#136a Shanksteps- followup

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#136a Shanksteps- followup
I sit here at 2AM unable to sleep.  I was called into the hospital to see Baldina as they said he had a low blood pressure.  On the way in I hear the wailing.  He has died.  I go through all we have done on him, all for naught.  He tried to kill himself and then there was hope, now he is dead.  He succeeded.  I hope his last few days were ones he used to ask forgiveness of his family and God, otherwise there is NO HOPE.
At the same time they call me to see another elderly woman who is unconscious.  I had admitted her this morning with epigastric pain and what I suspect is typhoid or malaria.  Tests have no been done yet.  I check her glucose and find it 41.  We start replacing her sugar with the IV but within 5 minutes she is gone also.  Too much death!
I sit here hoping for the day when Jesus will come back to get us all.  Rev 21:4 says: “and He will wipe away every tear from their eyes; and there shall no longer be any death; there shall no longer be any mourning, or crying, or pain; for these things have passed away.”
One day, when Christ comes, we will not have pain, sorrow, or death.  I pray that day come soon.  I’m tired of all the death and sorrow of this planet.
Greg

136b
Audrey here.  After Greg came home (and wrote the above follow-up) we prayed for the families of those who had just died. We reflected on the day, and prayed for sleep to come for us.  Two hours later I was called back in because Baldina’s wife was convulsing.  Apparently she hadn’t slept for about 5 days and had been crying hard for the past 2 hours. If finally took it’s toll on her. I gave her something to calm her and allow her a long sleep.  I too was unable to sleep after returning home. I reflected on the day.  Earlier that day, three children had died almost immediately upon arriving to the ER.  They were brought in about 4 days too late (which unfortunately is not unusual).  Five deaths within 12 hours.  Too much!
The following day was Friday. We had a lot of patients to see, both in clinic and in the hospital. After seeing them all and finally getting ready to go home, I started hearing someone crying outside the window of the ER. I looked outside and heard more wailing coming from the Adult Ward.  I ran over to find out what had happened.  The nurse said that Sali, an old man that had come in that morning with pneumonia, was taking his last breath. The family was wailing even before he was dead.  I examined him as he breathed his last.  I helped the family get his things together and return unused medication. As I was leaving the ward, another nurse asked if I had gotten all of Tize’s things together. I asked what had happened to Tize.  She said that was the man who died and his family was wailing.  He was a young man, around 36, who came in with abdominal pain but was getting better as of about two hours before.   Two deaths within five minutes of each other.  Two hours earlier, ne
ither looked like that day would be his last.  That brings the death count to seven within 24 hours.  Too much death and illness!!!  Greg and I finished up work (which at that point felt like it was never going to end) and walked home in a daze.  We got on the motorcycle and drove into the mountains to clear our heads.
Please pray for the families of these seven patients. Please pray for the emotional state of our workers who have had to deal with all of these deaths in addition to working overtime and covering for co-workers who are sick. Please pray for us to be able to hang in despite the grief, guilt, frustration, and fatigue.  Only God is able to sustain us during times like these. – Audrey

#135 Shanksteps – She dances too much!

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#135  Shanksteps – She dances too much!

“She dances too much!”  That was the reason that Pamda’s son brought her in to the hospital.  He was called by the other members of the family saying that his mother was ill and that he should come quickly.  So, he traveled the 8 hours from Garoua only to find his mother if good health, if not TOO happy.  The rest of the family said that she would be okay one minute, the next she was talking non-stop to people they couldn’t see, and would start dancing and singing.  This had been going on for several months and was disturbing to the family.

Sitting in front of me in my office was a cute little old lady covered with wrinkles from many years working in the sun. When asked a question, she got very animated and talked so fast I wondered how anyone could understand her.  She was obviously still very spunky.  I asked her son if she had been that talkative all of her life and he replied that she had.  I asked her all sorts of questions about her dancing and singing; about her religious background and beliefs; if she saw and heard things that others did not; if she was bothered by what was happening to her.  At first she seemed like she didn’t know what I was talking about. Little by little I guess she realized that she could trust talking with me (or at least that I understood a little of their beliefs) and started to open up to me about what had been happening. She said that although she was a Pagan, and believed in the spirit world, that she never had and never would “sacrifice” any of her friends or family for her o
wn wants and needs.  Someone like that is somewhat unusual to find within the Mafa culture.  Recently she had “unseen” visitors telling her to do some things that she didn’t want to do, and made her feel guilty. They would then tell her to dance and sing or they were going to be very angry and possibly take her life.  She said that she did all of this against her will, but was afraid to stop because she didn’t know what would happen to her.

