Sunday 30 October 2011

Lifting my eyes to the hills


There was a cardiac surgeon called Prof Hart who died and ended up at the pearly gates.  There was a massive queue and he was used to getting everything when he wanted.  He went up to St Peter, “I’m a professor in cardiac surgery, please let me come in,” he said.  “Sorry,” said St Peter, “but you need to stand in line with everyone else.”  There was also another late doctor there – Dr Jones, an eminent oncologist who had spent a lot of time developing cancer treatments.  He also went to Peter and explained, “I’m a famous doctor and oncology researcher.  Please let me in.”  Again St Peter told him he must wait like everyone else.  A few minutes later up walks a man in a white coat with a stethoscope around his neck.  He goes up to St Peter who gives him a smile and lets him straight in.  Prof Hart and Dr Jones muttered amongst themselves for a few seconds about how unfair this was and decided to confront St Peter about this.  The reply: “That was God.  He sometimes thinks He’s a doctor.”

This is not the most well told joke ever, but it does point out how we can try to place ourselves in God’s position.  Especially as doctors, we tend to be people who need to fix things and make things better.  This isn’t always possible.  Even when we do good things and “fix people” is it really us?  The motto at Tenwek Hospital is “We treat, Jesus heals”.  God is supremely in charge.  No-one else, including doctors, lawyers or even politicians.  We also automatically by having the title “Dr” gain some recognition and status.  We need to remember that it’s still Jesus who does the good work. We are just the vessels that he uses if we let Him. 

These last 2 weeks have been the toughest so far.  I was on call at the weekend – a full 48 hours, which I’ve never had to do before.  I also covered another 2 nights (though one I slept through) and had to go into the hospital on a night where someone else was covering for me because there was too much going on for her to handle alone.  Here is a selection of things from the last 2 weeks:
·         A 12 year old with meningitis who crashed twice, the second time we were unable to get her heart going again.  If she’d come a couple of days earlier instead of going to a dispensary where she was treated for the wrong thing it might have been a different story.
·         An 8 year old with probable anaphylaxis from a penicillin injection that she’d had before with no problems.  She was intubated on ICU, but she died later that day from problems with her airway (which would not happen in the UK or US).
·         A 3 month old with HIV we are treating for PCP, meningitis, severe oral thrush and severe malnutrition.  She has a history of very little feeding for 2 months.  (That’s 2/3 of her life!)  She got acutely worse last Saturday evening, but is somehow still alive although the effort that goes into every breath is massive.  Please pray for her and her mum (who has already lost 2 children).
·         A pregnant lady was brought into casualty by her neighbours after being in labour for an unknown long amount of time.  She didn’t have a pulse.  After commencing CPR on mum the baby was delivered by section.  Unfortunately the casualty/OB team could not help mum and we were unable to save the baby.  There was a large uterine rupture and apparently the mum’s abdomen was full of blood.  Again, if she’d come in earlier both would probably be alive now.
·         An 11 year old girl came in recently diagnosed with HIV.  She weighed only 13.5kg!  5 months ago she weighed 26kg.  She was being treated for sepsis.  She was one I saw in the very early hours of Tuesday.  Unfortunately she died on Tuesday night. 
·         A lady who was 32 weeks pregnant was kicked by a donkey and came in.  The following morning she delivered her baby who was fine.  Then we found out there was another baby still in her uterus.  (Many women don’t have scans during pregnancy although antenatal care is available.)  The second twin was delivered by Caesarean section and refused to breath….we bagged for 1 hour (probably too long), a while after that the baby started gasping and then started breathing about 5 hours after birth!  Unfortunately she still died 3 days later.

There have also been a number of other deaths in the past 2 weeks both on the ward and in the nursery.  Some are patients I had nothing/little to do with, some are patients I’d been very involved in.  With the latter there are always many thoughts going around your head.  “Did I miss something important?”  “Would someone else have done it better?”  “What did I do wrong?”  Really the most important thing to know is that you’ve done your best and trust in God’s sovereignty that He has everything planned out.  There is the freedom and actually the expectation here that you will pray with patients.  For me this is as important as the other things you do for each sick child.  The chaplains are invaluable, but to pray with patients and their relatives myself is so important, trusting God that He will take care of the child.

