MissionDocs.org

117 Shanksteps

It is feast or famine, as far as surgery goes.  I may go days or even a week and not do a surgery, then there may be so much I cannot do it all.  That is what Monday was for us.  Sunday we saw  about 34 in clinic and made rounds in the hospital on about another 40.  Some are on “autopilot” with healing wounds or other static things.  Others very complex, like patients in diabetic ketoacidosis and recurrent ascites with no known cause.  I started the day knowing that I was going to do a real long surgery.  There is a woman who had urinary obstruction after surgery for which I was going to do a definitive operation.  I was either doing an ileoconduit or a bladder suspension with extension to adapt the ureter to it.

Before we made rounds I met with Audrey to pray that the day would go according to Gods plan.  As I went to leave my office a man who I had seen the day before, came running in dripping.  I have been seeing him nearly every two weeks and draining 15 liters (4 gallons) of ascites off him.  The day before as I was seeing 34 clinic patients I told him to come back tomorrow to do the drainage that I was too busy that day.  I also reiterated again that if at any time his umbilical hernia started leaking that he should come back immediately.  So in he comes with his umbilicus (belly button) spouting like a fountain.  His umbilicus had indeed ruptured.  I sent him on to the operating room and followed the trail after him.  I put a clamp on his umbilicus to stop the flow so to not get the entry to the OR all wet…  We opened him up to fix his hernia.  There was a fleshy mass on his gallbladder and a small one on the left lobe of his liver.  I couldn’t find anything else so I suspect this is the cause of his ascites. (still undiagnosed)  He needs a biopsy, but then he didn’t even want to do the surgery for fear of the cost.  I just told him there was no other option!  During the surgery, Djoudge, the cleaner, came in to tell us that a woman was in labor.  I asked him to call Audrey to check her out, since there was no nurse free to see her.  Audrey came in a few minutes later saying that she was concerned about uterine rupture and that she needed a caesarean section.  I the man’s abdomen in the most water-tight fashion possible.

Immediately we were called to see a woman who was having difficulty with labor and had a possible uterine rupture.  After checking her out, Audrey and I decided it was best to do a caesarean section for fetal distress and imminent rupture.  So Aud joined me for her c-section for speeds sake.  We delivered a crying baby boy of about 9 lbs.  We decided to do the long surgery directly after.  I went to finish rounds, Audrey to see some patients in the clinic before starting.  The nurses would have to take care of the rest.

Nguizaye had been operated on before for extensive uterine bleeding and had been transfused a number of times.  At the time of her hysterectomy everything was stuck to the back of the uterus which was much enlarged.  After extensive adhesiolysis and much difficulty in the pelvis from all the adhesions, a total hysterectomy was performed.  She came out of the surgery well but with bloody urine.  Over the next 24 hours she made essentially no urine in spite of being rapidly replaced with fluids.  The day after the first surgery, I reoperated on her and was unable to identify the area of ureter entrapment.  I put in some makeshift stents as a temporizing measure while I decided what to do definitively.  The stents became infected and she was not doing well.  So this was the day for a definitive repair.  Having asked many colleagues their opinions (and only one responding) we started.

Entering the abdomen, was already difficult.  Adhesions everywhere.  Then omentum stuck down to the previous operation site and the area of previous adhesions.  With much difficulty and tedious work we dissected out the ureters.  This took about four hours.  I decided we did not have the room sufficient to use a bladder mobilization to reinstitute urine flow.  So it would be an ileoconduit.  About this time another woman was having difficulty with labor so Audrey set up for a C-section in the other operating room.  We changed around nurses to cover both rooms well.  Fortunately the student missionaries are up to speed and a real help in the OR now.  Soon I hear yelling and movement in the other room.  Audrey comes back in a few minutes with a crying baby in hand.  She delivered without the C-section.  So she would rejoin me again.  I resected a piece of ileum to make the conduit between the ureters and the ostomy.  Reconnected the intestine and then started the anastomosis.  Baya (the ER nurse on call) came panting into the room.  “A man has been stabbed and is bleeding profusely from his abdomen. “  As I have one patient open on the table with no one else who can do this I tell him to have them hold pressure and that they MUST go on to Mokolo.  People do not want to go to  Mokolo but it was necessary.  So I continued my surgery.  It was tedious and deep.  The woman had lost much weight, but unlike most here, she still had a bit of fat, making the surgery deeper and more difficult.  We finished the surgery at 10PM, ten hours after the start.  Back cramps, headaches, and extreme tiredness made it difficult to write all the notes of what had taken place.  We made it home after seeing some in the ER, about 11:30PM, massaged each other’s back knots and went to bed.  She is still very sick, electrolyte abnormalities, delirium, malnutrition, and three anastomosis; enough to make any surgeon worried.  Then put on top of that the absence of an ICU and monitoring.  If she makes it, it is only because of Gods direct intervention. I pray for her before going to bed, as I wake up and many times throughout the day.  Please keep her in your prayers also.  In His Service, Greg

