Anatomy of a broken heart

A classic Tenwek Mission Hospital case is a young expectant mother who comes in with Rheumatic Heart Disease late in pregnancy and slips into a coma to never recover. Bam. It hits like that.  No soft intro, just all up in your face when you start.

It is perhaps the archetypal patient that conquered our own youthful ambition and countless others along with their unborn lives.  Perhaps it stems back from the old Serpent in the Garden who has been consistently threatening the offspring of Eve.  So fraught with danger and vulnerability, the pregnant and the laboring mother is easy target for destruction.  But we come as citizens of the Kingdom of God, bringing Good News, fighting off Darkness, exhausting every last resource we can muster in the Name of Jesus to rescue the perishing.  We are not the Savior, and He has graciously broken that delusion for us.  We are simply the servants of the King and we try to follow His way, even all the way to the Cross and onward.  We do have to ask occasionally though, “What is God wanting to make out of what we are going through here and now?”

In a rare at home medical lecture, Daktari explained to us how RHD (or as our kids hear it “Drumatic Hear Disease”) works its evil:

In the West, when you get a sore throat and fever (with no coughing especially) as a child, you should have gone to the doctor.  They gag you with a giant q-tip and then grow strep cultures in a Petri dish, which is amazing.  And then they give you yummy bubblegum flavored penicillin for a week.  Bad guy (Strep bacteria) dies and good guys (immune system/ human life) win. End of story.

In Africa, if you get a sore throat and fever, no cough as a kid, you probably wait until it goes away on its own or take some herbal medicine.  The bacteria however aren’t killed so they begin to play tricks on the immune system.  Year after year of untreated simple strep throat, a protein on the HEART VALVES start to resemble the protein that caused the infection of the sore throat- fever- no cough, and the human immune system produces a response to attack its own member, hence it is “auto-immune”, meaning against itself.  The auto immune response will even attack its own heart, leaving little scars on the tissue of the heart valves and making a poorly sealed ventricle muscle.  (example: I was baking in our tiny Kenyan oven and the regular American sized cookie sheet would not fit in properly so the door didn’t seal properly and the heat escaped and the cookies were at least unburned, and that was good!) But if the door that won’t fully close is inside a chamber that needs to seal in order to pump blood to your lungs and brain and body that is not good. 

When that muscle of the heart can’t squeeze hard enough to force the blood through and seal it shut to keep it from regurgitating backwards, then the volume of blood is not pumping per heartbeat as it should.  This is the anatomy of a Rheumatic heart.

Now when you add pregnancy into the equation, the blood volume, oxygen usage, and heart rate of the woman is required to increase to care for the growth of new life.  That’s why pregnant ladies get tired so easily.  When a lady has RHD, she usually is young and late in pregnancy when things get really bad.  Her heart simply can’t meet the demands for blood volume and she can easily be left without blood to her own brain. That means severe trauma if not death.

A smart doctor named Starling mapped out the diagram of cardiac output and optimum blood volume.  It’s called the Starling curve.  Daktari Davis has a graph here to show the RHD spike.  It has no forgiving curve but rather a sharp drop where the heart either has too much volume or not enough volume to maintain function.  There is a teeny tiny happy place for the patient to live.  I think there is a way to solve for that equation one day, but for now all he can do is ask our Cardio-Thoracic surgeon how to get that, and she says the only option is to operate (typical surgeon response).  It’s an impossible and impractical approach.  What can be done?  Where can we go from here?  Maybe one day someone will solve this medicinally and mathematically.  Maybe one day strep throat will not cause the loss of so many lives in Africa.

3 young ladies in as many weeks were claimed by this fate just in our medical ward alone.  We try to process meaning out of these experiences.  We follow Christ in taking up our cross, and we believe in the resurrection of the dead and Life Everlasting.  We can only trust that He is Savior and we are not.  

*Regarding the anatomy of a broken heart closer to home, Mother Teresa said this in my August 12 daily reading from "Thirsting for God":

"Our sisters are working in New York with the shut-ins.  What they see- the terrible pain of our people, that loneliness, that fear, that feeling of being alone, unwanted, unloved.  I think that it is much greater than even cancer and AIDS.  The sisters have met people like that very often- completely brokenhearted, desperate with big feelings of hurt.  You may meet people like that and you must come to know them.  You must come to know your children, and very often we find this in our own communities- brothers and sisters who feel that kind of feeling.  Do we know the pain and poverty of our people with whom we come in contact?"

