Because Sometimes I Just Want to Talk About My Day...

I'm an innate debriefer, I always have been. It's a trait that often comes in handy as a teacher, but sometimes stinks when all you come home to is a cat. I'm not in the habit of talking to animals as if they were people unlike some folks are. Sometimes I just want to talk about my day.
I went to work this morning and got assigned to a male patient in his 40s. He had been admitted during the night from a rural hospital where he had presented to the ER with chest pain and difficulty breathing. On xray they had found a widening of the mediastinum and determined that the man had an aortic aneurysm. After all, he is have a history of marfans (a genetic connective tissue disorder that makes people prone to aneurysms).
Upon more testing at our hospital we found the aneurysm was 10.5 cm (the biggest I had ever seen) and so large that it was compressing his trachea (hence the difficulty breathing). When I arrived on shift, I was immediately asked to order and transfuse blood products, draw labs, complete an echocardiogram and prep. for surgery. Unfortunately I didn't the blood products hadn't arrived before I had to bring my patient to surgery. His airway had become so tenuous that we just couldn't delay any longer. I can still see the look on this man's face as we emergently wheeled him into the OR, he knew his chances were slim.
I had no sooner returned from the OR after dropping off my patient when I heard another nurse calling for help. I entered the room to find her manually ventilating her patient who was in respiratory arrest. During and after a rather chaotic intubation, the patient vomited the dreaded coffee ground emisis, the signature of a GI bleed. Only minutes later we found ourselves doing CPR and pushing ever vasopressor known to man. Ultimately the patient was resuscitated, but I'm not holding my breath about his long term outcome. Resuscitation is trauma in and of itself, one that I'm not sure a 91 year old man would want to or should have to endure.
Then as if multiple rib fractures from compressions weren't enough, we just had to go and start a central line in his neck. I'm all about working at teaching hospitals, but I have to say my arms and my back are still aching from standing in awkward positions with my hands under a sterile drape holding some guys head for over an hour.
My original patient never returned from OR before change of shift this evening. As I was setting up the room for his return I happened upon a "get well" card from his young son. It said: "I love you daddy. I hope you don't die. Could you please stay alive for me? I'll give you my whole allowance." (There was a wadded up dollar bill inside the card)

It's Not About the Dog

Last week I go a phone call from my mom at 5:30 am. She was in tears as she choked out, "Our little friend has died." I racked my brain for a minute desperately trying to figure out who it could have been but finally gave up and asked.
It was "Joshie," her itty bitty pocket dog. Joshie was the puppy of two of her previous dogs, a pom and Chihuahua; tiny and yappy indeed... In recent months the poor thing had developed congestive heart failure that was being managed by the finest "puppy cardiologist" around. Evidently the little guy had developed worsening shortness of breath during the night and mom had taken him to the emergency vet. She left him there for only a few moments to drive my grandmother home and that is when he finally died. She was ridden with guilt. "I never should have left him alone."
My mother isn't the most emotionally stable person in the world. Past experiences involving my mother and loss had me worried about how she would handle this. To make a long story short, she was devastated. My sisters and I spend several hours over the next couple of days with her sobbing on the phone.
I spoke with her one evening after classes and was quite surprised at what she said that day. "I know it's kind of ridiculous to be this distraught over a little dog. I'm scared, what am I going to do when Granny and Grandpa die? I've concentrated my life so much on those few things that I don't really have any friends. I put so many expectations on that dog, I thought he would be around forever to accept me, to greet me when I get home; but he couldn't, he was just a dog. The truth is that I'm alone with nothing in my life that is that meaningful."
Wow, she was dead on! She went on to describe a conversation she had with a neighbor in her driveway and then how she invited the little neighbor girl over to teach her how to crochet, a Bible Study Fellowship group she wanted to join... It's not about the dog indeed. If we just take the time to keep listening, we might find that out.

Heaven is Laughing...

I hadn't been to Beit Tikvah is over a year. I had thought about going several times, but the furthest I had gotten was to the parking lot. This last Friday marked the end of the Feast of Tabernacles and the celebrations surrounding the High Holy Days were wrapping up.
As I was driving home from clinicals, I decided to give it one last try. Long story short, I parked the car and this time actually got out. Unfortunately I locked the keys inside. I would be lying if I said I wasn't paniced. So... there I was with no choice but to go inside.
There was some ackwardness and intimidation involved in seeing people I hadn't been around in a year but overall it was good. In the end my sister was able to bring me extra keys and I'm pretty God had a nice chuckle.

A Cambodia Story

11 year old Mik Young was my 35th patient that day. He approached my clinic station in silence and took a seat at the end of the table; his gaze was fixed on the floor. My interpreters (I had two, one for English to Khmer and the other Khmer to the tribal language) asked the customary question; “What brings you to the clinic today?”

