Thursday, July 20, 2017


Today we are celebrating. Today we are throwing a party. It’s only fair. It’s payback. And you know what they say… Payback’s a bbbbbbbb….. birthday party!

There were really only two reasons I was ever popular in high school. One, I had a van. And not some piddly minivan. No, I had a full-size conversion van. Four captain’s chairs, a back bench that became a bed, and room for half a dozen sitting on the floor! It usually stored my bicycle, my kayak, my camping gear and many random other things. But on occasion, when folks wanted to go some place and all wanted to go in the same vehicle, my van was their go-to.

I always kinda imagined their discussions going like this, ‘Hey, who wants to go bowling!’ ‘Great idea! Let’s go bowling! How many of us are there? Like a dozen or so? Hmmm… does this mean we need to invite Olen again? Let’s draw straws for who has to call him.’

I wasn’t present, and on confrontation they never admitted to these conversations, and my therapist thinks I’m paranoid to this day, but there’s certainly no proof to the contrary.

At any rate, the ability to pile a dozen or more friends into my van was one of the reasons I had any degree of popularity in high school.

Secondly, and more importantly, I had the cool mom. Not just A cool mom. I had THE cool mom. And no, she never bought us booze or weed, but then again, we never asked her to. But my mom was the life of the party. My mom WAS the party. Whereas most teenagers cringed at the thought of their mother hanging out at their parties, I knew I needed it to keep people there.

In case you think I’m exaggerating, consider the evidence. One year, my mom called all my friends (more simply defined as ‘the people who frequently rode in my van’) and invited them to my birthday party. Not impressed yet? She called them and informed them that I was out of state traveling with my grandfather, but that she was throwing me a birthday party anyway in my absence. No lie. Still not impressed? My friends all came!!! And later told me what a great party my mom threw! Without me!!!

The next year, I called my friends myself to invite them to my birthday party, informing them quite clearly that I would be present in-the-flesh this go round. Their response? Each one asked, ‘Yeah, but your mom will still be there, right?’ before being willing to commit to my party.

My mom was the one who cooked, who planned the games, who decorated, who made sure everybody was having fun, who made sure the party kept its forward momentum, who cleaned up afterward, who did it all. Had we run out of soda, she probably could have found a way to work a miracle with tap water too. But of course, we never ran out of soda.

I had the mom who worked as an obstetrical and gynecological nurse, so she knew all about sex and she knew how to curse like a sailor, although always graphically accurate cursing and never in anger. If it was a vulgarity that technically referred to intercourse, it was used only in reference to intercourse. If it was a colorful word for excrement, it would only be used in reference to actual excrement or the act of defecation. If it was a female dog, my mother much preferred the efficiency of a certain single-syllable B-word as opposed to wasting all that breath saying ‘female dog’. Her curses were really just impersonations of a thesaurus. Ever the educator.

My sisters and I will always remember the time she actually lent herself to wrathful verbal outburst. My cat, Tatter, had once again gotten into the butter and was racing out of the kitchen with my mother hot on his heals. (In my memory, of course she has curlers in her hair and a rolling pin in her hand, but that may be exaggeration.) My mother, desperate to release the steam valve of anger building in her brain, blurted at the top of her lungs, ‘Tatter!!! You bbbbbb……. BAD BUCKET!!!’ Despite the million instances of four-letter words easing out of her mouth with the chill and smoothness of flowing lava and the technical accuracy of a German timekeeper over the years… this… ‘Bad Bucket’… was the greatest epithet she could manage.

Another time, I met my mother in the parking lot at the university when I was finished with school and she was finished in the nursing department. No sooner had I closed the door than my mother turned to me and said, ‘Feel my breasts.’ No sooner had she put the final ’s’ on ‘breasts’ and I had the door open again. ‘No! They’re in the backseat! Tell me if they feel right.’ Turns out, she had silicone breasts in the backseat for nursing students to practice physical exams and feeling breast masses. I kindly reminded her I had not much experience with breasts since abandoning breast milk at age one. ‘Well, then familiarize yourself. Get in the backseat and see if you can feel the lumps.’ This story is still one of my therapist’s favorites. He keeps coming back to it.

As payback, there was a several-year prank I pulled on my mom, and I even got my sisters to go along with me. Fresh off a horrible experience with a girl in college, of which my parents knew nothing, I was in no mood to discuss the ladies over Christmas break with my parents. One evening, while my mother was haranguing me to find a lovely girl, I told her I had decided I was gay and I would be going to bed presently, and then I immediately retired to the bedroom. My sister, unbeknownst to me, had also implied similarly to my mother, thinking my mother understood it to be a joke while my sister was trying to get out the door in a hurry. Confessing this to me, my sister offered to amend for her sins and correct any misperceptions my mother might harbor. I declined my sister’s offer and decided this could work to my advantage.

