“Flesh and blood cannot inherit the kingdom of God.” – 1 Corinthians 15:50
I hear the stretcher rattle through the doorway and quickly move aside. It’s occupant, a young man with a head wrapped in bloody gauze, appears to be the latest victim of yet another boda boda (motorcycle) accident and the next patient for the on call trauma team that night. Although the patient’s gender and location of injury are very different than those I am accustomed to treating, my thoughts wander to the challenge facing his surgical team and whether or not he will survive the night. His surgeons walk through the door less than a minute behind the stretcher and I am jolted back to reality. I try to refocus and finally finish listing our 8 surgeries for the following day on the OR scheduling board before starting the half mile walk down the hill to our house.
The day has been a challenge. It began by checking on the cervical cancer patient I did a radical hysterectomy and aortic lymph node dissection on the day before. Praise God she was doing well. The rest of the morning was spent in clinic where I met three successive patients with aggressive gynecological tumors. One appears to have early disease and is being scheduled for surgery. The second, Rose, has a large but resectable tumor and will undergo surgical resection hopefully in the next week or two. Norah has one of the most aggressive and advanced tumors I have ever seen, consuming essentially everything from her pelvic bones to her rib cage. The tumor is so large that the ulstrasound machine can’t properly characterize it and we order a CT scan (it’s incredible that we have that as an option here!). I will likely be forced to tell her that her case is too complicated and refer her to a mediocre cancer treatment center hours away for a second opinion.
It can incredibly difficult to know with the limited here resources which cases are too big, too risky and too dangerous for the hospital and our team to handle. I certainly believe we offer a high level of care but dread the thought of relegating a patient’s dying breath to the operating table in pursuit of futile treatment when that time could have been spent at home with their family. Lord please give me wisdom!
The remainder of my day was spent working on a treatment plan for periviable twins at 28 weeks gestation with stage II twin to twin transfusion syndrome. I take the mother, Joyce, to speak with a visiting cardiologist who determines that the hearts of both babies are still pumping properly (which is a good sign) but this doesn’t change the fact that one baby is “stuck” and severely dehydrated while the other incredibly overloaded with fluid. Because the placentas of both babies are conjoined, the fate of one is intimately linked to the fate of the other; with the death of one twin posing a 20-30% risk of stroke or death to its counterpart. To try and prevent this we make plans to remove fluid from around one of the babies, prayerfully hopeful that this will keep the dehydrated baby alive and buy more time for both the twins. Complications of the procedure or delivery at this point in the pregnancy would make it difficult for either baby to survive in Kenya but given the clinical picture and progressive nature of the twin’s condition, intervention seems to be the best option moving forward. We will monitor the status of both babies carefully and plan for delivery at just the right time but the future of this pregnancy certainly hangs in the balance. “This is out of our control Lord,” I pray. We will treat but you will have to watch over, protect and heal these babies.
Finally, I spend some time after dinner looking into possible fertility treatment protocols at the request of one of the local Kenyan doctors. What a day! I was not formally trained an an GYN Oncologist, maternal fetal medicine or infertility specialist (all of which require three additional years of training in the US), but today I found myself wearing the hats of all three. The patient problems here are exciting and terrifying all at the same time. I consistently feel inadequate and unqualified to meet the challenges at hand but am comforted by the words of Don Ford, my director at Kanakuk who often said, “God does not call the qualified, he qualifies the called. God has reminded me of this recently just as he reminded the apostle Paul of this same truth when he said, “My grace is enough for you; my strength is made perfect in weakness.” (2 Cor 12:9, KJV)
So it’s 3 am Thursday morning here and I can’t sleep. I’m feeling the weight of everything going on and trying to process everything that happened today. We lost two babies in the last 24 hours. One was delivered by the call team last night with a fatal heart condition and the other died inside it’s mother at 30 weeks before our team could figure out what was going on and make a plan for delivery. I am on call today (Thursday) then again this weekend. Who know what the next 72 hours will bring.
Amidst a newfound heightened awarenesses of my weakness, my inability to make everything and everyone better and of the imperfect power of modern medine, I have gained a deeper understanding of God’s grace and his presence on a moment by moment basis. I sense his presence around the hospital more than normal and I have been reminded, more than ever, that “this world is not our permanent home.” (Hebrews 13:14, NLT) People die at Tenwek on a daily, sometimes hourly, basis which for me has served as sobering reminder that “flesh and blood cannot inherit the kingdom of God.” There comes a point for all of us where we must let go of the lifeblood was have grown accustomed to grasping hold of so tightly. In the operating room I work with meticulous technique to restore flesh to it’s rightful place, keep blood loss to a minimum and to keep patients alive but more than my best surgical, diagnostic or treatment efforts, more than all of this, His grace is sufficient. It has to be! And I’m coming to realize that part of this grace, part of God’s goodness and part of God’s grand plan is at times for him to call people home to his kingdom. Lord help me to release and let go of the patients you are calling home and give me the wisdom, insight and endurance to treat those you plan to heal.
Please pray for Rose, Norah and Joyce (and her babies) and all that is before them. Pray that God would get the glory in their lives and through the care they receive. Thanks for your support!