We’ll Call Him Lazarus

A few weeks ago, I arrived on the surgical ward to round on a Saturday morning. Right away, I noticed a new face on the ward: a happy, smiling 5-year-old sitting up in bed and looking chipper. I started seeing my usual patients while waiting for my surgical partner (who had been on-call overnight) to sign out the new patient. When he arrived and I asked about the new kid, he was shocked, “That can’t be the same kid. The kid I saw last night was almost dead!” The boy’s family quickly nodded to Dr. Ben with huge smiles on their faces. “It’s a miracle!” they declared.  This little boy had been struck by a car and brought in with a severe head injury. The back of his skull had been crushed and he arrived in a coma.  Everyone thought he would die. If he didn’t die, everyone thought he would be severely brain injured. Yet, here he was, less than 12 hours later, sitting up and acting like a completely normal 5-year-old. He had ZERO neurological impairment. In fact he went home the next day, with a new name: Lazarus. 

(Story and picture shared with permission)

Changed

         During the recent election season, we treated many patients who were injured in violent clashes due to opposing views.    Seeing so much trauma week after week was discouraging to us as caretakers as well as to our patients who were suffering. One such patient was a young man who came in with a large machete cut to his foot. His big toe wasn’t salvageable and we worried the rest of his toes would be difficult to salvage as well. He was understandably angry, upset, and discouraged by the news that we would have to amputate the forefoot in order to save his ability to walk in the future. He underwent several surgeries and a long stay in the hospital.         

          During the month which followed, I would constantly joke with him because he had a new hairstyle every week. He had a fro one week, new cornrows the next, and small braids another week. He was constantly changing things up. In fact his name was Tok Pisin for “change”. Gradually, his anger subsided and was instead replaced by a peace, a smile, a word of thanks and a hopeful attitude. On the day of his discharge home, we found a note in his clinic book. It read: “Thank God for giving my life back. God is good to me because he saves me in tribal fight.” All our discouragement melted away as we saw the joy and hope that this young man had discovered during his time at the hospital. That was truly the best change of all—a change of heart. 

From The Brink of Death

    “I don’t expect either of them to survive,” the on-call doctor told me as I neared the hospital. Just a few minutes before, I had received a phone call: Motorcycle accident. Two injured. Both with severe head injuries. Upon entering the Emergency Room, I moved toward the first trauma bed and found a man in his thirties who only opened his eyes and moved when painful stimuli was applied. It was hard to tell if his unintelligible vocalizations were due to the trauma or inebriation. Initial workup revealed internal bleeding and a severely shattered femur. I suspected at least part of his poor mental status was due to hemorrhagic shock—something we could treat.  

    Next, I examined the patient on bed two, a 16-year-old boy struggling to breath. He was even less responsive than the first patient: intermittently responding to pain, intermittently extending his arms in a posture that denotes severe brain injury. He had several facial fractures, evidenced by the blood running from his nose and gurgling in the back of his throat. With suctioning and a device to keep his airway open, he was able to breath on his own. He also had a femur fracture, several lacerations, abrasions, and a puncture wound into the chest. We quickly placed a tube to re-expand his collapsed lung. Surveying his other injuries, I knew his poor mental status was due primarily to a traumatic brain injury. There was little that we could do. We have no CT scanner or advanced Neurological interventions. In a different setting, he would be in an Intensive Care Unit on life support. Here, the best we could do was prescribe some medications to decrease brain swelling, optimize his airway, and tell his parents to expect the worst and hope for the best. 

    After undergoing surgery overnight, we found the first patient to have significantly improved mental status in the morning. He remained pleasantly confused for the next few days, but eventually his neurological status normalized and he is recovering very well from surgery to stabilize his fracture. His companion, however, remained unchanged. We were amazed to see him still alive, but there were no signs of improvement. Every day we assessed his coma score --measured from 3 (coma) to 15 (normal exam). For the next few days, Kody (name changed for privacy) scored a 6 which denotes severe brain injury. He was teetering on the brink and we didn’t know which way he would go. The many days without improvement predicted a poor outcome, but his youth and the fact that he was still breathing on his own, gave us some reason to hope. 

