Friday, January 10, 2014

The Rock

In medicine, there are some patients we refer to as rocks.  I hope you’re asking what a rock is. 

A patient becomes a rock when his or her status changes about as quickly as a rock changes.  A patient who sits on your service for weeks or even months, with barely any evidence of change for the better or worse, and who has very little potential for getting better in the near future… That is a rock.  These patients are rarely more interesting than finding quartz in a quartz mine. 

In the beginning of December we had a bunch of rocks on our surgery service.  There were a lot of abscesses.  (There are always a lot of recovering abscesses here in Tchad).  They weren’t getting better fast.  They weren’t getting worse fast.  They were just sitting there. 

Like rocks.

Dressing changes every day.  A little better.  Not worse.

A little TINY bit better.  Doesn’t it look better today? 

Then Christolph came in.  He joined our service of rocks.  He was the worst rock.  The one where when you come to his bed, you gather up your strength to hold a straight face (one that is not putridly mean) and not vomit. 

He was in his 30’s, though you would think older by how emaciated he was.  He was just in a terrible state.  One of those where you just hope time passes quickly for him.  We’ve seen the same thing several times already here. 

Abscess of his mediastinum.  The point of exit was his neck.  The pus was everywhere.  When he first came in we cut into his neck (just like you would cut when you motion that someone is dying) to help the pus get out.  The infected area extended up into his neck.  Not just a little, but way up close to the base of his ears.  On both sides. 

When he coughed, thick green pus came up out of the opening in his neck.  We did an extensive dressing change, started antibiotics, and hoped he would die sooner instead of later for his sake. 

Then after a few days, he still didn’t die.  What in the world?  Apparently nobody gave him the memo.  He became one of our rocks also.  He didn’t die, but he wasn’t exactly leaning towards the living either. 

More dressing changes every day.  Even to the point of just pouring bleach water down his mediastinum.  One day on rounds the family stated that when he drank, water came out his neck.

“No way,” I said.  But I’ve learned to listen to my patients (as best I can with all of the language barriers here) before I say to much.  So I said, “show me.” 

Sure enough.  Water came out of his neck after he took a sip.  As well as pus.

Not good.  This means that the infection had eroded through his esophagus. 

Well, not much to do here in the bush.  We might be cowboys, but we’re not operating on an esophagus. 

If Christolph wouldn’t have been so mentally alert, I probably would have said to just go home and die.  This was severe.  Every time you pushed on his chest, his neck, anywhere, pus came out.  Every time he coughed, pus came out.  I don’t know how he was still breathing because you could see air coming out when he exhaled after a deep breath.  So the infection was clearly eroding into his trachea (wind pipe) too.

Christolph spoke perfect french.  So I could communicate with him.  (I didn’t say my french was perfect.  I said HIS was!). 

After he leaked water out of his neck, I did the only thing I could do that would help. 

I prayed.  We called the family around and prayed at his bedside. 

“Dear Father, Please help Christolph.  Please relieve his suffering.  If it is Your will, heal him.  This is a terrible situation.  You never want to see Your children like this.  We can do nothing.  We leave it in Your hands.  Thank you for hearing us.  In Jesus’ name, Amen.”

I asked Christolph what he wanted.  Did he want to stay for dressing changes or did he want to go home in peace with his family? 

He clearly stated that he wanted to stay.  Somehow he could still talk.  It was like those people who have holes in their trachea and have to cover their stoma in order to talk.  It’s so hard to let someone die when they clearly have a strong will to live.

My dad was visiting Moundou for the day to help James out while he was in America.  So I said I would talk to him when he got back and suggest a PEG tube so that Christolph would not starve to death.  Maybe this was being a little too aggressive for here, but it was either that or go home and starve to death. 

The next day Dad put in a PEG tube.  We stopped everything by mouth and told his family to feed him through the feeding tube that went directly into his stomach from his abdomen.

More dressing changes every day. 

A week or so later, he still didn’t die.  Several times a week I rounded on the surgery service so my dad could do more hernias in the OR.  During this time I got to know Christolph better.  Ann, a visiting midwife from France, had been helping with dressing changes and had given him some books to read.  He was with it.  He was alert.  But his neck abscess was NOT getting better. 

It seemed hopeless. 

We brought him to the OR to do a little more debridement.  No anesthesia lest he lose his airway and die.  Everywhere you pushed, thick green pus came out of his neck.  I extended his opening a little.  What he really needed was to remove most of the skin from his neck, but that would be quite severe for here.  So I just did a little.  The big problem was in his mediastinum (deep chest) and we couldn’t get to that. 

