Deliverance is nigh

Deliver Me

Deliver me out of the sadness
Deliver me from all of the madness
Deliver me courage to guide me
Deliver me your strength inside me

All of my life I've been in hiding
Wishing there was someone just like you
Now that you're here, now that I've found you
I know that you're the one to pull me through

Deliver me loving and caring
Deliver me giving and sharing
Deliver me this cross that I'm bearing

- By the Beloved from the album X -
(Covered by the David Crowder Band here http://www.youtube.com/watch?v=lnXYxevk-ak)

"In You, O Lord, I put my trust; let me never be ashamed; deliver me in Your righteousness. Bow down Your ear to me, deliver me speedily; be my rock of refuge, a fortress of defense to save me. For You are my rock and my fortress; therefore, for Your name's sake, lead me and guide me." (Psalm 31:1- 3). In the midst of turmoil, I will learn to trust that God has my best interests at heart. On the other hand, I've to admit that it's a rather self-centred conceit.

Sometimes I wonder how it's like to be God, to have to balance the good of the majority vs that of the individual (or as Spock would put it, 'the needs of the many outweigh the needs of the few' - utilitarianism neatly encapsulated). What type of philosophy would He subscribe to? Is it possible to chart a path through life that would result in the best outcome for every single created being, from the lowliest amoeba to the current leaders of the so-called free world (no comparison intended)? Theoretically, I guess the answer is 'yes'. All I know is I wouldn't like such a job, just thinking of the scope of the responsibility involved is enough to do my head in! It'll be worse than trying to spin plates, juggle balls, turn somersaults and eat fire (pardon the circus similes) all at the same time.

In the grand scheme of things, do my decisions make a difference? Does what I do in the here and now make a dent in how the future plays out? Does it ultimately matter if the answer was 'no'? Ah, the hubris of it all! The need to be known for something, anything, has been the downfall of many a person. The desire to leave a legacy, to make a mark that shows that yes, 'so-and-so was here'. Truly, "all flesh is as grass, and all the glory of man as the flower of the grass. The grass withers, and its flower falls away" (1 Peter 1:24).

"For no other foundation can anyone lay than that which is laid, which is Jesus Christ. Now if anyone builds on this foundation with gold, silver, precious stones, wood, hay, straw, each one's work will become manifest; for the Day will declare it, because it will be revealed by fire; and the fire will test each one's work, of what sort it is. If anyone's work which he has built on it endures, he will receive a reward. If anyone's work is burned, he will suffer loss; but he himself will be saved, yet so as through fire." (1 Corinthians 3:11-15) Even if it is my destiny to be forgotten, may my work be found to bring Him praise and glory forever, world without end.

Haste does not make waste

Before I expound on the title of my current post, here's a pic for those wondering why I've not shown any photos of myself. As you can tell, I'm quite well fed here (although I don't think I've put on weight, as trivial a concern as that is). The kids up at the orphanage are way too familiar with my iPad now and have been taking random photos of (almost) everything, including yours truly. It's one of the five dresses I had tailor-made in Kampala and I must say I'm quite pleased with the result.

Yesterday was rather depressing as my day at the hospital ended with another child's death. This time, of a two-year-old boy who likely had severe malaria and multiorgan failure. He came to us febrile, tachycardic (>200bpm!!), tachypnoeic (70-90/min), hypoxic and markedly jaundiced. Over the course of the afternoon, he became more and more obtunded and was anuric for the entire duration of his stay. It was such a frustrating day as there were a multitude of events that did not happen as (I thought) they should have. What with delays in getting the first dose of artesunate in, the NGT for rehydration (since no one could obtain IV access), the dextrose as he became severely hypoglycaemic (the glucometer reading dropped from 1.6mmol/L to "Lo" half an hour later) and finally, the decision to proceed to insert an intraosseous line. Was there a single person to blame? Would it have changed the outcome? No, but I feel that things could certainly have happened half an hour to an hour earlier at the least. Then, I can truly rest easy (or easier) that we had done everything that was possible within our limitations. As it is, it tears me inside that this sick, sick kid wasn't initially taken seriously enough and treated with the respect and urgency that the severity of his case demanded.

In contrast, another two-year-old boy today almost crashed as well but I'm hoping we caught it in time. This kiddo is one of the worst cases of malnutrition I've seen yet. He's two years and three months old but weighs just under six kilograms; yes, he's lighter than most infants! Poor boy's from a nearby camp for Congolese refugees (it still astonishes me that there are people who would seek refuge in South Sudan). He had a NGT inserted today as he was losing weight despite being on a therapeutic feeding regime; a few minutes into his second feed, he became acutely unwell with marked respiratory distress. I suspect he aspirated; as it is, we got him on oxygen and antibiotics pronto. At the moment, he still looks pretty terrible but thankfully, not as moribund as before.