You may come in contact with someone today who has a breaking heart of loneliness, fear, and unknowing the great Love of God. Our mission is not to be their savior, but to light their path to the Savior of the World. Only His heart can heal our brokenness.

Week 3/4 Daktari cases

Week 3 out of 4: a little late, but this is Africa...

The medical ward team from this month- includes 1 resident from home, 1 med student from TX, and the Kenyan staff here alongside myself...a sample of what we've seen:

Patient group 1: Sodium: little old ladies come into the hospital GBW (general body weakness) with a sodium of 106.  normal sodium 135-145, Tenwek normal 120-130.  Why?  I believe every Kenyan coming into the hospital is dehydrated by at least 2 liters. 1) Sodium and water have a nice balancing relationship in the human body and when one is missing, the other will follow. If there is no water, the sodium flows out, leaving one hyponatremic.  2) Clean drinking water has not been easy to come by historically and thus not part of normal daily meals. Chai is.  We once heard of an Kenyan man who was in his 90’s and never drank a glass of water in his whole life! 

Patient 2: Meningitis: 26 year old Massai man self-referred from Narok county hospital, headache and fever, treated for malaria without improvement.  Had bacterial meningitis with 1200 WBC in his Cerebral Spinal Fluid. Treated for streptococcus pneumoniae meningitis, improved on therapy and discharged home.  Praise God!

Patient 3: Pulmonary Embolism (blood clot in the lung): 32 year-old woman, post-partum 21 days, admitted to nearby hospital with chest pain, fever, treated for pneumonia without improvement, underwent CT scan (new to outlying hospital), found to have a large pulmonary embolism, transferred to Tenwek for higher level care.  We were able to acquire one dose of a rare clot-busting drug, streptokinase, from the pharmacy.  A newly available medicine for our services here, could revolutionize the treatment options for pulmonary emboli, ischemic stroke, and heart attacks. Thankfully for her, we did not have to give this med because she was able to keep her blood pressure up, but what a new opportunity for therapy.

-Highlights: In the  journal club with family medicine residents last week we discussed the recommendation to  get people to reduce their NaCl (salt) intake to 2 grams daily, which could save 33 million lives over 25 years!  How much sodium do you take each day?  Remember to drink your clean water with gratitude too.  Circulation article 2018.  Journal clubs here are great.  There are 100% eager learners among the residents with a challenging situation in which they practice medicine, but they really work so hard and are such pleasant people to be around.

-14 days on medical ward in a row, covering for some gaps here and there, sustained by grace and not taking myself too seriously.  One that I was helping cover for was on a mission outreach to a remote island in the middle of Lake Victoria, Western Kenya, where they were seeing 1000 patients in 4 days. I was glad to be here, not there.  We are also delighted that the hospital has hired a Kenyan consultant for medical wards since we were here last year.  Carrying one another’s burdens is much easier to shoulder when there are two or three shoulders to help.  

Sustained by grace,

Daktari Davis

Pictures from week 2/4

No hospital pictures, as you can imagine a doctor posting you on his blog may be questionable. 

Daktari has been delighted to engage in training Kenyan trainees again and challenged by the inscrutable mysteries of so many patients on the brink of survival. He coded 5 patients in one day this week. They come to the hospital largely lacking primary care and with about 20% mortality rate. Yet the access to care is increasing little by little. We’ve also been encouraged that his weekly quiz structure for medical team trainees in 2013-2015 is still going on.

We have quickly slipped back into our African alter-egos...

Here’s our happy guest house home away from home...

Hammocking about

Some things we should not take for granted-

Like spacing and punctuation!

Skimming the milk

Rip-stick Hockey is our new favorite sport!

This was a great way to spend one normal afternoon: out in villages delivering wheel chairs with the Tenwek  Disabilities Clinic 

                                         

O God, our help in ages past...

...our hope for years to come,
our shelter from the stormy blast, and our eternal home!

