour (North Central Ohio).  I am waiting for laundry to dry before I can finish packing, so now is as good a time as any.

My journey home to America began mid-December.  I was blessed to travel with the Dooley family, who were also headed to home assignment.  We spent a couple of days in Hong Kong.  WOW... what a city.  The first 24 hours were rather traumatic for we FOBs (Fresh Out of the Bush).  Once we figured out how to take the subway, we had an awesome time!  Here are a few pics of our time there.

Now this is what I imagined HK would be like!

Our first day in the city we took a cable car up to see the world's largest sitting Budda.  They weren't kidding!  He was gigantic.

Big Budda--up close and personal.

You can't go to [China] without seeing a giant panda!

My favorite stop in Hong Kong was this tea house.  None of the staff spoke English, and we (of course) didn't speak Chinese.  Lucky for us the menu was bilingual!  The pigeon came highly recommended as best we could tell from all the gesturing that was going on.  I gave it a try, but it definitely wasn't my favorite.  Scott finished it off.

Thanks to the Dooley family for letting me tag along on this adventure!  Safe travels, and see you soon in PNG :).

Saturday, 10 December 2011

Like a baby

In preparation for home assignment, I have been doing a lot of reflecting over the last three years.  Here are a few of my thoughts...

This is stating the obvious, but little babies are pretty much helpless.  They can't talk, walk, feed or dress themselves.  When they are learning to walk, they fall down and get bumps and bruises.  Or they put their clothes on backwards.  They cry and sometimes throw temper tantrums.  Yep, helpless.  Thankfully God gave babies some mamas and papas who teach them how to talk and what to eat.  They have sisters and brothers who hold their hands when they take their first steps, and lift them up when they fall down.  They have aunties and uncles who dry their tears.  The family is always there, loving and correcting and helping them.

New missionaries are sort of like little babies.  OK, maybe a lot.  When my first term began in January 2009, I arrived in PNG all bright eyed and bushy tailed.  I was eager to jump into life as a missionary.  But I didn't know how to speak Pidgin or eat kaukau.  I had never carried anything on my head.  I wasn't any good about walking on the mountain paths.  I have had my fair share of tantrums and tears.  There have certainly been times when I have fallen down.

Like a baby, I also have a family--missionaries and nationals--who have helped on this journey.  They have taught me to speak Pidgin, though I still have more to learn.  Even today I heard a new phrase that I had to have someone interpret for me.  They have taught me to carry a bilum, and how to prepare food for a mumu.  They have held my hand as I walked along steep and slippery bush roads, although I can't say that I myself am much better at walking those road.  Mi save pundaun yet.  Even now they are there to pick me up when I fall.  Most importantly, they have prayed for me along the way.  I could not have done it without them.

Thank you, Lord, for my PNG family!  I will miss them while I am gone.

"Now then, my children, listen to me; blessed are those who keep my ways."
~ Proverbs 8:32

Thursday, 8 December 2011

"1090" by Dr. Andy

From time to time, we docs borrow each others' blog posts.  Since Dr. Andy got to writing about this patient before I did, and he did such an excellent job writing about it... I am going to share it with you!  Here is the link to his original post.


"1090" by Dr. Andy Bennet

No, that's not a date.  Well, it is, but as a date that number is not the subject of this post.  1090 mililiters.  That's over a quart, for those who need to know it in those terms.  Not a lot of liquid, really, depending on the context.  1090 ml of gasoline would take most cars only a few miles.  1090 ml of warm water would be enough to wash your face.  1090 ml of bloody serum in a man's pericardium can be the difference between life and death.

I don't often get into medical detail here, but you need to know that the pericardium is the membranous sac that surrounds each of our hearts.  It is normally a pearly color, smooth, with just a bit of moisture inside to allow the heart to slide smoothly under it as it beats.  But Joseph's pericardium has turned against him.  Swollen, red from the tuberculosis that spread there from the surrounding lung.  Over the last few weeks, he had become increasingly short of breath, and weaker.  As the inflammation of the pericardium increased, serum began to ooze from it's inner surface, and blood began to leak from its now-engorged capillaries.  As the fluid built up, it began putting pressure on the heart.  More and more, the heart could not fill adequately between contractions, so the amount of blood it could pump diminished.  Joseph's blood pressure decreased.  Any movement became an exhausting exertion.

Joseph went to the nearby clinic in his village.  A few days of amoxicillin did nothing to reverse the relentless progress of the TB.  Finally, Joseph's relatives realized that he was dying.  They found someone who would drive them to a nearby government hospital.  There they were told that there were no doctors to see him.  In PNG, it is the privilege of all senior doctors to take "Festive Season Holiday"; basically 2 months off.  The junior doctors who are supposed to keep things going want to be like the senior doctors, so they take some time off, too.  Joseph's family headed toward Kudjip.

When they brought Joseph into the ER, I was working on another man.  I saw that the nurses were checking him.  One asked to use my pulse oximeter.  This showed that Joseph's blood was carrying adequate oxygen.  I did not fully appreciate just how sick he was.  I listened to his lungs and heard good air movement, so I left him for the nurses to "screen".  He was making a lot of noise, and I thought maybe he was just being dramatic.  A little while later, the nurse told me that Joseph was ready to be seen.  I examined him more carefully this time, but didn't find anything specific, except that his heart beat was rapid and soft.  I ordered a chest x-ray.

Some time later, I was informed that his x-ray was ready.  Here it is:

For those of you who don't know what you're looking at, suffice it to say that it's not OK.  I went and got the ultrasound machine.  It showed me that most of the volume of what appears to be the heart on the chest x-ray was fluid.  The heart was barely contracting under the pressure that surrounded it.  There was also a fair amount of fluid in the right pleural space, the space between the lung and the chest wall.  There are many things that can cause this, but here, most of the time, it's TB.

