Compassion From The Brokenhearted

Kristen here….

August was a hard month. As I have tried to put my thoughts together about all that happened it has been hard to figure out how to put it into words. With the hospital understaffed and all of us taking extra call, working for almost a month straight without a day off and with more than half of those days being on call led to a lot of sleepless nights and exhausted days.  August, September, and October are some of the busiest for labor and delivery in Kenya due to a lot of social and cultural factors that occur 9 months earlier. 

The steep increase in patients also lends itself to an increase in difficult cases.  Each case takes its toll.  At one point there was a series of three days where I lost 5 babies.  All for different reasons, all incredibly painful. I found myself one evening curled up in my husband’s arms sobbing and asking permission to quit.  Not wanting to be a doctor any more, not wanting to have the weight and responsibility of human life upon my tired shoulders any longer.  Of course, out of his love for me that permission was not granted and I trudged on.

Returning to work the next day, I found a rare quiet moment that afternoon and sat down on the back steps of the maternity department to breath and process the tragedy after tragedy that had occurred over the last several weeks. 

My mind wandered to a young, first time mom that I had been treating for high blood pressure. She was on the maximum doses of blood pressure medication available and had come to the clinic for a routine blood pressure check and fetal monitoring.  She was feeling sick and with legs swollen to the size of tree trunks. Her blood pressure was suddenly extremely high, the fetal heart rate tracing was a Category 3 leaving a pit in my stomach.  On the dopplers of the umbilical artery there was absent end diastolic flow.  This was a recipe for stillbirth, but at 27 weeks and 1.2kg the chance of survival if delivered was slim. She had received steroids two weeks ago, there was nothing else I could do to make this better.  I explained the situation to the mother and with a heavy sigh she told me to proceed with delivery.  An emergency c-section is what came next and resulted in a beautiful cry from her baby boy.  My heart sored, only to cry in anguish the following day when at 24 hours of life this precious baby stopped breathing and went to be with the Lord. 

I knelt beside the bed of this grieving mother.  Tears rolling down her face and all I could do was put my arm around her head whispering ‘pole sana’, I am so sorry, over and over again in her ear.  Another death.

I hate things like this.  I hate losing babies. I always find myself second guessing my management when things like this happen….wondering if there had been another doctor here would that patient have survived?  The reality is, there isn’t anyone else. God didn’t put me here at this hospital because I am perfect, but because I am willing.  This, however, doesn’t make the sting of every loss any less painful. 

As I was sitting on those back steps with all of these thoughts swirling around in my head this young, now childless mother sat down next to me.  I smiled at her through the tears welling up in my eyes.  What else could I say to her?  Little did I know that she wanted the chance to talk, I didn’t have to.  As she started to talk she presented me with a package of milk she had bought in the center.  “This is for you,” she said in her broken English. “I saw you sitting out here and knew that I must come talk to you. When you came to tell me about the death of my baby I could see the hurt on your face and I know that you cared too. I know you did everything you could and I know that God is in control. When you told me that I needed a c-section, I was scared, but when we made it to the OR, I had peace.  I knew everything was in God’s control. This was His will for my life and I must just accept. I wanted to thank you for all of the work you do here. I want to give you this because it is good to share, especially with those that are here struggling with us. I appreciate your work.”

I sat there stunned.  This simple act of compassion and kindness was so unexpected, so undeserved. What do I say to her?  Two days after her baby died she comes to console me.  I was grieving this loss, but surely my grief did not match that of this childless woman.  Where did her words come from?  How could she see through her own pain to reach out and comfort me? I don’t know how that is humanly possible, but it was exactly what I needed. God knew this broken heart needed help, and He picked the most unlikely person to be His angel to do it.

Dealing with grief at the hospital has been an interesting journey for me.  Grief is so much more common here.  Death and bad outcomes happen far more frequently than I ever experienced back home.  It is important to feel the pain and to be gripped with sadness. It keeps you human, it keeps you grounded, it keeps you compassionate, it makes you a better doctor.  But, it also can be crippling.  Out here there isn’t time for that because there is always another patient that needs you.  You must push on.  I am human too and the pain does not escape me.  Quitting though, is not an option.  It has become this delicate balance in order to stay healthy and to be able to keep going.  It is learning to accept loss without becoming complacent.  Letting it bother you without letting it beat you up.  Some days this is easier than others.  Some days it seems impossible and God sends you an angel in the form of the broken hearted to pick you up and push you forward.