We waited several minutes for an answer but Mik just silently fidgeting in the chair. After a few minutes, one of the interpreters set off to find the boy’s mother. Slowly, the story unraveled. Mik had been suffering from seizures for the last 7 years. His mother stated that he would often have 4 or 5 seizures in a day. Mik had been seen at the local hospital for this before but doctors said they were unable to do anything for him.

Seizure medication must be loaded and titrated to maintain the therapeutic levels in the blood. This requires close surveillance and laboratory monitoring. Our little clinic was not prepared to provide care at this level or for the longer term that the boy would need. There was nothing we could do either, nothing but pray that is.

Emily, the nursing student I was working with day, called Ernie and Mary and Paige over to pray for the child. The more we prayed, the more we found out about the situation.

Mik and his mother where both Christians and attended a local house group. However, before they became believers, Mik’s parents practiced the tribal religion which included devil worship and animal sacrifices. When he was a baby, he too had been offered to the devil. In the past when the boy began to have seizures, his parents would sacrifice an animal and the seizures would stop for a while. However, since they became Christians, they no longer made the animal sacrifices and seizures got worse.

As we continued to pray, the boy’s mother joined us. Mik said he saw a light shining brightly in his face. I found myself secretly hoping it wasn’t the precursor to another seizure. We kept praying and Mik held his hands up.

Mary spoke over him and his mother. Being a Christian means that you have offered yourself to God, the devil has no power anymore. Jesus made the ultimate sacrifice; no more animal sacrifices were needed. Both Mik and his mother prayed and to God that Mik now belonged to him.

When we finished praying Mik spoke to us for the first time and said he was hungry, something his mother said he hadn’t been for quite some time. We managed to dig a up a cliff bar and he went off nibbling on it happily.

I don’t know what happened to Mik after that, but I do know that when you offer yourself to Jesus and surrender to Him, Satan has no power.

Blood, it Does a Body Good!

Over the last few days I have been studying the blood covenant and what an amazing thing it is!

Apparently in ancient Eastern culture it was the tradition that when a king or important guest was expected, an animal of high value was selected to killed in honor of that person. The blood was then poured out at the threshold of the house. If the expected guest was a king, members of the army would precede him to the town. Each house that had blood at the threshold was considered loyal to the king, where a house without the blood was considered disloyal. The kings army would either kill them or drive them out.

Now when a guest came to enter into a home, he could cross the threshold and enter into a sort of covenant with the owner of the home. The guest would not rob the home and the homeowner would be hospitable to the guest. He would feed the guest and provide for him and even protect him with his own life as long as the guest was in his home. We see examples of this with Lot and his heavenly messengers and in Rahab the harlot. Now when a king sees his subjects as loyal, as part of his kingdom he pledges to protect them. Now think of the Passover in light of this, truly stunning. Now we have the precious blood of the Lamb covering our doors and coursing through our veins inviting the king of glory to come in!

Lift up your heads, O gates! and be lifted up, O ancient doors! that the King of glory may come in. Psalm 24:9

Shame, the Ultimate Isolator

Several weeks ago a friend and I went hiking on a Sunday afternoon. We carpooled together and she drove. Since her church was on the way to our hiking spot, I went to church with her that morning. As we were sitting in church, she turned to me and said, "What's you deal with church?"
Now mind you I hadn't spoken about church much at all with this person. I literally broke into a cold sweat as I wondered to myself what had made her ask that question and what I should say. "I don't exactly know," I said. I thought it was a pretty safe and noncommittal answer, it was also at least to some degree true. But alas, it was not a "safe" answer as the response I got was this, "Well, you should ask God."
So, there I was in church asking God to show me what "my deal" was. Surprisingly, the answer came quickly and it was only one word, shame.
As I pondered the meaning of this I was reminded of what happened when Adam and Eve ate the fruit from the tree of Knowledge of Good and Evil. Genesis chapter 3 says that when Adam and Eve ate of the fruit, they realized they were naked and they were ashamed and hid from God. Of course we know that we can't hide from God, so in reality we are only hiding God from ourselves. Shame robs us from community with Him and with others.
So where does this shame come from and what to do with it... Of course we've got the Sunday School answers, but in reality I have so much more to learn. It's only the beginning of this journey.

A Voicemail

"Hi ProM, this is Alicia. I hope I have the right number for you. I you were praying for a job for me, I just wanted to share the good news. I just signed on as a consultant over the summer. In lieu of benefits they agreed to pay me $50 an hour. I'll be working really hard but I'll make about $24,000 over the 3 1/2 months of summer. I was only expecting to find a job that paid about a third of that. Thanks for praying."

To fill you in: This student is about my own age and is pursuing nursing as a second degree (her first was environmental science). I taught her clinical group for the last rotation. She was at about a $20,000 deficit for tuition for next year and she was unsure of how she would get it. There was even talk about how she might have transfer to another school to finish, apparently God had other plans!