A thousand ages in thy sight are like an evening gone;
short as the watch that ends the night, before the rising sun.

Time like an ever rolling stream,
bears all its years away,
they fly, forgotten, as a dream dies at the opening day.  

September 2013
Two weeks after our arrival in country, a terrorist organization attacked and caused the destruction of 69 lives and the entire shopping center we had been in a few days earlier for supplying our new life. Westgate attack imprinted the reality of our new life.  Always on edge, never really "safe", but surely never lacking heart. The intensity of life in Kenya  was ratcheted up forever. Every trip to a supermarket or western restaurant comes with a security screening to remind you- be alert, the enemy is still active and out there, don’t be passive! There is no safe place, but in Jesus.

Two years later, July 15, 2015- 
We were in the pleasant places of the Sequatchee Valley, Tennessee, watching the far, far away planets of Jupiter and Saturn in the summer night sky.  At that time Jupiter and Saturn seemed closer than our Kenyan life.  Together with good friends who also moved from Kenya to Tennessee around that time, we sat by a campfire and reflected.  We were all so refreshed at living in such a safe and idyllic scene again.  Ahh, we foolishly pronounced.  "No Al-Shabab here.  Just peace and quiet." 
Until the next morning. 

 On July 16, 2015, exactly 2 weeks after we arrived back in our "home country" a lone terrorist attacked the US military installations in Chattanooga bringing our new city to a screeching halt of humble prayers.  There were 5 who fell that day, one could say gave the ultimate sacrifice for their country. Four US Marines, and 1 Navy sailor.  And we were given pause to reflect at a very deep level.  "What is safe?" The geography of safety just collapsed. Again. There is no safe place but in Jesus.

July 16, 2018,
The billboards around town are transformed for a few days to say "Never Forget" and they have the 5 uniform hats of those service men to remind us what happened.  I drive by the spot weekly on the way to my kid’s piano lessons. For heaven's sake, never forget what we are living this life for.  It may be taken in a moment of gun blast or car crash or long slow sickness.  But what is truly terrible is the ebbing of life under the deception of materialism and vain pursuits of pleasure.  To miss the moment by moment grace to be alive at all, to chase 3 fundamental idols of Power, Control, and Comfort-  as in spending our life on small conveniences, and the perversion of the "American Dream"- the pursuit of selfishness - that is the terror of losing Real Life.  I am not safe even in my own heart- only in Jesus. Pastor Kevin always tells us at New City Fellowship “The safest place for a sinner is in the arms of Jesus”.

July 16, 2019
Reflecting on the normal day, normal town, normal job, that our Fallen Five were living their normal life in, I wonder do I live for what I believe in every normal day? Or do we forget? Is my goal self oriented (yes by default) or is my heart remembering that my life has been bought at a very high price- the Life of Jesus? Will my life be eaten up by hate and fear and political ratcheting of anxiety? No. I have been four years pondering this story. I pray that you ponder it four seconds even. Where is your Safety?

week 1/4

7/11 There’s a Lifting

Foreword: We started this blog to document the medical missionary life.  It was hard to get the medical experiences in writing during the crucible days of 2013-2015.  We returned to the States July 1, 2015 and have come back to do one month rotations here in Kenya for the past 3 years.  The blog will now try to resume its original identity for a while in attempt pull out of the mommy-blogosphere. 

Back home in Chattanooga, TN, New City Fellowship was worshipping the last Sunday in June with the song “There’s A Lifting” and it has been reverberating in our heads ever since.  The song is about lifting up our eyes to realize where our help comes from.  Our help comes from the Lord, the Maker of Heaven and Earth.  As we lift our eyes, he lifts our hearts.  Here are some case reports of the lifting:

 Patient 1 is a 31-year-old man who was admitted to Tenwek for an upper gi bleed caused by an ulcer in his duodenum.  There is an increased incidence of peptic ulcer disease in the developing world because of the prevalence of a bacteria called Helicobacter pylori.  The bacteria spirals down into the lining of the stomach, and allows the stomach acid to erode down into blood vessels below the surface.  This causes the bleeding.  Yesterday he had an endoscopy procedure to cauterize the bleeding vessels.  Today, he done fell out on the way to the bathroom just because there was not enough blood volume in his body to perfuse his brain when he stood up from the squatting position. This man, thankfully fell on the floor near, not in the bathrooms  (The bathrooms are not a pleasant place for falling out as you could imagine). Thankfully for the medical team, the excitement of shouting family members called our attention to him. The team ran to him, and found he was awake and talking so we raised his legs up to drain the remaining blood volume up to his head before he was lifted up and put into a wheel chair, then promptly placed in bed with his legs elevated and a nice pint of hearty blood transfused from the family  (that’s how we get blood  here at Tenwek- family donors on the spot- no lie).  Imagine- the family members were documenting the event on their mobile phones the whole time.  Maybe we will be on their social media posts.

Patient 2  is an 81-year-old man who suffered an intertrochanteric femur fracture from a fall.*  He had also some shortness of breath and a cough, and was “sick-looking” thus an internal medicine consultation was requested for evaluation prior to orthopedic surgery. He improved after a day of antibiotics and supplemental oxygen, was breathing more comfortably and had no other cardiorespiratory conditions to prevent him undergoing an operation to fix his fracture. After reviewing the American Heart Association guidelines for perioperative clearance, we gave our clearance to proceed with surgery.  Approximately 10 minutes after we cleared him for surgery, he sat bolt upright in his bed and fell over dead.   Resuscitation was attempted with what was available on hand i.e. our hands., but unfortunately unsuccessful  (90% of patients remain dead after losing a pulse in the developing world hospitals).  We have no idea why he suddenly died and there is no way to find out for sure.  As we broke the news to his adult grandson who was there to care for him, he stood bolt upright also and yelled aloud and  fell out on the ground.  Gladly, at least the young man recovered.

Life is not a guarantee. Doing medicine here can knock me over at times too.   It’s intense, and an intense challenge to my assumptions: that I can figure out and fix the medical problems that our patients are suffering.  I lift up my eyes to the green hills of Africa- where does our help come from? 

Every Wednesday at Tenwek we have staff devotions at 8 a.m..  Today, our hospital statistician, Geoffrey Mushyoka,, gave the message to us.  He said, “You people are wonderfully trained and gifted by God to serve your patients.  But by yourself you can do nothing.  Jesus is the only healer. Our job is to serve the best that we can but without Jesus, we can do nothing.”  .  He is the Lifter of our heads and our hearts. He is the Lifter of the living and the dead.  We must realize where Our Help comes from.

Lecture 1- today I gave a lunch time lecture on antibiotic stewardship in the hospital classroom. We had 2 faculty members attending and about 20 medical students, interns, and residents.  We came here for the purpose of preparing God’s people for works of service, so that the body of Christ may be built up.  These are the long term investments we are aiming at: teaching the teachers, equipping the national providers to steward medical resources wisely.  The projector was broken and thankfully too, because power point is a smoke screen all too often.  So I “hand crafted” the lecture on a white board with markers.  The risk of drug resistant bacteria in the developing world is far more potentially hazardous because the only available antibiotics are on a very short list here.  We must carefully steward the gifts that God has given us through modern medicine. Antibiotics are a gift, but they too must be submitted to the LORD for appropriate usage.  Here’s a picture of how that wonderful design works scientifically:

Thanks for lifting us up in prayer,
Daktari "Davies"

Emigrant

Emigrate means to leave one's country to live in another.
Immigrate is to come into another country to live permanently.

2003- I came to your country without your language, but Steven came and patiently taught me.
 I came without car, house, bed for my disoriented head, but Tim and Lorna graciously received me in as one of their own.
I was one of three people with my skin color in the town.  The other two left and I was not afraid.  I was safe from hate, safe from fear, only an object of curiosity.
There was a young lady from Sudan who wore a black covering over her head and face.  She befriended me when I was alone.

2013-  I came again to your country a second time with my everything worldly packed in some suitcases and 4 hearts full of a dream.  A husband, a wife, 2 children, and "no home little sister, we are free in the wild now".  We went on faith and they took us in.  They gave us a wild and free chance to live our dreams.  It was more than we could've asked or imagined.
 