# 116 Shanksteps- slow miracles

“The people were amazed when they saw the mute speaking, the crippled made well, the lame walking and the blind seeing.  And they praised the God of Israel.” (Matt 15:31)  “I tell you the truth, anyone who has faith in me will do what I have been doing.  He will do even greater things than these, because I am going to the Father.” (John 14:12)

If I read these two verses correctly, I, Audrey Shank, daughter of the King, should be able to make the mute to speak, the lame to walk, and the blind to see.  Sometimes I get frustrated that I can’t just say a word, or pray a prayer for my patients to be instantaneously healed. I like the idea of instant gratification – I don’t like waiting.  I was feeling this way the other day, thinking about how useless I was as a prayer warrior, when I started to think about some of the patients I’ve taken care of here.

There was Marie.  During our first meningitis epidemic in Feb 2006, Marie came to the hospital with meningitis.  She had been in a coma for several days.  When she was finally conscious, we realized that she was blind in one eye.  I looked in her eye and she had no blood coming to her retina.  Physically speaking, she should have been blind in that eye for the rest of her life.  She remained in the hospital for 3-4 weeks, with us praying for her every day. By the time she left, she had full sight AND a saving relationship with Jesus, as did her parents.  Through prayer, Jesus made the blind to see.

Then there was Baldagui.  Baldagui came in the meningitis season of 2007.  He was in a coma for almost a week. When he woke up, he was paralyzed on one side of his face, both arms, and both legs.  It wasn’t until we stopped giving him medications and relied entirely on prayer for his healing that he started to get better.  We prayed by his bedside every day, often telling him of Jesus’ healing power and love. We encouraged him to pray as well and to accept Jesus. We gave him a Bible and he read from it every day.  Although Baldagui didn’t walk out of the hospital, he did leave with fully functional arms and a full reliance on God.  The Peace Corps worker here, who was also a physical therapist, worked with Baldagui at his home almost every week.  One of the most amazing days I can remember since coming to Africa was the day that Baldagui hiked down the mountain from his home to return to school.  He still walks with a stick or arm braces, but if you ask him, God healed him from being a cripple.

Maybe you remember Birme.  She came during the same meningitis season as Baldagui.  When she regained consciousness, she was also paralyzed and was unable to speak.  Although her paralysis was only for about a week, she was unable to speak for several months.  As you may remember, her grandfather “sold her soul” in the devil’s heaven to gain longevity.  We prayed with and for her every day,  for a miracle.  We tried to convince her family to have belief in Jesus, not clay idols.  We got together in group prayer and commanded the evil spirits to leave her alone. Then we left to go to the US.  I found out that several weeks after we left, one day she just started speaking again.  Her family gave glory to God and now regularly attends a church in their village.  Who says the mute can’t speak.

I have not yet told you about Guidaidi.  Guidaidi came to us after suffering from abdominal pain for 16 years.  He had already had 3 operations for this problem, none of which helped him get well.  At first, I thought he was faking his pain, looking for attention.  Soon though, I realized that he had already lost everything because of this pain.  All of his money had gone to paying hospital bills. He was unable to work and support his family.  I started to really listen to his story, and then started praying for him, and for guidance.  I was very strongly impressed that his pain was more spiritual in nature than physical. So, I asked him what he thought about that idea.  He agreed that he felt that someone was trying to harm him (spiritually).  We began to pray for him in earnest. He repented before me, our chaplain, and God. He started to get better.  Then one day, he had a crisis.  He had intense abdominal pain and became unconscious. Then he started thrashing about, screeching, eyes rolled back in his head, and foaming at the mouth.  His wife said that he had had similar episodes in the past, but that this one was by far the worst.  We must have prayed for him for over an hour.  I commanded the demons to leave him alone and never return, in Jesus’ name.  He was finally calm and was unable to speak, but raised his hands toward heaven.  I left him to sleep, and when he woke up, he was willing, but unable to tell me what happened.  He stayed in the hospital for several weeks after that, never again having abdominal pain. He said he would go back to his village and tell everyone what God did for him.  “They (disciples) went out and preached that people should repent.  They drove out many demons and anointed many sick people with oil and healed them.” (Mark 6:12, 13)

Looking back on the past 3 ½ years, I realized that although none of my prayers have been answered instantaneously like happened in the New Testament, each of my patients that was healed now gives glory to God.  After all, isn’t that the reason we are supposed to heal in Jesus’ name; to bring glory to God?

My prayer for myself and for you is: “Lord, consider their threats and enable your servants to speak your word with great boldness.  Stretch out your hand to heal and perform miraculous signs and wonders through the name of your holy servant Jesus.” (Acts 4:29, 30)