Yesterday was precious. It was Bible presentation day in literacy class. Since we finished stage one and they know all the letters now, we give out Pidgin Bibles so they can start reading them. (It’s a great tradition to inherit from the literacy teachers who developed this program.)
We’ve been talking about it for, well, since the beginning of class. I expected it to be a special day. However, I did not anticipate the depth of emotion this day would bring.
Class began as usual. We took roll and prayed. Then, Noni and I stood on opposite sides of the podium to congratulate and shake hands with each student. They would walk by us, then Pastor would receive each one with excitement, presenting the New Testaments.
We called the first name. Amon. He walked forward, shook my hand, turned to Noni, shook her hand, and then stepped toward Pastor Ben. My eyes filled, and so did theirs. Pastor hugged him with vigor, and then handed him the Word. Amon sat down, clutching the Scriptures with both hands. Tears coursed down his face, and his shoulders shook with every silent sob.
The realization was overwhelming. Amon is a father, a husband, a deacon. Until now, he has never been able to read the words of God for himself. For his own discipleship, his family’s, and the church’s, this is a moment bursting with significance.
Pastor and Amon, with Noni on the right
Next came Amon’s son, Leten. The contrast was striking. This little boy, today hugging his pastor around the waist, will grow up knowing how to read, with the Word in his hands.
Little Leten
By this point, half the class was no longer watching the proceedings. Faces were buried in folded arms. The usual shuffling and murmuring audio backdrop had ceased. The only sounds heard were high-pitched moans and muffled sobs.
We called one name after another. Young women, mothers, and grandmothers hugged my neck, weeping and smearing snot on my shoulder and in my hair. I didn’t mind.
Sober handshakes followed as Pastor gave each one a Bible, and they returned to their seats.
Timoti (affectionately dubbed “Pops”) and Satina are working through literacy class for their second time. Learning to read is unimaginably difficult for adults in a pre-literate society, yet their desire surmounts the struggles.
Satina didn’t respond the first time we called her name. She hid her face and wept. We kept going, to try again after a few others. The second time she heard her name, she stood and came forward slowly. I hope that reading is the same for her. In this second time through class, I pray she comes forward slowly and learns to read.
Since I was ten years old, reading biographies and translators’ stories, I have dreamed about a day when I could hand someone the Scriptures I helped to translate for them. This day felt like a small taste of what that may be like. Yes, this Bible was translated years ago by someone else, but these people in this class have never had access to it for themselves. Since learning to read, now they do. Teaching them to read opens the world of the Word for them.
Their tears flowed from tender hearts. Their pastor teaches the Word so faithfully, they have learned to long after it. And now they have it, outside the church gathering, in their hands and in their homes. (Yet another day is coming, when they will have it in their heart language…)
The chance to join in this work is a priceless gift.
What about you? Do you treasure God in His Word? The ability to read is a gift. May we revel in the Book, exploring with joy the world of the Word.
L – Satina holding her daughter, Klensi; R – Tesela
Nov. 24 P.S. – By God’s grace, Satina did learn to read.
I perched on a rock, taking in the view. Trinity Beach in Cairns, Australia, may not be a magnet for surfers and jet-skiiers, but to eyes that had been looking at mountains for seven months, it was glorious. I was out of the bush on my mid-internship holiday.
The day had been mostly overcast, with occasional showers that made us grateful for umbrellas and raincoats. When we arrived at Trinity Beach, however, the clouds dissipated and the sun emerged triumphant. The change of weather, a stroll, and then a stony seat enabled some quiet reflection.
The waves that rolled in were not particularly impressive. Their diminutive crests fell, splashing onto preceding waves racing back to the ocean. Their only feature that caught my attention was their regularity. One comes, then returns to where it came from as the next follows suit. And the next, and the next, and the next.
Peering farther out to sea, I wondered at the barely discernible ripples that would eventually make their way to the beach and turn over, as a million before them had already done.
I asked my friend Hannah, “I wonder if these waves are like the ones William Shakespeare admired as he wrote ‘Sonnet 60’? Couldn’t have been…since his beach was pebbled, not sandy like this one. But the thought is the same…”
Like as the waves make toward the pebbl’d shore, So do our minutes hasten to their end; Each changing place with that which goes before, In sequent toil all forwards do contend.
I don’t get to teach literature anymore, so I thoroughly enjoyed enlightening my friend to the significance of Shakespeare’s simile. (She was awestruck, I’m quite certain.) “Just like these waves keeping rolling in, one after another, the minutes that make up our lives never stop coming. As one ends, another begins and takes its place.”
And a little more than a week later, Shakespeare’s words of wisdom echoed through my mind again.
April 13, 2019
I crouched in the darkened hut, taking in the scene. Kyle and Lauren had entered the hut before me, and they now leaned against the corner of the bamboo walls on my right. Marie sat to my left, quietly crying. Sila laid her head on Marie’s shoulder, cuddling someone’s baby. Continuing around the circle of mourners, there was Gideon, and Ham’s second wife, three older women, then Osula and her little son Losten. Two old ladies sat in the corner across from us. Ham’s other wife was beside them. Kilau’s wife and Kimatu took turns wailing. Hidden from view, a woman mourned in dissonance from the next room.
In the center of it all, the fire smoldered, filling the room with a smoky haze. Manada sat by it, cross-legged, occasionally jabbing the embers with a piece of bamboo.
To my right lay the reason for the gathering. Her body had been clothed in a royal blue meri blaus and matching skirt. Her legs were bound together at the knees and ankles. Her hands were swollen. Her eyes were closed, and her mouth turned upward slightly at the corners, giving the appearance of a little smile.
I thought about her life. Adnapi was born in this rainforest. She had worked her garden, eking life from the nutrient-deprived soil of these mountains. She had raised her children, Mandela, Manada, and Donanda. In her lapun (old age) years, she held her bubus (grandchildren).
As we knew her, Adnapi had been sick off and on for several years. Her lungs were tired from breathing decades of smoky air in huts like the one we sat in now. A few months ago, her sickness worsened to bring her oxygen saturation below 80% (that’s very bad). She was staying at her daughter’s house, across the road from the mission: a good location, since she needed shots and twice-a-day nebulizer breathing treatments for a couple weeks. Marie, Emma, Manandi, and Sarah walked back and forth, praying and providing the care that would prolong her life.
Pastor Ben and some friends from church went to visit one evening. They stayed until late in the night, talking, singing, and praying. Clearly and sweetly, Adnapi testified of her faith in the cleansing blood of Jesus. Whatever would follow in the coming months, the certainty of eternal life provided hope beyond the grave. We thought she might see Jesus soon, but she recovered and went to stay with her younger brother Amon.
A couple months later, we heard that she was sick again. She never came to the clinic, but the nurses sent medicine. When they made a house call three days later, they discovered that Adnapi hadn’t taken any of the meds. She was sitting quietly by the fire, surrounded by her children and grandchildren. They said she wasn’t talking much. For another ten days, the nurses asked for and received updates, taking the time to visit her on the way to market.
And April 12th, Adnapi closed her eyes in a bush hut and opened them in the presence of Jesus.
