Gabon - January 2011, 26

Wednesday has been interesting.

Started with giving a lecture to the hospital medical staff - primarily nurses. It was a modified version of one I give at the IU School of Medicine - Purdue each fall. Fun to show them the "big" cases which are from their own hospital and are shared in the US.

I'm not sure what happened for the scheduling, or what kind of word got out last week, but this past Monday nearly every patient I saw needed a hysterectomy! I was actually grateful to see someone with a snake bite, and another with a gangrenous finger (smell and all) just so I could schedule something else!

Thankfully Jean Claude also was seeing patients - so it wasn't me alone who scheduled these cases - and he had the same! So...we are in the middle of a three day stretch of 7-8 hysterectomies and myomectomies - with a lap chole, a couple of scopes, and some debridements to break things up.

Yesterday and today we had two of the toughest ovarian cyst and hysterectomy cases I've had in the past 12 years. Tough describe, but the best comment is that my neck is sore from bending over :) And, it is comforting to know that I haven't seen the worst cases yet, seems I keep stumbling into them on these trips. The good news is that even with long days I've made every supper invitation thus far this trip! It's the "small" things :)

One picture I decided not to include was the debridement of a man's hand - that was today.

He ran it into a wood planer and effectively lost the three middle fingers of his left hand. He was seen in another "hospital" for the past week, and then came here out of desperation when he saw it swelling further. We opened it up, removed more bone, and closed. It was a bloody but welcome break in the marathon of removing uteri. He was grateful as well.

So far I've only seen three snakes - all dead. Those are generally the best variety when it comes to poison and close proximity to me. We have two guys in the hospital secondary to snake bites - thankfully both have survived. The spiders have all been the "good" variety as far as what has been running around in my house. And we, Dr. Johari and I, survived an excellent restaurant excursion. Granted the restaurant did have electricity AND a lightbulb this time. And, the food was quite good given the accommodations and state of the "kitchen"!

Our lady with the punctured brain is doing quite well. That is a no small miracle.

She tripped and fell onto a small sapling. It had broken off and the end ran directly up her nose. They said when they pulled the stick out her nose bled a lot. She arrived with stroke-like symptoms, and was treated accordingly. About 4 days later her entire history was re-reviewed by the medical doctor here, when the family complained of water running out of her nose. Thankfully she immediately ordered a head XRay (see above) - which revealed air in the patient's skull. That led to a consult from surgery (us) and the question of what to do was entertained.

Air was taking the place of her fluid, and you could see the fluid level in her head on the X-ray. Sort of like looking at a pitcher of water and seeing how full it is.

It was at this point that the "water" running out of her nose was diagnosed as Cerebral Spinal Fluid by the medical doctor who assured us that the patient was definitely a "Trauma" patient and not strictly speaking "medical". I quickly noted we were not going to open her skull and try to patch it!

We agreed that the patient really was a trauma patient, layed her flat, gave her antibiotics, and prayed. It has been 4 days now without any more leak (that we can tell), and much of her muscle function is returning on her "stroke" side, although I doubt she will ever be able to open her eye. She will have some permanent damage. But she is still alive!! (and her brain is still on the inside of her skull).

There are always surprises here.

She is a really nice older lady too. Hoping and praying she continues to do well. Appreciate your prayers.

That's it for a Wednesday!

Almost forgot - had a really great supper at Lisa's house with the other visitors and short-stay workers. People, patients, and friends which make life full and good. God brings the fulfillment in all of it. In a place like this you see His work very clearly. The effect of those who hate Him is just as evident. Thankful to be serving the one, True, and living God. Walking with Him brings order out of the chaos. Literally :)

Here's a picture of the sweet old lady who happened upon the stick:

Gabon - January 2011, 21

Interesting day.

When one wakes up in the morning, you can never tell just what might occur that day. I often begin the day thinking about who may not be here tomorrow.

Today was one of those days.

It was another beautiful day in the jungle with splotches of sunlight interspersed with a nice rain, occasional thunder, and people. Karen interpreted for me again - she is a huge help and source of inspiration. When it became quite solemn as I described the operation a young lady needed to remove her tumor, and the fact that she may never have children again...Karen asked the lady and her husband if we could pray. It set the entire situation back in focus. There are some things which can only be handled by God, no matter how much we think we are in control.

Later, as Dr. Johari and I were getting ready to leave the hospital, we went with Dr. Jean Claude to see a young baby with Malaria. Johari was hopeful that the baby had turned the corner after 4 days of medicine and close care. The baby had been doing well this afternoon, but in the few minutes it took to find us and go back to talk with the Mom, something occurred and the baby definitely began to look worse.

