At Hand

I should be packing my suitcase, but there is only one hour of daylight remaining and I would rather spend it in a hammock surrounded by bromeliads, date palms, and the birds that inhabit them. A quick look at my weather app tells me this opportunity will not be available upon my return to Wisconsin. After this, we have a mayoral dinner and he apparently has a tast for tapir, armadillo, and javalinas. So if Montezuma doesn't get me, the PETA operatives might (please don't tell them). By the time the sun rises tomorrow, we will be checking into the Aeropuerto. Hoping for a less harrowing experience this time, I have made sure all the laryngoscopes are in Jon's suitcase.
( http://campbellexploratorysurgery.blogspot.com/2012/11/bourne-in-bolivia.html )

The last 24 hours have been truly remarkable. I can hardly find words, but those who know me know that this will not keep me from trying.

Yesterday morning, in this same hammock, I was reading Matthew and pondering what it means for the kingdom of heaven to be near, to be "at hand." I'll admit, I'm still feeling around the edges of that concept even as I try to be obedient to its implications. How does this mean I should pray? How does it mean my prayers might be answered? Alas, no epiphany; at least not before breakfast.
We soon piled into the back of Rueben's truck (1985 Toyota Land Cruiser, sans seatbelts, speedometer, odometer, cup holder, muffler... you get the idea) and were headed to the Hospital - about a. 20 minute drive away. We had an ambitious day ahead of us. Did 4 cases Monday, 5 on Tuesday, why not 6 on Wednesday? And why not make them big ones (comparatively)? The day started as they have all started - slowly. Difficult to say why - it is always the sum of a million little things, none of which are worth the haste or rudeness it would take to overcome them. I have begun to accept that we will always do two operations before lunch, no matter how large or small they are, there will be two; no more, no less. They went well. Lunch was delicious as usual. This left four cases for the afternoon. So much for making it back to the hotel before dark.
First case of the afternoon was the largest of the day. A huge hernia, I had cringed upon seeing it in the consultation room the day before. She had her gallbladder out two years ago in Santa Cruz. Whatever they closed her facia with didn't work, half her GI tract now living in a basketball-sized bulge drooping down over her right hip. No binder or girdle can contain it, she must constantly lean to her left when upright. I usually prefer to take on such cases earlier on in a project (more time for follow up) and when we have multiple surgeons (even if only so there is someone else to talk me out of it). But she has no other recourse and she is why we are here. The case takes a long time - much of her colon and small bowel are adherent to the walls of the hernia, making things tedious and a bit bloody. The mesh (polytetrofluoroethylene + polypropylene patch to repair the hole in her abdominal wall) went in well, though (much thanks to mesh donations from Dustin Willette with Atrium!) and we were able to move on to the last few cases (more gallbladders and some smaller hernias).
About an hour later, we receive word that her blood pressure is low. Really low. Certainly, it must be the cuff, or maybe the size of her arm (big). If she were bleeding, her heart would be racing (it wasn't). We gave her more IV fluids and Franz kept checking and re-checking the BP. Different cuffs, other arm... still low. Really low. One liter of saline, then two - still low. Heart still not racing. We finish our cases - it's now around 7:00pm. We have the lab personnel come in so we can check a blood count. It's low. She has bled. She might still be bleeding internally, but her pressure is too low to put her back under anesthesia - just taking a look could prove deadly. She needs an ICU. We're in San Carlos.
An hour or so later, she's had more fluid and her pressure is stabilizing, not normal yet, but improving. It will be a few hours before even re-checking labs will be useful. We must wait. I feel powerless, but at least they have a blood bank if things get worse. We leave her in the hands of the on-call doctor and a straightforward plan: she will spend much of the night at her bedside with us on the other end of the phone. The weary team returns to the dark hotel. After a shorter, quieter dinner, I headed back to the room. I couldn't sleep, so I started packing my suitcase (mostly souvenirs... also known as coffee) in case I wouldn't have time later. Sure enough, a call came around 11:30. Pressure was lower. Could we come back in?

Pretty quickly, Franz, Paola, Jon, and I were piling into the back of Rueben's truck. Mariela, a volunteer from previous projects, had come up from Santa Cruz that afternoon to bring us cookies and help out. Our day went too late for her to head back, so instead she came to the hospital with us as well. It was a cloudless night, cold, or maybe Reuben was just driving that fast. The red, half-moon was setting in the West over the mountains, the stars were brilliiant and inumerable. I prayed for our patient while I stared at them, knowing their distance, feeling small. Surrounded by the heavens, yet they seemed anything but near.
In spite of road blockades developing both to the East and West of us, we managed to make it to San Carlos in under 10 minutes. We weren't the only ones making the unscheduled trip. The laboratory personnel and sterile processing staff had also come, just in case they were needed. They would sleep all night on hallway benches.
The lady was sick, really sick. Visibly swollen with the fluids she had received, her pressure was low, and now her heart truly was racing. A hemisphere away from my own ICU, there was not much I could do. Surgeons operate and give orders... that's about it. She was too sick for an operation, and I don't speak much Spansh, especially when tired or anxious. I felt quite small.
Around me however, an ICU started to form. Jon grabbed meds from the OR to temporarily support her blood pressure while starting a larger IV in her swollen arm (because this is what Anesthesiologists do). Mariela was able to translate the detail instructions we gave out (because that's what she does). Paola placed a foley (urine) catheter. Franz knew where all the supplies were as he had been manning the ward all through the day. The Bolivian phlebotomist managed to find a vein in a swollen yet dehydrated arm (because that's what they do). The blood count was low, but not beyond reach. The blood bank lady showed up with 2 units of cross matched blood - O positive - and the tubing to transfuse it. Jon hooked it up, and when it couldn't drip in fast enough, manually pumped it in using a large syringe as a piston.
Sure enough, her pulse started to slow and strengthen. She became more arousable. Some urine even started dripping through her catheter - the kidneys were still working. The second unit now running in, it was now time to wait. Or to pray for her together, as Mariela would suggest. We found some unoccupied benches in a lonely hallway, together making our requests known in whichever tongue came most naturally. We could hear the beeps from the monitor echoing down the hall. Subtle differences in their pitch tell of the trend in her blood pressure and oxygen level - they were rising.
We returned to the ward and watched the second unit finish going in. Another half hour and she continued to stabilize. She was more awake and said she was feeling better. We put together a plan and Mariela communicated it to the hospital doctor and nurses. It was almost 2:00am. In spite of the blockade now backing up to San Carlos, we were still able to make it back to the hotel. Later that morning, she looked great. Her labs would show that the bleeding had indeed stopped (I will never know what bled, but I'm blaming the omentum) and that her kidneys had survived the adventure. She was hungry.

My day had started swinging in a hammock, my mind in an esoteric cloud of theories about how God might answer prayers from His heavens which are apparently near. By night, I was offering up real prayers from the bed of an ancient pickup truck while staring at stars which were billions of miles away in these nearby heavens. How would God answer?

It is not without reason that he calls us His body. When I needed knowledge to do what I could not technically do, he gave me Jon. When I needed tongues to speak, He gave me Mariela. When I needed safe transit amidst blockades, he gave me Reuben and at truck without a speedometer. When I needed to know I was not alone, he gave me dear friends to pray with, and it struck me that while I was sending prayers to Him, I was doing so WITH his very body, which was also the same body with which He chose to answer the prayer. How does He answer prayer? In person, then it would seem. And that is indeed heavenly... and near. Amen.


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