Not to pass any judgement on either my parents or those who are homosexual, one must understand that homosexuality was not anything my conservative Christian parents would have willingly chosen for their children.

Before Christmas break was finished, my mother and I set out, just the two of us, on a cross-country trip from California to St Louis, alone in the car for days. My mother, completely capable of keeping conversation going for days on end, was unusually silent and deep in thought, taking in the vast and beautiful deserts of Arizona. Suddenly, she asked, ‘You know, Olen… Do you ever wonder if you’re gay?’ To which my most rational reply was, ‘No, Mom. I don’t need to wonder.’ I could see my mom playing over and over in her mind a list of my closest friends, my years in glee club (errr… choir), and those years of Home Ec I took as electives in high school (free food!). Silence and desert continued until Texas.

A year later, my senior year of college, I was falling head over heels for a girl, K, yet completely lost as to what to do about it, since I was graduating in a few months and she still had years of college left. During this awkward phase, while the girl and I were determining what to do about our mutual attraction and impending separation, my mother came to pay me a visit. Picking her up from the airport, the girl accompanied me and got to meet my mother, again. She was re-introduced as ‘my friend, K’. (My mother had already met her a few weeks before when she came to visit my house with a group of friends.) 

The next day, on a walk with my mother, Mom couldn’t stop raving about the myriad virtues of K. ‘Oh, she’s just so beautiful, but you can tell K’s really so much more than just a pretty face. Oh, I know she’s just sooo smart too and what a wonderful personality, and…’

I had to interrupt. ‘Mom. You know she and I are just friends, right?’

‘Oh.’ And here the girl had already passed the no-penis test and everything too.

It wasn’t until 2005, six years after the first misdirection, that my mother met the love of my life, a girl named Danae. By then, I think my mom was actually looking forward to being the loving and accepting mother of a gay son. In fact, I think I noted a tiny twinge of disappointment upon learning that Danae was, in fact, born a girl.

In case you’re feeling sorry for my mother, shame on you. For one, don’t be homophobic. For two, oh… Mom had gotten me on PLENTY of pranks. Don’t you worry one bit about that. My revenge was but a drop in her bucket of creative mischief. In case you wonder where any mischievous bone in my body came from, you needn’t look far.

One of my mom’s favorite and most enduring pranks was making me sandwiches with special ingredients. No, the special ingredient was not love. Well, maybe there was love in there too. But Mom enjoyed hiding things in my sandwiches. Things like giant globs of dijon mustard in the middle of a peanut butter and jelly. Or giant globs of jelly in the middle of a veggie burger. Or a pickle in the middle of a peanut butter and banana. Then she advanced. She’d put dollar bills in sandwiches! Her pranks started to get expensive. Or coins! Things not approved by the department of child protective services. Or toothpicks! My friends would always ask, ‘What did your mom put in your sandwich today?’ That’s Mom. Always making me interesting and popular. Leaving my friends wondering if it was intense love, or an effort to dispatch with me and collect on my generous life insurance policy.

My parents left me an empty-nester when they moved from Berrien Springs to Silver Spring, leaving me alone in our unsold house at the age of 17. I think it’s maybe the one thing my mom might still feel guilty about. It was the right decision for them to go where Dad’s dream job was. And it was the right decision for me to stay and finish my senior year where I had spent the last five years and where I’d be the next year for university anyway. But that knowledge didn’t make it easier. 

Mom drove out to visit as often as she could, but I no longer had the cool mom. Well, actually I still did. But she was a lot farther away. Interestingly, it still didn’t stop my friends from hanging out with her, not only when she came to visit me, but also when I went to visit her. I often drove all Friday, getting in early Sabbath morning to my parents’, then leaving again Sunday night, getting back to Michigan in time for school Monday morning. So many friends wanted to drive home with me on these lightening trips, eager to spend some quality time with my mom again. I had to turn friends down for lack of room in the car.

Some of these trips would be planned, and some would be the spontaneous surprise type. Invariably, a surprise visit would bring us in to Maryland in the wee hours Sabbath morning. My friends and I would go to where beds were typically available to find strangers already occupying them. In the morning, Mom would explain, ‘Well, so and so was in church and needed a place to stay. I just met them.’ Or ‘My old friend’s previous dentist’s vet treated this guy’s neighbor’s dog for venereal disease, so it’s like we’re practically family! So they’ll be staying here until they find a new place (or new job or new spouse or or or).’ My friends would not be disappointed to discover that my mother was still my mother and we would happily pass the weekends on couches.

In addition to Middle Eastern hospitality, my mother taught me about parenting, that it’s fine to love, it’s ok to screw up, you always need to forgive, and even parents need to ask forgiveness when they screw up. She taught me that children should always be having fun, even when learning responsibility. She taught me the value of travel and expanding your worldview. She taught me the value of service to others. She taught me to try and mess up and try again. She taught me to be a productive member of society, but that career wasn’t all that important. She taught me to be outgoing and work hard to make sure everybody in the room is smiling and enjoying life. She taught me that doing this is part of what makes life fun. She has tolerated all my exploits and outbursts and been more patient with me than I am with my own children. She has taught me that God comes first, but you had better not forget how important family is. 

