Gopal

Pray for Gopal, a 7-year-old boy who had a bad fall several days ago, resulting in a severe head injury. He had bleeding in his brain and was unconscious. One of his pupils was "blown" (which is medical speak for the pressure in his head was too high and his life was in danger). One of the other surgeons here took him for emergency surgery early in the morning to evacuate the blood and try to take the pressure off his brain.

He survived the first 24 hours, though he didn't seem to be showing any signs of regaining consciousness, and we were still quite concerned for him. We started praying with his family and praying for him. Many prayers are going up for him. It seems like each day he's getting a little closer to waking up. His pupils are now just about equal in size (meaning the pressure and swelling in his brain has significantly decreased). Today he opened his eyes twice, not fully, but he definitely opened them. He also has been crying when we do things that hurt him, again an improvement from making no sounds at all. Today as we were washing out a wound on his arm (he also has a very severely broken arm), he actually said, "Mommy" in the midst of his cries.

Here at Tansen hospital our motto is, "We serve, Jesus heals." I have been very aware of this lately as I've cared for and operated on many patients who were close to death, and as we've been praying for them, they've recovered, despite being very sick before and after surgery. I wish I could say this happened with every patient. There are others that we pray for who don't survive, like so many of the burn patients I wrote about last week. I don't have answers to the "Why" question, but I do know that Jesus heals, and we're praying that He heals this little boy, so that he not only wakes up, but wakes up and walks out of here with normal neurological function.

Where we live

Not too much to say at the moment. Things on the burn ward have quieted down...mainly because almost everyone has died. Paul has been working on our new house to get it ready for us to move in next Wednesday. He is keeping his workers amused up there as he liberally uses the few Nepali phrases he has learned so far. He definitely brings a lot of smiles to a lot of faces :)

We thought for today we'd share some photos of where we live. We certainly are blessed with beautiful surroundings, especially when the weather is clear. It's not hard to be reminded of God's greatness living in a place like Tansen!

On a clear day you can see the Himalayas off in the distance. We live in the foothills.

This was taken just outside our new house. You can see the mountains from both our bedroom and living room windows!

The "White Lake," as it is known, can also be seen from our house (though this wasn't taken from our house). We live above the clouds!

Not scenery, of course, but I couldn't resist. This kid wouldn't stop looking at his X-rays. A budding doctor, perhaps?

Burn ward - Part 2

The reality of caring for badly burned patients is that it is discouraging work with a very low success rate, especially in the third world. But even at home infection often gets the best of them. Here is an update on the patients I wrote about in the last post:

Died yesterday: The 18-year-old girl, who was badly burned by fire 3 days after her wedding. Her husband had stood faithfully by her throughout the whole ordeal. What will he do now?

Went home after almost 2 months in hospital - disabled but alive: The baby whose feet and legs were burned by fire such that all the toes of one foot were amputated and some of the toes on the other foot were, as well. He underwent 2 skin grafting procedures, and even after the 2nd one not all the skin had taken, but he'll be okay and his wounds are small enough now that they'll heal on their own. His mother doesn't look more than about 18 years old.

Died the day after she received the news that her 2nd skin graft had failed: The young woman who had 2 skin grafting procedures and who screamed every time her dressings were changed. When we looked at her wounds after the 2nd operation, we saw that this one had also failed and she would need yet another operation. The discouragement and despair was evident both in her face and in her aunt's, who is the only one there caring for her. She had already been in hospital a month.

Died: The woman in her early 50's who, after finding out that her 3rd skin graft procedure was yet again a failure, lapsed into unconsciousness.

Went home to die: The man in his 50's who showed up one month after being badly burned in both legs? The burns were so deep that trying to operate and remove the burned tissue would result in not enough leg muscle or tissue for him to walk. We recommended that he have an amputation high up on both thighs, just to save his life. He opted to go home, because at least he could walk. It's only a matter of time before infection gets the better of him.

Still alive, but his skin grafts failed twice. His family wants to take him to Kathmandu - they're freaked out by all the people dying around them: The young male athlete in his 20s who begged us to make sure he can still do his athletics after his operation. His legs are so badly burned this is very unlikely. He had 2 failed skin grafting procedures.

Went home and should recover without disability: The young woman who, in the midst of no electricity in her house, accidentally sat on a pot of boiling water instead of her chair. Fortunately her burns are pretty superficial.

Both died this week: The 2 woman whose burns were so extensive that we are only treating them palliatively (pain control, fluids, and pastoral care). Actually, one of them seemed to be doing so well that we decided to start treating actively. We started doing dressings in preparation for her to go to surgery soon, and then she died yesterday.

We decided to treat actively. Took her to OR and she died the next day

: The woman with 40% of her body surface area badly burned from her sari catching on fire. Our usual cut-off in deciding whether to actively treat these patients medically versus palliatively is 40%. She was right on the cusp. 