The family had been pushing to go home.  Christolph was always content staying.  He wanted whatever we thought was best.  That was the problem.  It was hopeless.  And we didn’t know what to do.  He was so skinny.  He was so weak.

I told Christolph that we would try some really strong antibiotics for 5 days.  If it wasn’t better after the 5 days, then maybe he could go home to be more comfortable. 

“Please try the medicine,” he said. 

I rummaged through our office and found some expired Vancomycin (really strong antibiotic) that someone had donated.  We started 1gram every 12 hours.  Plus the only vial of Zosyn.  I gave that too.  If this didn’t work he was going home.  But he had such a strong heart to live. 

He got the 5 days of antibiotics.  It was possibly a little better, but not hugely.  So they went home.  It was better that way.  He would be more comfortable.  I was sad, but knew I would see him again in Heaven.  He was a Believer. 

We continued our daily grind.  Life is sad here.  I avoided writing blogs because it’s true that life is sad here, and I didn’t want to be too depressing around the holidays back home.  People don’t like things that are too depressing.  Sometimes that’s just the way things are here. 

But then… this week I saw a ghost!  I was just outside of the operating room looking for the next patient to see. 

It was the ghost of Christolph.  He was walking with his brother from the hospital entrance towards me.  The point was that he was WALKING with a cane.  He was weak, but he was walking!  He was NOT dead.  It was a miracle! 

I got tears of joy in my eyes as I went up to greet him!  I wanted to tell everyone around that this man was supposed to have died, and I could not believe that he was living!  It was truly a miracle. 

He looked fatter too. 

The family had continued the dressing changes at home.  They had lovingly continued to give liquid food through his feeding tube.  They had continued an antibiotic through the tube.  Ann had given him a natural supplement to try also.

We know that God made him better.  His feeding tube had fallen out 2 days before on its own. 

His neck looked surprisingly better.  It was dryer, less pus, and smaller.  His feeding tube hole was nicely healed over.  And he said for the past 2 days that he had been able to swallow water and liquid food without it coming out of his neck. 

We were all so happy that he was doing so well.  I said that he needed to be a pastor now because he had a second chance in life.  God clearly has a good reason for keeping Christolph alive.  I gave him a french Bible and a few other things to read.  He yearns to learn more about the true living Rock, who is Jesus. 

It’s nice to see miracles here!  Please pray for his continued recovery. 


There is something that is common to all ways of life here.  It is not a big thing.  It is tiny.    It unites the poor and the poorer.  The Muslims and the Christians.  The beautiful and the ugly.  The tall and the short.  The white and the black.  The corrupt and the corrupter. 

It’s nutritious.

It’s delicious. 

It’s the incredible, edible PEANUT!!! 

Peanuts are a part of everyday life here.  When you visit your neighbor here in Tchad, chances are you’ll spend the time shucking off some peanut shells before you pop that yummy morsel of protein in your mouth.  No, not the bug crawling on it… the peanut! 

They have the best peanut butter in the world here!  The peanuts are roasted and then ground into perfection, making smooth, creamy peanut butter.  You put it on everything.  You put it IN everything. 

If a kid is malnourished, you tell the mom to start putting ‘pâte d’arachide’ (peanut butter) in the bouille (pronounced ‘bwee’ and like rice malt-o-meal) that they eat every breakfast. 

We put peanut butter on bread.  We put peanut butter on bananas.  We put peanut butter in our smoothies.  We put peanut butter on papaya, mango, etc.  We have peanut butter with our spinach.  We have peanut butter with our rice.  We put peanut butter on our dogs’ noses.  We have even been known to put peanut butter on our peanuts. 

Every time you cook, you use peanut oil.  All of your food ends up having a little hint of peanut in it. 

So if you had a peanut allergy would you come here!? 

Well, not if you were sane!  But we have some insane people here!  And we are so thankful for them! 

Maranatha is here again this year!  And yes, one of them happens to have a peanut allergy.  And he is on his RETURN visit to Tchad.  He came last year and he is BACK!  He and his wife are here with 3 other couples to help us finish our construction project. 

And….there are 13 more maranatha volunteers coming this week! 

We are going to have a building party here in the heat while all you others freeze in the snow!  Mind you, it will be a peanut-less party, but we’re going to have some fun anyways! 

We’ll keep the epinephrine on hand!