—
Facing death forces us into reflection. As Solomon writes,
“It is better to go to the house of mourning than to go to the house of feasting: for that is the end of all men; and the living will lay it to his heart.”
Ecclesiastes 7:2
In that hut, I pondered realities of life and death. In my home country, death can masquerade as a gentle good night. In this place, without funeral homes, embalming fluid, makeup artists, and extravagant caskets, the charade is impossible. This place has a way of systematically dismantling every construct that insulates a person from the harsh reality of death.
I have plans and hopes and desires for the future. But the truth? The future isn’t mine. Death is the end of all men, and no one knows how many days will delay that end.
My thoughts were interrupted when I saw the little guy across the room. His eyes lit up, and his lips spread into a broad smile. An auntie extended her arms, and he ventured a shuffled step, falling in her direction. She caught him, and he bounced happily in her lap.
The comparison between the baby and Adnapi was striking. He, a cherubic child with smooth skin and undeveloped major muscle groups. Adnapi, an aged woman with wrinkled face and withered limbs. He, at the beginning of his days, still unaware of life beyond eating, sleeping, and staring wide-eyed at bright colors. Adnapi, at the end of her days, having lived them to the full in this remote corner of the world, mostly unaware of life outside these mountains.
Once upon a time, Adnapi was a child too, toddling into her mother’s arms. The difference between her and this little boy suddenly didn’t seem so vast.
And then I realized I was looking at the second and third quatrains from “Sonnet 60,” in real life.
Nativity, once in the main of light, Crawls to maturity, wherewith being crown’d Crooked eclipses ‘gainst his glory fight, And Time that gave doth now his gift confound. Time doth transfix the flourish set on youth And delves the parallels in beauty’s brow, Feeds on the rarities of nature’s truth, And nothing stands but for his scythe to mow.
The minutes of that child’s life pass with the undisturbed regularity of waves breaking on the beach. Presently, time is a blessing to that baby. Physical strength, cognitive abilities, manual dexterity – all increase as each passing minute bequeaths her gifts to him. Time will enable him to walk, to talk, to understand, to learn. He will become a powerful young man, and someday he will hold his own children.
Yet there will come a day when time will turn against him, and every passing minute will steal away some of the strength he enjoyed, and he will grow old.
Adnapi knew time as both a benefactor and a thief. And this is the end of all men.
Death may be the end of all men, but it is not the Christian’s final end. There will be a day when minutes will no longer hasten on, either giving or taking. When time ends, and immortality begins, we will receive the fullness of God’s everlasting joy. Eternal life will only give…and give…and give.
Sitting next to the body that had housed Adnapi, I imagined scenes from her life. But I couldn’t begin to imagine the scenes that were at that moment unfolding before her eyes. Nothing about her life in time was as precious as the grace and faith that secured her life in eternity. I breathed a prayer, “God, as time gives and takes my strength by Your sovereign hand, make my life matter for eternity. Let me spend my strength in this world for what will matter in the next. Let me proclaim the power of Your salvation in every season of life, so others believe like Adnapi did. Make my time count for eternity.”
The next time I see Adnapi, we won’t smile and shrug and say things to each other in our respective languages. We met in time, but we will know each other in eternity, as we worship our God together in boundless delight.
Shakespeare concludes his sonnet,
And yet to times in hope my verse shall stand, Praising thy worth, despite his cruel hand.
I am sure the object of the poet’s affection was smitten with his desire to speak her value beyond the time of his life. He accomplished that goal, obviously, as ninth-graders memorize his words four centuries later.
Yet truly, there is only One Who is worthy of eternal praise. That is the end for which we must spend every degree of our strength.
May our efforts in time stand to praise His worth, with all the hope of eternal giving to come.
The last few sessions of translation checking had gone incredibly well. Pastor Ben, Brother Yali, and I had worked through three or four chapters each time, with very little discussion or meaningful corrections needed. I had hopes of finishing Luke yesterday.
Pastor Ben on the left, Brother Yali on the right
However, the end times teaching of Luke 21 is not as straightforward as simple narrative. Considering my still-growing abilities in a language like Pidgin that has a limited vocabulary, sentences like “there shall be…upon the earth the distress of nations, with perplexity; the sea and waves roaring” require a little more thought to sift through.
My brothers work very hard in multiple ministries, and sometimes they end up translating late at night. Laughing, they both said they had labored through Luke 21 when they were tired (not the most conducive for clarity in language work), so we all had plenty of questions for each other. It quickly became apparent that we would not finish Luke that day.
We did finish chapter 21, though, and moved back to narrative in 22.
Judas makes his plans to betray Jesus. Jesus sends Peter and John to prepare the Passover. They sit and eat together. Jesus breaks the bread and pours the wine, speaking of a new covenant and stirring hope for the coming kingdom. The disciples question who will betray the Master, and (oddly enough) who is the greatest among them. Jesus patiently instructs them (and us) in the path of the servant, again promising them the coming kingdom.
Then Jesus turns to Peter and says the words that would echo in his mind that night, and probably many nights following:
“Simon, Simon, Satan hath desired to have you, that he may sift you as wheat; But I have prayed for thee, that thy faith fail not: and when thou art converted, strengthen the brethren.”
Luke 22:31-32
I read the Pidgin text, and two words leaped off the page. Brother John had made them bold in his translation so they wouldn’t be missed. “Saimon, Saimon, Harim, Seten i bin strong long kisim yupela, bai em i ken sakim yupela…”
Yupela. Yupela? Really? That’s plural?
In Pidgin, second person pronouns (you – the person being spoken to) show the distinction between number, singular (yu) and plural (yupela). Back in the day, English did too, but no longer. Now we just say “you,” whether we are addressing one person, two people, or seventy-eight people.
So every time I have read Luke 22:31, for my entire life, I just assumed Jesus told Peter that Satan desired to have Peter, that he might sift Peter. I know the difference between the older usage of thou vs. ye and thee vs. you. But honestly? I have to make a confession: I don’t automatically read you as exclusively plural in Scripture, probably because I don’t anywhere else. However, when I read that text in Pidgin, the distinction of the plural yupela was obvious.
Greek distinguishes number for all pronouns too. I read the verse in Greek, and sure enough, there was the plural pronoun ὑμᾶς. What do you know? Wow…
The significance is striking. Jesus looks at Peter and says, “Simon, Simon, Satan has desired to have all of you. You yourself, and all your brothers gathered here. These men you have walked beside for three years — Satan desires to sift every single one of you. He has designs on your lives: all of them.”
Do you feel the gravity of His words? Jesus repeats his name: “Simon, Simon.” You get the impression He is looking deeply into Peter’s eyes, piercing to the depths of his soul. This is weighty. This is frightening. The enemy of all good desires to devour those you love, Peter. And Jesus leans in to speak to you of them.
So what can you do, Peter?
Jesus continues,
“But I have prayed for thee, that thy faith fail not: and when thou art converted, strengthen the brethren.”
Here in verse 32, Jesus addresses Peter singularly. “I am praying for you, Peter, in particular. Your faith will not fail. You will falter, but you will turn again to Me. And then you will strengthen your brothers to face the enemy’s attacks.”