She has been there to support, if not encourage, swimming across Lake Erie, kayaking across Lake Michigan, skydiving, traveling Europe for a year, traveling to Korea for six months and then Africa for six months, climbing Mount Kilimanjaro and a thousand other adventures of dubious wisdom.

She has taught me that so long as she is drawing breath, there will be a human who loves me unconditionally, and she has outfitted me with a personality that has allowed me to be surrounded by people whom I love and people who love me.

And she has taught me that even after all whom I love cease to draw breath, there will still be One who loves me unconditionally.

And so, Mom, for all you have done, for all you do, for all you will do… and for all you have loved, for all you love, and for all you will love without conditions or questions… Know that I have always loved you, I do love you, and I always will love you.

And I will always celebrate your birthday on July 20, whether we are together or not. That’s just payback.

Happy Birthday, Mom!!! I love you.

Saturday, May 27, 2017

The Good Lord

The Good Lord…

He Giveth…

Today was awesome. So awesome. Ridiculously awesome. Best day since we’ve been back. Today was Sabbath. Our day to escape the hospital. We went back to Nangjere for the first time since our return to Tchad ten days ago. And it was so much fun. We sang all the songs we had translated into French and Nancere. We prayed. We told Bible stories. We high-fived. We blew a tire, but we didn’t care. We just changed it and moved on. We went and did the same thing in Guissa Goro. Then we went to Moungoulou and did it all over again. So very much fun.

And here’s the best part… We discovered we’re useless! We aren’t needed any more! This is awesome!!! During our two-month absence, the youth of the church continued going out to the each village several times each week. People from the villages attended Jonathan’s Bible classes. They were baptized. The pastor, who had thought we were rebels and wanted to start a competing church, had at one point forbid me from going out to the villages and telling Bible stories. Well, he finally agreed to come visit and came several times and was dutifully impressed with what the kids were doing in these villages. What were once perceived as joyrides for kids, are now respected evangelistic efforts. And supported efforts! The chiefs of the villages are giving us lands for churches and now with the pastor on board, they are finally breaking ground! Well, not exactly breaking ground, but ready to use the lands. Now that the pastor is backing them up, they are building wood and cloth and grass mat churches. And the elders are getting involved in it too! Pierre has been faithfully going out to preach whenever he isn’t schedule in church. They have enough coming now interested in earnestly learning, they are now splitting the groups into kids and adults. The adults are going through pretty earnest Bible studies and the kids are so enthusiastic and attentive. These villages are now getting to the point they are ready for genuine evangelistic efforts! In the meantime, we will buy some mats and benches and drums for the churches! What the youth (and some older folks too!) are doing here in Bere is just so exciting. PLEASE pray for them young men (and a few women!) who are telling the story of Jesus several times a week. They get nothing for this. They do it purely out of love.

Today we had some more selfish fun too. We got to pass out a few of the GodPods we bought! We even stopped by our friends in the Muslim village and gave the imam a GodPod of the New Testament in Chadian Arabic. So cool. They were listening to it when we left them. Danae also bought more literature while we were in America, but we haven’t started passing that out yet. Maybe next week.

We even took a little time after lunch to go swimming in the river, drive through the sacred forest and climb up a big ol’ tree. 

Sometimes, He giveth so rootin’ tootin’ much… But then… 

He Taketh Away…

While ruminating on how incredible of a day it was, there was a knock on the door. Danae’s patient died. Not just any patient. A patient Danae operated on many times. For free. Danae had been feeding her for a while now, trying to get her to fatten up. She was so skinny. She just kept wasting away despite it all. At about 8pm Danae went up to the hospital to give her condolences to the family. She also paid for them to be able to get the body back to their home village (several hours away). It was a patient Danae had given a Mesme GodPod to just this last week. Life is just so tenuous here. It’s now midnight and I still can’t sleep. It occasionally doesn’t seem fair. But we were never promised fair. My dear wife has the purest conscience I know and can always sleep no matter what. I’ll put my wife’s medical skills, surgical skills, compassion, love and Christ-focused nature up against anybody’s. But even that can’t save them all. Edith was suffering. She was ready. She had made her peace. It seems she willed her way out, assured of her Paradise. 

Sometimes His taking is out of mercy and love, taking from a fallen world He never intended to fall so far.

Sometimes He taketh away…

Friday, March 3, 2017



I reached down to my right front pants pocket and rubbed my pocket knife back and forth between my thumb and index finger.

‘If I drain this pleural effusion from her chest it will take the pressure off her inferior vena cava and with a few quick chest compressions, I’m positive her heart will start back up.’