In the very few minutes we were standing there he died.

He was only a month old.

I can't tell you how many people I have watched die during my short time as a surgeon.

- I've lost count.

But the same sense of utter dependence on God remains the same.

The one thing I have found that makes the most difference to me is how I interacted with each person for the time I did have to relate with them. I can order tests, do operations, try to provide the "best" medical care - but in the end what matters most is how I cared for the person, not just their medical condition.

I learned this lesson the hard way a few years ago while working in the Sahara. A little gal I was attempting to care for died while asking for a drink of water. She was anemic (lost a lot of blood), needed IV fluids and blood, and needed antibiotics. I ordered all the tests and treatments she "needed" to survive. What I didn't recognize was that she was already dying, and what she really needed the most was a drink of water to ease her suffering as she died.

She did not get her last request for a simple sip of water.

The death of that little 12 y/o gal hit me pretty hard. I realized that there are a lot of people around me who are trying to do all the "right" things...yet what is really needed is completely missed. Not only in my medical world, but in the world around me.

Tonight someone will not wake up in the morning. What matters is what happened today - how we relate with each other and with God.

Tomorrow (or later tonight), when I go back to the hospital, the baby will not be there. But others will be - other people who have needs, medical and non-medical - and there will be people around who will be interacting around those needs. I pray God gives each of us the eyes to see what is really important - to recognize that for each of us it is only this day we are living. What matters for eternity is happing now.

It has been a real pleasure working with Jean Claude this week!

I added a photo of him and a little 3 y/o guy who suffered a complete pelvic fracture 3 months ago. Shattered pelvis, lacerated rectum, and destroyed urethra. But he has been healing. He has a permanent catheter - but he doesn't let anything slow him down! It is an incredible miracle the guy can walk!! These are the happy moments :) I thank God He gives us ALL of life.

Thank you for your prayers.

Gabon January - 2011, 20th on Thursday

A beautiful day. Warm, sunny, and friendly. The kind of day that you think about when you think of the jungle on the Equator - where there are good friends and good work to do.

I sometimes can't quite figure out how God chooses to bless us so much at times. The picture on the right was taken as I walked to the hospital yesterday. The sun was rising, steam rose with it as the jungle stirred and settled from the night activities. Birds began flying and the bats began to roost. And I was wondering how the day would go.

The time here has gone quickly. Monday came and went and it felt like we had been here a week. By the time Wednesday arrived I kept thinking it was Tuesday. Time plays funny tricks on the mind as fans spin keeping the humidity from becoming insufferable. The heat kind of grows on you :)

This morning started with a race - a race to see if twins would survive with one of their umbilical cords prolapsed (delivered without the baby coming too). Jean Claude (pictured below) is the chief resident here while the team is away - so I assist and teach. Needless to say, the assistant gets the bath during a C-section, especially with twins, and emergent. Jean did a great job, and both babies survived! One was a bit depressed, but pulled through in the end. The air-conditioner for the OR remained off till the little ones were out of the room - hence a new level of humidity from my head toes.

After a laparoscopic cholecystectomy performed with video equipment that no one in the US would dare use, we worked on a re-do open fixation of the broken wrist of a 9 y/o girl without the requisite imaging equipment. They brought the films during our last case to show that it was finally put right on the 3rd try. Sweet gal, and tough to see her go through 3 ops to get a broken wrist set right. But hopefully now it will give her back her arm to use in the future.

An open biopsy followed.

Then a hysterectomy along with two other hernia repairs for the same lady.

By the time the day was finished, including morning meeting with entire hospital staff, rounds, C-section... it was time to head to Jean Claude and Christine's house for dinner.

They are a young couple, both physicians, headed to the Congo. There are no qualified surgeons in the entire region. And there have never been either. Jean C. will be pioneering a whole new venture in a hospital made renown by Dr. Helen Roseveare. Jean Claude and Christine's families have been instrumental in the medical and spiritual development of that part of the country. They are returning to begin a new era of healthcare and ministry. Working with them is a real privilege and blessing to me. It is rare to work alongside with people who you know will be the leaders of entire regions of the world. Seeing what God has done in their lives is simply amazing.

Almost forgot - the man with a snake bite :) That was at the end of the day as we finished our last case.

He was sure that two pairs of socks and knit pants were going to be fairly good protection. Unfortunately one of the fangs made it's way through (See picture). So far he is doing well after a boat-load of meds, shots, and IV fluids. Blood will be the next option.