Is this how you measure your jeans?

Kristen here…

A little over a month ago I had the chance to go shopping in Eldoret with some of my Kenyan girlfriends.  One of the other missionaries and I had decided that the dirty, overcrowded, busy town of Eldoret probably had more to offer than what meets the eye.  Our Kenyan friends like to go to “town,” as they call it, frequently to go shopping.  As far as I could tell there were no great shopping places in Eldoret and our girlfriends offered to take us along and show us the ropes.  I was pretty sure I was going to see a side of Eldoret that I didn’t know existed and I was starving for some girl time and a chance to get away from the hospital so I was all in!

We met in Eldoret and set off to do some shopping.  I didn’t really have anything I needed, but I was excited just to explore with some trusted friends and tour guides.  Soon we turned off the main road and walked down an alley that was lined with little shops selling all kinds of goods.  This alley gave way to another and then another.  Soon we were winding ourselves through the bowels of Eldoret that had previously been completely unexplored by me.  There were shops (little 5 feet by 10 feet alcoves in the walls) that sold anything from shoes to dresses, to kitchen ware and hair products.  You could probably find literally ANYTHING if you were willing to look hard enough.  The walls are lined with goods to sell from floor to ceiling, piles upon piles.  Shop owners would stand outside their stores and try to entice you to enter and see what they were selling.  These are not places that “mzungu” or foreigners frequent very often so you can imagine the attention we were drawing…including several marriage proposals.  Everything is on the bargain system here too.  Our friends told us if we wanted to buy anything to tell them and they would do the bargaining for us.  Kenyans are able to get a much better price than we are.  This actually made it even more fun.  I knew I wasn’t going to get ripped off and watching these three ladies in action bargaining away in their own culture with the shop owners was hilarious.  Those poor shop owners didn’t stand a chance!

As we wound our way through the stalls we stopped at various places that our friends knew and seemed to particularly like.  One thing that seemed to be sold in abundance at the shops we were visiting was jeans.  Men can wear jeans anywhere and in the city it is also becoming more and more acceptable for women to wear jeans as well.  There were both used and new jeans for sale in almost every store.  We took a few pairs down from the walls they were hanging on and looked them over.  How in the world do you ever try these on to know if they will fit?  I looked around, definitely no area to change in these small, closet like shops. 

I turned to one of my Kenyan friends and asked her how she knew the jeans would fit.  This is where the real lessons of the day began.  Apparently you have to place the jeans up to your waist to see if the length is right.  If that seem ok, then you button the top button at the waist of the jeans and pull the waist of the jeans around your neck.  If the waist just fits around your neck so that you can just touch the ends of the waist together at the back of your neck the jeans fit.  Who knew?  I didn’t buy any jeans that day (being so short nothing passed the first part of the test for me), but I later went home and tried the “measure the waist around your neck trick” with some jeans I had brought with me from home and the trick seems to work.  Now we just need to test the theory.  Try this with some of your own jeans at home and let me know if it works for you too.  I am really curious to find out.

Anyway, the day was a blast!  It was so fun to have that girl time. To wander, shop, talk and just enjoy some time with friends was exactly what I needed.  At one point when people were heckling us two mzungu while we were shopping one of our Kenyan friends turned to us and said, “I forget that we are not the same color and all of these people keep feeling the need to remind us.”  So interesting and so great to be breaking those boundaries with a few close friends.

What is everyone staring at?

Dan here...  It has been awhile since I have posted a blog.  This past week, I was asked by the Kapsowar Theology School to come and teach….a computer class.  All of the students were about 30 - 35 years old.  Most of them have had very little experience working with computers especially the internet.  Of the 10 students, only one had an email address.  This would be almost unheard of for someone back home to not have their own personal email address, let alone someone in their 30’s.  Kapsowar is definitely a different place from America in terms of technology.  Most people here do not have internet, they have never done a Google search, and they have never seen or heard of Facebook or YouTube.  These are things that we take for granted in America.  They are part of our weekly if not daily lives.   