Her heart had just stopped. Just now. I saw her last agonal breath and saw her pulse oximetry stop picking up.

‘No. Let her go. She’s gone. Don’t bring her back. Bring her back to what end?’

I knew he was right. He usually is. But something inside me wanted so badly to stab her in the chest. Even now tonight, I know she’d still be alive if I had. But tomorrow she might not be. In a week, probably not. My father-in-law knows. I push. He holds his ground. It goes against everything you train for as a doctor, particularly as an emergency physician, to just give up. To give up on a 17-year-old girl. But what can we really do here? We can’t save her. And he knows it. And I know it. And he does me the favor by making the decision, sternly, for me.

Months go through my mind in an instant.

My church elder and former accountant brings in his daughter with impressive left leg swelling and a bit of pain. I think blood clot, but ultrasound is normal. I think abscess, but there’s none on ultrasound and I can’t find any with a needle. So I go with cellulitis and put her on ciprofloxacin and cloxacillin maximum doses, as well as aspirin and ibuprofen maximum doses. Covering all bases. It keeps getting worse, so I go with elephantiasis, even though it doesn’t really look like it, and put her on doxycycline and ivermectin maximum doses. I treat all parasites. Still getting worse. I get Danae involved and she does a skin biopsy on the wound that finally formed. Danae sees lots of bacteria and lots of Donovan bodies and puts the patient on azithromycin. She even gets ceftriaxone for good measure. Still, the leg grows. The patient gets hospitalized.

One day the staff tell me she’s dead. I start over to the private ward to give my condolences to the family. I see the folks milling about and gawking, not unlike folks at a nascar race. I hear the familiar wailing. But then I see Ndilbe hustling her in a stretcher toward the operating room. Ndilbe quickly tells me he gave atropine and she has a heartbeat. He also tell me she hasn’t peed for the better part of a week. Oh great. She’s uremic.

In the operating room, we place a percutaneous nephrostomy tube and evacuate the urine sitting inside her kidney. We just put in a central line instead of a real nephrostomy tube. I also see that her pelvis is full and her right leg is now also edematous. We figure her infection turned into an aggressive cancer, which Donovanosis can occasionally do. I give her three grams of cyclophosphamide, a really aggressive chemotherapy dose. She’s completely unresponsive, not urinating and already required atropine. You can’t kill a dead patient, and she’s practically there.

The next day, she’s sitting up and laughing. The tumor in her pelvis is smaller. It’s unreal. A few days later, she starts urinating from her bladder, as opposed to from the tube we shoved into her kidney. I decide to repeat the dose of chemotherapy a week later. The pelvic mass disappears. Her right leg is back to completely normal. Even her left leg has returned to normal size and the wound has dried up.

But Danae and Rollin and I know this is not a cancer we can cure with chemotherapy. Sure, we may have bought her a little time, but that’s about it. I let her go home.

She comes back in Saturday night with trouble breathing. Dyspnea, hurts to breathe, tachycardia. Oxygen saturation still good, but she has that sense of impending doom. She just smells like a pulmonary embolism to me. She’s the perfect set up. Cancer patient. Immobile for a long time. Makes perfect sense. I run home to rummage through the medicine on the porch in the dark. I find enoxaparin. I run the Lovenox back over and explain to the nurse to give 1.5mg/kg/day subcutaneously. And I start aspirin and ibuprofen as well, not necessarily for any good reason.

And Sunday morning I stand beside her with my hand by my side, fondling my pocket knife and wrestling with what the right thing to do is. I had just finished rounds when I saw her struggling. Pulse ox in the 70s. No breath sounds on her right. (Why hadn’t I listened to her the night before?!?!?!) Ran for the ultrasound. Complete effusion. Stabbed her with a needle. Aspirated straw-colored fluid. All happened in a couple minutes.

Now her heart has stopped for a full minute. I have the ultrasound probe in my left hand to prove it. My right hand still has a death grip on the knife in my pocket. A quick stab to the chest is all it will take. But Rollin is right. There’s a reason she has a pleural effusion, and that reason is the cancer. A new finding despite my most aggressive chemotherapy. Our chemotherapy and nephrostomy tube bought her an extra three weeks she wouldn’t have had otherwise. What lies ahead of her are either peaceful rest in death or worsening suffering in life.

I know Rollin made the right call. I loosen my grip on the knife. I pull my hand from my pocket. I send the nurse to get her dad. I tell her dad she’s dead.

I drive the family home and sit under a makeshift thatch hangar while watching the women of the family wash and prepare the body for burial. Then I drive the body to the church. I sit by myself, the only foreigner in the church, while the congregation sings in French and Nangere. And I weep. I see the mothers and sisters and friends come in. I see the father stay strong. I see the choir members plucking up their courage and singing for their lost friend, a fellow choir member just a few hours prior, who’s voice will never again be heard on this earth. I hear the elders tell the family not to cry. It’s a sign of lack of faith in Christ’s return and ingratitude if you shed a tear. In the corner at the only Tchadian event I could ever go unnoticed at, a funeral, I weep still more.