Thankfully bites are rare - at least ones with venom.

That's just a snap shot of the last 14 hours. Not to mention a birthday part on the way home from dinner. Incredible deserts - just to be sure that none of us waste away! I don't know how the missionaries do it - but I've eaten some amazing

meals these past few days. I can't complain in the least. It is a huge privilege and blessing to be here.

Sure, there are bugs, ants, bats, snakes... But there are also good friends, amazing people, amazing patients, opportunities to bless those who have next to nothing, and beautiful people in a beautiful jungle. I am so thankful the people in this part of the world have some place to come to when they are bit by a snake, have painful gallstones, are falling apart, and just plain need help physically and spiritually. Those who have gone ahead make it possible for

those like me to see the rewards of their efforts. I'm still amazed by what they do here.

God is good. Thanks for your prayers.

It worth washing blood off my feet twice today - to see two new babies, and help and old woman see another day. It is a humble privilege. I wonder at what Jesus has done for me.

And those are the initial thoughts for this evening :)

Gabon - January 2011, 17th

Monday evening, and my belly is full :-)

Full of good food, and "full" of good fellowship with friends.

It is a rare place on earth where one can go and find friends waiting to relate and engage about life. People that are happy to see you, and prepared to work together with you and tackle the challenges of whatever comes through the door, around the bend, or from under your bed.

In a place like this any of those challenges can happen on any give day.

Take for example the man pictured here.

It isn't just living, or living the moments, but the reason for living those moments. It reminds me of my days in English Literature class discussing various philosophies and perspectives of various writers. Existentialism was one of those perspectives which seemed to represent a lot of lives around me. Others such as Buddhism, Hinduism, Hedonism, naturalism,... (you get the idea) all lacked one important thing - a true, honest to God, personal and vibrant relationship with the Creator God. Jean Claude and I examined him, and there is obvious extension of the cancer around his carotid arteries and throughout his system. There is little we can do for him at this point. Life is going to come to an end on this earth for him, and soon. We know it. He is coming to grips with it.

The real difference between him and I is that he knows his time on earth will likely be shorter than mine. What really matters in reality now is what happens to us when that time here is finished.

To live each moment fully is only possible through knowing and walking with Jesus. It isn't believing that He exists, or trusting that He really is God, but it is walking with Him - together - Him and I. The same is true for you.

Why? Because Jesus said it was so. I have found He is telling the truth.

He also said that life was only lived abundantly (fully) in relationship with Him. Tough claims.

Crazy thing about Jesus is that He really WAS crazy, or He really IS God. No other options.

Looking at my patient this afternoon reminds me of why I am here. Why he was here today.

Speaking of crazy...

Dr. Miller and I are having a fun time trying to survive :)

Had an uneventful (relatively speaking) "bus" ride south across the Equator for 7-8 hours, then in a private vehicle (old Land Cruiser) for another couple of hours cutting through the jungle the whole way. The Gabonese government has done a whale of a job putting a new road in for the North/South traffic and it was simply amazing! Hurtled up to speeds of 120 kilometers an hour, rocking from side to side, with all the tires staying intact (though we stopped once when they smelled a bit burned). We bottomed out a few times (or quite a few) and the tires were rubbing the wheel-wells nicely - just to assure us we really were loaded to the gills. What you can't see from the picture is that we were sitting shoulder to shoulder so tightly that we didn't need seatbelts (not that there were any) much like sardines don't usually get mixed up when shaken in their can.

Dr. Miller has been extremely gracious in all the events - even the driver found a toilette at a stranger's home mid-way on the trip just for her. Nothing like pulling into a church (he figured that would be ok) to ask complete strangers to use their toilette. Yep, very gracious people here. The other 16 passengers were left to fend for themselves.

Today Jean Claude and I saw a few patients, and signed up 4 for hysterectomies, two wrist fracture pinnings (peds), another "large" ovarian cyst (pictures to come - maybe), hernias of all shapes and sizes, and a urological case of some kind (still trying to figure what he plans to do). Since I'm the "attending", i.e., substitute chief, I'm supposed to be guiding him through the operations as needed. We have a great relationship - and it really is more like two colleagues assisting each other than a "teacher/student". He will be heading into the Congo within a year to be the primary surgeon for 100's of thousands of people. That is your Ob/Gyn, Peds surgeon, head and neck, General/Trauma, Ortho... So - needless to say, we are working "together" at this point in the training. He is doing well, and I greatly appreciate his humility and heart to work for God, not himself or only to serve others. Big difference. He works out of his relationship with God, not because of his relationship with God. Subtle, but profound difference.

