When things get exciting

So needless to say, things got exciting. Just a quick disclaimer, I'm here on a medical mission and this post will probably be more about the medical stuff, so if you are feint of heart, here is a link to a video of cute puppies to make you feel better. I can't vouch for the video, however, as Youtube is blocked on the Mbingo internet.

Just a little casual musing first. Why is it that we fixate on our failures and not our successes? Is it because we really want to better ourselves and think that by working through lapses in judgment we can avoid them in the future? Do we feel the need to punish ourselves even when no one else condemns our actions? Maybe our pride demands that we expect more from ourselves than we are capable of and failure is an affront to inflated self-esteem. Still trying to understand this reaction...

That said, I have had a lot of successes here. My first patient is looking great and smiles and waves every time he sees me. That's an emotional boost! I feel like I've connected pretty well with the residents and have been able to do some teaching and some learning from them on cases that I'm unfamiliar with. I've taken on some surgeries that I've only read about, with the help of some very competent, experienced residents and some friends from home weighing in by text message. I'm not sure how it will turn out, but on Sunday I operated on a 2 kg 5 day old baby whose intestine failed to develop correctly leaving it in discontinuity. After discussion with the residents here, a panicked text to a friend (who just happens to be a stellar pediatric surgeon) and a consultation with my lovely wife (who knows WAY more about turning sick babies into healthy babies than I do), we charged ahead and managed to get through the repair feeling pretty good about things.

Yay! Fireworks! Cigars! Champagne! (except there is a ban on tobacco and alcohol on the hospital grounds) so... Orange soda! Granola bars!!

And then the next day, I was signed up to take a kidney out of a 2 year old for cancer and the cancer turned out to be too advanced to remove. The worst part is, I didn't realize it until we were most of the way through the operation.

That kind of stuff happens in medicine, but it happens a lot less when you have good imaging studies and specialists and seemingly endless resources. A simple CT scan would have shown us the tumor was too advanced to operate, but all I could think of was why I wasn't more careful early in the surgery to determine if proceeding was a good idea. I'm not sure, but I'd like to think I could have figured that out much sooner than I did and saved the child unnecessary trauma. I feel like after an experience like that you should get a time out and everything should stop until you're ready to forge ahead, but that was about 4-5 surgeries ago and somehow you just keep going.

I wonder sometimes how hard it would be to raise a bunch of money for a noble cause. I really like to think that I could get up on a podium somewhere and tell a really inspiring story and people would be so excited that they would just start donating like crazy to some charitable cause. There's a family doc here who is a really great guy and some one who doesn't sit on an idea long before taking action. When we talk about things that we are worried about, he is always the first to say, "Well let's just pray about that right now!" and proceeds to do so. I was talking about this case with him and he just suggested that we raise the $125k that the hospital would need to buy a CT scanner. I love that idea. They already have a room under construction and a guy training to be a radiologist and there would be immeasurable good done here by the addition of CT capabilities.

To illustrate and tell one more medical story, a guy with a head injury came in over the weekend and rather than getting a CT scan, which we would normally do, to guide treatment, we took a hand drill and drilled a hole in in his skull to see if there was any internal bleeding causing a problem. There wasn't. The patient didn't have much of a chance even at initial presentation, but it sure would have been better to know what we were getting in to than going in blind. This guy was probably more the rule than the exception unfortunately. This place sees a ton of trauma and a CT scanner would likely be working 24/7 assuming it didn't break down. I'd love to tell you where to donate to help this place get one, but I haven't been able to figure that out. Hopefully I will before I leave.

I feel like the tone of this post was much darker than I intended, but as I said, I think we tend to focus on our failures more than our successes. I'm having a great time here and will be leaving in a few short days. It has been awesome to reclaim that feeling of inspiration to get outside my comfort zone to try to do some good in the world. Being here is making me a better person, a better surgeon and a better follower of Christ and I'm incredibly grateful to be here.

Cameroon

Hey, so I think it has been several years since this blog saw the light of day, but it's also been a while since I've been overseas for any kind of humanitarian purpose, so what the heck, might as well do a little catching up. No promises about being particularly entertaining or insightful. I'm planning to use this more as a person reflection/travel log.

