Andy's Third Medical Journal Entry

17.Jun.2009 -- Day 7

Aphematoh! Oh doe! Yo-lo!

We greet you in the name of our LORD!

Today is Wednesday, the second of four calls in 7 days. Our short-term surgeon, Dr. Bruce Dekinga from Northern Michigan, is leaving today. The next volunteer surgeon comes in on Sunday. So for the next 5 days it’s three of us (the pediatrician Dr. Russ Ebersole, and Dr. John Briggs, a family doc who also does surgery. Interestingly, they are brothers-in law! John married Russ’ sister Susan). Not much happened yesterday. Andy was post-call and slept the afternoon away.

We’ve already had one answer to prayer – friends for the boys. Several of the boys who played soccer with Drew last time have visited. Drew and Tony love the company. They have been playing soccer, baseball, and riding bikes. It’s been a lot of fun for them to have someone other than mom or dad to play with! Drew also had his first over-the-handlebars wipe out. Fortunately he fell into grass so injuries were fairly limited.

Today was kids club at the Ebersoles. They host 60-80 Togolese children every M-W-F, with games M-F and lesson time on Wednesday. Cari jumped in and helped teach the lesson today! Pretty typical VBS type lesson, except she taught in French. Melody did give Cari an interpreter so at least she wouldn’t have to teach in Ewe. : ) She said it didn’t go very well, but I’ve heard otherwise. It’s pretty neat to hear the laughter and yelling of that many kids running around the compound.

The medicine here is just as complicated and sad as I remember. Monday call was long and tiring. We have several patients in the four bed SI unit (our “ICU”) who are very sick.
SI-1 is a 70 year old lady with pneumonia who hasn’t gotten better despite 3 days of antibiotics. Her sugars are high (bad) and her white count had been coming down but now is going back up (50,000, also bad). I am worried she will die soon.
SI-3 is a 30 year old lady who became unresponsive after losing her sixth pregnancy. Her glucose was off the scale (diabetes). I spent most of the night getting it into measureable range. On morning rounds it was 550 and Bruce (the surgeon) said “Üh-oh, that’s high.” I responded, “Oh no, that’s wonderful, I’m just glad the machine is finally giving us an actual number!” (I’m thinking it could have easily been over 1000 when she came in) She is doing much better, alert and talking to us. Unfortunately, almost no one has refrigeration so controlling her diabetes with insulin is a near impossibility. So now we have to explain that she probably has miscarried 6 times because she has diabetes, and continuing to get pregnant with this condition may end up killing her. But the emotional burden of being barren may be just as devastating so she likely will continue to try.
SI-4 is a 12 year old boy in liver failure. His liver and spleen are huge, his direct bilirubin is 10 (normal is less than 0.3), he can’t breathe well, and we haven’t been able to make him better either. I’m afraid at some point we will need to discharge him because there is nothing else to do. His liver will continue to fail, and then he will die.
We have 3 preemies all less than 33 weeks but they seem to be doing well. A 10 year old girl with nephritic syndrome (kidney failure) who also has high blood pressure, blood in her urine, and high creatinine (bad) – there is one type of nephritic syndrome that responds great to steroids and kids do fine but unfortunately she doesn’t have that kind. The 5 year old MVA is still in a coma, its been a week now, I feel so bad for the mom. Every morning during rounds I imagine myself in her shoes – if that was Drew in a coma, sitting at the bedside, wondering if he would ever wake up so I could play games with him again -- and it’s a crushing thought. Malnutrition, typhoid, malaria, hernias……… Yesterday, Russ had a worst of the worst come in, a child that drank lye (used to make soap) causing burns covering his mouth and esophagus, he likely will have permanent scarring. Neuro-ICU, CCU, PICU, OB/GYN, dialysis, orthopedics, NICU -- Andy gets pretty tired from the mental exercise.

I guess it’s just a reminder that our surgeries and medicines are just temporary reprieves, everyone we treat will eventually still die, and that ultimately we are powerless over death. How great it is to know that we have a God who is both personal and powerful. He loves each one of us enough to die for us, and he has overcome death for us.

Drew says his favorite things about being in Africa are “playing with the kids, feeding the monkey bananas, and playing his new computer games.”
Tony says his favorite thing about being in Africa is also feeding the monkey bananas (accompanied by monkey noises).
Cari says her favorite things about being in Africa are “the much slower pace of life and buying things at the outdoor market in Adeta.”
Andy says his favorite thing about being in Africa is “being back in Africa.”

In the Shadow of the Almighty.

CADT (The Robertsons)