Everyone in the picture at the top of this post is staring at my laptop screen.  They were all huddled around the computer watching as each person took a turn to setup an email address for the very first time.  This is how I spent most of my first day of class, helping my students setup an email address.  I then showed them how to use email.  I helped them setup email accounts on Gmail and we practiced sending emails back and forth to each other.  For most, it was the first time in their life to have ever sent an email.  I then moved on to showing them how to do a Google search.  They seemed amazed at the amount of information that they could find about any topic in the world so quickly.  One of their searches brought up a YouTube clip.  This pretty much ended the class.  They were so enthralled with what they could find on YouTube.  While all of them have seen TV before, they probably do not own a TV.  YouTube has opened a whole new world.  They suddenly began to realize they could use the internet to help find information for their sermons and theology classes.   

On a different note, the medical director and I went down to one of our sister hospitals in Kijabe last week.  Kijabe hospital is much larger than Kapsowar, and they are looking to pilot an EMR system in a smaller hospital.  The meeting went well, and we plan to partner with Kijabe to implement an EMR system here in Kapsowar.  We are working on trying to find servers, pc’s, and networking equipment.  Assuming we can get the equipment we need, we plan to install EMR in the next month or so.  Once it is installed, I will be training a whole new group of Kenyan’s how to use a computer for the very first time.    

A Sacred Moment

Kristen here…

 I was standing over the table in the OR about to start a c-section when the call came that there was an emergency coming to the operating theater.  I wasn’t sure what the commotion was about, but I didn’t ask question as we quickly ushered out the current patient and made way for the emergency.  I poked my head outside the building to see a team of maternity nurses rushing a patient up to the OR on a gurney.  The patient was covered by a blanket and on her hands and knees trying not to fall off the bed that has no railings as the nursing team turned the corner.  The other patients turned their heads with curiosity from the surrounding wards to see what all of the commotion was about.

As they reached the OR doors one of the nurses seemingly attached to the patient looked at me and said, “cord prolapse.”  Her arm was inside the patient trying to hold the fetal head up above the umbilical cord.  This is the maneuver that would save this baby’s life.  Cord prolapse is a true emergency.  The umbilical cord tries to deliver first which is a life threatening problem when the after-coming head of the baby slams down on top of it cutting off the blood and oxygen supply with every contraction.  It is exceedingly difficult to fight against the strength of every contraction and keep the head from pinching off the cord.  Time is of the essence.  “She was transferred here from another clinic for cord prolapse.  When I checked her I could feel the cord pulsating,” the nurse said as we ushered the patient into the operating room.  Pulsating tissue in the birth canal is pathognomonic of a cord prolapse.  “Is it still pulsating?” I asked, hoping that the answer would be yes, hoping that there was still a chance that this baby was alive.  “Yes, I can feel it pulsing,” she replied.  Relief washed over me as we moved the patient to the operating bed.  I left to go scrub as the OR exploded with activity preparing the patient.

 I stood across the table from one of my colleagues and flew through the maneuvers to do this c-section and deliver the baby as quickly as possible.  I had no idea how long the prolapse had been going on for or how much reserve this baby still had left.  I opened the uterus and reached my hand inside to deliver the head.  My fingers touched the fingers of the nurse still desperately trying to hold the baby up from the other side.  For a split second my mind paused, I couldn’t feel the cord. Something wasn’t right. 

I looked down as I pulled the baby up through the abdomen.  I couldn’t help the groan that came from deep within.  Anencephalic.   This is a rare condition where the brain does not develop properly in utero and much of it is missing.  The whole back of the head was sunken in where normal brain tissue should have been.  I looked down at the soft spot between my fingers and could see brain tissue protruding through the forehead.  This is what the nurse felt pulsating.  There wasn’t a cord. It was much, much worse. 