Fortunately her son was a Christian.  We spent a long time talking about the evil spirits versus the good angels.   We discussed how God is much more powerful than these spirits and that HE could protect her from future attacks.  I reminded them that although we are in an (somewhat) invisible war, that Jesus has already paid the price and won the war.  We pondered over possible avenues that the spirits were allowed in to torment Pamda.  In the end, Pamda decided to trust that God could save her from her tormenters.  Her son considered taking his mother back to Garoua with him so “spirit worshippers” wouldn’t be surrounding her, and so others in his church could pray her.  Before they left, my translator and I both prayed for Pamda and her son to be cleansed and protected from further tormenting.  I don’t know what the future will hold for Pamda, but I have agreed to pray for her continually.  I have asked her son to send news from time to time. Please pray with me that Pamda
finds Peace in the arms of Jesus.
In His Mighty Grip,

Audrey

#134 Shanksteps

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#134 Shanksteps
I walk into the hospital not quite feeling all-right.  Audrey asks me to stay home, I won’t!  I have had a runny nose and feel achy all over for two days.  I did the malaria test and typhoid tests, both of which were negative this time.  The day before I did not have the stamina to last all day like usual.  So I decide at least I will go in and make rounds on maternity/surgical ward as I usually do.  I feel tired but know I can at least do this.  I woke up with a fever of 102*F.  Now it has come down after some Tylenol.  I make rounds, sitting down often on the patient’s beds to talk to and examine them.  After rounds the administrator asks me to do one administrative thing with him before I go.  He and Audrey are in cahoots to get me out of the hospital.  I’m not entirely full of “fight” anymore and decide to go home after helping him.  Then there is the all too frequent call to the urgence (ER).  Kalda has a patient who he thinks I need to operate on.  So I saunter over the
re.
The teenager is lying on his back with abdomen exposed.  He is a thin guy but has a very protuberant abdomen as I see him.  He has slightly sunken eyes.  I feel for his pulse and it is rapid, I count-128.  His father has brought him into the hospital after being berated by one of our nurses to come in.  He has been at home 4 days without any bowl function.  He is completely obstructed.   I find no hernias, no previous surgery, and no starting point for the pain.  The history taking is less than optimal, but as I re-ask he questions I’m getting no further.  I give up and examine him.  He is tender to palpation and as I thump on his abdomen he winces in pain.  At least it is clear what I need to do’ Operate!  I have them send him over to the OR and ask Jacques to get him ready.  He calls me a half hour later saying all is set to go.  So I meander to the OR, gulp down some water and scrub.
We pray for him, as we usually do before starting surgery.  I open his abdomen, skin, minute amount of fat, fascia, peritoneum.  Dark purulent fluid runs out.  I’m glad I didn’t let my own feelings keep me from doing what I needed to for him.  As I open further his intestines burst from the incision, being liberated from their confinement.   As I explore inside I find a black piece of tissue in his lower abdomen with stool coming out near by.  I realize that his ileum (last part of the small intestine) is necrotic and isn’t even visible as a structure any more, but on both ends of where it used to be there is open small bowel and the same where it used to be attached to the large bowel.  Everything else is dark and has the characteristic red rash appearance of typhoid.  Typhoid is likely the real culprit.  I bring out two ostomies because of all the fecal contamination inside.  We irrigate repeatedly, but then again, what can really get rid of this contamination?  After clos
ing and putting ostomy sacs on the ostomies he goes out to his room.  I sit to write the note and suddenly feel very tired.  I go home, have a fever of 101.5 and sleep covered with many blankets even though it is 90 in the house.
I am comforted by the fact that God gave me the strength to make it though the surgery even though I didn’t think I had it in me!

