Thursday, March 20, 2008

Not for the faint at heart :)

Just a couple of pictures from a recent surgery I scrubbed in on! It was a ressection of an adenocarcinoma of the thyroid. I have plenty more photos, but thought I'd pick the least "offensive" for those of you whose forte' is not blood and guts!

Wednesday, March 19, 2008

Long time no blog??

Hello !!!

Yes, its me! I am indeed alive and well. Contrary to popular belief, I have not been eaten by a pride of lions, fallen to my death from a bananna tree, or been forced to walk the plank into the deep blue abyss! I still have all four limbs and some detectable traces of cerebral activity, allowing me to function at my baseline! :)

In all seriousness, I thankyou for your patience as its been well over two weeks since I've last updated my blog. I've been quite busy, working six of seven days for the last couple weeks. As you can imagine its been a very rich time, seeing much and learning even more. My only regret with regard to being able to share all of this with you, is that I'm forced to skim the surface of my experiences by choosing a HANDFUL of the amazing stories I have either witnessed or been a part of. In addition, the "heart" of my mission here in Liberia has taken place in the hospital, at the bedside of many beautiful patients whose privacy I have tried to maintain.

That having been said, please allow me to give you an idea of what I've been up to for the last twenty days or so....

As you might recall, my first few weeks on board the ship I found myself caring for many thyroidectomy, facial tumor, cleft lip, and hernia patients. Most of these people, though malnurished, were relatively "healthy" and did quite well post operatively. They were often admitted the night before surgery, and were discharged "home" within 2-3days. We had the privilege of providing a great deal of bedside teaching, covering topics of sexual health, personal hygeine, and care of surgical wounds. Once our patients were able to demonstrate an ability to properly care for their new sutures, staples, and dressings, they were discharged home with a followup appointment scheduled one week later.

Young and old, their stories varied greatly, but their joy was similarly made complete by the life changing surgeries they recieved. For example, it was incredibly moving to witness a mother's pride when her son Abel, four years old, was able to smile back at her for the FIRST time. He was born with a severe cleft lip and palate, making speech slurred and smiling impossible. Likewise, it was a privilege to see Alysha, age of 12, squeal with excitement as she looked in the mirror to see that for the first time that she had a profile! She was born without a bottom jaw and surgeons created one for her, made of titanium and bone! It was more than heart warming to watch Victor, a 70 yr old veteran, sleeping like a baby on his back for the first time in 15 years. He had been plagued by an enormous, painful, and extremely bloody spinal tumor, which not only disfigured him, but prevented him from ever laying on his bed. And it was truly a "sight for sore eyes" to witness Comfort, age 9, take off the patch to reveal a beautiful new prosthetic eye that replaced the reminants of the infected eye, eaten away by bacteria.

Thankfully, this list of celebratory stories goes on and on! Each one of them, in their own way, demonstrating strength, resilience, and sincere gratitude, touching me deeply. However, amongst the crowd, there's always one that leaves a footprint on your heart more profound than the rest. For me, this was Henry. A 21 year old student of Liberia's university, Henry was studying maritime law and sailing. His family had a local shipping business and he had high hopes of taking this industry to new heights. Attending school by day and working side jobs at night, Henry was doing his best to make that dream a reality.

Suddenly one day Henry's rigorous routine was interupted by a seemingly innocent toothache. As the days passed and the pain increased beyond the point of bearing , it was clear that he needed to extract the tooth. With only ONE dentist in all of Liberia, servicing several hundred thousand people, and costing far more than Henry's family could afford, he had no choice but to take the tooth out himself. Unfortunately, even with the tooth out the infection spread to his gums, the tissue of his right neck, and was rapidly making its way past the nipples of his chest. Once again, the pain became unbearable and his mental status was rapidly deteriorating as a result of the infection that was overtaking his system. He couldn't stand up on his own, nor could he speak coherently by the time he made his way to our gate late one night.

He was immediately placed in the ICU, requiring one to one care for the management of a plumeting blood pressure, horrific wound, and climbing temperature. The rate at which this bacteria was traveling and essentially "eating" his flesh was like nothing I've ever witnessed. By the time I took over on the evening shift, his entire right neck and chest was stripped of the first several layers of skin. His muscle and bone were exposed and there was no telling when or where it would end. He had 6 drains coming out of his mouth and another 12 in his chest to try to manage all of the purulent puss and blood accumulating between the layers of flesh he had remaining. He could barely respond to us and there was frank discussion about the possibility that he may not make it through the night.

I entered the isolation room to introduce myself to Henry. I remember thinking that he was too young, too handsome, and had too much to live for NOT to pull through this. When I bent down and took his hand, he looked me in the eyes and I distinctly remember seeing strength deep inside. You've heard it said that the eyes are the gateway tot he soul, and never before was this more true in his case. Though he was too weak to speak, his eyes told me he was somehow strong despite the drains, the blood, the puss, the pain, and the odds piling up against him with every minute that passed. I remember being comforted by that which I saw in his eyes. From that moment on I was committed to do whatever I could to help him return to health and to remind him of the strength he possessed, should he forget. Despite escrutiating pain, lack of sleep, and a completely foreign environment, Henry allowed us to perform the exhausting and painful dressing changes, the puss extractions every couple of hours, and even tolerated five more trips to the O.R. for tissue debridement.

Despite the odds, Henry made it through that first night like a champ. He made it through the next night and every one thereafter until he "graduated" from the ICU and joined the general population of patients on the ward. He had a long way to go and many risk factors related to his weakness, the extensive tissue damage, and his ability to regenerate healthy skin to that would protect him from future infection. However, as the days passed, I watched as he began to eat on his own, become more talkative, laugh, and even sing!Eventually he was walking on his own, and high fiving me in the hallway with the biggest, most vibrant smile I'd ever seen. With complete awe, I watched as precious life returned to Henry. I was overjoyed and simultaneously humbled by the memory of the fragility of this same life, demonstrated days before as he lie close to death in front of me.

My last interaction with Henry was at church last Sunday morning. We hold a service right in the ward in order that all, healthy or sick, can worship together. Henry and I had the privilege of sitting side by side, lifting our voices together, praising God for the great gifts He had given ...the BOTH of us.