There have been multiple times in the last couple of weeks where I just felt so inadequate. (Note: this is different from incompetent.)  In the times of emotional stress and physical tiredness from lost sleep I saw how God started to show some of His strength through my weakness.  When we feel like we can do everything, we place ourselves where God should be and we think that we don’t need Him because we can do it ourselves.  That’s the temptation anyway and a very real trap we can fall into.  For example, on Tuesday night Leya was doing the full call by herself (normally I do the call, but call her if I’m unsure of anything, but have never rung her at an awful hour) as I’d not been 100% well for a couple of days.  At about 2.30am I was paged and directed it to Leya with the thought, “Thank goodness I’m not on call, I just can’t do it.”  By that I meant physically, emotionally, everything.  However, by the time she called me, only a short time later to go in to help her, somehow I had the energy to get up, go into the hospital and help a very sick child.  This can only have been through God’s strength and his power.  When we are weak I think we have 3 choices – give up, struggle along as best we can, or look to God.  I am thankful to say that I did the last of the three. 

At my lowest the other day, God reminded me of Psalm 121:
“I lift up my eyes to the hills.  From where does my help come?  My help comes from the Lord, who made heaven and earth.  He will not let your foot be moved; he who keeps you will not slumber.  Behold, he who keeps Israel will neither slumber nor sleep.  The Lord is your keeper;  the Lord is your shade on your right hand.  The sun shall not strike you by day, nor the moon by night.  The Lord will keep you from all evil; he will keep your life.  The Lord will keep you from all evil; he will keep your life.  The Lord will keep your going out and your coming in from this time forth and for evermore.”

However, I’m going to end the work stuff with a good story.  This boy in the picture below came in with bad tetanus the week before last.  He was admitted to ICU originally, but was moved down to the ward a couple of days later.   With the help of large doses of diazepam he has gradually been able to move more and more and is now eating and walking.  Every time we saw him he would open his mouth to show us how much more he could open it.  Although he still has a way to go, he got to go home on Friday. 
I have also been struck by how happy some of the children on the ward appear, even those who are stuck in traction for weeks will sometimes always have a big smile on their faces.  I find this really humbling.



On other subjects, it was my birthday about 3 weeks ago.  I had a really good evening!  It was also Jonathan Bacon’s birthday.  (He’s an orthopod here for 6 months.)  We were invited round to Leya and KE Mathew’s apartment for dinner.  (Leya is possibly the best cook I’ve ever met and makes the most gorgeous authentic Indian food.)  Then we had cake and ice-cream with all the guesthouse people and then watched a film, The Gods Must Be Crazy, which is set in Africa in about 1980.  It is really funny, but does make you think a bit as well.  I definitely recommend it.  Thank you to those who sent, or attempted to send, cards and parcels.  I felt very loved that day both by people here and those at home.



Thanks:
·     That there has been a larger paeds team than normal the last 2 weeks which has helped with the workload
·         The God reigns supreme and is always there for us
·       For the prayers from everyone at home and those I’ve met here who I know are praying for me even after they’ve left.  (Seriously, I can tell.)
·         For those children who have got better and all the babies we’ve discharged from nursery/NICU
·         For the new friends I’ve made here over the last few weeks

Prayers:
·         Please pray for the interns here.  There are currently 15 (which is 1 short causing them to have to do extra calls).  They work so hard and get no annual leave.  They get 7 days off a month, but they have to round in the morning on 2 of them, so 5 full days and 2 half days.  They work so hard serving God.  This should be the last rotation for most of them, but some are having to do an extra 3 months as the next lot of medical interns don’t start till April.
·         For good rest in the times when I’m not working.  Especially on safari next weekend.
·         That I will continue to rely upon God and find my identity in Him more and more
·         There are a lot of sick paeds patients at the moment – please pray for them.
·         That the things I learn here will not be left here, but will have an impact on me after I return home
·        For continued protection over me.  I wasn’t completely well on Monday or Tuesday, but am now back to full health. 