J’entends ta douce voix,
Jésus, je viens à toi.
Je viens, ô Sauveur, lave-moi
Dans le sang de ta Croix!

Jésus, Roi des rois,
Qui mourus pour moi,
Je veux mourir avec toi,
Avec toi sur la croix.

J’entends ta douce voix,
Qui me dit : ‘Crois en moi!’
Je crois, Seigneur, soutiens ma foi,
Tiens-moi près de ta croix.

Jésus, Roi des rois,
Qui mourus pour moi,
Je veux mourir avec toi,
Avec toi sur la croix.

J’entends ta douce voix,
Elle pénètre en moi
Et me dit d’aimer comme toi
De l’amour de la Croix!

Jésus, Roi des rois,
Qui mourus pour moi,
Je veux mourir avec toi,
Avec toi sur la croix.

J’entends ta douce voix,
Toi qui mourus pour moi.
Seigneur, que je m’unisse à toi
Dans ta mort, par la foi!

Jésus, Roi des rois,
Qui mourus pour moi,
Je veux mourir avec toi,
Avec toi sur la croix.

I hear Your soft voice,
Jesus, I’m coming to You.
I’m coming, oh Savior, wash me
In the blood of the cross.

Jesus, King of kings,
Who died for me,
I want to die with You,
With You on the cross.

I hear Your soft voice,
Which tells me: ‘Believe in me!’
I believe, Lord, sustain my faith,
Hold me near to You.

Jesus, King of kings,
Who died for me,
I want to die with You,
With You on the cross.

I hear Your soft voice,
It penetrates me
And tells me to love as You
From the love of the Cross!

Jesus, King of kings,
Who died for me,
I want to die with You,
With You on the cross.

I hear Your soft voice,
You who died for me.
Lord, that I be united with You
In Your death, by faith!

Jesus, King of kings,
Who died for me,
I want to die with You,
With You on the cross.

Mon Dieu, plus près de toi,
Plus près de toi!
C’est le mot de ma foi :
Plus près de toi!
Dans le jour où l’épreuve
Déborde comme un fleuve,
Garde-moi près de toi,
Plus près de toi.

Plus près de toi, Seigneur
Plus près de toi!
Tiens-moi dans ma douleur
Tout près de toi!
Alors que la souffrance
Fait son oeuvre en silence
Toujours plus près de toi,
Seigneur, tiens-moi.

Plus près de toi, toujours
Plus près de toi!
Donne-moi ton secours
Soutiens me foi!
Que Satan se déchaîne
Ton amour me ramène
Toujours plus près de toi,
Plus près de toi.

Mon Dieu, plus près de toi,
Dans le désert!
J’ai vu, plus près de toi
Ton ciel ouvert!
Pèlerin, bon courage!
Ton chant brave l’orage.
Mon Dieu, plus près de toi,
Plus près de toi.

My God, nearer to Thee,
Nearer to Thee!
It’s the word of my faith:
Nearer to Thee!
In the day or in the trial
Overflowing as a river,
Keep me near to Thee
Nearer to Thee.

Nearer to Thee, Lord
Nearer to Thee
Hold me in my pain
Right next to Thee!
Even when suffering
Labors in silence
Always nearer to Thee,
Lord, hold me.

Nearer to Thee, always
Nearer to Thee!
Give me Your relief
Sustain my faith!
When Satan unleashes himself
Your love brings me back
Always nearer to Thee,
Nearer to Thee.

My God, nearer to Thee,
In the desert!
I have seen, nearer to Thee
Your heavens opened!
Pilgrim, take courage!
Your song braves the tempest.
My God, nearer to Thee,
Nearer to Thee.

From the church, it’s another drive out to where she will be buried. Men have been hard at work chiseling at the dry earth six feet down. It’s much easier in rainy season. After being warned of the chastisement to follow, should there be excessive weeping, the pathfinders sing. Her nearest friend starts, solo and a cappella, brave voice quivering. Gradually her friends follow suit, joining her, a cacophony of teenage sorrow, genuine and profound, but doing the memory of their friend a grave justice and they hold it together, tears streaming from their faces. Grown men all around me, we tremble and shake and shame our cheeks with tears of our own, feeling the pain for our loss, but feeling so much more the palpable and heavy pain of the youth having to sing for, and then bury, one of their own.

She is lowered into the ground. The first handful of dirt tarnishes the white drape. There are a few more handfuls. And then the shovels come out. Shovel after shovel, the men work at a torrid pace, slinging the dry earth and heaving a thick cloud of dust into the hot January air. The dust dries the tears to the face. The frenetic shoveling has filled in six feet of hole in a matter of a couple minutes. The dirt is now piled high and the men walk around the hole counterclockwise, smashing the dirt down with the blades of the shovels. She is buried. I drive the family home.