What reassurance this would be for Peter! Within hours, he will plunge to depths of despair, doubt, and then regret. But Jesus tells him, before the chaos of that night begins, that he will turn again. Jesus doesn’t command that Peter should return, He just says that Peter will return. That part is a fact, not an imperative depending on Peter’s volition for fulfillment.
Because Jesus has prayed for Peter, he will not be lost. Even his foray into faithlessness will be redeemed; and Peter will then establish the faith of his brothers, whom Satan has desired to destroy.
It’s a fabulous story of patient providence. So how are those plural pronouns helpful?
Well, they remind us of the importance of the church. The attacks coming to the disciples were both individual and collective, but they were not to face the onslaught alone. Jesus gave them each other, and he particularly marked Peter as a leader who would help them all be strong. Our faith needs community, and our faith needs the spiritual leadership of pastors and elders (Hebrews 10:23-25; 13:7).
Those pronouns also show us a picture bigger than the testing of one individual. Peter would fall, but God was sovereign even over that sin. God did not tempt Peter to unbelief, for He doesn’t do that (James 1:13-16). Yet, Peter’s testing, departure, and subsequent return were all components of a greater work God was doing: strengthening His men for the battle and work ahead. Even in our temptations, there is always a greater story unfolding than what we can presently see.
Decades after that conversation in the upper room, an old man picks up a pen and writes a letter to beloved believers under duress. And that letter, 1 Peter, was inspired by God to serve generations of suffering Christians. In the Scriptures, Peter is still strengthening the brethren.
He closes out that letter with these words:
“Be sober, be vigilant; because your adversary, the devil, as a roaring lion, walketh about, seeking whom he may devour: whom resist stedfast in the faith, knowing that the same afflictions are accomplished in your brethren that are in the world. But the God of all grace, Who hath called us unto His eternal glory by Christ Jesus, after that ye have suffered a while, make you perfect, stablish, strengthen, settle you.”
1 Peter 5:8-10
Yupela have an adversary who is seeking to devour. He still desires to have yupela, to destroy yupela. Remember that you are not alone, remain stedfast in the faith, and resist the lion.
Your afflictions “are accomplished.” They are being completed, fulfilled. There is purpose behind them. Just as Peter’s testing that night in Jerusalem was part of God’s greater purpose in strengthening His people, so is yours.
Be encouraged, follower of Jesus. Whatever we are suffering, including the enemy’s attacks, is not outside the realm of God’s care. We may falter, but our faith will not fail; for God Himself, the God of all grace, is the One Who purchases, provides, and preserves our faith (1 Peter 1:3-5; 2 Peter 1:1,3; 2 Peter 2:9).
“To Him be glory and dominion for ever and ever. Amen.”
Her face was hard. In a culture of friendly openness, Lina seemed to wear a harsher expression than most women I’d met. I met her when we started literacy class. She was one of about thirty people who didn’t give their names in advance…they just came to the first day of class.
I wondered what her story was, but her Pidgin was limited and my Kamea doesn’t go beyond times of day and basic introductions.
We didn’t know that she and her sister argued often. Her sister insisted that Lina was going to hell, no matter what. After all, Lina isn’t married, and she has two children. Her sister’s words tore at her soul. “You are a wicked woman. You walk around down any road, and have anyone’s children. You can never go to Heaven.”
In literacy class, day after day, Lina heard something different. “We are, every one of us, sinners. We have only done what was wrong, and we all deserve the wrath of God in judgment. But Jesus only did what was right! So when He died, God didn’t ‘court’ Him for His own sin. He didn’t do any! God punished Jesus for OUR sins. And everyone who ‘hangs everything up’ on Jesus will be forgiven.”
“Jesus is the ‘namelman’ [middle man] between us and God! We are God’s enemies, as we break His law and follow our own ideas. Jesus did everything necessary to bring us back to God.”
“The grace of God is bigger than all our sin. The blood of Jesus is stronger than all our sin. He can clean us and give us His righteousness!”
Lina sat on the front row, day after day, shaking her head and clicking her tongue in amazement. Noni and I observed that God seemed to be working in her heart, and we prayed the more.
Monday, May 20th, Lina’s face was downcast. Gentle Noni asked her if she was alright.
“No. I have a hevi.”
“Let’s talk after class.”
During reading circle, Lina sat on my left, pressed against my shoulder. God, I love this woman. I want her to read, but I want her to know You.
As the last students sauntered out, Noni whispered, “I have a request. Pray for Lina. She has a question that I’ve never answered before. She wants to know if she can go to Heaven even though she has children and isn’t married. I think I’ll tell her about the woman Jesus talked to in John 4.”
We prayed together right then, and I left as Noni sat down beside Lina. Over the next two hours, I hoped and prayed and waited to hear how the conversation went.
At 1:40, I walked back to the school building for the afternoon class. Noni and Lina sat exactly where I had left them, hugging and weeping. Is this good or bad weeping?
Noni smiled through tears as I walked up. “God i kisim bek em!” I sat down and hugged and cried with them. Then Lina got up, wiping her face, and left.
“Noni, tell me the story! What happened?”
“I read her the story from John 4 about Jesus and the woman from Samaria, who had five husbands and then was with a man who wasn’t her husband. Lina listened and understood. Then I read to her from John 8, about the woman who was shamed before everyone and brought to Jesus so He could ‘court’ her [bring justice]. Jesus said, ‘Mi no kotim yu. Go, na no ken mekim sin gen.’ Lina told me, ‘I feel like Jesus is saying these words straight to me right now. What do I do?’
“I read her Romans 10:9-10, and told her to call out to Jesus. She replied, ‘I don’t know the first step of prayer.’
“I just told her it’s Jesus, and she knows Who He is and what He’s done. So call out to Him. And she did! I didn’t tell her what to pray, she just prayed and wept and asked Jesus to save her.
“Then she wondered again, still crying, ‘But can I really go to Heaven?’ So I showed her John 14:6, that Jesus is the road to the Father. She cried, ‘Mi painim Jisas bilong mi! I found my Jesus!’”
The next thing Lina told Noni was astounding. “Yesterday, you could have heard bad news about me. I was thinking that since nobody loves me, not even my family, I would kill myself and my children. But I didn’t. Now I know that God was giving me the chance to repent.”
Noni embraced her, mixing her tears with Lina’s, and replied, “Now you know that God loves you. And Jesus came to give you life.”
“The thief cometh not but for to steal, and to kill, and to destroy; I am come that they might have life, and that they might have it more abundantly.”
John 10:10
How grateful we are that the thief could not kill and destroy our dear friend! How precious is the Good Shepherd, Who gave His life to give us ours!
Lina and Mata reading from John 1
As I reflect on Lina’s conversion, I am overwhelmed by two things. One, I marvel at God’s grace to me. I am the Samaritan woman. I am the woman brought to Jesus in John 8. I am a sinner, just like Lina. And God saved me. The blood of Jesus cleansed me from all my sin. I am washed from my filth because Jesus claimed my condemnation as His own. I am pure and righteous, not because I have done pure and righteous things, but because Jesus did. God gave Him the wrath I earned, and now gives me the favor Jesus earned.