Before I started serving here, I don't think I truly understood or grasped the concept of the so-called "golden hour", the hour in which one can potentially change the clinical outcome of a critically unwell patient (although I think the concept came out of trauma medicine). There are so many factors that affect how a resuscitation plays out, e.g. if the patient deteriorated around handover time, the proximity of the patient to vital equipment, the seniority of the staff on duty, if it was a normal working day or a weekend and in daylight hours as opposed to in the dark of night etc. I recall one of the codes I attended while on cover shift back home: a middle-aged man scheduled for elective cardiac bypass grafting had arrested on the ward the day before his operation and I was sent to get his ABG results. I was flabbergasted when first the ICU nurse then the ED nurse refused to let me process it in their respective wards. Seriously, this guy doesn't have a heartbeat and you're saying that I can't use your machine because the correct procedure is to bring it to the lab?!

This rather reminds me of Jesus' warning to His followers to discern the hour of His second coming.
"Now learn this parable from the fig tree: When its branch has already become tender and puts forth leaves, you know that summer is near. So you also, when you see all these things, know that it is near, at the very doors...But of that day and hour no one knows, no, not even the angels of heaven, but My Father only. But as the days of Noah were, so also will the coming of the Son of Man be...Watch therefore, for you do not know what hour your Lord is coming. But know this, that if the master of the house had known what hour the thief would come, he would have watched and not allowed his house to be broken into. Therefore you also be ready, for the Son of Man is coming at an hour when you do not expect Him." (Matthew 24:32-33,36-37,42-44)

Sometimes, we need to know when to hurry. It may well be that we still have time to eat, drink and be merry. But it might also be that this very night, our souls will be required of us (Luke 12:13-21). Before Whitney Houston, Michael Jackson, Heath Ledger and Cory Monteith closed their eyes for the last time, I doubt any of them imagined that they would end up six feet under shortly thereafter. Whether self-inflicted or not, death comes for us all. May we be found ready!

Addition: Sadly, the second boy passed away today afternoon (22 Oct); I was called to his bedside after he arrested but this time there were no warning signs or any preceding deterioration. It's a bit of a mystery but my money's on some electrolyte imbalance or overwhelming sepsis.

Eye of the storm

The picture depicts a recent thunderstorm here. A more violent version of the drizzles we get in Melbourne and similar to the ones we have in Malaysia that causes roads (and homes) to flood and closes schools and offices for the day.

A fitting simile to the one plaguing my heart and mind, in other words. I'm officially unemployed for 2014 and I'm in a quandary regarding the right way forwards. It's definitely not the end of the road; there are many options available but I just don't know which is the correct one to pursue. I haven't had time or energy to properly seek God's will in this matter; poor excuses, I realise.

On one hand, sure, it's a blow to the ego, but I'll live. On the other hand, I don't want to take the path of least resistance for the sake of convenience. It's disrespectful to the other party and just plain lazy on my part. I could apply for a job elsewhere (which would most likely be overseas since most of the job openings in Australia have closed). I could undertake some postgrad courses, an option that has always been on my radar (specifically a Masters in Public Health or Diploma in Tropical Medicine which would involve travelling to either the USA or UK for a time). I could bum around (an option that would probably give my parents a heart attack!). And I could always stay here if Pioneers and Harvesters would have me, I suppose. Again, I just don't want to make any decision out of desperation and merely because I don't have any alternative choice.

I have strived to operate under the belief that God has placed a calling on my life; to medical missions long term but also to first complete my specialty training (whatever and wherever that may be). Have I been mistaken? I don't think so but there's always the danger that my desires have clouded my hearing from His Spirit regarding what He wants, as opposed to what I want. They may not be dissimilar but I doubt they're identical.

Acts 20:24 "But none of these things move me; nor do I count my life dear to myself, so that I may finish my race with joy, and the ministry which I received from the Lord Jesus, to testify to the gospel of the grace of God."

1 Corinthians 9:24-27 "Do you not know that those who run in a race all run, but one receives the prize? Run in such a way that you may obtain it. And everyone who competes for the prize is temperate in all things. Now they do it to obtain a perishable crown, but we for an imperishable crown. Therefore I run thus: not with uncertainty. Thus I fight: not as one who beats the air. But I discipline my body and bring it into subjection, lest, when I have preached to others, I myself should become disqualified."