Tonight I will hear the heartbeat of Africa continue on in the mourning of the drums. They beat regularly here. They typically don’t bother me. I may wake up and hear them, and then go right back to sleep.

But tonight it is different. It is my 17-year-old patient, daughter of my elder and friend. I will hear them. They will keep me up. My right hand reaches instinctively back into my front pants pocket. The knife hasn’t left the pocket all day. I reluctantly pull it out and toss it into its drawer. While my head knows her earthly life had nothing but suffering ahead of her, and that we made the right decision to let her go, and that my father-in-law did me a favor making a very wise decision so I wouldn’t have to, my heart will always wonder… And tonight I will hear the drums.

Wednesday, February 15, 2017


“Mouaaaaaahhhhhhhh…, Mouuuuuaaaaaaaahhhhhhh.”  The patient laying on the ground in front of me was coming out of yet another hypoglycemic coma.  She arched her back.  Her tongue stuck out.  Her eyes were rolling around doing crazy things.  If I didn’t know anything medical I may have thought she was Devil possessed too.  I do believe in Devil possession.  

But this was not that.  

I’ve seen this many times with the families here.  A patient is sick.  They get worse.  Their family gives up and decides the medical treatment isn’t working and would rather go to the Marabout (witch doctor).  This family was no different.  Already today I had diagnosed her hypoglycemia by listening to her history and looking at her.  

I noticed four small cuts on her forehead.  There were some dried herbs that had been crushed up and mixed with water and sprinkled over the patient’s face and neck.  I’d seen it before.  I wasn’t naive.  This was definitely not God-driven.  This had it’s origins in curses and non-God-centered spirits.  

I got upset.  I yelled.  I told the family they could chose our hospital, which was centered around believing in God, or go to their witch doctor.  Not both.  

After she awoke again with our glucose drip, the family agreed to stay and not do anymore witch doctor stuff.  Still she was very sick.  

I don’t speak Nangere, but I can understand certain words and phrases.  I overheard them saying that they were ready to take her home.  The nurse was also translating certain things to me in french.  

I got really mad.  This girl, Honorine, can live!  She just needs a little TLC.  Her crazy movements were from her actually getting better and coming out of her deeper coma each time I gave her more glucose.  

I spoke to her father. He had his excuses, “Where would we bury her if she died here?  How would I get her home?”

I replied, “You are worried about the dead.  I am worried about the living!”

I told her big sister that if she stole her in the night I would call the police!  She replied with, “Bring me to the police, You are not keeping her here!  She is Devil-possessed!  Look at her!”  This made me even more mad.  No one was respecting me.  They knew her sickness more than me supposedly.  

I kicked out all of the family members.  I told them all to leave.  Several of them weren’t listening, they just stared at me when they clearly understood!  So I started shoving them out of the door.  I called the guard.  He helped me get them out.  I told them they had to leave the hospital compound.  Somehow, though they always find a way of getting back in!  I locked the doors and told the nurse to not let anyone in!  I decided I was going to have to take her to my house.  

This was a full sized 8-month-pregnant woman!  How was I going to get her home?  I was going to have to use the stretcher.  My kids were already in bed and asleep at home with my mom babysitting since Olen was in NDJ.  Maybe this was a bad idea. This girl has gone diarrhea several times on herself.  Where was I going to put her?  Right in the middle of my living room?  I imagined what I was going to do with her.  Watch her drip.  Open it wider when needed.  But if one night of this could make her live, I was going to do it.

I came home to get the OR keys so I could get the stretcher.  I was so exhausted from yelling and kicking everyone out at the hospital.  How was I going to stay up the whole night and work the next day too?  Mom was in the living room and said she would watch the patient if I needed her to.  I went into my bedroom and closed the door.  I needed guidance.  I closed my eyes and prayed, “God, please help me know what is the best thing to do.  Should I bring her home?  Should I let them go?”  

I had left the hospital very annoyed and upset.  How could I care more about Honorine than her own family?  They didn’t seem to care to give her a chance to live.  Clearly she kept getting better with the glucose drip. 

I went back up to the hospital with peace.  This was not my battle.  It was God’s. 

There was a big group still standing around the outside of the maternity area.  The guard was there.  I very calmly asked who was the one person who was responsible for Honorine.  

“I am,” said her father-in law who was a very young-looking man.  He had actually been the reasonable one all along.  

“Thank you,” I said.  “Now can you please pick two other people who you would like to also be responsible.”  He said he would like her father and mother, and his wife.  “Well that’s three, but okay.”  Everyone else has to leave, please.  

I did my best to get the rest to leave, but still, it was extremely difficult.  

Right then and there we sat down and discussed their fears and ideas.  I discussed my fears and ideas.  