We are surviving incredibly well with three great dinners thus far, a good day of work, a cool evening, and the jungle noises echoing off the walls and through the windows. It is really quite noisy in the jungle at night with all the insects.

By the way, Johari (Dr. Miller) was able to find spiders on her walk home tonight by shining the light in their eyes. They look like glittering green glass in the dark. Quite a start though when she flashed her light up the path and saw two "big" green eyes moving towards her! Thankfully she discovered it was just a friendly domestic cat. Her laugh of relief was real!

So just a few random thoughts from the first couple of days here. Many more, but it is late and there is a full day of operating in the AM - two wrist fractures to pin, two hysterectomies, and a urological case. And...anything else we need to do.

If there are any particular questions you would like to ask - please do. I realize some are reading this for curiosity sake - and if curious I'm sure there are questions. I'll try to answer.

As I finished up the night last night I sent an email to my parents. Thought I would leave this blog with a couple of thoughts I shared with them:

"11:30pm and just finished chatting with the construction guys and headed to bed. Need to sleep hard and quickly :-)

Will be praying for each of you. One life to live. Now. Not in two weeks. 21 days, or next year. Now.
Same for each of you. :-)
It may not be the life you want, but life is not about us - it is living what we are given, and doing it in relationship with God.
My thought.
Bon Nuit. Blessings!
John"

Gabon - January 2011

Gabon Blog January 2011

January 14 Friday

So far it has been a rather uneventful journey. We are now flying over the land of Nigeria. The flight over the Sahara was less than stellar as the dust was quite dense and unfortunately little of the landscape could be appreciated. But this airplane is quite comfortable, almost luxurious compared to the prior two flights. Plenty of room, pleasant service, and relatively quiet. Caught up a bit on sleep. Johari and I watched “Inception” - brought back a lot of memories, no pun intended. I wonder if the writers really grasped what they were portraying? Obviously someone had some insight into the reality of the influence of Satan on human minds. I know from personal experience the reality of what was portrayed. Thankful for God who is able and ready to redeem and save us from guilt and sin - there IS true life and it IS worth living!! The movie ended almost exactly as I anticipated.

Yesterday we left, Dr. Miller and I, from Indianapolis, travelled through Atlanta without difficulty, then crossed the ocean during the night, landing in Paris in the dark at 5:30 am. The oceanic flight was less than desirable. Not sure what happened but Delta/Air France used their oldest, smallest airplane to transport a packed group of people. None of the workers were very happy about it from what I could tell. Reminded me of the plane I took in ’91 - and I’m sure it was as old. We arrived, so no complaints.

Another adventure (story) in the making. Every day is an adventure to be lived whether or not we recognize it. Unfortunately so many days pass by without ever realizing what is transpiring. To the untrained eye it appears so mundane, “normal”. There are moments which catch our attention, when something appears to interrupt the daily ebb and flow of routine. But then we quickly settle back to normalcy, never recognizing those moments are just as influential and profound as the ones which seemed to rouse us from the complacency of life for few seconds, minutes, or hours. Every moment is unique, lived only once. And the multitude of those moments drives us to consider them routine. Nothing is routine when you look below the surface. No more than the river rushing through a gorge may appear routine. Every second brings change even if unnoticed by a casual observer. Each life - yours, mine - is lived in the moments. Sitting here enjoying the music through my earphones while watching the clouds over the edge of the Atlantic slide below is a once in a life-time experience. Nothing like this will ever be exactly the same. Without relating with God I would have no context, no reference, and certainly no certainty of knowing that these moments exist for a purpose. To know there is real joy in living. Not just felt or hoped for, but true meaningful joy. Joy that comes from walking in relationship with the One who created us to know and relate with Him deeper than we can yet imagine. To smile and know the joyful contentedness goes deeper than eternity. We are made to relate. No matter where you are or who you are with, He is always there relating with you. There is joy in learning to recognize His smile in the moments.

And...just finished supper here at the Guest House in Libreville. Very nice to receive a warm welcome from the Straws. Nice to catch up with Drs. Dave Thompson and Keir Thelander, Philadelphia and Simplice. Great guys and great surgeons.

Now to get some sleep since we are leaving again in 7 hours. Looks like a nice bus ride (Philadelphia says the bus drivers are crazy) tomorrow - warm and sticky for about 7-8 hours before getting in another vehicle for the additional 2+ hour drive to the hospital. Keir drove up today - left at 5:30am and arrived at 9:30pm. That is a little bit of a day :)

Thankful we are all here and safe!