Monday 3 October 2011

The days of room 3

Today was the day that I was promoted from room 3 downstairs in the guesthouse to apartment 1 upstairs, hence the title of this entry.


I am now settled at Tenwek having been here almost 3 weeks.  I find it strange to think that for some people that would be the end of their time here.  There has already been one couple who've come and gone within the time I've been here so far.  The turnover at the guesthouse is pretty quick, though some people can stay here for a few months at a time.


I'm learning a lot whilst I'm here.  I'm learning how to act in a more senior role, reviewing patients who've already been seen as well as seeing patients myself.  I'm learning general paediatrics (albeit slightly African stylee) with some neonatology thrown in.  I'm learning more how to praise God for everything and trust in Him more in my everyday working life.  I'm learning how it feels to be really rich.  And I'm sure I'm learning more than this.


The feeling rich thing is interesting.  I'm not badly off by any standards in the UK, but here where there are some people who have so little it becomes really obvious.  Practising medicine here is very different from the UK.  You have to consider every test that you order and every medication you prescribe.  The patient has to pay for each thing.  There is a national insurance scheme that some patients have, but not all.  I think this makes a better doctor in some ways.  It can be so easy ticking a load of boxes, but then to think about whether you really need everything that you've ordered.  There's the new CT scanner (which we're waiting for approval to use at the moment) which is going to cost about £40 for patients to have a scan which could really help their treatment.  Even at a price that cheap, so many people will not be able to afford the scan.  We take CT scans and MRI scans and even nuclear medicine scans so much for granted in the West (even if sometimes you end up arguing with a scary radiologist to get them).  Although it has so many problems, the NHS really is a good thing at its heart - everybody being able to access free healthcare at the point of access.  It doesn't matter whether you are thousands of pounds in debt or a millionaire, you can still get the treatment that you need without having to worry about a massive bill.  I've been getting so used to a nice amount of pay entering my bank account for the last 2 years and taking it for granted, but being here reminds me how fortunate I am to have that.  But also that money is not anything to have security in.  The recession has shown that!


I'm also learning a lot being part of a Christian ministry at work.  There are doctors' devotions once a week on a Wednesday morning.  Last week one of the interns led it and what she said was just so inspired.  She basically was talking about how everything we do should be for Jesus.  We ended by singing a song together.  I just felt that it was a really powerful moment with nearly all the medical staff there praising God and dedicating their work to God together before starting work.  I find being able to pray for patients openly on the wards quite freeing.  I don't think that I'm doing it quite enough at present, but as the motto of Tenwek says, "We Treat, Jesus Heals".  This actually is the attitude of the staff here.  All we can do is love the patients and try to make them physically better with medications, surgeries etc, but it is God who really does the healing.  We can just try to be His representatives on Earth, but remember to give Him the praise for the things that He blesses us and our patients with.


A couple of Saturdays ago I went to a place called Kisumu which is Kenya's 3rd largest city.  It is on the banks of Lake Victoria.  We had a very relaxing few hours when we got there (following 3 hours of Kenyan driving, though I trust Donald's driving completely), sitting by the lake and eating yummy food.  We also went to a large supermarket called Nakumatt ("You need it, We got it") where I bought Nutella amongst other things.  It was great to see more of Kenya especially during the journeys.  I would have liked to have stayed there overnight really.


Prayer time
Thanks for:
- keeping me safe and well
- the internet and electricity working better
- that I've been able to switch rooms
- that I'm settled here and starting to make friends
- all the children who've come in and been able to go home again
Please pray for:
- protection over my mind and body
- me to hear clearly from God about His plans for me for this year and the future
- the children on the paeds ward and the babies in the nursery/NICU.  Especially for an 18 month old girl who came in really dehydrated and is still not very responsive.  There's also a baby in nursery with congenital heart disease who's requiring quite a lot of oxygen and we don't know if we're going to be able to do anything for it (although there is a cardiac surgery team coming in November).
- the interns at Tenwek as they start their last rotation
- for God to use me as a tool to show people His love