Well, I thought I was running low on material to share, but then this weekend happened. Referred to by doctors as being ‘on call,’ we take turns covering for all the patients that come to the hospital, and this weekend I drew the short straw.
It was a steady weekend of women in labor, broken bones, lacerations (none, remarkably, inflicted by way of machete…) malaria, a stroke, and gangrenous toes. But there was one case that got my attention most.
First of all, it started with one of my communication conundrums. I heard the call, and the nurse started to fill me in over the radio. As usual, I didn’t understand her very well. This, I believe, is a combination of several issues. One, my ears just flat suck. I just can’t hear. I think I must have a huge ball of wax mixed with various bug larvae lodged in an obstructive position in my external auditory canal. Or, could just be all the U2 concerts and 12 gauge discharges that my ear drums have absorbed over the years. At any rate, I can’t wait to get my hearing aids in a few years.
Next, my Spanish is a work in progress. It always feels like I’m taking one step forward and two steps back with my language development. My latest Snafu has been the word ‘Sello,’ pronounced ‘Say-yo,’ as in ‘when I say yo, you say yo, SAY YO! We often need to put a stamp on prescriptions. The word Sello means stamp, or seal. The word ‘Celo,’ (Say-Lo) literally means ‘Zeal.’ But guess what? That’s not what it really means. It means ‘Horny.’ I kept asking the staff to put a HORNY on the prescriptions, and the ladies kept giggling at me. It took one bold young lady to explain to me in painstaking detail what this word meant. Ahhhhh! Right! I was happy to provide some comic relief for a couple weeks, there.
Back to the call. I’m going to have to lay at least a little bit of the blame in my communication challenges on the equipment. Because, as a former athlete, that’s just what we do, right? “Oh man, my glove was too loose!” “The bat has a dent in it.” “The rain made the football too slippery.” “I lost it in the lights.” In this situation, “My radio was ‘crackly.'”
So, I asked the nurse a couple times what she said. I definitely heard the word Fuego at the end, which is fire. And the word Pierna, which is leg. OK, so this 15 year old young lady must have burned her leg. I am getting trained to expect the worst here, so I started picturing her entire leg as a charred and crispy barbecued drumstick, and thinking about how to estimate percentage of body surface area for fluid replacement, and other technical doctory-stuff. I took the bridge across the “Pit Viper Ravine of Death,” and thought about my treatment strategies.
As I entered the hospital, I immediately saw a big coagulated drop of blood on the 1970’s teal blue tile in the foyer. And another one 2 feet away. And another, strangely headed in the direction of the emergency department. And I was trying to understand why her burn was causing a steady flow of blood. A really charred leg that is cracking from deep tissue involvement might start to bleed. Or some related trauma to the burn. When I arrived at the room, the young lady had a pile of blood soaked gauze wrapped around her knee, and a bloody left hand. But this scene didn’t look like a burn situation. There were sober faces surrounding her. The nurse handed me the chart, and I read: “Baleada de la arma de fuego.”
Baleada. The name given to the most common Honduran meal (simply a tortilla stuffed with beans, salty cheese, and sometimes some eggs—very tasty!), and also the word for a bullet.
Ahhh! Mr. Obvious gets hit in the head yet again. After a decent amount of time straining my faulty Spanish-ears, I was able to understand that she and her friend, were riding in a car with her “father figure,” (not sure if he was stepfather or Godfather). Some bandits threw a chain across the road to stop and rob them. The father decided to hit the gas and make a run for it, and the bandits opened fire on them. The young lady was shot in the knee, and cut her hand in the commotion. The other young lady suffered a laceration to her scalp, which I sewed up. But sadly, the Father was killed. This accounted for the extremely somber mood.
It was difficult to sort out the social aspects of this case, so I was grateful to Dr. Jeff for coming in and adding his expertise with both the psychosocial as well as medical insights in the situation. The family that brought this young lady in was not her own family. Her mom was not with her. This other family wanted her to leave the hospital as soon as possible, which seemed a little fishy. After some time, it became clear that the young lady wanted to stay at the hospital, so we kept her. We also had the police come and get involved. They actually stayed and watched over (guarded?) her for the rest of her stay. I am still not quite sure what the truth of the matter is, but I get the feeling it was what we technically call in the medical field as, ‘not good.’ This was a good reminder to me that although I feel safe here in general, we’re not in Kansas anymore…
I had another case that was rather interesting in it’s morbidity. A very pleasant elderly gentleman who was sent to our hospital from Roatan to ‘have surgery.’ He was sent urgently for his toe that was bothering him for 9 months… That being said, what was interesting about this case was that his toe had been gradually deteriorating into gangrene over the months, so 22 days ago he opted to just lop it off. Yep. He just cut his own toe off. Not sure how he did it, but I like to picture him using a machete. He then waited 3 wks to see some sort of medical person on the island who told him to come to our hospital urgently, although it certainly wasn’t urgent at that point. His definitive care will be a below the knee amputation, unfortunately.