2018- The inverse
They came to my country not speaking the language, so I offered to tutor.  No safe neighborhoods to sleep for them, no car or navigational device for deciphering this insane Leviathan of "American Health Care".  Their dad found a job at a chicken plant, a job nobody wants, but it's a job. He has five children to feed and one on the way. 
They came to my country with a few suitcases and hearts full of dreams we can't yet know about because we don't speak the same language yet. 

But something made them want to leave home for all this.

2019- Their baby was due, but we weren't confident of when. We went to the doctor's office.  I was facing the gate keeper who wanted a $100 entry fee.  No insurance.  No means to acquire insurance either.  There was the symbolic glass ceiling, but it was really a window.  Would we get discouraged and overwhelmed and quit?  I recall all the hospitality and endurance of African mothers I know so I press on.  My God breaks walls down into windows all the time. 

The first year OB resident is the very fist American physician my friend ever sees.  She is kind and courteous and treats her like every other patient she sees. Thank you!

 My friend was referred to a high risk clinic, no charge.  4 of her 5 children were born at home in Sudan, with low birth weight.  Number 6 does not need to be like that.  The mom is not worried though.  She says "They were all fine before.  This one will be fine too".

The OB in America tests, sticks, scans, screens, and labs her into culture shock.  American health care feigns at control.  But every week I took her to get that ultrasound I was amazed at the black and white image of a tiny human packed full of hope and heart beats and amazing awe that was like a first face-time encounter with a child.  They eventually determine the child's due date will be Easter and guess when she came- Easter night!  Healthy and ambitious in her outlook on leaving the tiny safe womb to come out into all this wild world. 

A few weeks later, I am at the pediatrics clinic with the siblings from Sudan.  They have been vaccinated now against polio, measles, tetanus and other things people back home die from.  The 5 year old girl asks to listen to the stethoscope.  The nurse lets her hear the child's own heartbeat, and then puts the chest piece on her own chest.  The little girl catches the heartbeat in her ears and her face lights up with wonder and awe and exclaims "Is like me!" 

 

Fall- first frost

October 2018 
    The flurry and hurry of getting 2 kids ready for school in America: out the door, to dad's truck, the pick up will drop you off and the van will pick you up.  First, brush your hair, brush your teeth, did you get all your things? Lunch is packed- please eat it all today.  Cold air rushes in the house as they rush out of it.  Remember to be kind and be honest and look out for the lonely.  Latch the door and silence.
    The cold air from outside washes over like a sugar glaze to wake me up inside.  Now it is me all alone and awake, loading up cereal bowls from the sink.  And I think, it went so fast.  Even though we woke up so early.  My little ones have now become medium sized.  They outgrew their shoes and jeans just now.  And they will have outgrown the mornings with mom before I know it.  This silence is foreboding.  So I turn on the machines that make things clean. The clothes machine, the dish machine, that do their jobs so quick and easily.  They hum and beat that old drum!  Keep moving quickly so no one gets hurt, or at least so no one feels the emptiness.  Keep moving, hustle. Hurry and worry about the appearances.  Curate, de-clutter, remove the evidences.  But life was just here a minute ago.  
   And now we are six, no seven, soon she turns eight!  And that's just the baby.  The Man-cub is both longing to stay little and growing into freedom.  I must let him grow up and out from me, however it hurts.  They never told me how labor pain continues for life in some ways.  The heart contracts to contain her baby, while forcing the strength of the child to prevail against it.  But these little daily habits of the heart, launching him on small explorations is my practice for the day he drives off to college, or to the moon, or wherever.
   In America, here we strive and pray and drive to pave the road a little ways.  And then we trust the child to blaze his trail, to grow strong, swinging his Masai sword through the woods.  He will carve a path that is his in a rhythm that is his, not to the beat of my dryer drum.  It's too cold in America to hang the laundry out to dry now.  So I shift the clothes from one machine to another and pray Dear Lord, "let mercy lead so that every footprint that he leaves there'll be a drop of grace."* And let me not mistakenly call it clutter.  So much life was here just a minute ago.

*Thank you, Rich Mullins and Beaker for that song! Let Mercy Lead- Brother's Keeper 1995