That will never get old.
Two, I marvel at the power of God’s plan for discipleship. That Monday afternoon didn’t just happen. For years, people have invested in Noni’s life. Sarah especially has spent much time discipling her. Last year, Chelsea started a Bible study to pull the youth girls of our church together to grow in the Word. Pastor Ben shepherds Noni (and all our youth) so well. His teaching of the Word and passion for evangelism and holiness is cultivating Biblical knowledge and sanctification. And behind Pastor, there are John and Matt and Andrew and others who invested much in his discipleship.
And we could go back further. Who discipled Sarah, and the Allens, and Andrew, and Chelsea? They have a part in Lina’s coming to faith too.
My part in the story is small, but it was still a part. I got to lift up the glory of Jesus in the gospel daily in literacy class, as others have magnified Him to me before.
And the Spirit of God, working through the Word of God in the mouths of the people of God, breathed new life into a dead soul here in the bush in PNG.
How many people did He use as His instruments? Who knows. It doesn’t really matter. What does matter is that God is building His church. He is saving people, and in grace He calls us to be part of what He is doing!
How can you measure the impact of discipleship? It’s not possible. Eternity, and nothing else, will reveal the yields of spiritual investment.
Lina has two children. They will grow up with a mother who can read, and mother who knows Jesus. What will those children become?
There are other women in these communities who are shamed by sexual sin. Will Lina be able to reach them?
Noni’s soul is on fire. Lina was the first person she saw converted. How much will this encourage her to proclaim the gospel more and more to others?
And on and on it goes.
What are you spending your life for? Whether we’re preaching the gospel in a mountain village, or repairing engines, or selling cars, or telling small children the same basic facts of life forty-two times a day, if we are Christians, our life is about discipleship. “I long to faithfully follow Jesus all the days of my life. What can I do to help other people follow Jesus too?” That is the mission Jesus gave His church.
I know every Christian doesn’t go to the mission field. But shouldn’t we all ask the question, as we are about the work of the mission? “Can I go to one of the places in the world where there are no disciples, and start making disciples there?”
If we go to Kazakhstan, we go there to make disciples; and if we stay in Kentucky, we stay there to make disciples.
Why wouldn’t we make discipleship the most important work of our lives? The kingdom of God is advancing. He commands us to engage in the only thing that will matter eternally. “Make disciples from every nation.” He will save and sanctify them. And He will use us in that process, as He uses others in our lives to do the same.
One day, an innumerable multitude of disciples will gather around God’s throne, redeemed from every family and language group in the world. May we live our lives today for the praise of God on that day, and into eternity beyond!
“And Jesus came and spake unto them, saying, All power is given unto me in heaven and in earth. Go ye therefore, and teach all nations, baptizing them in the name of the Father, and of the Son, and of the Holy Ghost: teaching them to observe all things whatsoever I have commanded you: and, lo, I am with you alway, even unto the end of the world. Amen.”
Matthew 28:18-20
“And they sung a new song, saying, Thou art worthy to take the book, and to open the seals thereof: for thou wast slain, and hast redeemed us to God by thy blood out of every kindred, and tongue, and people, and nation; and hast made us unto our God kings and priests: and we shall reign on the earth.”
I thought that would be a great accomplishment, commemorated by pictures and probably a self-congratulatory facebook post. After all, isn’t that the coolest thing you get to do if you’re a “bush nurse”? Especially if you’re actually just an EMT…not even a real nurse. How many EMTs get to say, “I stitched a person’s body part back together”?
Marie hard at work on a late-night suture job
In my first two weeks here, I had been the second set of hands for quite a few suture jobs. I thought that was just how things go here. Every other day or so, you stitch people back together (and there was that one night with four jobs from the same fight…). So a couple weekends in, I sat down with a suture kit and a skirt I had shredded while climbing out of a river. Perfect opportunity to learn the stitch, which wasn’t as hard as I had thought.
Then, right on cue, the fountain of suture jobs dried up. The end. Lots of tuberculosis and broken bones followed, but no more suturing. Apparently, maladies come in waves, and the suture wave was over. Oh well. Good for everybody here – good job not chopping body parts open!
Last week, I told Manandi that the next time she saw a suture job, I’d like her to talk me through the process. She smiled and nodded, “Sure!”
The next day, Wednesday, a woman walked up to the porch, carrying a little boy – her nephew. She told the story with shaking hands and frightened eyes.
“His mother went to the bush and left her kids with me. I was clearing some bush in my garden…I cut a pineapple and gave it to them, then went back to work. Somehow, he fell and rolled to where I was cutting.”
His right hand was shaking too, and he was crying. His name was Sedrik, and his right pointer finger was gone just below the middle knuckle.
Before going further with this story, I have to stop and praise the Lord for His protection of this little boy (who became my buddy). I don’t want to imagine how bad that injury could have been. I’ve seen women cutting grass with machetes here. They don’t mess around: they work hard. Sedrik could have lost much more than a finger.
My heart hurt for Sedrik and his auntie. They were both traumatized.
Manandi sent her back to the garden to find the missing finger. “We’ll see if we can sew it back on.”
A couple hours later, auntie returned. We cleaned the finger, gave Sedrik some knockout meds, and turned the exam room into an operating room. Manandi fished out the extender tendon from the stump. While she was working on clamping the one in the detached finger, I tried unsuccessfully to find the flexor tendon.
“It’s okay. We need to get it sewn – it’s already been off so long.” Shaking her head, Manandi made the call to go ahead and put it together without reattaching both tendons. In retrospect, I think she knew that Sedrik’s chance of keeping his finger was very small; in which case, it really wouldn’t matter that both tendons weren’t repaired.
I held the finger in place, and Manandi sutured all the way around. I was afraid she was gonna ask me to suture. After all, I’d just told her I wanted to. But this was different. I sat beside this little boy, literally holding his hand together, thinking of my nieces and nephews – both my brother’s children, and the crowd of kids at my church whom I love like family.
Reni, my four-year-old niece, makes my heart sing when she holds my hand. My pastor’s kids love playing dodgeball and nerf wars and guitar with me. My best buddy Isobel draws me pictures. Gentry runs into my classroom every morning to give me a hug on her way to her kindergarten classroom. Liam loves pillow fights at my house (even though he nearly lost an eye during one…). Ben became a proficient guitarist through a couple years of lessons. Max gives me high fives and big grins every week. Red-headed Emerson holds his hands out asking for candy. Baby Ellison just grips my finger and drools on my arm.
If something happens to one of those kids, they can go to an actual hospital with an actual operating room and an actual surgeon. Sedrik? We were all he had. And in spite of our best efforts, he probably would still lose his finger. You’re awesome, and you’ve got this, Manandi. Holding the parts of this hand together is really as much as I want to do right now.