Philippians 3:8-14 "But indeed I also count all things loss for the excellence of the knowledge of Christ Jesus my Lord, for whom I have suffered the loss of all things, and count them as rubbish, that I may gain Christ and be found in Him, not having my own righteousness, which is from the law, but that which is through faith in Christ, the righteousness which is from God by faith; that I may know Him and the power of His resurrection, and the fellowship of His sufferings, being conformed to His death, if, by any means, I may attain to the resurrection from the dead. Not that I have already attained, or am already perfected; but I press on, that I may lay hold of that for which Christ Jesus has also laid hold of me. Brethren, I do not count myself to have apprehended; but one thing I do, forgetting those things which are behind and reaching forward to those things which are ahead, I press toward the goal for the prize of the upward call of God in Christ Jesus."

All three passages echo the sentiment that our journey through this earth is an ongoing process that would only find completion in the next life. But how to see clearly where the road leads? And what should we do when it branches? I don't do well with uncertainty but that's just too bad, I guess, since that's part of living in a fallen world. God help me, I just want to serve You. As Mary said to the angel Gabriel in reply to the Annunciation, "Behold the maidservant of the Lord! Let it be to me according to your word." (Luke 1:38). May my life ever reflect Your glory and Your goodness. May it be that at the end of days, when we finally meet face to face, I would have the passing joy of hearing You say, "Well done, good and faithful servant" (Matthew 25:21,23)!

Life and Death

It has been a turbulent week to say the least. How to chronicle the emotional rollercoaster of resuscitating a baby born with severe birth asphyxia for an hour before withdrawing treatment then see her practically come back to life an hour later? Of having to inform a family that their three-year-old son probably has only hours left to live? Waking up to the wailing of a mother who has just lost her child?

How to address one of your patients for whom you've been caring from the time she was admitted with preterm contractions, held at bay for a week or so before elective Caesarean section delivered her a pair of beautiful twin girls, only to be robbed of one of them a couple of days later? Do you avoid her gaze when passing her in the corridor? Try to pretend nothing's happened? What do you say after the paltry and customary 'maleesh' (sorry)?

What words are there to comfort the primigravida (first time mum) whose premature daughter has had multiple episodes of apnoea and bradycardia requiring CPR each week during her one month stay? It breaks my heart every time I see the look of fear in her eyes, wondering if her child will survive to the next day. And this in the context of her having already seen at least three or four others in the adjacent beds not making it. In the photo, her daughter's the one to the extreme left; these three precious bubs were all born at 31 weeks' gestation.

At least, let me tell you the story of Gloria, our miracle baby (not shown in the pic). It's one of the most amazing sequence of events that I've had the privilege of witnessing. She was born twenty minutes past midnight after a difficult second stage via vacuum assisted delivery. There was meconium present and a history of prolonged rupture of membranes but her mum did receive one dose of prophylactic ampicillin. She had poor Apgar scores from the start - floppy, bradycardic and only occasional spontaneous respiratory efforts. We bagged her for an hour but her cardiac output seemed entirely dependent on artificial ventilation, which unfortunately isn't sustainable in our context. After some tearful discussion with family, we decided to stop and allow the baby to pass on in peace. This was followed by a sorrowful outburst from the mother, who cried out to God asking over and over for forgiveness and for Him to spare the baby.

Well, at this point in time, the baby was still breathing but only at a dismal rate of one per minute (contrast this with the normal range of 40-60/min), the kind of pre-terminal gasping that heralds imminent death. We fully expected her to die over the course of the next few hours. The team subsequently debriefed in a separate room; after an hour of wrecking our brains trying to figure out what went wrong and what could have been done differently, I returned and was promptly informed by the baby's smiling aunt that the baby was ok! And indeed, the baby was breathing spontaneously at a regular rate with a strong pulse and much improved tone.

What did all this mean? Was it transient respiratory depression secondary to...what? No drugs were implicated, there was no evidence of a neurological cause, the baby was not floridly septic and yes, the baby was born at term. Was it a divine answer to a desperate cry from the heart? We later found out that the mother had been pleading for forgiveness due to a messy history of the baby being conceived to a different man to the one she was intending to marry - her original plan was to basically abandon the baby to the biological father. Not ideal but it could have been worse (I recall another mother who almost bled to death from a self-induced abortion). Whatever the rational explanation accounting for this remarkable turn of events may be, I firmly believe God was behind it. Nature may elucidate the how but never the why.

I am reminded of the following passage...
1 Samuel 1:15-16 And Hannah answered and said, "No, my lord, I am a woman of sorrowful spirit. I have drunk neither wine nor intoxicating drink, but have poured out my soul before the Lord. Do not consider your maidservant a wicked woman, for out of the abundance of my complaint and grief I have spoken until now." Then Eli answered and said, "Go in peace, and the God of Israel grant your petition which you have asked of Him."
And He did! Hannah had a son, the great prophet Samuel. Only God knows what Gloria will grow up to become but we've a hunch it'd be anything but ordinary. :)