I had a pretty uneventful trip. Typical trans-Atlantic stuff like watching movies until my eyes were bleeding and I developed a pressure sore or two and enjoying the free adult beverage service. I slept most of the way between Paris and Yaounde. Arriving in Cameroon brought two considerable reliefs, #1 seeing my bags make their way down the conveyor amidst a huge throng of travelers cramming themselves up against the belt. (Why do people feel like they need to stand next to the baggage claim belt? Doesn't it make more sense for everyone to step back a couple paces and just step forward to grab your bags???) And #2 seeing a smiling face with a white "CBC" sign. I've always thought it would be cool to be one of the people that had a sign person waiting for them at the airport. And trust me, the actual experience lives up to the hype. (CBC = Cameroon Baptist Convention, an organization that runs several hospitals and clinics in Cameroon)

My sign-holder was a guy named Fon (like phone) Bangaman and after gathering the other two visiting docs from the airport, he whisked us away to a pretty ghetto hotel, a restless nights sleep and then an 8 hour drive with questionable passing methods and even more questionable road conditions. We survived and the spent a few days recovering from the whole ordeal. Day two (Saturday) one of the longtime docs here took us on a 7 mile hike around the property to show us some of the current and planned infrastructure while getting a great view of the surrounding mountains and countryside.

A quick recap of some of the highlights of the past few days:
-My first surgery here was an ex lap for a bowel perforation in a 13 year old. Apparently typhoid fever is still out there and can cause spontaneous holes in your small intestine. Caution advised.
-Cameroon church was a lot like American church with an accent. I was kind of hoping for some sweet African drum sessions, but alas, Western culture has come in like a plague.
-Been having a great time hanging out with Ethan Helm and his fam. He is a pediatrician and his wife is a family doc and they are here for 2 years. They gave me a shopping list before I left Alaska and so we got to have chocolate frosting on their 3 year old's birthday cake the other night. I could write a whole blog about these guys. Maybe I will. Fortunately, they did already here.
-The surgeons and residents here have been really welcoming and wonderful. I've really enjoyed working with them and have been amazed at their level of skill, breadth of knowledge and devotion to God. This is a pretty awesome place.
-I've been recycling some of the lectures I put together in residency for teaching sessions with the residents here.
-All of my meals have been provided by an extension of the hospital that houses and feeds short term missionaries and docs. Food has been great and meal time is a good time to catch up with the other short-termers and compare notes on our experiences.

I'm on call tonight so we'll see what the night brings! The residents take care of an incredible amount on their own but you never know when things could get exciting...

Loma de Luz

I'd heard of this hospital on the northern coast of Honduras a few years ago and had kind of tucked the connection into the back of my mind, so when I started planning a trip to Central America again, the memory surfaced and thus I found myself cramming into a 3-wheeled moto-taxi on a dirt road to the middle of nowhere.  I had woken up that morning on the island of Roatan, taken the ferry to La Ceiba and the bus to Jutiapa before finding transportation for my final leg.

I arrived at the hospital and after the initial deliberations and niceties met a middle-aged guy in jeans and a T shirt who introduced himself as Dr. McKenney.  He and his wife, a family practice doc, were in the middle of their persistent work of organizing, planning, arranging and coordinating the work that is Loma de Luz and its many offshoots.  Graciously, he took some time to show me around in the midst of all that and incidentally set and casted a patient's arm. 

They have a pretty incredible story of which I only heard a small part, but essentially they were stymied in their efforts to become longterm missionary doctors for any organization so spent 10 years developing contacts and organizations both in the U.S. and Honduras to build a new hospital.  The Honduran government steered them to a location where the mountains meet the ocean that years prior, Dr. McKenney had seen on a map and dreamed of going.  His dream coincided with the need in Honduras and Loma de Luz was born.

The actual facility defies the conventional model of a Latin American hospital in that it provides a multitude of services in the same place, but extends to provide a foster home for children, educational facilities, a hub for communications, housing for visiting missionaries and many other services.  Additionally, a majority of patients are able to hear the Gospel, not in a compulsory fashion, but in a "this is who we are and why we do what we do" fashion.  As a side note, Dr. McKenney has also been working on developing his own biodiesel from African oil palm which has been planted liberally around the grounds in an attempt to get off the grid a little more. 