Sarah, Sedrik’s mom, arrived after we were done. He was still knocked out. (Ketamine is weird – the patient’s eyes stay open, even thought he’s totally gone.) Sarah climbed up onto the table, picked up her boy, and cradled him. I thought of my sister-in-law, and my friends Sheila and Peachee and Amber and Amanda and Cheri, and how much they want their kids to be okay. This momma is exactly the same. Yet, even if his finger lives, it will never work right.
Lena had told me that Sarah was a good friend, so I loved her more already. For the next five days, we saw Sedrik daily. He needed strong oral antibiotics and shots, because the risk of severe infection was so high. Each day, I got to play silly games with him and his baby brother, Seth. He started smiling, eventually, and Sarah started calling me his “nani” – big sister. Go ahead and melt the rest of my heart, why don’t you…
We prayed. And gave shots. And checked color and capillary refill and suture line. And prayed. And sent pictures to Lena for input. And prayed.
Today, the tip of his little finger was dry and shriveled, the rest soft and dark. It had to come off again, or gangrene could eat up the rest of his finger (or worse). Sarah wanted to wait until the end of the day, when the other patients had left (it’s hard to do anything serious in the clinic without an audience).
Sedrik played on the steps while I treated patients all day. He played peek-a-boo at my table, ran behind me and poked my side, and mimicked my silly faces. Little Seth, clad in his birthday suit, just laughed on his mom’s lap. These boys are too much…
By the time the last patients were done, Sedrik had fallen asleep on the porch. I picked him up and sat next to Sarah. He was half-sleeping, half-whimpering. Poor little guy. This has already been so much pain for him.
Time to start. Emma gave him the Ketamine shot, I handed him a pack of Maggi noodles, and then he was out and we got him on the exam table for the second time.
I unwrapped his finger, removed the splint, and wiped his hand down with saline. A piece of saline-soaked gauze helped to soften the crusty parts. I felt a little nauseated as I snipped the sutures that held the dead finger to the living stump and then removed them with tweezers.
Manandi came in just in time to pull the dead part off. I glanced up at Sarah, standing beside me, silent tears streaming down her cheeks as she caressed her boy’s head. I knew this was hard for Manandi too; Sarah wasn’t only a patient, she is a relative of Manandi’s.
We cleaned and cleaned. Such risk of infection still…
Manandi snipped away hardened pieces of dead flesh. Marie kept up communication with Lena, sending pictures and questions and relaying her responses. Manandi kept saying, “Mi no save (I don’t know),” as she cleaned and cut.
“Do you want a scalpel?” Marie offered.
“We have to cut away enough flesh to fold skin over the bone and suture it to the other side.”
“It’s really tough…this is all muscle here.”
Sarah pressed in on my left, inhaling sharply every time Manandi leaned in with the scalpel. Does she understand why we have to cut? I tried to explain what we were doing, but it was still painful to watch.
Finally, Manandi set the scalpel down. The skin still wouldn’t reach the other side. Too much flesh in the way. “Do you want to try?”
Um, no, not really. But I guess I will anyway. I signaled with my head, and Marie understood my unspoken request.
“Here’s a chair, Sarah, you can sit down. Here’s some gauze; can you wipe his mouth?” Thank you, friend, for giving her something to do so we can just cut what needs to be cut and get this finished.
After some further surgery, the skin would finally cover the bone. I held it in place, and Manandi began suturing. We are almost done…
“Once I’m finished with these, you can do the rest.” I didn’t think I understood her right, but when she handed me the needle, I realized I had. And just like I’d practiced, I stitched the rest together. Manandi was a great teacher and help. I still need to practice more. My fingers felt awkward and clumsy.
Then it was done. We cleaned the suture line thoroughly, tossed the needles and scalpel into the sharps container, then wrapped up the bloody gauze and gloves in the chuk and tossed it. Marie carried the instruments into the other room and scrubbed them down. The end.
Sarah held Sedrik while I secured his arm in a sling. We chatted a bit. Kind-hearted Emma brought over some cucumbers from the house; she was concerned for our friends since they’d been here all day without eating. We waited until Sedrik was responsive, and then they headed home.
So…my first time to suture, and I really don’t care if anyone got a picture. It was just sad. We weren’t just stitching together something to heal, we were closing up a wound that meant a kid lost his finger. Yeah, we did our best. We tried to save it. But it didn’t work.
And there’s still the danger of further infection, and we’re still praying that he doesn’t lose any more of his hand. That’s part of why I think I feel the need to write about this now, before it gets worse (if it gets worse).
It’s almost time for sleep now. But one thing about suturing is the smell of iodine and blood that lingers in your nostrils. As I sit here at the desk, having taken a shower, changed, and eaten dinner, I still smell it.
And then there’s the picture that stays in your mind. A bloody stump, the bone exposed. Sedrik’s eyes open, glazed over, drool trickling from the corner of his mouth. Sarah’s tears.
And there’s the feeling too – holding a little hand in my gloved ones, regularly dabbing the blood away with gauze to keep my grasp from slipping. The warmth of mom’s body pressed against my side. Manandi’s head brushing mine. But mostly just his little hand.
I don’t feel self-congratulatory. I mostly just feel sad.
Maybe the next suture job will be different.
January 12th PS – This story needed a delay to share for a couple reasons. For one, people generally like to know the actual ending of the story. While I needed to write this before knowing the end for my own sanity, I guess I figured other people would expect to know how it ended.
Also, Sedrik was the first patient I got so attached to. This one is more personal, because Sedrik stole my heart. It’s hard to write a story and be so emotionally invested in it.
So the end…
Praise the Lord, the “it could get worse” was never realized. After another month or so of antibiotics (tablets and shots), Sedrik was discharged with a healed stump of a finger. I saw him last week, watching volleyball with an auntie. He’s a little stinker, so he just frowned at me. But the next day when Sarah came to clinic, she told me his secret. He was happy to see me – he told her so when he went home.
My hands (and shirt and lungs) got covered with chalk dust today. It’s been awhile – eight months to be exact. This time, I wasn’t demonstrating formation of Greek letters, diagramming compound-complex sentences, or creating a timeline of Restoration Age English literature. I was drawing circles and lines.
Our class worksheets involved no translation, parsing, or analysis of sentence components. We were circling pictures that looked the same. (See the cup on the left? Look to the right. What’s that? A pencil. Good. Is that the same as the cup? Nope. Okay, skip it. What’s next? A pot. Also not the same. The last picture in the row? Yes! That’s a cup! Circle it! Good work!)
Providing feedback to students involved no editing or morpheme cuts. Just… finding the students whose pages were upside down and helping them get to rights. Then, identifying that someone matched a fish with a plane. (Nope. Sorry. Those are not the same thing.)
Why all the struggle? It’s not because my students today are children. Most of them are adults with children of their own. It’s not because they lack intelligence. They know how to survive in a harsh place. They can wrangle food out of the ground on the sides of mountains that I just fall down. They can build houses with no power tools. They know how to use everything in their world to provide for their families, and they’ve been doing that for generations. Oh, and they also know how to speak and understand a language that has a dizzyingly complex verbal system with seemingly endless affixes.
So why the challenge with these worksheets? As I look out the window, I see why. There are no billboards in view. No street signs (not even any streets). No newspaper stands. No bookstores.