    About the fifth day, he started opening his eyes spontaneously. It may seem like a small thing, but it was a big sign of improvement.  Over the next week, we started feeding him through a tube into his stomach and he slowly started moving his arms and legs — another huge relief for us. By the third week, he gradually become more aware of his surroundings and could focus his attention on those around him. His parents noted that he would respond to commands and squeeze his mother’s hand in response to her questions. The day that he raised his hand in a wave to return my morning greeting, I knew he would be okay. The only question was the extent to which he would recover.  His ability to swallow returned and he was able to eat without a feeding tube. However, his speech remained impaired. He would moan and groan but was unable to speak or make intelligible vocalizations. I could tell this frustrated him as he struggled to communicate his needs. A family member who works at our nursing college asked me about his prognosis. It is always hard to tell how much function will return with brain injuries. Often it takes months to see improvement and determine a patient’s new baseline function. I told her that his recovery so far was miraculous but I didn’t know whether he would recover his ability to speak or if he would have to relearn some skills. She assured me that from the moment of his injury his family had been fervently praying. His grandfather was one of the first pastors in the area and despite the initially grim prognosis, they had not given up hope. 

    At prayer meeting that Thursday, I asked our missionary community to pray for this young man and for restoration of his speech. That night, I researched communication boards and other adaptive equipment for patients with aphasia.  The very next day, his mother proclaimed he was speaking. I didn’t believe her. I thought she was misinterpreting his groans as words. Try as we might, we couldn’t get him to say anything. The following morning, as I walked up to his bed, I greeted him as I had every morning, “Morning, Kody.” “Morning” he prompted replied. I was shocked, amazed, and very excited. That was definitely intelligible speech! Since then, we haven’t been able to get him to stop talking. He rambles on in full sentences, mostly asking for his favorite food: donuts. 

    Kody is now a month out from the accident and still has a long road of recovery ahead. However, looking at where he started a month ago—on the brink of death, struggling to breath, minimally responsive, with a very poor prognosis—I would say his recovery is nothing short of a miracle. We praise God for his hand of healing and the renewed life he brings. At Easter we celebrate that God can bring life from death and hope from despair. I pray that you may experience a taste of new life and hope this Easter. 

Easter Sunrise 

The Long Way Back

 

Desert places painted by my grandmother

It has been a long time since I posted anything here. It’s been an equally long time since I’ve felt like putting words to my thoughts. Perhaps someday I’ll delve into the full story of what it’s like to walk the wilderness road of burnout: to feel completely shattered and empty, to spend a year and a half resting, healing, and allowing God to restore the broken pieces and imbue new life where there was none. Something tells me that many of you know what I’m talking about or have experiences that echo the tales I might tell. Suffice it to say, it has been a long journey to recovery. 

Beauty from ashes

But God is faithful. This phrase has stuck with me and carried me through many dark times. There were times when I was tempted to despair. But God was faithful. There were times when I felt I was taking more steps back than forwards. But God was faithful. There were times I never thought I would experience true joy again. But God was faithful. He brings beauty out of ashes like wildflowers growing in a burn scar. 

"Those who sow with tears will reap with songs of joy." (Psalm 126:5)

Truly, God has turned mourning into dancing. In the places where tears have fallen, new life has sprung forth. A new day is dawning: 

"Forget the former things; do not dwell on the past. See, I am doing a new thing! Now it springs up; do you not perceive it? I am making a way in the wilderness and streams in the wasteland." (Isaiah 43:18-19)

Sunrise. New Years Day 2022

As I prepare for the long journey back to Papua New Guinea—physically, mentally, and emotionally— I am filled with a new hope for what tomorrow will bring. Because God is faithful. 

Please join me in praying for smooth travels Jan 8-11, and a smooth transition back into work and ministry. I know the Lord goes before me and behind me and surrounds me with his promises like this cloud-bow around the shadow of our airplane. 

Grace and Peace to you all. 

The New Theatre is Operational

     Twenty months after breaking ground on our new Operating Theatre expansion project, we have finally moved in and started operating in the new building!






The new building houses two new operating rooms, a larger and improved central supply/ sterilization department with a new autoclave to sterilize instruments, and a new centrally located sterile stock room.






We have transitioned to working out of this space temporarily while our old building is renovated. Once all the construction is complete. We will have a total of 4 operating rooms as well as a new minor procedure room, pre-op and recovery rooms, and a conference room for teaching.

This week we performed our first cases in the new theatre. We are still adjusting to the new, temporary arrangement, but we are thankful for God's provision.  A huge thank you to AusAid Incentive Fund and all the many individuals who have helped make this dream a reality.


Below is a video of the move-in and first day operating.

https://vimeo.com/437029297

Overwhelmed

         

Dr. Mark and Dr. Alex attend to patient with
near amputation of the hand.

