Thursday, June 1, 2017

Where are the locking caps?!

Flossy came into casualty paralyzed.  She had been assaulted and the CT scan of her neck confirmed a severe dislocation of her spine that had resulted in a spinal cord injury.
Sixteen hours after we placed her in cervical traction, her spine had realigned.  We were then able to take her to the operating room to perform a spine fusion, which uses screws and rods to hold the spine together while it heals.  One of the big differences between practicing in Kenya as opposed to the US is the fact that I am keenly aware of my finite amount of resources here.  With every spine fusion I do I try to carefully discern what the minimum number of screws is that I can use and still provide the best care for my patient.  And I try to keep an accurate inventory of how many screws and other necessary implants I have left.  I'd decided I would use six screws for Flossy's case and then after surgery leave her in a neck brace while she recovered.  

Well, I hadn't done such a good job of keeping an accurate inventory.  Here I was in surgery, feeling good about the six screws I'd just put in, and about ready to finish the case and get on with my Saturday.  After you've placed your screws and put in the rods that connect those screws, you have to put in what are called locking caps, one for each screw, to keep the rods in place.  I knew I was running low on those, but for some reason I'd thought I had at least enough of them to finish this case; it was only six screws after all.  So you know I felt like an idiot when I opened the lid to the locking caps and saw only three sitting there.  I rummuged through the rest of the set, thinking surely they'd been misplaced, but I couldn't find any.  I had already begun to strategize how I could most effectively use those three caps when suddenly I remembered that Alisa had told me the day before that a newly arrived visitor to Tenwek had dropped off a package at our house with some supplies.  I had told some people back in the US of my locking cap shortage and was expecting some spine equipment to be arriving soon so I quickly unscrubbed from the case and ran home to see if this package had what I needed.  It was like Christmas morning when I tore the box open and sitting there in a Ziploc bag were over a dozen locking caps!  Still out of breath, I made the run back up to the hospital, scrubbed in, and finished Flossy's case.
Flossy's X-rays after surgery showing realignment of her spine, with the rods and screws holding things in place.
Dr. Al Rhoton was one of the most influential figures the world of neurosurgery has ever known; you'd be hard-pressed to find a neurosurgeon anywhere who doesn't know the significance of his efforts.  He used to say that if God had come to earth and had told him as a young man, "Al, today a boy is being born who is going to develop a brain tumor that will cause him to become deaf, then unable to walk, and ultimately this tumor will take his life.  However, if you go through 12 years of schooling, then 4 years of college, 4 years of medical school, 7 years of residency, sit through countless exams, sacrifice time with family and friends, at the end of all those grueling years you at last will become a neurosurgeon.  Yet all that time and studying will be not for the sake of saving the lives of thousands, but that of only this single boy.  Would the sacrifice be worth it?"  And Dr. Rhoton always said with conviction, "Of course it would."

Jesus tells a somewhat similar set of stories.  The first recalls a shepherd who had 100 sheep.  One day he discovered that one was lost so he left the 99 and went after the one until he found it.  And when he found it and returned home, he called his friends and neighbors, saying "Celebrate with me, for I have found my sheep which was lost!"  The second story tells of a woman who had ten silver coins but lost one.  She lit a lamp and swept the whole house and searched carefully until she found it.  And when she'd found it, she called her friends and neighbors, saying "Celebrate with me, for I have found the coin which I had lost!"

Neither of these stories likely resonates with you much.  I'm no shepherd, and shoot, if I'm sweeping my house and come across a coin, I'm likely to just add it to the pile and throw it in the trash.  Certainly I'm not shouting from the rooftop that I found it.  But I bet most of us can feel the emotion in the third story Jesus told.

There was a father who had two sons.  After what must have been years of tension with his father, the younger son had had enough and requested his half of the inheritance.  He figured he was better off on his own.  So he took his money and left to indulge himself, but quickly squandered everything he had.  A severe famine came to the land and the son hired himself out to feed a man's pigs their slop and soon found himself longing to eat with the pigs.  Jesus said, "But when he came to his senses, the son said, 'How many of my father's workers have food to spare, and here I am starving to death!  I will return to my father and say to him, 'I have wronged heaven and you.  I am no longer worthy to be called your son.  Make me like one of your hired workers."  So the son returned to his father, fully expecting a public reprimand at best, a door slammed in his face at worst.  But while he was still a long way off, his father saw him and was filled with compassion for him.  He ran to his son, threw his arms around him and kissed him.  And the father called together all his servants and held a feast, saying 'This son of mine was dead and is alive again; he was lost and is now found.'