Their fears and ideas were that Honorine was sick with a curse.  If they did not get her to the witch doctor in time, she would die.  My fears were that she had hypoglycemia.  If the family took her away, she would die.  I argued my side.  They argued their side.  It was mostly her father speaking.  He clearly cared for her, but he was so concerned that she had a curse.  He even claimed to be a Christian, but he clearly trusted the curse over God.  

The story is that someone stole some money.  They bought some food with it.  Honorine was the first person who ate this food that was bought with stolen money.  That’s why she was sick.  I’ve heard this story multiple times.  It’s a well known fact around here.  If you don’t pay the witch doctor to remove the curse, you will die.  

So I asked the father why was the witch doctor hiding?  Why didn’t he come out here and reveal himself?  Why was I publicly stating my side?  I am not afraid of the witch doctor.  I know my God is more powerful!  If it was a curse, why did my medicine work on her?  All of this was translated into Nangere from French.  

After a long discussion, they agreed to stay.  They agreed to have all of the other family members leave in the morning.  So I agreed to leave her in the delivery room area.  

That morning at 4am I got called in because she wasn’t doing well.  I revived her with D5 and she awoke somewhat.  Still she wasn’t talking.  One of my friends had written and suggested I try something new.  My sweet husband had brought back several small containers of the most yummy frosting you have ever eaten.  So I became a big girl and decided to share some.  

I put some on my finger and shoved it between her lips.  I didn’t want to give too much because she had been vomiting.  I had thought about an NG tube with sugar water, but the vomiting deterred me.  This yummy frosting seemed to do the trick!  She sucked it off of my finger.  She was alert enough to do that!  Still, she was very sick.  She had a very high fever, so we gave her IV Tylenol.  

I told the nurse to give her some often.  

I went home.  I asked God for guidance on whether to do a c-section or not.  Maybe taking away the pregnancy would help her glucose control?  God, please just show me what to do.  

When I came in to do rounds I noticed there was a new young man who was also a family member.  He was mumbling stuff about N’Djamena and leaving.  Suddenly the girl’s father also wanted to leave again.  

“Seriously!  This new young man comes and you want to leave again?  Be a man!”  Why are there so MANY family members still here?  “You promised there would only be you four in the morning,”  

I forced the new young man to leave because he was just stirring up the family to take her to the witch doctor in their village or to another hospital (um, ya).  

Back with the patient, I opened the glucose drip again.  She came to and when I offered frosting, she actually opened her mouth.  She grunted when the family asked if I was the Nasara.  Since there was now a nursing student there, I told him his only orders today were to give my patient frosting every 20 minutes.  He did a great job!  He faithfully wrote down each time he gave her frosting every 20 minutes.  During my day, I kept coming back to check on her, making sure the family did not take her away.  She still was pretty comatose, but awake just enough to suck down some frosting.  She vomited a few times, but kept most of it down.  

That night I put the kids in bed.  Then I went to check on Honorine.  

I walked in the delivery room area and Honorine was SITTING up!  There were several (way too many) family members gathered around her.  She was greeting them.  I was in shock to see her NOT DEAD!  “Wow!  It’s a miracle”, I said!  “Merci à Dieu!  (Thanks be to God!)”  

Her whole family was in awe she was alive and were grateful to God for his healing.  It was clearly not the witch doctor who healed her.  She greeted me and shook my hand.  Then, all I could do was stare at her… in awe of God’s miracle.  

She continued to recover.  The next day she went into preterm labor and delivered very quickly a 2kg (4lb, 7oz) baby boy.  He didn’t cry right away, and, even though he was big enough, he didn’t seem like he was going to live.  We put him on antibiotics with D5 and taught the family how to do skin to skin to keep him warm.  I really didn’t expect him to live.  It seems like in Chad, you can’t have too many happy endings.  There’s always a little sadness.  And it seemed like this little baby boy was going to die.  

But today on postpartum day 1… Both mom and baby are doing well!  He was actually breastfeeding today.  And crying!  And mom is eating!  And hasn’t fallen into a coma for 36 hrs now (since Friday night).  

It’s a miracle from God.  

And… vanilla frosting is not always unhealthy!  

Not What You Think

Who runs on postoperative day two after a laparotomy?  Not many people.  But this young lady was literally running across the room.  She looked so much better, yet she still looked like a skeleton.

My medical student tells me I should write a case report on her, but part of me feels guilty for having to do a laparotomy.  It did work, however.

Bilal is a 17-year-old girl who presented to us last week.  She was a month or so post miscarriage of “4 months” (sex of baby was known).  The family explained that at another hospital she had already had FOUR dilation and curettages (D and C’s) in the month of December.  In her medical booklet, there is nothing written.  Often times people will have surgeries elsewhere, but we can never find an operative note.  It’s like people are scared to write what they did or didn’t do.