The baby gave a guttural cry as we cut the cord and handed him over to the waiting nurse.  My heart sank.  Though there is some very rudimentary brain function that allows for reflexes such as breathing and some gross movements, anencephaly is not a condition that is compatible with life.  The hours for this baby are very, very numbered. 

We finished up the c-section with heavy hearts.  How was I ever going to explain this to the patient and her family? I asked one of the nurses what the people in the patient’s village would say or what her family would think and she responded, “they will say that there was a curse put on the patient or her baby, or maybe they will say that there is a deep family conflict and god is punishing her.”  All of it is so far from the truth, but so much a part of the reality here. 

I went to check on the baby after we had finished in the OR.  Still alive.  Still breathing, moving, crying.  I wanted desperately for this mom to see her baby while he still had life.  I didn’t know how long that would be. 

After she got settled in her bed in maternity, I walked quietly over to her side and pulled the curtain – the only form of privacy on the ward.  Kneeling down beside her I began the heart wrenching conversation.  As I told her about the baby and the anencephaly tears rolled down the side of her face as she stared at the ceiling.  Still numb from the anesthesia she lay flat on her back, unable to move.  I described the baby’s appearance, reiterating that this was not a curse, that she didn’t do anything wrong, but unsure that she was hearing anything that I was saying.  After discussing that this baby may only have a few hours left I asked if she would like to see him.  She agreed with some hesitation.  Scared by what she might see and haunted by the thought that he might die before she had ever met him.

I could hear his cry as the nurse brought him down the hallway and set him on the bed beside her.  I stepped back as she took it all in.  The mixed emotions raging within this 19 year old mother came in waves across her face as she looked at him.  Slowly, she reached her hand out to touch him with hesitation.  He grabbed hold of her finger and held tight.

I knew in that instant that I was standing in the presence of a sacred moment.  Witnessing the bond between mother and child that God forms so strongly before they have ever even laid eyes on each other.  Something holy, something beautiful was happening in those few, precious moments.   It was a moment that I didn’t deserve to be a part of; it was a moment I will never forget. 

 

 

Life

Kristen here…

One of the things that the speaker said to us at orientation was, “you are the same person when you get off the plane as when you got on the plane.”  We all laughed at the comment because of how painfully obvious it was, but there was a lot of hidden truth in this one statement.  Just because you move overseas doesn’t make you a super hero, you don’t suddenly become more holy or a better person, you don’t have different needs or desires and your personality stays the same.  The point is that living on a different continent doesn’t mean that you don’t still have to do/want to do life. At the core you are the same person no matter what continent you live on.  The hospital consumes a lot of our time, but there is still a need for sanity and the need to “do life” outside of medicine.  I thought I would just give a glimpse into what “life,” aside from the hospital, means here.

Garden cleared and ready for planting

I helped! :-)

Recently, we planted a garden in our backyard.  This was a project that Dan dreamed up and has been really fun!  With the help of my in-laws sending us some seeds to get things started we have been able to plant. Things are now starting to grow and we are eagerly awaiting these much desired vegetables from home that can be hard to get here.  I have to confess that in residency I was given a small pot with a bamboo plant in it.  I single handedly almost killed the plant completely until my roommate took over caring for it.  I have wanted to learn how to garden for years, but knowing my epic failures with potted plants in my own home - I was aware of my limits and never tested those boundaries.  I can’t really take much credit for this garden either as Dan did everything.   All I did was drop the appropriate seeds on the ground where he told me to.  It has been really rewarding, though, to watch as the plants come up and to see success in our endeavors. 

 

Weeding

This last weekend we decided we needed to do some weeding.  It was time to sort out what we had intentionally planted versus the unwanted invaders.  We were getting ready to head outside, gardening gloves in hand, to tackle this chore when I had to admit that I didn’t know how to weed.  Actually, I didn’t even know what tool to use or how to properly pull up the plants.  The look on Dan’s face when I shared this shortcoming was priceless – complete disbelief.  This was then followed by so much laughing that he had to leave the room and wipe the tears from his eyes.  Well, there is a first time for everything and it was the first time this girl had ever pulled up weeds!