In His Service, Greg

#133 Shanksteps

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Like most women here she started labor at home. It was her first. Her husband went away because it is shameful for the nomadic women if their husband hears them cry out in pain during delivery. She had contractions and around midnight two days ago she broke her water. Then her labor stopped. The following morning she went to a local health clinic and was watched there for some hours. In the afternoon they referred her to the hospital for better care. I evaluated her, felt she had sufficient room to deliver and decided to wait a few hours. I instructed the nurse to call me if the labor didn’t start again. She was more dilated than when they examined her at the health center, so I felt she was progressing even though she didn’t know it. We were called to see others during the evening and I forgot about her. The nurse never called and I slept fitfully. At 4 AM I awoke to banging and crashing sounds. There was a strong wind storm and thunder in the distance. Tree
branches rubbed and crashed on the tin roof making a terrible racquet. Dust was flying heavily in the air and I felt sand all over the bed and between my teeth. I closed up the windows to the house but it was a little late. Every step left a gritty feeling under my feet. I finally drifted off to sleep again.

At morning worship they talked about the woman who was not progressing in labor. She had now been more than 28 hours after breaking her water, too long! I asked Jacques to check her out, and if she was not close to delivering to take her to the OR and get her ready for a C-section. He called me a few minutes later and said she was in the OR, ready. The power was out since the windstorm and so we started the generator. It started and we began the surgery. Audrey and I pulled out a crying baby and were happy that we had done it early enough to save the baby.

I made rounds on the maternity ward. The boy with the puncture wound to his head is doing well. I tell the family that it is God healing him that is keeping him alive, they smile and nod even though I think they do not believe in God. I am thankful I do, and the He is healing this boy! I see the others and then go to the office. In the office I see about 12 patients. Then the next surgery is finally ready. Three hour turn over! I’m frustrated, but go back to the OR. Frustrated mostly because I expect that it will take about 4 hours to take out a pelvic tumor on this next patient, and it is early afternoon.

Audrey and I start the surgery and we find a lot of small intestine stuck into the pelvis to the top of the mass. After much dissection we determine that it is a huge hematoma, likely an ectopic pregnancy. I guess her having a period a few weeks ago was not correct. We evacuate the hematoma and remove what was left of her blown out uterus. She didn’t want any more children so it made it an easy choice.

Audrey, Jacques and I clean the OR as the cleaner has already left. Then off to the ER to see what patients were waiting for us. We see a large row of people still there. It is about four patients with many family members. We see them in each of our offices. Yaouke, the nurse from maternity comes to my office. He asks me what I want to do with the man that came over with the infection near his scrotum, it smells so bad that the patients are leaving his area because of the odor. I had not heard about him. Someone thought that I had. I went and looked at him. The odor hit me about 100 ft before I arrived at the building. I put on a mask to not show my facial expressions. Lifting up the cloth over him, I see a black area on his perineum. I touch it and feel bubbles under my gloved finger, gas gangrene (Forniers Gangrene). He needs to be operated on right away. He has about a 40% mortality if he were in the US and getting good ICU care. I believe his chances are m
uch better here as we will be praying for him. I take him in the OR. As we go through the doors I fight off the mass of flies trailing him. Only a few make it in the OR with him.

Dr. Okudire and I start the debridement behind his scrotum. Brown, foul smelling fluid runs out. We take off a huge chunk of skin all the way down to muscle and down to anus. There seems to be an area tracking up in his inguinal region. We follow it up. We are now on his lower abdomen. The skin looks normal but the infection runs along his fascia (necrotizing fasciitis). We resect more and more. Off come layers of muscle, fascia and more muscle. The infection is deeply seated. We end up debriding off all the skin on the right half of his abdomen up to the right nipple. The infection skims along on his ribs up to here than back to his right back. Finally we get it all open and removed. Raw muscle and peritoneum are showing everywhere. It looks like an anatomy lesson on a live patient. I put dressings on it and we clean the OR thoroughly. I wish I had done it somewhere else. Will I have wound infections with my other cases now? I say a prayer for him again and
give instructions to Ganava. He will be taking care of him tonight. “God, please send your angles to keep him safe and please heal him of all this infection and the insult I have just created.”

I head home to a loving wife and rice and white beans. The salad is wonderful, fresh vegetables!!! I eat my first meal of the day at 7:30 PM. I guess all those pounds I made in the US are keeping me going. I think I gained about 15 and have now lost about 5 already. It is amazing to me how resilient we are. I can gain and loose weight, and this man can live in spite of the odds. Pray for his recovery.

In His Service, Greg and Audrey