Posted in Daily Prompts

Deprive

 

One side of the coin – deprivation.  In so many ways the people of rural Guatemala are deprived due to their circumstances.  Safe housing, clean water, nutritious food, health care and many other physical needs are lacking.

But on the flip side of the coin is their abundance.  Guatemalan life is a wealth of love, kindness, perseverance, friendship, family, sense of community and devotion.  We came to share our material blessings. And in return we were blessed by their abundance!

 

Deprive

Posted in Daily Prompts

Awe

Have you ever wondered how blood gets into the blood vessels to start with?  I mean, the vascular system is a closed system – there is no spout whereby blood gets poured in from a hose and a stopper placed to keep it in.  And yet, there is blood pumping through the arteries and veins of itty bitty embryos.

There are 3 initial cell layers of the embryo – ectoderm (outside), mesoderm (middle) and endoderm (inside).  The blood and blood vessels come from the mesoderm. In response to a bunch of chemical signals around day 13, some mesodermal stem cells are “drawn” to coalesce into “blood islands”.  These endothelial type cells “form” into a vascular network, sprouting branches in response to even more chemical signals within the 3 layers of the embryo.

In the adult, red blood cells are made in the bone marrow.  In a 13 day old embryo there are certainly no bones yet.  It turns out that the cells on the inside of the primitive vascular cords are “signaled” to change into blood cells and plasma cells.  The inner most cells within the blood vessels are “differentiated” into red blood cells and plasma cells and become a liquid that flows, able to carry oxygen and carbon dioxide and nutrients.

Embryology was my favorite subject in medical school.  After learning how the morula divides and gastrulation occurs and then all the folding and differentiating happens, I found it nearly impossible to believe that anyone was born at all, ever.  I was in awe of the profound complexity associated with even apparently  “basic” aspects of embryologic development – like blood.  I was equally awed by the gaping holes in our understanding despite the fact that what we already knew was extensive and intricate and detailed and divinely precise.

350px-Vasculogenesis_angiogenesis

Vasculogenesis

 

Awe

Posted in Daily Prompts

Companion

light

I was a 2nd year resident in Idaho and barely able to put one foot in front of another for the 3rd night in a row on ICU call.  I took care of Leo that night.

An older Indian couple (in southeast Idaho, the Indians were mostly Shoshone but they called themselves Indians not “native Americans”) had anxiously brought him to the ER in late afternoon. After the initial ER flurry to bring his O2 sat over 88% (which is mostly acceptable at altitude in Idaho) he was deemed stable enough to go to the floor.  His friends wanted to stay with him until visiting hours were over but Leo insisted that they go home and take care of his little dog, Shorty.  They left and promised to see him in the morning.

Leo was stable all evening and since there was a lull in my busyness I had sat and listened to his story . He had been a sailor and a ranch hand and then a drunk.  He told me how he had been freed from his hard-drinking days and loneliness by the love of this Indian couple.  They had helped him get sober and had taken him into their home to live for the last 5 years as a brother.  He had a Bible on his bedside table and from it he produced a rumpled photo of Shorty – a wired-haired dachshund with an overbite and cataracts. He fell silent and it was obvious that he treasured both the Bible and Shorty.  He drifted off to an agitated sleep and I placed the Bible and picture back on the bedside table so he wouldn’t drool on them.  I got paged and left.

Sometime later Leo started crumping and I was called back to his room. As I was drawing a blood gas he told me he didn’t want to be intubated.  For several more hours the floor nurses worked with him but finally, when the O2 was consistently 85% or lower they paged me and requested I do something.

I came back to his room and saw the rough skinned, slightly jaundiced, balding white guy with grey lips sitting upright in the bed smiling but struggling for each breath.  “Hey doc!” The Bible and photo were in his lap.  We had our discussion about going to the ICU and what could be done short of intubation.  Agitated, he agreed to bipap in the ICU and I began the transfer process.  After finishing up the orders,  I went in his ICU room to “tuck him in for the night.”  He grabbed my hand and lifted the bipap mask to speak to me.  “My, gasp, Bible, gasp, is still, gasp, downstairs.  Bring it to me?”  I didn’t think lips could be more grey in a living person.  I squeezed his hand and said I would look.

Several admissions, multiple diet cokes and 2 or 3 swigs of Maalox later, I remembered the Bible.  The floor nurses had found it and so I carried it up the stairs noting it seemed well-read with a shabby brown cover that smelled of dog.  I placed it in his lap and while he wasn’t really awake, he immediately grasped it in his hands. I left and collapsed in the call room down the hall.

At 5 a.m. I came to sudden consciousness and realized I had missed several pages.  Terror jolted me out of bed and down to Leo’s room.  He was dead.  His Bible was clutched to his chest and they had removed the bipap mask because his friends were on their way in.  Leo had been the only ICU patient that night.  Because he was a “DNR” there was not much the nurses, Connie and John, could do for him so they had just sat quietly with him during the final hours of his struggle.

When I entered his room they told me of his passing.  All had been quiet and he seemed to be slipping away when suddenly, with an O2 sat of 79-ish Leo had opened his eyes.  Both nurses had gotten up as he removed his bipap mask and said clearly “Do you see them?”  Connie and John said they had tried to put the mask back on but he pushed their hands away and pointed to the corner of the room and said again more excitedly, “Do you see them?”  The nurses looked at the empty corner of the room and said, “No, Leo, we don’t.  What do you see?”  No longer gasping or struggling to breathe he hugged his Bible closer to his chest, eyes fixated on the corner of the room for several intense seconds.  “They are absolutely beautiful!” he said to them.  ” And it’s so bright!”  He smiled and died.

Connie was LDS, John a Lutheran and I was an atheist.  Standing in the room over his body in the dim light that morning,  the three of us were silent and still, thinking our private thoughts on the matter.  Finally, Connie said, “I know he saw angels.”  John answered, “He certainly saw something that was glorious to him.”  They squeezed Leo’s hands and went to the nurses station.  The hairs on my body tingled and shivered electrically.  I said nothing, patted his balding head affectionately and slowly left the room with the niggling idea that perhaps I was wrong.

Companion

Posted in Places we've BEEN

Guatemala 2015 Medical Trip

 

3 physicians, 1 pharmacist, 1 medical student, 1 physical therapist, a bunch of nurses, MAs and people who just wanted to help…together we were able to see about 600 patients in 3 days in 3 separate remote villages!

We also held babies at the Rescue Center, packed meals and medication baggies, and served a meal at the dump (200 children).  It was a busy 7 days!!!

Huck and Sophie were glad we could help but missed us!!

 

Posted in Places to GO

World Help Medical Trip (11/16)

November Medical Trip

URGENT NEED FOR PROVIDERS FOR THIS TRIP – Physicians, PAs, NPs!!!

Guatemala_April15_AL_1836

Approximately 70 percent of Guatemalans living in rural areas are entrenched in poverty. Today, 80 percent of children living in these regions are malnourished due largely to the lack of clean water.

We are looking to build a medical and missions team of:
• medical doctors
• nurses
• physicians assistants
• dentists
• sponsors
• World Help donors & advocates
• others with a heart to serve

On this trip, you will work alongside our national partners:
• Caring for malnourished children at the Operation Baby Rescue center
• Visiting remote Guatemalan communities and performing medical clinics for the villagers there
• Working at St. Luke’s Hospital and Kelly’s House at Hope of Life
• Interacting with orphans at the Hope of Life children’s home in Zacapa
• Experiencing the vibrant Guatemalan culture and its rich history