By this time all of the patients in the Outpatient Department had been seen, and doctors were starting to home.  I felt that we needed to drain some of that fluid out of the pericardium, but I'd never done it before.  I knew that Dr. Erin Meier had done several, but she had left.  I found Dr. Steph Doenges, who is on call this evening.  She had helped on a pericardiocentesis once.  She agreed with my idea of involving Erin.  After sever failed attempts, I reached Erin, who came right in.  The three of us began to assemble supplies.  It was decided that since I had never done or even helped with one before, that I should be the one to do this.  This may seem like backward logic to some of you, but it makes complete sense to us.

Erin held the probe for the ultrasound that would guide my needle into the pericardial space.  I use an intracath, usually used as in intraveneous catheter.  This is a plastic tube around a steele needle.  We found a nice long one.  I washed his chest with an iodine solution.  Ering guided the ultrasound as I guided the needle into his chest.  The needle appeared in the image.  I slipped the steel needle out of the plastic sheath, and connected a syringe.  As I pulled the plunger, dark, bloody fluid filled the syringe.  20 ml.  They say that many times you only need to remove a few ml from the pericardium in order to make the patient much better.  The patient didn't look any better.  I tried connecting some IV tubing so we could just let it run, but the blood was too thick, so I went back to the syringe.  Syringeful after syringeful came out, and was emptied into a nearby basin.  When the fluid wouldn't come any more, we'd reposition the catheter.  We worried that a random movement by me or by the patient would dislodge it, so Steph put on sterile gloves to hold it.  The patient's relative counted syringefuls, and totaled the volume.

"Wow, we're past 100 ml!" one of us commented.

A few minutes later, "hey, that's almost 500!."

Then Joseph began to quiet.  With her free hand, Steph felt his pulse.  "Stronger", she said.  We could see the movement of the heart on the ultrasound screen returning to normal.

Joseph began to talk to us.  Erin and Steph asked him about his wife and children.  A boy and a girl, ages 5 and 3.  The brother and I were counting and adding.  The tally was nearing 1000 ml.  A liter!  Now we began to have to manipulate the catheter more often, but still the flow came.

At some point someone (yes, it was me--the mood was much lighter as we watched Joseph improve from moment to moment) began to speculate as to whether the Guiness Book of World Records had a category for the largest volume of fluid removed in a pericardiocentesis.  Probably not.

We help people all day long.  And once in a while, with God's help, we do we have the opportunity, despite our limited equipment, supplies, and experience, to save a life.  Sometimes in a critical situation there isn't anything we can do, and that is miserable.  But often it goes well, and a life is saved.  That's really a lot of fun!


We all stopped by medical ward the following day to check on our patient and get a picture with him.  He was a hundred million times better than when he came in the day before.  Doesn't he look great?


Tuesday, 6 December 2011

Christmas cookies

This past weekend I invited some of my little sisters from the College of Nursing to come over and bake Christmas cookies with me.  Baking is not a common hobby in PNG.  Most cooking is done over an open fire; ovens are few and far between.  So we all put on our aprons and I guided them through the process of measuring and mixing and baking and decorating.  Brigetta and Rachel were naturals, despite their lack of cookie-making experience!  I think licking the beater was their favorite thing.  Well, maybe that was mine.  And most importantly, we had a really "sweet" time together.  Love my little sisters :).

Random things

I have the world's bestest sister.  Her name is Ami, or "Aim" for short.  She has been my best friend for most of my life and pretty much all of hers.  And she has been a great support for me through the years, especially now that I am a missionary in PNG.

My family sends me a box of goodies every couple of months or so.  Aim always finds the most random things to put in the box.  Once upon a time she sent a pink stuffed [plush] animal tail, which made for a perfect Cheshire Cat costume for our Mad Hatter Tea Party.  The fuzzy Italian mustaches (and/or eyebrows) were a hit across the station.  I have no idea why she sends the things she does, but they are always a lot of fun to share.

Last week Tuesday, I was post call and pretty much delirious.  Mr. Joe, the outpatient supervisor, forgot to tell me until that day that I was the speaker for the following morning's devotion.  Geesh.  Post call and delirious is not the time to hope for inspiration.  But nevertheless, I was inspired.  

I started thinking and praying about how I could encourage our staff during this time when so many are leaving for other jobs.  Hebrews 12:1-3 came to mind--the verses about running the race and fixing our eyes on Jesus.  I shared with the OPD staff about the "great cloud of witnesses," all the people around the world who are praying for Kudjip Hospital.  And I shared about others who are "running the race" as well--the college guys who biked across the US and the school kids that collected medical supplies for the hospital.  Keep running the race, and keep looking to Jesus!  I passed out a winner medal to each of the staff, just one of those random things that Aim sent me in a box.  But the gold of the medal doesn't represent money or jobs or the things of this world, it represents the true prize:  eternity with our Lord.  They really were encouraged!

Thanks, Aim, for the random things you send!

P.S.  I also have the world's bestest bro.  I will write about him another time.

"Therefore, since we are surrounded by such a great cloud of witnesses, let us throw off everything that hinders and the sin that so easily entangles.  And let us run with perseverance the race marked out for us, fixing our eyes on Jesus, the pioneer and perfecter of faith.  For the joy set before him he endured the cross, scorning its shame, and sat down at the right hand of the throne of God.  Consider him who endured such opposition so that you will not grow weary and lose heart."
~ Hebrews 12:1-3