Yesterday after rounds, when I discovered that 3 more of our patients had died, I went home and wept. Even as I write this, there are tears in my eyes. I guess maybe you get used to it after you've cared for burn patients for awhile, but maybe not. At any rate, this is my first real exposure to multiple severely burned patients, and it seems tragic to me!

As I process it all, I realize that the tears are good, because they mean I'm still a human being and I haven't become hardened by it all. And I hear Jesus saying, "I make all things new." We may not see it here in this life, but He promises a day when He will make all things new, and He will wipe away every tear from our eyes, a day when there will be no more death or mourning or crying or pain, because the old order of things will have passed away. That is the hope that we have when we know Him and trust in Him.

I don't know if these patients found that hope and life or not. I did start to pray for each of them in the name of Jesus in my faltering Nepali every day. It was something I felt God was prompting me to do. I guess I'd hoped that His response would be to bring physical healing, but we didn't see that. But maybe there was a more eternal reason I was to pray for them. I pray that through their time here, they did find Him. Only He knows.

 Reminds me of a photo I took last year of what looked to me like a window to heaven through the clouds. As I looked at it, I thought, "Now we see in part." We don't know or understand why things happen they way they do, but one day we will understand fully. And in the meantime, we hold onto the One who is good, who knows all their names, and who holds all things in His hands.

Burn Ward

Which burn patient shall I tell you about?

The 18-year-old girl, who was badly burned by fire 3 days after her wedding? Her legs were so badly burned that even if she does walk again she will be severely disabled. Her new husband stands faithfully by her. Thankfully her skin grafting procedure seems (so far, at least) to have been a success. But the dressing changes sure are traumatic for her!

The baby whose feet and legs were burned by fire such that all the toes of one foot were amputated and the toes on the other foot may have to be, as well? His mother doesn't look more than about 18 years old.

The young woman who has had 2 skin grafting procedures already and who screams every time her dressings are changed? Yesterday we looked at the places that had been grafted previously and it seems they haven't worked, so she's going to need yet another operation. We pray this one works. The discouragement and despair was evident both in her face and in her aunt's, who is the only one there caring for her. She's already been in hospital a month.

The woman in her early 50's who, after finding out that her 3rd skin graft procedure was yet again a failure, lapsed into unconsciousness, and hasn't awoken since?

The man in his 50's who showed up one month after being badly burned in both legs? The burns were so deep that trying to operate and remove the burned tissue would result in not enough leg muscle or tissue for him to walk. We recommended that he have an amputation high up on both thighs, just to save his life. He opted to go home, because at least he can walk right now. It's only a matter of time before infection gets the better of him.

The young male athlete in his 20s who begged us to make sure he can still do his athletics after his operation? His legs are so badly burned this is very unlikely.

The young woman who, in the midst of no electricity in her house, accidentally sat on a pot of boiling water instead of her chair? Fortunately her burns are pretty superficial.

The young girl whose skin grafts actually were a success, and who will be going home soon?

The 2 woman whose burns are so extensive that we are only treating them palliatively (pain control, fluids, and pastoral care)?

The list goes on! At last count, there were 17 burn patients in our hospital, 12 of whom have major burns. No wait, 18 and 13...one more came in yesterday with 40% of her body surface area badly burned. Our usual cut-off in deciding whether to actively treat these patients medically versus palliatively is 40%. She is right on the cusp. Neither decision is an easy one. Nobody here can remember a time when there were so many burn patients in the hospital.

Most burn centres in the west will only accept up to 5 patients before they close and won't accept any more. Most burn patients are on ventilators because of the amount of pain medication they require to be kept comfortable. They are given complete anaesthetics (put to sleep) for every dressing change, as least initially. The resources in terms of OR time, nursing time, doctors skills, and just emotional energy that are needed to care for these patients are significant. Here in Tansen patients are given a small dose of morphine (if that!) before their dressing changes, and even the strongest of them screams in pain. It's really heart-wrenching and emotionally draining. And there are still so many of them who need surgery, and often who need several surgeries before all is said and done. The ones who seem to be doing well initially often experience setbacks, which sometimes result in much longer hospital stays, and sometimes claim their lives.

It's draining and exhausting. We're so thankful for a German plastic surgeon who is here at the moment to help with the load and to share his expertise. But he's just as overwhelmed, and he's leaving on Friday.

It's easy to become discouraged, or to develop a callous heart towards these patients and this situation. It's a defense mechanism to keep from getting burned out (no pun intended) from caring for them. But they have nowhere else to go. I am continually reminded that I need to just focus on the one in front of me, take them one at a time, and approach them as individuals loved by Jesus, not as "another burn patient." I am continually reminded of my absolute dependence on the Lord for strength, grace, wisdom, and endurance. He promises that His grace is sufficient and His power is made perfect in our weakness.

We pray that in the midst of these situations these patients and their families will experience the love that only Jesus can give, and that He would show Himself to them, both in life and in death. And we pray that His light would continue to shine through us as we do our best to be His hands and His feet, and to communicate His heart, to them.