I just wanted to give you a short update on the 10 month old girl I did a tracheostomy on before leaving for the conference in the US. When we left we took her to another mission hospital in Maroua. They took care of her for the days that we were gone and when we came back we picked her up and brought her back to Koza with us. I did a bronchoscopy on her yesterday and her airway is slowly opening up. she still cannot breath through it well enough to be without the tracheostomy. Please continue
to hold her up in prayer that her airway will heal in a way that the tracheostomy can be removed and she can grow normally. In HIS Service, Greg
Shanksteps #108
Shanksteps – Fasting
I had just finished a book by Paston Jentezen Franklin on fasting that morning. In it he discussed how the Bible encourages us to fast to become closer to God. I had decided earlier that week to start a fast, and was now on my seventh day without food, only taking water and juice. It really did make me more “tuned in” to the things of God. Greg and I woke up early that Wednesday morning because he had to leave to go to Maroua to attend a two day meeting for all the directors of the hospitals in the North of Cameroon. After he left, I read, and had my worship and prayer time. During that time I had a “feeling” that a woman would come in that day in need of a C-section. Now, I want you to realize that that has been one of my biggest fears since arriving in Cameroon; for a pregnant woman to come in distress in need of surgery, and Greg be gone. I had scrubbed on many c-sections in residency for this very purpose, but had never before needed to do one on my own – as I always “consulted the surgeon” when cases came in needing surgery. So, that morning, I told God that if He did indeed send someone my way, I would just trust in Him.
The day started like any other, with lots of kids to see. Fortunately, many of the kids had gotten better and I was able to discharge a bunch of them. I saw several people in clinic after finishing rounds on the rest of the hospital. All in all, everything had gone really smoothly. Right up to the point where the guard for the hospital came and said that he needed the key to the operating room. I asked him why he would need the key to the OR, but not the doctor, and he replied, “Oh, they need you there as well!” So, I went, not having any idea where the keys to the OR were. What I found in the delivery room was a woman who had just delivered a live baby girl, but the hand of the second twin was protruding from the vagina along with the umbilical cord of the first twin – the second twin was TRANSVERSE! I called Greg and told him to pray. There was no way of delivering this child vaginally, so we quickly wheeled her to the OR (through the nurses call room – as I still couldn’t find the key). Just as we got her on the table, Ganava came to assist me (he also had the key to the suture closet). Kalda gave her Ketamine anesthesia as there wasn’t even enough time to get sufficient fluid in her to do a spinal. As we were getting her prepped, I noticed that she already had a vertical C-section scar. “Oh great!” I thought, she’s going to be all scarred down, and I’ve never opened vertically. I called Greg a second time and he said to go in through the old scar and walked me through what to do, and again said he would pray. We prepped the woman, I said a prayer that God would get us through this ordeal, and started. I won’t give you all the details, just that EVERYTHING was scarred together. It was difficult to identify any normal layers. The uterus, which is usually paper thin, was already contracting after delivery of the first twin, and was almost 2cm thick. Even after doing many c-sections in residency, I NEVER was allowed to open the uterus (legal reasons), so this was my first time. I wrestled with my hand inside a contracting uterus, trying desperately to get the baby out. Finally I could feel it coming, a boy! A boy that was not breathing and floppy. I sucked out the mouth and nose, and stimulated the child until I thought I might rub his skin raw. Finally, the sound every OB enjoys hearing, a cry! I passed him off to Kalda to clean him up and weigh him. Now I had to deal with a very thick bleeding uterus. I put ring forceps all around the edge and did my best to close up the uterus, suturing through as much thickness as I could, realizing after closing the gaping hole in the uterus, that I would need to do a second later to include the true full thickness. Finally all the bleeding stopped. I then tried to approximate the fascia, but it was almost impossible to identify the layers with all the scarring. After checking and re-checking, I was finally satisfied with the closure. Finally, Ganava said he would close the skin for me, and I could write the orders and the procedure note.
When I finally got home, I was more tired than I can remember being in a long time. I was also very hungry. I spent a long time in prayer and thanksgiving to God, then ended my fast, on my 8th wedding anniversary, alone, but more at peace than I could remember being in a long time. I thank God that He once again “gently” showed me who was in control. Thank you all for your continued prayers for us and the people of Koza. -Audrey
Thanks for praying for us!
I want to thank all of you for praying for us. The passports were retrieved the day before we left and sent to Maroua. As we traveled through Maroua we retrieved them and continued on to Chad to leave. Thank you so much for your prayers. Greg
Shanksteps #107
Shanksteps #107
I’m being shaken awake by my wife. “Wake up, get up”. It was 11PM. I had just fallen into a deep sleep. i hadn’t heard the knock on the window. She had, and had gone into the hospital, finding a 10 month old who’s breathing could be heard outside the building. “Come in to the hospital, I think we need to do a tracheostomy”. Well that got my attention. I don’t have equipment for tracheostomies except a few sizes in adults. This was a 10 months old. She had apparently taken some rice grains
and tried to eat them but inhaled them instead, five days before. Since that moment she had breathed terribly and now was much worse. I crawl into cloths acceptable for the hospital and walk into the ER with Audrey. A small girl is breathing about 50 times a minute. At every breath her small chest is retracting and all extra musculature is helping her to breath making a LOUD wheezing sound at each shallow breath. she will not last long like this, I agreed. It IS necessary. We had been up since
three the previous morning and were still groggy. We quickly took him off oxygen and headed to the OR calling for the nurse to come do the Ketamine anesthesia. She dropped her oxygen rapidly during the transfer to the next building. The oxygen was replaced and the respirations again dropped from 70 to 50 (a slight improvement, but still very bad). I selected an endotrachial tube to modify and place as a tracheostomy. The girls neck was opened above the sternum. We slowly dissected down, attempting
to make this as bloodless as possible, so as not to drowned the trachea when we opened it. We made a “U” shaped incision in the trachea. Immediately, extensive coughing produced a significant volume of pus from the lungs. After suturing the tracheostomy open I performed a bronchoscopy. I aspirated pus from both lung bronchi. then I scoped upwards. It was difficult to see but something moved. Afterwards I examined the larynx. There lay a dislodged piece of rice. Everything was very inflammed
and edematous. I placed the modified tracheostomy tube into the trachea and sutured it in place. She was breathing normally at 16 breaths a minute.
After finishing my notes and placing the patient in her room with oxygen I headed towards home. I fell asleep dreaming of having a respiratory therapist. One and a half hours later I was awakened by “the knock”. She was breathing difficultly. I ran in, finding that the tube was nearly plugged with dried secretions. I suctioned them and she started breathing better. I told the nurse that if she was breathing badly or desaturating to call me. OR if it completely plugged and the patient was dying
to cut the sutures and remove the tube. I was called an hour later. It was plugged and he had cut the suture and pulled it out. I arrived to her breathing calmly without a tube.
Today was Sabbath and I have spent much of the day worrying about her and making sure this stays open. i pray that the swelling in her throat will go down rapidly so she can breath normally from above again. I’ve tried to sleep but it would not come. Wasted but unable to sleep, I continue to think of her. Lord help her live! In His Service, Greg
