Tuesday, October 30, 2007

Cambodia: Days 4 & 5 - Grace defined

There is never a good time to share disturbing news. However, news like this needs to be shared to simply remind us of how vulnerable we are at times.

We arrived at the village to find a swarm of people waiting for us. Within minutes of our arrival a torrential rain started, leaving us ankle deep in mud and water and little dry place to set up our examining tables, pharmacy, registration, glasses, and spiritual counseling. But as always we were able to adjust and within an hour we began seeing patients.

By 11 a.m. the drama began.

Kelly our main missionary here, was said to be sitting in the van cooling-off and not feeling well. I went to check on him and found him to be extremely pale, diaphoretic, and slightly incoherent. With backup called, a blood pressure of 80/30 was recorded and I quickly put in a large bore IV and ran 1 L of fluid in as fast as I could. We transported him to the hotel bypassing hospitals as it is said that one goes go to hospitals only to die here in Cambodia. At the hotel with the team now back at the village seeing more patients, I gave Kelly two more liters of fluid and watched him closely. By the time the team returned from seeing about 170 patients for the day, Kelly was feeling better but now complaining of indigestion. It was that very word "indigestion" that was of concern. By now it was clear that we had to move Kelly to a higher level of medical care. But first I needed an ECG. The first hospital we tried sent us away telling us they did not have an ECG machine despite the fact that they were a trauma hospital. We drove into town and found a roadside medical clinic and we rescued in old ECG machine. The primitive ECG that I was able to obtain showed significant and concerning changes. It was clear that we had to move Kelly to Phnom Penh. At 9:30 at night we began the four and a half hour drive in torrential rain to Phnom Penh in order to get Kelly and his wife on an airplane in the morning for Bangkok. By early morning Kelly and his wife were on their way to Bangkok and I tried to get the MAF airplane to fly to Battambang, but it was down for maintenance. So another 4 1/2 hour ride by taxi this time back to Battambang to meet the team for the rest of the day's clinic. We wound up seeing 350 patients today. I just heard from Kelly who confirms that there is a strong probability that he has had a small MI and he is scheduled for a stress test in the morning and that he is doing well and in good care. Grace was with Kelly and still is. There is always grace from He who leads us and directs all that we experience.

But there is another part to the story. This afternoon I saw a 41 year old man with complaints of a fast heart rate for over a year and a 30 pound weight loss over the last two years. He was extremely cachectic, anxious, and sick. His heart rate was 125 and his blood pressure was 160/110. He said he had seen 2 doctors in the past, both of whom said that he had heart problems and that they would not do anything for him since he had no money and told him to go away and that he would die soon. He had no family and lived alone and came to us for reassurance and help. This man was no different than Kelly, entitled to the best care available and an opportunity for cure. But because of what he was, a poor man, he was denied that which is a simple right: compassion. I started him on medication and arranged for weekly follow-ups with the hopes of finding a way to get him the care that he needs. And for all that I'm embarrassed to say that I pretended to be better than those two other doctors simply because I gave him some medication.

I am not a god in a white coat, and for me, kindness and compassion has not come easily. There are many definitions of grace and for me its definition came one afternoon as I cared for a young child in the intensive care unit: grace means simply moments and gifts of kindness. Both Kelly and this man received grace today. But the thing that's missing the most is what happens because of that grace. Kelly will get better because of grace. That man, despite grace, will more than likely die. As I watched him walk away, I saw his hand clutch the medicine he was given and look back just once, before he disappeared. I caught his eye, and gave him a smile, but he looked away. Grace. Moments and gifts of kindness. I pray that where ever he goes that grace goes with him. May kindness and compassion be with him always.

In all things give thanks,