When I read this story and think about my relationship with my son Liam coming to the point where he walks out of my house in haste, disgusted with me, to go at life on his own, my stomach goes in knots.  What it would feel like to wonder if I'd ever see him again, if we'd ever speak.  And to think about him suffering alone in the world, realizing the effects of his decisions but doubting that he could come home, again makes me pang.  But how quickly I too would run out my front door at the first sight of his return.  No matter what he'd done, no matter what he'd said, I would want him to know that I loved him and forgave him. 

Of course in this story the father represents God.  And the way that father felt about his son is the way God feels about me, who has been that indulgent son, and who too often still tries to sneak out the back door.  And it's how he feels about you.  And it's how he feels about the people coming here to Tenwek in need, many of whom find themselve at a place in life where they are with the pigs so to speak.

Just like I dropped what I was doing, scrubbed out of my case, and went running home to search for a locking cap, so God pursues us.  And just like that father who went running to greet his repentant son, God eagerly awaits us to turn to Him.  Some people critique medical missions, fretting that it's not realevangelism, or suggesting that it's a waste of time and resources when there will always be countless people to be treated.  But like Dr. Rhoton, if all my studying, if all my training, if all my efforts here at Tenwek, no matter how many the years, were only for the sake of treating one person who might come to understand God's love for them and His desire to give them life to the fullest, my response would be the same..."Of course it was worth it."
Flossy on the day of her discharge.  It was nothing short of miraculous.  She was walking the halls without help, feeding herself, and waving;)
Work at the hospital continues to be fulfilling.  On March 14th, the nationwide doctors strike ended...after 100 days.  Fortunately, the hospital census and my work load has become more manageable as a result.  

And after she made us wait a few extra days, we finally welcomed another little girl into the world last week...Emery Laura Chepkemoi Copeland, born May 24th.  We will call her Emery, but our Kenyan friends are already lovingly calling her by her Kipsigis name, Chepkemoi.  I'm so proud of my superwoman wife.  Alisa walked up the hill to the hospital in labor, birthed a kid at 11:03pm, then walked back down the hill and was in our bed by 12:45am.  She and Emery are both doing well.  If only I could say the same for Nora who has been dealt the harsh reality that she's no longer the baby of the family.

Thanks to the many of you who support us in various ways, including those individuals and companies who so generously provide equipment and supplies for the hospital.  I hope Flossy's story is a tangible example of what a real difference it makes.

Will

Monday, March 6, 2017

Panga attack

As one of the few hospitals still fully functioning in western Kenya, we are seeing more and more patients like John here at Tenwek.  As you may know, there has been a nationwide doctor's strike here in Kenya since December 5th of last year.  That means that for the last 13 weeks all government hospitals in the country have effectively been shut down with no doctors to care for their patients.  
John came in to casualty with his brain quite literally hanging out of his head. He'd been yet another victim of a panga (machete) attack.  In addition to the chop through the back of his head, he'd been hit higher above his ear and deep in his forehead, as well as having his finger nearly taken off.  We took him to the operating room where I amputated the exposed and contaminated brain, then patched the covering of the brain using tissue from his thigh.  Next to me were two general surgery residents washing out and closing his other scalp wounds while an orthopedic resident repaired his finger.
The strike has drastically changed the already busy workload here at Tenwek and the way I have to practice neurosurgery.  I'm seeing far more patients than I could ever treat...victims of assault or accidental trauma, those with brain tumors, or with spine infections, or babies with hydrocephalus. Patients that need an operation to save some aspect of their neurologic function, or even more, their life.  And that's to say nothing of the many with degenerative spine conditions causing them "only" pain, affecting their quality of life and often compromising their ability to work and provide for their family.  The latter have been destined to a long waiting list.  For the others I have had to resort to offering surgery only to those who I judge to be able to benefit most from my efforts.  And the ones I triage out I can't just send somewhere else.  There isn't a somewhere else for the vast majority of our patients who can't afford the prices of the few private practices still open in the country.  And that means I have to look a mother in the eyes and tell her I can't operate on her 7 year old son with a brain tumor because I'm estimating that his prognosis will be worse than the 14 year old girl in the bed next to him who came in with an intracranial hemorrhage from a vascular malformation, which if I remove will likely allow her to live an otherwise normal life.  Or telling every adult I suspect has a malignant brain tumor that I can't help them, like the 34 year old father of two I saw this week who may have his life extended by a few years with an operation.  
Two of my patients sharing a bed, a more common occurrence now during the strike.
The young man on the right is my most recent panga attack victim from last week.
When I reflect on the needs of so many hurting people and am at times tempted to give up, I'm reminded of Jesus, who made it his mission to serve others, even the "least of these", in the hope that they would come to know of God's love for them.  When Jesus was asked what the greatest commandment was, he answered and said "Love the Lord your God...and love your neighbor as yourself."  He told his followers that "By this all men will know that you are My disciples, if you love one another."  The New Testament writer Paul went so far as to say, "The only thing that counts is faith expressing itself through love."