For having only spent a couple hours there, the impact and amount of information I gained was huge.  My head was reeling a little bit as I traced the route back to La Ceiba and boarded a bus for Teguchigalpa.  I was incredibly grateful for the example and incredible dedication of the McKenneys and was really challenged to take seriously this work I have been called to.

Honduras to Nicaragua

I started getting the itch to travel this last year. Not just to go somewhere, but to be on the ground, seeing life as it is elsewhere, smelling the air, tasting the flavors and walking the streets. I hadn't been out of the country since residency started but didn't really have a great idea of a place to go or a time. So I conferred with some friends and picked a week in late April to head off... somewhere. My friends couldn't go, but I came to find out that my sister had planned a vacation that same week for Nicaragua and thus my destination was set.

I'd had in the back of my mind for a while a trip to Honduras to visit a hospital on the northern coast started by a Christian surgeon and his family practice doctor wife and thought this would be the perfect chance to swing by. So after a long week of late hours at the hospital (which I have come to accept without such opposition as before), I took an early morning flight out of Albany.

I had planned to spend the night in San Pedro Sula, but after talking to some folks on the plane, I figured out that the northern coastal city of La Ceiba had a litte more to offer, including a ferry ride out to an island named Roatan, known for scuba diving. Walking the streets of Honduras put me on edge moreso than other Latin American countries I'd visited. Maybe it was the swath of strangers warning me about the dangers of being robbed at machete-point or maybe just the looks that I got walking around, but either way, I retired early and didn't seek out the night life during my time there. So after catching a taxi and bus to La Ceiba and spending the night in a cheap hostel, I found myself on a rough ferry ride out to Roatan.

The cultural scourge that is Facebook served me well by connecting me with a classmate from medical school, Camille, who happened to be in Roatan at the same time. I was hoping to meet up with her there, but while walking the streets shortly after my arrival, I ran into some one else first. A girl who had walked by on the street caught my eye and looked a litte too familiar for me to not say something. So when I said her name and she turned around, I was surprised, but expectantly so to see Scarlet, another friend and classmate from medical school, who I'd visited in Boston earlier that year.

I spent the next few hours catching up with her and then wandering around for a while and hiking down the beach to the neighboring town where I ran into Camille and her family. I ended up hanging out with them all night and was treated to dinner, drinks, a herbit crab race on the beach and an evening fire-dancing performance. A fantastic day!

Waking early in the morning and catching the ferry back to the mainland, I traveled all day and spent the night in a sketchy-looking hotel in Tegucigalpa, roommates with a big black guy named Robert, a Nicaraguan working in Grand Cayman and taking the same long bus ride as me from the northern coast of Honduras to Managua, Nicaragua over two days. The actual bus ride was fairly uneventful and found me rolling into Managua in late morning. Two side notes, 1) Tegucigalpa (or "Tegus") is not a very pleasant place to be, particularly on the street at 11p.m. and 2) If you're going to be on the street at 11p.m. in Tegus, having a big, black friend is quite reassuring.

Part of the day's travels included a quick jaunt out to Loma de Luz, an incredible place worthy of a dedicated telling...

Intern Year

Intern year ended a little over a month ago and already I'm caught up in the bustle and newness of being a junior resident. I had intended to write some reflections on the year earlier, but am just now finding the time to sit down and really reflect on the importance of what has happened to me over the last year. Briefly summarized, I have seen over the last year that the time for me to grow up has finally come.

I entered residency cautiously confident, believing that I had been adequately prepared, that I had much to learn and that I would do the right things at the right times. Over the course of a year, through poor decisions, false perceptions and inadequate knowledge, I have learned that the complexities and intricacies of dealing with sick people are beyond me. The year was a cycle of gaining ability and confidence only to be forcibly reminded of my inability by sobering mistakes.

The need for help
Self-deprecation is not my goal in writing, for I sincerely believe that I will develop into a capable, even possibly excellent, surgeon and doctor; however, I have not yet arrived. Despite my constant desire to question the edicts dispatched by my superiors, I now trust that I need their guidance and teaching more than ever. Many of my mistakes could have been avoided if I had asked for help sooner rather than later.