Twenty-two. TWENTY-TWO. Twenty-two surgical procedures in the past FIVE days. To say that I am exhausted is a bit of an understatement. We are only scheduling 2-3 elective cases on each surgery day (Tuesdays and Thursdays), but the number of urgent and emergent cases seemed to explode this week, filling every day of my schedule and pouring over into next week. Appendicitis, ruptured ectopic pregnancies, small bowel obstructions, abscess in the chest, abscess in the abdomen, abscess in the leg, and so, so many traumas: Stab to the back, chop to the upper arm, chop to the lower arm, partial hand amputation, gunshot to the bladder, gunshot to the neck. Of all the cases I treat, trauma is by far the most physically and emotionally draining. Most people can’t control when an infection will occur, but violence is preventable.  Why do tribes perpetuate the age-old feuds? Why do husbands abuse their wives? Why all the fighting and violence? Some days, I feel like the biblical prophet, Habakkuk, crying out, “How long, O Lord, must I call for help....Why do you make me look at injustice? Why do you tolerate wrongdoing?” (Habbakuk 1:2-3). It is easy to become discouraged or angry as we labor to piece together broken bodies and broken lives. But when the huge tidal wave of traumas comes during an already busy week, it is simply overwhelming.

Thankfully, our prayers do not fall on deaf ears. On Thursday, when I had about hit the wall, one of our leaders at prayer meeting shared from 2 Kings 6. This is the story of Elisha, a man of God who is surrounded by enemy forces. Starting in verse 15:

 “When the servant of the man of God got up and went out early the next morning, an army with horses and chariots had surrounded the city. ‘Oh no, my lord! What shall we do?’ the servant asked. 

‘Don’t be afraid, ‘ the prophet answered. ‘Those who are with us are more than those who are with them.’ And Elisha prayed, ‘Open his eyes, Lord, so that he may see.’ Then the Lord opened the servant’s eyes, and he looked and saw the hills full of horses and chariots of fire all around Elisha.”

              

             Those who are with us are more than those who are with them. And in that moment, during prayer meeting, God opened my eyes to see that we are not struggling against flesh and blood. As much as I despise those who inflict physical injuries on others, they are not my enemies. This is a spiritual battle. The forces of evil, agents of darkness, pain, and destruction, are engaged in an epic war against God’s army of light.   But those who are with us are more than those who are with them.  As my fellow missionaries prayed over me, I felt a huge weight lift from my shoulders, and the presence of God enveloped me with his assurance and peace.  And once more I was overwhelmed... overwhelmed by the presence of God and his angels of light standing guard over us. 

             Please continue to pray for the hearts of the people here in Papua New Guinea and around the world who are gripped by fear and darkness. Pray for God’s light to break through. Pray that they may be overwhelmed by the presence and peace of God. 

Life Changing Surgery

Anton, pre-op

        All surgeries are life-changing, some are even life-saving, but very rarely is the result so visibly obvious as it was in one of our recent patients. Anton had been admitted to the hospital many, many times in his 8 years of life. Every time he was treated for stomach pains, gastrointestinal infections, and malnutrition. He would improve enough to go home, but would return again within a few months to repeat the cycle.  On his most recent admission, he started to manifest symptoms of intestinal obstruction, so our surgery team was consulted to evaluate him. At a mere 16 pounds, he was so emaciated by his chronic illness, that Dr. Ben and I were doubtful he would survive surgery, let alone benefit from it. But without surgery he would surely die, so we took him to theater praying that we would find something that we could do to help him. 

        To our amazement, we discovered that he had malrotation with chronic volvulus, a congenital condition in which the intestines don’t form in the proper position or with the proper attachments inside the abdomen. This allows the intestines to twist around their blood supply leading to obstruction and ischemia. He had been intermittently obstructing for the past several years! Now the intestines were so twisted that a portion had become ischemic and died, leading to his current presentation. We were able to untwist his intestines, remove the dead portion and reconnect what remained, but we were still worried that he might not survive in his severely malnourished state. By God's grace, Anton recovered faster than we could have hoped. He was eating within a week of surgery and has steadily gained weight over the past month. When I saw him in clinic for follow-up, I didn’t even recognize him as the same kid we had operated on! His hair is growing, his face is fuller and he now has the strength to walk on his own! I praise God for saving and changing Anton’s life in such a dramatic way. I know God has big plans in store for this growing boy.  

1 Month post-op. Is that even the same kid?!