It's a privilege to serve alongside my Kenyan brothers and sisters here at Tenwek, where we are trying to live out these words by loving our neighbors as we would ourselves.  Often it means providing care to patients with little or no resources to offer the hospital in return.  Or working longer, busier hours and taking on additional responsibilites as the hospital capacity overflows.  It means keeping our doors open and continuing to serve when so many around us have chosen not to.
Our 5 little monkeys lined up on the Maasai Mara during a recent safari.  How cool is that?!
Our family is doing well.  For the last two months I've been taking Swahili classes in the mornings, then trying to cram a full days work into the afternoons.  Perhaps not the wisest timing on my part, but I'm really enjoying it and think it's important to learn the language so I can best connect to the people here.  If you haven't heard, we're expecting our sixth baby in May...our fifth girl.  Heaven help us.  

Thanks for your continued support.  Please know it means so much to us.

Will

Sunday, January 22, 2017

Mimi

I have a college degree in communications but I am a poor communicator.  Day to day life overtakes me and there is always an excuse not to write, call, text, or reply.  This is true regardless of which side of the world I am living.  New experiences have piled in my mind to tell you - our first Christmas season in Kenya,  a special visit to a village church, our first Kenyan birthday party, and more.

But today all I can write about is Mimi.

Will's grandmother, Charlotte Copeland, passed away on Thursday morning.  The news that Mimi had died came suddenly and unexpectedly.  We love her so much.  The distance between Kenya and Arkansas is always far but feels even greater as we try to grieve from miles away.

One of the last things she asked of me this summer before we moved was for a hand-written letter with news about the kids.  I never sent one.

These are my thoughts that I wish I had communicated to her had I known...

Mimi, 
I remember being at your house one day and you were admiring my mothering saying "Hon, how do you do it all?" And I laughed and said, "Oh Mimi, but you've done it all too!" And you said, "You know, you just do what you have to do, don't you?"

Those words "you just do what you have to do" have come to my mind often.  

You just do what you have to do...

When I am weary, when I am lonely, when I am overwhelmed.

You just do what you have to do.

And I think about how that rings true in your life.  You have set a high standard of what it means to do what you have to do - of making the right choice day after day, of living faithfully and loving well.  

I love this about you.  You passed this on to your son, Billy, and he passed it on to Will.  These men carry these traits of you.  Now I get to reap the great benefits of your legacy.  

Your legacy of living faithfully and loving well.  

Our fourth baby, Charlotte, carries your name because we hope that she can follow in this same example that you have set.  You are a true reflection of Christ and that is the greatest hope we can have for her.

Thank you so much for that.

Charlotte and Charlotte
On Thursday night, our family sat down and talked about the many things we remember and love about her...

Liam looked forward to motorcycle rides to her house with Pops (Billy).
Hayden remembers having a special morning with Mimi, making macaroni and cheese and cookies, just the two of them.
Harper loved popsicles at her house and remembers Mimi teaching her how to clap to turn the lamp off and on in her hallway.
Charley loved playing tea party with Mimi and going upstairs to see her purses.
We all remember celebrating Mimi's 87th birthday and Nora's 1st birthday together this summer.
We all loved the cards and gifts she never forgot to send on birthdays, holidays and anniversaries. 
We all remember how she loved Pawpaw.
We all loved how thrilled she always was to see us and be with us.  
Birthday celebration this summer
My grandmother has dementia and was moved to a nursing home not long ago.  Mimi began visiting her there.  I loved her so much for that.  And this summer I told her thank you for taking the time to go see her even when my grandma doesn't know who she is.  And Mimi said, "Oh, it just brightens my day to see her!"  It brightens HER day to visit my aging grandma in the nursing home.  Mimi was a rare and bright light in this world. 

We honor your memory across the ocean, Mimi.  We praise God for you and the glory you brought Him.  May we serve others here in Kenya as you did in your life.