 

Weeds are all gone!

Other “life” things that contribute to our lives here in Kapsowar are learning how to make your own fun.  Back home you have a variety of things to choose from including going out to eat, going to the movies, going to a sporting event, various weekly church activities, spending time at the gym, etc.  In Kapsowar, “life” is different in that these types of run of the mill entertainment activities are non-existent.  Nevertheless, the desire for them, the desire for activities, for date nights remains the same.  Now, we just have to get creative. A few weekends ago Dan suggested that we have a date night – just the two of us.   There is nowhere to really go in Kapsowar at night so instead of going out for our date we stayed in.  We made dinner. Filled the house with candles.  Got dressed up.  We cleared the living room of all of the furniture and recreated our first dance from our wedding.  It was a priceless, special evening.  It wasn’t fancy, it wasn’t extravagant, but it was “life” and doing it together.

Date night fun

 

We have also recently added to our family.  We got a dog!  Moto is our newest member and has been really great.  He makes for a great companion for me when I am out hiking or running the trails in the mountains surrounding Kapsowar and a great watch dog for our home.  He is full of energy and keeps us busy as well as entertained with his antics. He eats vegetables and kills bugs.  Perfect for being overseas! He is so much fun.

Moto means fire in Swahili

 

Though the hospital consumes most of our time here, I hope this has given you a little glance into the everyday normalcy that is “life” on the mission field.  Sometimes you have to be creative, but doing “life” is an important part of staying sane, keeping perspective and being sustainable on the mission field.

A Modern Day Miracle

This picture is taken of the patient three days after the surgery.
Posted with permission from the patient.

Kristen here….

Practicing medicine in Kenya where many of the modern day technologies and conveniences aren’t available have led to many frustrating moments, but it has also given the opportunity to really demonstrate the power of prayer and to see the impossible become possible.  There have been many of these such cases that appear to be miraculous to me in our short time that we have been here and last weekend was no exception.

I had the weekend off and decided to dedicate my Saturday afternoon to the kitchen.  My last batch of banana bread muffins were in the oven, and the yeast I had mixed together to make bread was bubbling in the bowl on the counter.  I had just finished prepping all of the things I needed to make broccoli cheddar soup for lunch when my phone rings.  I looked and saw it was the doctor that was on call that was calling me.  Uh oh.  You see, when you live at the hospital there really is never a time when you are completely “off.”  I answered and heard the hurried voice on the other end.  “Kristen, I have a patient that has a retained placenta and is hemorrhaging.  I have done everything I can and the bleeding won’t stop.  I think she needs a hysterectomy.” My mind was racing as I hung up the phone and looked at the unprepared food on the counter.  This was going to have to wait.

I changed into scrubs and ran to the hospital.  I started reviewing the events that were likely to unfold in the next several minutes.  This was not a good situation.  The patient had delivered at another clinic and the placenta never delivered causing her to hemorrhage uncontrollably.    I reached the OR and waited at the door.  The other doctor and some nurses were running her up the hill on a gurney.  The doctor that had called me was covered in blood.  “Her hemoglobin is 4,” he said was we pushed her through the door.  I looked at her and called out.  She moved her head and looked at me.  At least she was still responsive….. barely.  If you or I had a hemoglobin of 4 we would no longer be conscious.  We were working on borrowed time and we all knew it. The other doctor and I moved her weak body to the operating table.  Blood was spilling over the sides of the gurney as she was moved.   “Do we have blood?”, I asked knowing that she was going to need more than one transfusion to have a chance at recovering from this.  Her heart wouldn’t be able to take much more blood loss.  “No.  Her blood type is B negative.  A rare blood type for Kenya and the lab doesn’t have anything that matches,”  the other doctor said from across the table.   Not good.  We needed to move faster.  I started to get ready to scrub and called out for the nurses to start calling all of the wards to see if there was a student or staff member that was willing to donate that had her same blood type. 

