Sonu, Part 2

Sonu died last night.

I knew earlier on in the day that this was likely to happen. She has deteriorated and bounced back several times before, but this time it was different. Her breathing was becoming more and more laboured, and she was lapsing into unconsciousness. I knew it wouldn't be long.

She had continued to hang on since my last post, and in fact had perked up again. I really wondered if she was going to surprise us and make it after all. We did end up amputating her one leg a few days ago. Her mother knew this and had given us permission. Sonu had given a head nod that day to say that we could do it if we had to, but I don't think she realized after the fact that it had been amputated. But she did complain of a lot less pain after that. In a way I'm glad that she didn't realize that her leg was gone - she had been so against that from the start.

I don't usually go into the hospital if a patient dies in the night. The residents are usually very capable of handling it, and Nepali people have their own customs for mourning. But last night I wanted to go in and see her once more, and (much more importantly) to give her mom a hug, sit with her if need be, and pray with her. Sonu's family lives very far away from the hospital, and I knew it would be awhile before any other family member would be able to come. I didn't want her mom to feel alone, and I also wanted to connect with her for the sake of my own closure.

Nepalis are very community-oriented people, always very interested in everyone else's business. Whereas we tend to be quite private about our personal lives and our health issues, they are very open, and like to show off whatever medical test results they have, talk about their problems, and be involved...even with total strangers. In fact, there have been times where I've thought I was giving discharge instructions to a child's parent (and they nod very interestedly as I do so), only to find out later that the person I was talking to is with some other child and not related at all to the one about to be discharged! At times this interest in everyone else's business is amusing, and at times it's frustrating. But last night, it nearly melted my heart.

When I went into the burn ward, Sonu's mom was sitting on a stool, holding her young daughter who has been with her this whole time. Around her sat the other 2 female burn patients in the ward (who are both doing quite well), as well as their family members. There is a young woman, 22 years old, whose skin grafts have taken well and will be going home soon. Her husband is with her. They were clearly concerned and sad for Sonu's mom, and the husband was making multiple phone calls from his mobile phone to try to contact a family member, or at least someone from Sonu's village, to pass on the news that she had died. The other woman, who is also doing well, was sitting up in bed and trying to offer comfort to Sonu's mom. Her granddaughter (maybe 15 years old) was sleeping when I came in, but she later woke up, and immediately went over and hugged Sonu's mom, held her, and let her cry on her shoulder. She then took 500 rupees out of her pocket and gave it to Sonu's mom for mobile phone recharge cards or other expenses. Later, they took the baby from Sonu's mom, and the husband of the young woman held the baby (below) while Sonu's mom cried. It was so touching to see the love and care that they showed for her. The poor woman is still all alone. Her husband is supposed to arrive tomorrow. It's a long way. In the meantime, she has nowhere else to go, so she is sleeping on the burn ward with the only "family" she currently has. I'm so thankful that they're caring so well for her.

I took one last look at Sonu before they wrapped up her body and wheeled her away. She looked peaceful and had a little smile on her face...the first smile I've seen on her in weeks. I had been told yesterday morning by one of the members of our Pastoral Care team that she said yes to Jesus a few weeks ago. I believe she is with Him now, and her suffering is over. Thanks be to God!

Yesterday evening, before she had died, Paul and I were praying for her in our home. I was initially crying tears of sadness for her and for the whole situation. But then I felt like Jesus showed me that His arms were going to be open for her that night, and that the next time I see her, she will be whole. Then I heard His words: "Whatever you did for the least of these you did for me." The tears that followed were tears of gratitude. Gratitude for the opportunity to care for Sonu and show her the love of Jesus in the midst of this tragic situation. Gratitude for His love for her, which far surpasses mine or the love of her family. And gratitude that He made a way for us to be with Him forever. Death no longer has to be the ultimate enemy.

Welcome Home, Sonu!

Dipesh

I should have taken his picture, but I didn't think of it in time. The beautiful smile he flashed for me today was priceless. It was the first time I had seen him smile since I met him a couple months ago.