No words for the eyes.
They live in a society that doesn’t require literacy for people to function. Many of these adults have never in their lives needed to read or write. Paper, pens, letters, written words – what are those for?
So as we gather for the first day of literacy school, the first steps are discriminating marks on a page, starting from the left and top of a page, and holding a pencil. If you’ve never needed a piece of paper before, wouldn’t you wonder how to hold it and what the marks meant? Would you understand how lines in different shapes correspond to reality?
This bears the question “Why learn to read?” What will you read? Where will you get a book? What has changed in this society now so that forty-two people crowd into a room, looking nervous and happy and worried all at the same time? Of course, the kids need to learn to read so they have a better chance for school. But why these adults?
We started class with that question. I asked, “How will it help you to learn to read?”
Leften and Imai, two of the fathers in the class, answered immediately, in surround sound: “So we can read the Bible.”
You see, fifteen years ago, the gospel came to the Kamea. God moved, people believed, and a church was born. And the church is nourished by a book. For these believers, learning to read became a need precisely because they started following Jesus.
Amon is a deacon. His wife, Margaret, learned to read a couple years ago. Amon wants to lead his family in worship. He sits in class next to his son, Leden, helping him as they learn to read together.
Leften runs a store. He is a sharp guy. He and his wife, Sedina, have three children whom they need to train in the gospel. They sit in the same class now, across the aisle from each other (since men and women don’t sit together).
Imai attends Bible school on Mondays and Fridays. It’s hard to study, write notes, or take tests if you haven’t learned to read. Imai’s wife doesn’t always come to church faithfully. Imai needs to know the Word so he can shepherd his wife well.
As we gather, we are about a bigger work than sounding out letters and sentences. This class is not about reading for its own sake. This is about family and personal discipleship. These brothers and sisters can hold in their hands the revelation of God, but right now they can’t read it. This class exists so they can eventually see for themselves the glory of God in His Word. In this room, we are about the work of expanding eternal joy. What a weighty opportunity!
Have you ever considered the value of literacy? Think about it. What would your spiritual life look like if your only option for truth intake was a sermon several times a week? How would you be growing in discipleship if you could never feed on the Word of God for yourself? How would you discern truth from error in preaching if you could never check to see what God has spoken?
What does your spiritual life look like?
Is your only truth intake a sermon several times a week?
Is your discipleship stunted because you never feed on the Word of God for yourself?
Are you susceptible to shifting winds of doctrinal error, because you don’t cultivate the discipline of Biblical discernment?
Do you hold in your hands the revelation of God, possessing every ability to read it, but neglecting to see for yourself the glory of God in His Word?
Are you daily expanding your eternal joy in the God of the Book?
Or do you take for granted knowing how to read and possessing the Scriptures in your own language?
May we thank God for the gift of His Word and the literacy to read it. Then may we be faithful to do so, that we might know, and worship, and rejoice, and love, and serve.
“Em klostu. Yumi go long 8:00 na kam bek long 10:00.”
Some phrases spoken by a friend here should make any outsider wary. For one, “It’s a shortcut.” If you hear those words, go the other way, unless you love doing one-leg squats up a muddy ninety-two degree incline, sliding down the other side on your derriere, and/or balancing on slippery pyramid-shaped sticks over a twenty-foot drop to the river below.
Closely following the “It’s a shortcut” phrase is “Oh, it’s nearby” (“Em klostu”). When you hear those words, prepare yourself for a journey to the center of the earth. Then, you’ll be pleasantly surprised when your destination is only a couple hours’ walk away.
On Sunday, Sila told me that she was taking Marie to her garden later in the week.
“May I come with you?”
“Mm,” and she nodded.
Plans materialized into a Saturday morning excursion. I had been told of Sila’s garden, accompanied with a warning about not falling into a hole or down the side of the mountain. Fairly confident I could handle those two goals, I was excited about the chance to spend time with Sila, get out of the house, and learn about life here.
“Wait, I told Selestin I would teach her guitar on Saturday afternoon. Will you be gone all day? Is your garden near or a long way away?”
“Oh, it’s close to here. We’ll leave at 8:00 and come back at 10:00.”
Perfect. We’ll go to the garden in the morning, work on some stuff at home after, and then finish the afternoon with guitar lessons.
Saturday morning rolled around, and Sila came for us at 7:45. Water bottles, bilums (string bags that can be used to carry everything from sweet potatoes to small children), biscuits (thick crackers = lunch) – we’re ready to go. The only question was which shoes to wear? My Chaco sandals had given me blisters the last walk I took, and I had failed to clean all the mud off them, so they didn’t seem a good choice. The garden is close by, I thought. I’ll just wear flip-flops. I’ll clean the sandals later. (Spoiler alert – that was the wrong decision.)
Following Sila across the field, up the hill to her house, and down the hill to the stream, I marveled at the beauty around me. It’s easy to get caught up in the work of the clinic and miss the fact that this place really is breathtaking. The sun was shining (a recent phenomenon) and the sky was clear. Both the foliage around us and the mountains in the distance seemed to sparkle. The water in the stream we splashed through was cold and clear. What a perfect day!
“Hey, you wore flip-flops,” Sila observed with a half-laugh, half-grimace. “You’re going to fall.”
Of course, I’m going to fall. That’s part of walking here. Every time I leave the house, unless I’m going to clinic or church, I plan on falling – that way it’s a win when I don’t.
Should I have known better, and run back to the house for actual shoes at this point? Yup. Did I? Nope.
We crossed another stream and headed up a steep incline…then another, and another. Sila was so kind and patient. “Yumi rest here.” She picked plenty of places to stop so we could catch our breath. I didn’t mind. I like breathing.
As the trail became muddier and narrower, I began to realize the error of my footwear choice. The flip-flops sank into the mud, sometimes remaining there after my foot emerged. The mud here is like grease. Once my feet were muddy, they would no longer stay on the soles of my shoes. Sliding left and right, slipping and falling, I decided to drop the offending flip-flops into my bilum and proceed barefoot.
Another incline…still going up…more mud. Tree roots created steps in some places, and thick layers of soft, green moss covered others. Sticks and stones may or may not break my bones, but they sure can make my feet tired.
How far is “close to here”? I wondered. Wait…I remember this now…never ask someone who doesn’t own a watch how long it takes to get somewhere. There’s no telling how far away this garden is.
The surrounding bush really was beautiful, if I stopped walking to look up at it. And Sila was looking out for me so well – she stopped walking often to cut footholds in the clay. When we reached a small pit crossed by a log bridge, she laughed, “When I took Chelsea here, she fell into this hole.” So THAT is what Chelsea was talking about…Noted. I will follow Sila stepping down INTO the hole and NOT across the log. Success! I’ll make it to the garden without falling into a hole.
I wasn’t worried at all until we came around the side of one incline, and the trees opened up to reveal the garden. I took a step and was startled as the “ground” wasn’t actually ground – just grass and sticks that disappeared beneath my foot. I fell. Again.
Sila apologized, “Sorry – step HERE,” pointing to the barely perceptible trail.