The need for caution
I sincerely believe that things will turn out for the best in all circumstances. Whether this is a byproduct of my upbringing, a facet of my faith in God, or simply a hopeful desire, I do not know, but while a joyful and good character trait, it can predispose to danger. The truth is that things don't always turn out for the best, particularly when dealing with sick people. Sometimes they take a turn for the worst possible outcome and my work is to guard against that possibility, even while hoping for the best.

The need for discipline
Now this is what I mean by growing up: Not giving up joyfulness and excitement and adventure, but by recognizing the proper time and place for such things. My last post hints at this, but explicitly, I can't achieve excellence on talent alone. To truly love my patients requires sacrifice. To truly love God requires sacrifice. To that end, there are days when I will want to go play, but when duty necessitates discipline and study. There are countless mornings when I want 10 more minutes of sleep but when dedication to God demands that I get my butt out of bed and spend some time in prayer and in the Word before I am ready to face the day.

The need for humility
All the above culminate in a concerted effort to take myself out of the middle. The tendency toward an attitude of self-preservation is so strong in residency that it can overwhelm all other desires and dreams, but it is not an unconquerable urge. When I stop trying to take care of myself, every controversy above resolves and the need for sustained effort transitions seamlessly to an outpouring of other-centered goodness. The only way I can practically achieve this in my mind and in my life is to be fully confident that in neglecting myself, God will provide. In fact, this is the challenge to believers for generations past and will continue to challenge us for as long as the war between selfish desire rages against love.

Therefore if there is any encouragement in Christ, if there is any consolation of love, if there is any fellowship of the Spirit, if any affection and compassion, make my joy complete by being of the same mind, maintaining the same love, united in spirit, intent on one purpose.

Do nothing from selfishness or empty conceit, but with humility of mind regard one another as more important than yourselves; do not merely look out for your own personal interests, but also for the interests of others. Have this attitude in yourselves which was also in Christ Jesus, who, although He existed in the form of God, did not regard equality with God a thing to be grasped, but emptied Himself, taking the form of a bond-servant, and being made in the likeness of men. Being found in appearance as a man, He humbled Himself by becoming obedient to the point of death, even death on a cross.

For this reason also, God highly exalted Him, and bestowed on Him the name which is above every name, so that at the name of Jesus EVERY KNEE WILL BOW, of those who are in heaven and on earth and under the earth, and that every tongue will confess that Jesus Christ is Lord, to the glory of God the Father.

The Next Step

It's been a pensive day. Lots of things have converged lately prompting me to take a census of what's going on with me, God and life. And it's been good. Real good. I don't really write on here anymore, but today was one of those days when I felt like writing.

If you haven't been around, my journey for the last several years has been centered around the realization that God is among us, active and hopeful that we will lift our eyes from our own lives and join in the story that He is writing in the paths that we walk. That prompted some reevaluation of my spiritual beliefs and practices resulted in the exploration of true freedom, relationship and service to others. It has been a joy to discover new ways to glorify God, to feel myself slowly unburdened from the legalism that so often accompanies religion and to see prayers answered, whispers of God in all things and meet others in whom Christ so obviously dwells.

In the midst of that learning, I was learning to experience God through enjoying good things in life. Now unfortunately, I may have associated things like skiing, rock climbing, good music, food and beer with carrying out the simple call of Christ a little too strongly. All beautiful things to enjoy, but lifeless in and of themselves and missing pivotal elements of the life of Christ. I still can and will enjoy all those things in life that God has gifted to us, but those things can't be at the center. I don't know what it was today, but I was reminded of my first steps toward a life lived fully with God. Back then, I was miserable but found simple joy in working for the happiness of others. It happened in Guatemala and continued in Texas and then Alaska and so forth.

A lot of people ask me how I like living in New York. Those from Alaska (including myself) sometimes have a hard time understanding how I can be happy somewhere so far from home. The truth is, my happiness, my joy, even when I was there, was never about the mountains, the wilderness, or the exhilaration of extreme sports. Rather, the joy I experienced occurred secondarily to taking myself out of the center and using my life to build up others. Even good things can become idols. It is the recognition of where God is moving and joining in that brings joy, not in recreating the specific context of where or how He has acted in the past.