5-year-old Dipesh was another one of our burn patients. We treated him a few months ago in hospital, and I have seen him in clinic a few times since then. He was one of those kids who screamed every time you even looked at him, let alone made any move to touch him. While in hospital he had been quite sick with high fevers for awhile, and we had wondered if he would make it. Many in that situation don't. But he did, and he eventually went home. He still had some wounds that we thought would need grafting, but for various reasons he went home without that being done.

When I saw him in clinic a month later, there was still a wound that needed grafting, so we brought him into hospital and did the surgery. Only some of the graft took, but we decided at that point to send him home and see him again in a month, hoping the wound would have healed, or at least gotten smaller.

Today, as usual, he started crying as soon as mom opened the door to my clinic and started to walk in. I looked at him, smiled, put my hands behind my back, and said, "See, I'm not going to touch you. You lift up your shirt and show me." Reluctantly he did. The wounds were all healed, and I told him so. I asked to see his leg, which almost made him cry again, but I promised not to touch. That wound was healed, as well.

When I told him he didn't need another operation, he looked at me with the kind of disbelief you don't usually see in a 5-year-old. And then, cautiously he flashed me a smile. I then said, "No more surgery, no more hospital, no more injections. You can go home." Then he smiled a big smile, showing his beautiful huge dimples in the process. I proceeded to hand him a frangipane blossom, which for some reason I had brought with me to clinic today. They are a favourite flower of mine, and are blossoming beautifully right now. Their fragrance is amazing. When I handed it to him, he actually laughed. Mom looked me in the eye and said, "Thank you for saving his life."

There are many days when I cry out of sadness or frustration over one patient's story or another's. I have plenty of patients in hospital right now who are worth shedding those kinds of tears for. But this time I shed tears of joy.

We serve, Jesus heals!

Sonu

They teach us in medical school not to get emotionally involved with our patients. We are taught to stay professional and objective so that we can best care for them. There is certainly wisdom in this. If we were devastated every time we cared for someone really sick we would never be able to keep going. Having said that, it's impossible to stay completely unattached, and there are some patients who really get into your heart. Sonu is one of them. For privacy reasons I won't post a photo of her.

She is a beautiful 16-year-old young woman, newly married (yes, girls, especially poor girls, marry early in Nepal). Her husband can't be more than about 18, but I don't know his age for sure. She comes from a family of 8 children - 6 girls and 2 boys. The youngest girl is 1 year old, a spunky, very cute, curly-headed little girl, who is staying here at the moment while her mom cares for her sister. About 2 months ago, Sonu was holding some kind of metal rod in both hands, when it touched a live electrical wire. The current went in through both hands, travelled through her abdomen, down out both her legs, exiting, I suspect, around both knees, though also affecting her below the knee. When she came to us, both hands were completely black and shriveled. She had a huge, gaping abdominal wound, with some bowel exposed. Her legs weren't charred, but they were also badly burned, and bone was exposed and infected around her knees.

When she came in, we could see immediately that she needed both hands amputated. She knew this, as well. We couldn't see the rest of the damage because she was covered with blankets and dressings. I took her to the minor procedure room, sedated her, and took a look. When I took the dressings down, all I could do is stare for about 10 minutes. We usually measure burn severity in terms of percentage of body surface area burned. Her total percentage was only about 35%, but it had so badly affected her arms and legs that the injury was devastating. I stared, prayed, and wondered what I could do for her...or more to the point...what I should do for her.

Looking at it all I realized that full treatment would involve amputating both arms and both legs above her knees, a tragic circumstance, even in the west, but here in Nepal, coming from a very poor family with lots of mouths to feed and lots to do, is it even a survivable circumstance? We have funds here to pay for the medical care of poor patients, but even if she survived the care (which was unlikely), what would happen to her after she left hospital? And so I stared, and prayed, and wondered, and eventually decided that the best option would be to stick to comfort measures, knowing that she would die, but at least giving her the chance to die without (hopefully) too much pain and suffering, and hopefully being cared for in a compassionate way. As I made this decision, and for several hours afterwards, it weighed so heavily upon me that I found myself weeping, both for her situation, and for the weight of responsibility that I felt for making that decision. Then we spoke with both Sonu and her husband, and they pleaded with us to try. They said they knew her hands needed amputation. They didn't want her legs amputated - they were adamant about that. They knew she had a severe abdominal wound, but they were hoping that it might heal. They asked us to try and give it some time and see if her abdominal wound would heal, and see what happens.