Ok, the post isn’t finished, but Heidi has told me that I need to warn people about the picture below. So I am going to make a space in between, and the picture will follow. If you are squeamish of stomach, you may want to quickly scroll past it. Or, if you happen to be eating a pork taco, you may want to finish it first. However, I think it’s important to post it, so you can understand the desperation this fellow was facing.
Another tough case was the stroke that I saw last night. She is a 60 year old lady that had sudden onset of right sided paralysis, drooping face, and became unresponsive to verbalizations, although she appeared awake. What turned out to be another funny miscommunication of language was that they told me she had a ‘Rama,’ which means a stick or branch. So when I went to the hospital I was expecting to find some lady that had fallen on a stick. Sucky-Spanish-Ry strikes again… Not a deep wound foreign body at all, but rather a Stroke. What they had said was she had “derrame,” which means a ‘Leak.’ Ah man, can’t you just call it a Cerebrovascular Accident–inuficiencia de cerebrovascular—so I can understand what the heck I’m walking into!?
So once I realized that it was a stroke, I ordered a CAT scan of her brain, and got our Neurovascular team on the line to see if she was a candidate for early reperfusion thrombolysis with an IV Infusion of alteplase, or would she be better for a mechanical Thrombectomy? Oh, wait… We don’t have all that? Oh, shoot. Ok, well lets just put her on some IV fluids instead.
That was a little frustrating, not being able to give her literally any medical intervention other than a bag of saltwater. But what I was able to do was bring her family together, and the nurses, and pray for her. When we were done, daughters, husband, and myself all had tears in our eyes. I went off to deliver a baby and see some other patients. And when I came back this morning, she was a little better…
Addendum: We just so happened to have a neurologist down here this week, Dr. Sung, who was able to consult regarding this patient. When he saw her yesterday, he validated my plan (remember: prayer, saltwater, and time), but cautioned that she wouldn’t likely recover much. Today, however, she was moving her previously paralyzed arm and leg. His comment: Miracle!
Few more tidbits:
- We just wished farewell to the Otolaryngology team, As well as Dan the Man from New Jersey, who leant his Anesthesia skills for the week. What a great group of folks. They served so many patients well and they brought a fun and life-giving energy to our family of servants here at Loma de Luz. Can’t wait for them to come back. Here is a link to Angelique’s Blog.
- Our own personal team from Yakima will be joining us in 12 short days, from our church home of Grace of Christ Presbyterian Church.
Dr. Chris Trammell (Dentist, best friend, and my cousin)
Hannah Trammell, 15 (student, soccer player, kid-hugger)
Jason Cavanaugh (mechanic, worship leader, total stud…)
Jessica Cavanaugh (Do-it-all homeschoolin’ wife/mom/adopter of kids)
Needless to say, we are so excited to see 4 of our favorite people, down here serving Jesus and the Honduran people. Jason and Jessica are still doing a little fundraising for their trip, which we were humbled to see is also in support of our mission:
This is a picture of our new friend, Carlota. Carlota is the spanish version of the name”Charlotte,” so says Mandi. Giving her a friendly name like Charlotte makes her seem a little less intimidating, right? I met her a week ago in our bathroom. It was late at night, and I walked in and turned on the light, and there she was. I had my phone in hand, so I took a couple pics. Then I thought, ok I’ll scoop her up and put her outside. But, I didn’t happen to have a Tarantula-scooper handy, so I decided to grab a Chaco instead, and do the Smashy thing. When I returned with swatter in hand, Charlotte seemed to look at me and say, ‘Well, think I’ll be going now. It’s been a lovely encounter, but I really must be on my way.’ And with that she shrunk down into a oozey blob of hairs and slinked into a crack in the wall.
So then I had to go get in bed, a mere 3 meters away (see how I used meters instead of yards—I’m gettin’ so metric savvy) and try to fall to sleep. I could just picture ol’ Charlotte deciding to pull a ‘Brady Bunch visits Hawaii episode.’ —by the way, I really don’t think they have Tarantulas in Hawaii.
- That we would get the back-up generator fixed here in a timely manner
- Language skills (see above)
- Wisdom with patients
- Here is an email excerpt from one of the missionaries here, with a heart for the women of this community: I have been talking with some ladies here in the surrounding communities and I have been seeing some major issues with self-identity/self-worth. Seems like either ladies are so defeated that they accept abuse due to being “trapped” or they don’t need the guy…they think they can raise a family on their own. I would like to address these two issues, along with pre-marital sex and the dangers/consequences. In the same way/spirit of the Christmas tea, I would like to celebrate Mothers Day in a new way, providing a day conference for them. It would be Saturday, May 7th– 8 am to 4 pm. You are invited to help if you would like.