Oh, I see now. Step HERE, not six inches to the right. Step here, and you’ll follow the path. Step six inches to the right, and you’ll fall down the mountain (probably not very far, but still not a comfortable turn of events).
“Wait here. I’ll go make a road.” And Sila scampered off, practically prancing along, chopping away at brush and grass with the greatest of ease. I marveled again. These people are amazing. And Sila is so kind and patient.
We made it to the garden without further mishap. Sila taught us how to dig up taro, gather kumu (greens), and find siko that is ready to eat (We harvested quite a few that were too big and prickly. She laughed at us, split them open, and tossed them aside. They would become new plants to produce more siko).
I loved being with her. She gave us easy jobs, and then jumped across a stream fifteen or so feet below to gather kumu on the other side. She reminded me of a gazelle – just gracefully bounding from one place to another, filling her arms with kumu…nevermind the drop to the water and rocks below. We clumsily attempted to follow her directions. I felt like a child.
After eating our crackers, we bundled everything up into the bilums to head home. Marie was following PNG fashion. You sling that thing over your head, girl. You will make Sila happy…and procure a sore neck and a headache in the process. I was too lame to carry stuff on my head.
The walk home was just like the walk there, only in reverse (shocking, I know). We stopped at a stream to wash the taro and kaukau. Once we reached Sila’s house, she turned and pointed. “You see that tree at the top of the mountain?” Yes, we do. It’s tiny. “We passed that and went down the other side.
Wow. Perspective. That was quite the climb.
But for Sila, it was just a walk to get some food for a couple days. No big deal. It’s like running to Walmart for some milk and eggs.
I understand now what it means when Sila walks up to our door with a shy smile, holds out a bundle of kumu, and says, “This is for you.” She walked barefoot over a mountain, wandered through her garden, leaping from rock to rock, plucking the tender ends from the vines that cover the mountainside. Then, she put the kumu on top of the kaukau and taro in her bilum, slung it over her head, and returned home across the same mountain. She stopped at a stream to wash the dirt from her root crops, dropped off some at her own home, and then walked across the field to our porch to share with us the life that she had gathered that day. It isn’t just food that she’s offering. It’s friendship.
That day we spent together – every time she chopped away at brush or mud to make the path easier to walk, every time she extended her hand to grab mine, every time she paused and smiled, “Yumi rest here” – there was a picture of divine grace. Sila didn’t need us. There was nothing we could do to help her with her work. We actually made her work harder. She could have been to the garden, gathered the food, and returned home in less than half the time we spent. So why did she want to take us with her?
Because she’s our friend. And that was the point of our Saturday trip. None of this was about our helping her. But just like a mother who tells her toddler, “Yes, you can help me – hold the dustpan,” Sila loved us by bringing us into another part of her life. Our garden excursion was her gift of friendship to us.
Tuesdays are long in general, because we run three clinics simultaneously: the usual sick line, the baby shot line, and the bel mama (expectant mother) line. On this Tuesday, Marie and I had been working together, independent of an experienced nurse for the first time. Emma was working the baby shot line, and Manandi was taking care of the bel mama clinic.
Sick line was down in numbers, which was fortunate for us. New nurses take longer with each patient, probably due to inexperience and paranoia about missing something (coupled with learning Pidgin in the process). A little after three o’clock, Marie and I were finishing cleaning up on the porch. Manandi was still checking several bel mamas in the exam room. I don’t remember what Emma was doing – probably cleaning after finishing the day’s vaccinations. Down the road, we could hear and see a crowd gathering (never a good sign). Then Anjuda, Pastor Ben’s wife, ran up the clinic steps, breathless and teary-eyed.
“They’re — they’re bringing a man in a stretcher…there was a fight…he was cut,” and she motioned a slash across her neck.
Dear God, I thought. Help. I don’t know a lot, but I know that a cut across the neck as she indicated would probably mean a severed carotid artery. If this man had sustained THAT kind of injury, he was either already dead or about to die on our porch. How far had he already been carried? When was he cut? How much blood had he lost already?
MaryBeth appeared behind Anjuda to offer help. She had heard from someone what was coming our way, and started gathering supplies with us. IV kit, suture basket, extra saline and iodine bottles, absorbent pads, pulse oximeter…
The poor unsuspecting bel mama waiting for her checkup was cleared out of the exam room, joining the audience on the porch to open space for whatever was coming up the clinic steps. The crowd surrounded the men bearing the pole on their shoulders, supporting a body wrapped in a pink sheet. As they lowered him onto the porch, my stomach churned in apprehension of what we would unwrap.
He was moaning softly. That’s good – at least he’s conscious. His neck was not bloody. So where’s the big cut? There wasn’t much blood on him or the sheet. So why is he about to die? Is there internal bleeding? Is this drama? What in the world is going on?
Marie the ER nurse slid seamlessly into incident commander mode. “You count respirations. I’ve got blood pressure. Pulse ox is 94. Somebody write this down…”
“Hemoglobin’s 11. That’s good.”
“Blood pressure – one hundred over forty.”
I tried unsuccessfully to get people to back away on the porch, then gave up and went inside to find a pillow and make sure the exam table was cleared. As soon as Marie and Emma completed the initial assessment, Manandi got the stretcher-bearers to bring the patient inside.
Pieces of the story drifted together over the next hour (and week, actually). His name was Simon. On Monday, he and another clan had disputed ownership of some ground. On Tuesday, Simon went to his garden. Nine guys from the rival clan came for him and beat him up with sticks. There was a knife involved, but fortunately he wasn’t cut severely, though he was unquestionably in pain.
3:27 P.M. – pain med administered
We started with him on the exam table, but he began to lose consciousness and then wanted to be on the floor. Okay. Whatever you want, bro. He’s shaking so badly…he must be in shock. But where’s the blood he’s lost? Transitioning to the floor, we got him wrapped up with blankets better, and that eased the shivering.
3:37 P.M. – BP 100/64, RR – 24, HR – 59
Simon’s vitals remained stable, but I expected an imminent crash anyway. I was just certain that he had lost a lot of blood, and he was about to go down. He had been beaten with sticks, and his torso was bruised on the upper left quadrant. Spleen rupture?
There were two cuts to be addressed – one on the back of his left arm, and one on his head. It was impossible to tell how bad the cut on his head was, under such thick, curly hair, matted with blood. Manandi shaved it away, with remarkable speed and dexterity, revealing a less-than-remarkable laceration that had already stopped bleeding. His head was swollen where he’d been hit. Intracranial bleeding?There HAS to be something critical here…
3:50 P.M. – BP 100/70, HR – 73, O2 – 95%
Marie started an IV. “Can you grab the 20-gauge? Thanks…Hm, he has nice veins.” (I’m sure he was proud to hear that.)
“Hey, inap yu holim dispela?” I recruited an observer (friend or family – not sure…probably some kind of family…we were down from the audience of fifty-two on the porch to only seven in the exam room) to hold the saline up for his drip, and took vitals again, adding the stats to my little 3×5 card.
Simon started shaking again, as the IV fluid entered his bloodstream. We got a pillow underneath his torso to get it off the floor, and the shaking stopped.