This took pressure off me in terms of the decision-making. We still thought she was likely to succumb to her injuries pretty early on. She had raging fevers for the first several weeks. But she remained spunky and spirited, and it really seemed like she was fighting. After long discussions with them, we amputated her hands (which obviously needed it), and performed a skin graft on her abdominal wound, which actually was starting to heal on its own. Amazingly, the skin graft took better than almost any other skin graft I've seen! Instead of dying, she seemed to be actually thriving. She was maintaining her weight (i.e. nutrition), and was still energetic and holding on. But she still remained in a lot of pain, and there was still the question of her legs.

About 2 weeks into her hospital stay, her husband disappeared, and nobody has seen him since. I suppose you can't blame him...what a circumstance to find yourself in when you're just a kid, newly married, with your whole life ahead of you. But it added to Sonu's woes and to the tragedy of the situation. Her father came to stay with her, bringing with him a notebook in which people from his village had written their names and pledges for how much they would give to help pay for Sonu's care. The pledges were generally in the 10-20 rupee range (15-25 cents maybe), and amounted to about 5000 rupees (maybe $60) - a fraction of what her care would cost...but it was really touching to see.

Now, about 2 months later, Sonu is still with us. But she isn't herself anymore. She sleeps a lot and she's refusing to eat. We keep on putting feeding tubes through her nose into her stomach to feed her, and she cries and cries and begs us to pull the tube out. But she is losing weight, and is now looking more like a skeleton than a girl. She cries in pain whenever we touch her legs, so we have to sedate her for any kind of dressing change or wound care. She hasn't had a fever in about a week now. We don't know if that's a good thing or a bad thing...good thing because the infection is more under control, or bad thing because her immune system is so compromised that she can't even mount a fever anymore. We're not sure which.

I spoke with her and her mother the other day about how things are going. It really seems like she is going to die. But she's surprised us before. I talked with them once more about amputation of her legs, which may put more stress on her body than she can handle at this point, or it may be what is needed to save her life. But for what? They haven't made a decision yet, which means that the decision may end up being made for them soon. The other option is comfort care and letting her die. She's almost past the point of us being able to do anything more for her, and delaying this much more may put her past that point. We'll see. When I said to her mother that her daughter might die, she began to cry, and said, "My daughter is going to die?" I said - with tears in my own eyes - that yes, that was very likely. There really is no easy answer in this situation. And with my still limited Nepali, having an indepth conversation about all of this is impossible. All we can really do is pray for wisdom and compassion as we continue to care for Sonu and her family as best we can.

It has been an emotional roller coaster for me and for the other doctors caring for Sonu for the past few months. But it sure is a reminder of why we are here. She was sent away from 3 other hospitals because of both the severity of her injuries, and their poverty. At least here we have funds that we can use to pay for her care, we have compassionate staff, and a wonderful Pastoral care team who has been very much involved in caring for her. Whether she survives this or not, we do know that she has had the opportunity to hear about the God who loves her, created her, and died for her, and who will gladly welcome her into His arms if she'll put her trust in Him. We pray that she does. 

Contentment

Life in Tansen, as with anywhere else overseas, has its ups and its downs. You can't argue with the view we get from our window. We have a full-time house-helper, who not only does our laundry (by hand), cooking (all from scratch), and cleaning for us, but she is also a lovely lady. Nepalis in general are really lovely people, easy to get along with, very warm and friendly. We have a very comfortable house to live in (at least we do now that Paul has done so much work on getting it fixed up). Jessica's work is steps away from home, which means we usually get to see each other periodically throughout the day, and we can often eat lunch together. We have a great team of people here, and some good friends. And being here together is such a blessing...so much better than being here (or anywhere) as singles. We have much to be thankful for.

Still, there are many challenges. Water and electricity supply is somewhat sporadic. It is a rare day where the electricity doesn't go off at least once. We have to filter all our drinking water. Even with filtering, we still get sick regularly. We have each had Giardia (a GI infection that is very common here) - Paul twice, Jessica three times - in the last 4 months. Not to mention the wicked food poisoning that Jessica got just after arriving in Nepal in January. Even when we're not overtly sick, we still often don't feel well, and that tends to be most people's story over here. It takes a toll on your health, energy, and overall sense of well-being. Work is busy. There are many cases that are not straightforward, and even those that are take more work and energy here than they would at home. Why? A culture that is different than our own. Trying to do it in a language not our own. Not feeling well a lot of the time. Etc.