Upon arrival she weighed in at 30kg.  She had previously been 54kg… SEVERELY malnourished!  Bilal had no appetite.  She looked like death, like someone with HIV who was about to die.  I put her on triple antibiotics for presumed endometritis and ordered an ultrasound.  She also got a bag of blood for her hemoglobin of 6.  Her HIV test was negative.

Ultrasound done.  Dang.  She had debris in her uterus still.  Really?  After 4 D and C’s?  But here, who really knows what happened previously.  I repeated her ultrasound that showed no clear endometrial line with evidence of debris.

I told her not to eat in the morning and scheduled her D and C for the next day (Friday).  I would start the day with her on Friday, which I would later discover would be bloody Friday since all 3 of my cases bled like stink that day (her, a postpartum hemorrhage, and a ruptured ectopic).

Friday morning I started with her after rounds.  Just obtaining a spinal seemed scary enough since she was so thin it looked like you would poke right through her.

After an excellent spinal, I started her case with dilating her cervix.  It seemed a little infected which wasn’t surprising.  I was able to dilate her and gently put a curette up to her fundus with ultrasound guidance by my husband.  She was a big set up for a perforation so I was extra careful to be slow and intentional.

I could feel debris up in the left side of her fundus.  Some of it was coming off.  Great!  This might be easier than I thought.  I had previously consented her for a hysterectomy just in case things went south.  She was so young, only had had 2 pregnancies, and I hoped it would not come to that, especially since she did not have any children.

I continued.  The rest of the debris was so stuck on!  Some of it came off, but a good part of it would NOT come off!  Then she started to bleed!  A lot.  I tried to curette faster, but it would NOT come off.

Okay, plan aborted.  We are moving towards a hysterectomy.

But while I prepped for this, she was shooting out blood like a water faucet.  And she was so anemic already!  Second line was already in.  Someone was starting blood in a 16 g vein.  We were opening the hysterectomy kit.

I put a foley in her uterus with ultrasound guidance and added 40cc of water to the balloon that compressed the bleeding.  The bleeding stopped.  However, there was still debris in her uterus.  Quite a lot of it.  And it was infected.  It had to come out.

I wondered if I should try to open her uterus and pull the debris out under direct visualization, like a c-section.  No, dumb idea.  Fleeting thought.  She is sick.  She has been sick too long.  Her debris was causing a big infection in her body.  She needs to be healed.  Her family said to do whatever it took to get her health back.  They were at peace with a hysterectomy.  She was a peace with a hysterectomy.

While prepping her, I observed that she was so, so skinny to even undergo such a big surgery.  Her pelvic bones were so prominent.  But she was too weak to bleed or be infected any longer either.  Such hard choices.  But such easy ones too.  Do whatever it takes to give her her health back.

Dad and I scrubbed and opened her belly.

Patricia (medical student) dared to speak out loud and asked if we could just take it out like a c-section.

That’s just what I was thinking, I told her, but it was taking a risk because she could bleed more. Although we did already have the bleeding controlled temporarily with the balloon.

Classical incision into the uterus.  Wow, that debris is really stuck on.  I tried wiping it off with a compress.  I grabbed ring forceps and pulled it out chunk by chunk.  This was much more controlled than from below when I could not get it removed with ring forceps or a curette.  Eventually, it looked like it all had come off.  Hopefully not too much endometrium with it!  It was still bleeding after that, but not extensively like before.  I took some of the water out of the foley so that I could close the uterus back in 4 layers.  Then blew the foley back up to make sure she didn’t hemorrhage.

She may have been in partial DIC, because everything seemed to bleed.  I used a small needle to get the little bleeders left on the uterus, bladder and muscles.

Well, that was weird, but it seemed to work.  Praise God, we didn’t have to do a hysterectomy…yet.

I wrote on the operative note hysterotomy (cutting into the uterus).  One of the nurses interpreted it as hysterectomy (removing the uterus) and told the patient that night that she could no longer have any kids.

When Patricia went to see the patient later that night to check on her bleeding, she told the patient that we saved her uterus.  They both had tears of joy in their eyes.

On post-op day 1, I removed her foley from her uterus.  Very minimal bleeding!

Today, on post-op day 2, our patient is a whole new person!  She wanted to know what she could eat!  She hasn’t wanted to eat in over a month! She had been so skinny, and I told her she was going to stay here for a long time to regain her strength.  I stood her up to walk.  She asked if it was okay to move around.  I said, yes, she could run if she wanted to.  She started fake running across the room!  She was so happy.  Praise God.

The nurses at the other hospital had told her she had HiV and that’s why she was so skinny.  (She was negative here).  Her family told her there was no point going to another hospital because she was just going to die.  She might as well just die of her sickness.

Her sickness was an infection from retained products of conception (debris from her placenta)!

It will be a while before she gains back all of her weight, but she’s off to a good start!  Please continue to pray for her!

Story and photo shared with permission from the patient.