I prayed before the first incision was made and watched as her pulse spiked and her blood pressure plummeted.  We moved through the hysterectomy as quickly as possible.  These types of hysterectomies, just after someone delivers, are the most complicated.  The risk of significant blood loss is higher than normal and none of the tissue looks or acts normally.  I prayed for wisdom as we moved through the surgery.  I sighed some relief as the major arteries were clamped and the patient still had a pulse.  We hadn’t won the battle yet, but at least we hadn’t lost.  We finished the surgery just as one student came forward to donate blood.  She was the only one that could be found that was a match.  She could only donate one unit.  The patient would need at least 4 to have a fighting chance at surviving the traumatic insult she had just gone through.  I shook my head as I thought about her newborn baby waiting with a relative.  Was this child ever going to know her mother?  Did this mother even know what her baby looked like?  Had she already chosen a name for the baby or carefully picked out receiving blankets to welcome this newborn child home?  I didn’t know the answers to any of these questions. 

I held her jaw forward in the ICU after surgery to help her breath as the anesthesiologist looked for the appropriate tubing to hook up to the wall to give her oxygen.  Her pulse was in the 160’s and her blood pressure was 70’s/40’s and falling every time we took it.  The one unit of blood that was waiting for her wouldn’t be enough.

I left the hospital that afternoon praying for this patient.  A few of the staff came up to me and told me that I had saved her life.  I simply shook my head.  I didn’t save anything and I knew it.  Her chance of survival was betting against all odds.  The only thing that would pull her through until morning would be the Lord.  As a physician, these are some of the hardest cases because the control is completely out of my hands. 

The next morning I walked into the ICU and found it to be empty.  My heart sank.  She had died!  She must have died overnight and no one bothered to wake me up to tell me.  My eyes welled with tears.  It was over.  I walked through the empty halls on that Sunday morning until I found one of the OR staff.  “What happened to the patient in the ICU?” I asked, “Did she die?”  The man standing in the hallway with me smiled and with a chuckle he said, “No, she did not die.  She did so well overnight it was decided that she didn’t need to be in the ICU anymore and we transferred her to one of the regular wards.”  I am sure the look on my face must have been priceless, because he couldn’t hold back his laughter any more.  I huge wave of relief washed over me and I could feel the color coming back into my face as I rushed to the ward to check on the patient. 

As I walked into the ward I could not believe my eyes and I knew immediately that everything was going to be fine.  There was the patient, sitting up in bed and holding her baby!  She had survived the night and was doing better than humanly possible considering what she had just gone through.  My jaw dropped.  She made a full recovery and I discharged her from the hospital three days later.  There is no reason for her to have done so well after something so traumatic.  It was a miracle.

Update on Baby Faith and her Mom!

Kristen here...

Baby Faith and her mom.

Yesterday, we had the privilege of doing a home visit for Baby Faith and her mom.  It was so nice to see these sweet patients thriving and doing well back home.  Baby Faith and her mother have both gained weight and look very healthy.  It is so wonderful to see them happy and enjoying life.  Her mother has a bright smile as she cares for her daughter and delights in this child.  They are currently living and being taken care of by the friend that brought them to the hospital.

Ashley (the physician that took care of Baby Faith), the Good Samaritan friend holding Baby Faith, Baby Faith's mom, me

Watching this friend yesterday gave me a lot to think about.  My patient had come to her looking for work and asking for odd jobs.  This friend then heard her story and found out my patient was pregnant.  Being filled with compassion she brought my patient to the hospital for care.  They live very far away and the expense of the transportation alone was $40 US. A huge expense for anyone living here.  She has then taken in this patient and her newborn child, cared for them, fed them, given them the warmest and most preferential place to sleep on the whole compound (in the kitchen) and as far as I can tell has asked for nothing in return.  When the baby is old enough she has provided a small hut on her property for them to live in. What an incredible, real life example of a good Samaritan. I stand in awe as I watch the poor help the poor and wrestle with my own selfishness.  I was recently reading Mathew 25 - surely this is what God was talking about.

Inside the kitchen where they sleep. Notice the wood burning stove build into the hut on the floor to the right.

They live in the mountain highlands.  This is a view from their property.  God sure did know what He was doing when He created Kenya.