There are critters...spiders, cockroaches, snakes (not too many around here compared to where Paul was in Mozambique, but still an issue), termites, and other lovely things. The weather is not freezing cold in winter, but cold enough when you don't have heat inside and you get frostbite from washing your hands because the water is so cold. And in the summer it's hot, and soon it will be monsoon, during which we get so much rain that our 1 million litre water storage tank gets full within 3 days! You don't come to Nepal for the weather, except maybe in October!

Then the community we live in, as wonderful as it is, is small. We get bored of each other. And we say a lot of good-byes, since most people that come come at most for a few years, and then leave. So far in the last 3 months we've said goodbye to 3 families that had been here for 3 years or more! Thankfully, that's it for awhile, now, I think. Goodbyes are tough! We get a bit claustrophobic here in Tansen at times, because there isn't really all that much to do, and there aren't many options for going out or getting away. If you enjoy walking/hiking, living in Tansen is a dream, but that can get old after awhile. Other than that, there's not a whole lot to do, and boredom is an issue more often than we'd like. We watch a lot of movies and TV series (on my laptop). If you want to get away, the nearest place you can get away to is Pokhara, a 4-5 hour drive on a road that makes you so nauseous you really want to make sure you are truly ready for a break before you venture on that trip. Add that to being far away from friends, family, and all else that is familiar, and at times you wonder if you really would be better off packing your bags, heading home, and forgetting this whole thing.

It's easy to think that the proverbial grass is greener on the other side. But if we're always living for the next weekend, the next vacation, the next time we go home, the end of our term, graduation, our children growing up, retirement, or whatever, then we'll miss what God has for us TODAY. At a retreat we were at recently, the speaker said that "the only time that matters is now and the only place that matters is here." This doesn't mean that we don't plan for the future, or look forward to future events. But it does mean that we choose to be thankful for the opportunities God has given us today to love and serve Him, to experience more of His presence and His love in our lives, and to be thankful for all the blessings we already have.

We've been working on contentment this week. The apostle Paul tells us that Godliness with contentment is great gain. He also said that he had learned the secret of being content in any and every circumstance. You don't need to do an extensive study on Paul's life to know that he didn't have it easy! Shipwrecks, beatings, hunger, cold, tiredness, being stoned, etc. (Makes our life here in Tansen look pretty cushy, actually, but that's beside the point). He learned that he could do all things through Christ, who gave him strength. This is true for us, too. God has called us here, and that is far more important than weighing the pros and cons of staying or going. We know that where He has called us, He will give us not only grace, but also joy as we do what He's called us to do.

And really, in the midst of the challenges, we are very blessed. We may not be able to go out for breakfast, or to Starbucks (or Tim Horton's - take your pick!), or out for a nice dinner. But we've been learning to make breakfasts that we'd say are worthy of a restaurant, and we love our weekend breakfasts together. We've also figured out how to make bagels and even some version of cream cheese! We make our own lattes, and other nice coffee. And our most recent endeavour was creme brulee...yum! It's been fun to experiment, and fun to enjoy nice food that we've made with our own hands.

Paul has dreamt of having an orchard/vineyard for some time now. While we're not sure if this will ever happen (at least on this side of eternity), around our house is a plum tree (currently full of yummy plums), an orange tree, a peach tree, and an apple tree! Our didi is currently making plum jam, since we have no way of eating all the plums, even after sharing them with many others. We grow vegetables in our garden, and we're getting some fencing ready to plant grapes in a couple months when the season comes. So we have our own little orchard here, and we haven't even really had to work for it. What a sweet blessing from the God who knows the desires of our hearts and who loves His children!

So we're praying that in the midst of the challenges, we would learn to rest in a place of contentment, knowing that God has called us here, and that sooner than we'd like to think, our time here will be over. May we not miss the joy of embracing TODAY, with all its joys and challenges, and may we be content whatever our circumstances, for that is great gain.