I've learned well over the last few years how to live, how to love myself. I see this as a dangerous destination if viewed as such, but as a necessary precursor to the next step. To love your neighbor as yourself, you necessarily must love yourself first by understanding the great love that God has for you. I am here in New York not only to live life to the fullest for me and for God, but to live fully and to share that richness with all those around me in simple acts of service.

"Teacher, which is the most important commandment in the law of Moses?"
Jesus replied, "'You must love the Lord your God with all your heart, all your soul, and all your mind.' This is the first and greatest commandment. A second is equally important: 'Love your neighbor as yourself.' All the other commandments and all the demands of the prophets are based on these two commandments."

Leaving Peru

As a rule, I hate leaving. Maybe it's just me, but I think at some level, we realize that we were not meant to be apart from those we love. Yet another little cue that points my eyes toward God. All that to say, there are some really wonderful people that I will miss having left Peru. I love the diversity and unique personalities that you encounter when outside your element. I also love friendships that grow quickly and the ability to create lasting bonds in such short time.

Early in my trip, I started compiling some unique things about Peru, some serious, some not so much. This is what I came up with:

Everything means something else/is innuendo
I realized quickly that I had to be really careful what I said here. Almost every word in Spanish means multiple things. Sometimes, this only creates a sense of confusion for the gringo that doesn't understance the nuances of the language. Other times, it creates for particularly embarrassing circumstances.

Not all parts of speech are mandatory
Now this may be true in English also, but I found it particularly challenging that a sentence could contain neither a verb or a subject and everyone else in the room would understand exactly what was going on. Not me. A simple prepositional phrase is not sufficient. But toward the end of my trip, I started doing it too.

Peru is not a poor country
There are some incredibly poor people here, but I was struck by the diversity of agriculture (read POTATOES), commerce and industry here. This place is rich with resources and has fairly decent infrastructure. It also has room for development, which I think we will see in the coming years. Unfortunately, Lima has had a HUGE influx of indigents and there is a real need in the surrounding areas.

Oompa loompas are real
I couldn't resist a dig a this, just because it cracked me up and made me happy so frequently. One of the first sights I saw arriving in Peru was a VERY SMALL person cleaning the sidewalk. As time went by, I adapted to the fact that it is very common for indigenous Peruvians to work in city improvement, but I SWEAR that they hire the smallest people they can find for the street sweepers.

The sun really is hotter higher up
Oh the burning. THE BURNING!!

Latin Americans really can dance
I'm sorry, but what we do in the U.S. just isn't dancing when you compare it with Latin America. I had a ton of fun not only trying to not move like a gringo, but just watching the people dance here. They manage to be really smooth and sensual without being hypersexual (if that makes sense). Not to say that everyone at the clubs was a Puritan, but the mood was different for the most part.

Plans don't count for a lot
I found it was quite possible to agree to a course of action with some one else, only to find out in hindsight that they really weren't totally serious. I never quite figured this one out, but it seemed like sometimes you made plans and they happened, and sometimes, they just didn't count.

In medicine, sometimes less is more
I can't contest the fact that the U.S. has amazing health care for those that receive it. What amazed me here is that everyone gets treated at least to some extent. The ugly side of U.S. medicine that most people don't have the privilege of seeing are those patients with potentially curable diseases that are working to make ends meet as it is, and then get diagnosed with something terrible. While that can still be devastating here, it somehow seems more recoverable. There is clearly a lower level of care delivered to the working class here, but rarely is some one simply denied treatment.

God is always moving, you just have to look
While I didn't have a particularly moving spiritual experience here, there were definitely some sweet times of communion with God in a very unique part of His Creation. There were chance encounters with folks doing their small part to demonstrate that God loves all people, not just those with money, and a lot of wonderful relationships formed here. I know that leaving Peru, I feel closer to God and more in tune with His plans and wishes for my life. It has been a sweet time and I am excited to see what Costa Rica will bring.