Once everyone was certain he was stable, the next task was determining what to do with him from there. The head trauma seemed to indicate that he should be observed overnight, which we are not able to do here at Kunai. We had given him pain relief that could have been masking the severity of his injuries, so even though he seemed alright, we couldn’t really be sure about his neurological status.
4:25 P.M. – Manandi cleans and sutures the laceration on his arm
My recollection of the conversation is unclear, but the decision was to send him to Kanabea Hospital for the night. Unsure of their supply, we packaged the meds he would need and gave them to his sister.
4:30 P.M. – Transfer to Kanabea General Hospital
Simon walked out of the clinic, which felt like a win since he had been carried in. Regrettably, he was not the least bit interested in going to Kanabea. “You fixed me. I’m a strong man. I’m going to my house.” The end.
His family said he was talking crazy. Was that from his head injury or the pain meds? No way to be sure…but he was walking down the road, arguing with his company (and the other random people who just came to watch the show. I guess there was nothing interesting on the evening news or sports channels in their huts).
I felt sick again. What if he really was critical, but we gave him too much pain medicine? What if his confidence in his ability to walk two hours home was based on the meds? What if he went home feeling fine and died in his hut from internal bleeding or swelling around his brain?
The drama after Simon left the clinic was just about as intense as the drama that preceded his arrival. He’s walking towards Kanabea, entourage in tow. He’s turned around and sauntering towards home, entourage still in tow. Everyone’s yelling. He’s going to the hospital. Now he’s going home. Now he’s going to the hospital. What is going on?!?
Should we go get the medicine back? We hadn’t given detailed instruction for the oral antibiotics, because we thought we were just sending the stuff to Kanabea. Did anybody in Simon’s crew know the amount and timing of the required dosage? Also, we had sent something for an IV or an injection (I didn’t know what…and I still don’t). That was a total waste if it went off to the bush instead of the hospital.
I walked toward the company with Linda (she works in the clinic) to at least explain to Simon’s sister, the holder of the medicine, how to take the antibiotics IF Simon ended up going home. Manandi came right behind me – good. Far better. Linda could translate my Pidgin into Kamea, but Manandi understands everything that’s happening and can just talk to whoever. She’s awesome.
After plenty of dialogue incomprehensible to me, we walked back to the clinic together, Manandi shaking her head. “These people…” You said it, not me…and they are your people, so that’s okay for you to say, I guess… “I don’t know if he’ll go to the hospital or not. He wants to go home. He says he is fine. He’ll go home and then get people and go fight back tomorrow.”
Well, that should work out beautifully…
And we cleaned up the clinic and went back to the house. The end.
Sort of.
Over dinner with MaryBeth and the kids, we reviewed the afternoon’s scenario – what we thought was happening, what actually happened, what we would do differently, what we’d do again. Did he actually need an IV? Did he actually need the pain medicine?
I realized that my initial response was an adrenaline spike and the expectation of a very critical patient. What we uncovered was less than what we expected, but my mind never came down from the expectation of imminent death. I convinced myself that since what I saw was not critical, there must be critical internal damage.
Or not. Drama happens. Maybe the patient really has a severed artery and is bleeding out. But maybe he has two small cuts and some bruises. We don’t know what we’re getting until the sheet is unwrapped.
We determined that we need to communicate better, both what we want to do for treatment and why we want to do it. We need to learn to balance a sense of urgency for patient care with an ability to pause and assess what we see. AND, we need to assess what we SEE, not what we expect to see – without losing the ability to still look for what we can’t see at the moment.
And at the end of the day, patients are autonomous. We can do everything we know to help them, but they can only get the care they decide they want. Once again, I am not God. I cannot determine the ultimate outcome for any patient. I can and will do everything in my power for their care, but I have to trust and pray where my power ends.
That has to be enough.
(PS – Simon did end up going to Kanabea overnight. He walked home on Wednesday, and was feeling well enough to gather his clansmen and go fight another round on Thursday. But that’s another story…literally.)
(By way of intro…I’ve written about some experiences and people over the last seven months. Since I’m serving in the bush, “Stories from the Bush” seemed to be the logical thing to call these sketches.)
September 8, 2018
Sandra’s dad carried her to the clinic on Saturday afternoon (my first one in the bush). Her brother had been cutting grass with a bush knife, and she walked up beside him. He never saw her. On a long swing, the knife sliced the back of her left ankle.
We (editorial “we”) got her foot unwrapped and cleaned to determine the severity of the damage, which ended up being serious. The knife had severed all the way through her Achilles’ tendon, calling for a surgeon and an OR. Wait, our room is the OR…and one of us is the surgeon…
I got to take in the scene with the eyes of a newbie. Sandra lay on the wooden exam table, quietly enduring the pain. Her dad stood nearby with arms folded, quietly observing. Chelsea and Mom A poked and prodded, quietly discussing the likelihood of suturing the tendon. Emma scurried around, not-so-quietly gathering supplies. I stood by the table, holding a flashlight and trying not to pass out.
Chelsea seemed reticent to begin searching for the two ends of the tendon. Though I didn’t understand why at that moment, I did about two hours later.
The first step was lidocaine. Emma was leading out, so she took the syringe Marie had drawn up and inserted it above and below the wound, numbing the entire area. I’m told it is painful at first, but then immediately puts everything to sleep (which is significant when you’re about to dig around inside a part of someone’s body).
Emma began the suturing process, with help from extra hands. She inserted the tweezers through the groove where the tendon used to be, searching invisibly for something that would feel different from the soft flesh and muscle. Blood is slippery, which makes the process more of a challenge.
After squeezing and slipping and splattering blood for awhile, feeling the tendon but struggling to clamp it, Emma switched out with Chelsea. She leaned in, picking right up with the squeezing-slipping-splattering. Emma (whose face was also in close proximity to the wound as she was holding things for Chelsea) kept jumping at every splatter of blood from the slipping clamps, which could have been funny in another situation.
Chelsea eventually found the tendon on top, clamping it and pulling it down into the opening. The end on the bottom proved to be more challenging, but she was ultimately successful. Once both ends were secured, Emma pulled the two together as Chelsea began to suture them with absorbable stitches. The process looked complicated, more so because of how tough tendons are. This was my first time to see suturing. Talk about total immersion…
Once the two ends of the tendon were re-attached, Chelsea tapped out and let Emma suture the flesh back together. I also switched out with Marie – her turn to hold the flashlight. It was day, but there isn’t great light in the clinic for that sort of job. The little light Landmark gave me has been a huge help for several suture jobs.
I was feeling weak in the stomach and mind. It sounds so simple – “just suture the tendon together.” It’s a two-hour job. At least, this one was. The pressure Chelsea felt was apparent. Tendons are apparently quite significant, if people are going to be able to walk. Having in your hands the responsibility for someone’s ability to walk – that is pressure.
When you walk away from a job like that one, there is just this nagging “What if?” What if we didn’t get it right? What if the sutures dissolve too fast? What if we missed something? If Sandra can’t walk right, is it our fault?
When I closed my eyes that evening, all I could see was her gaping wound and the blood (even after I cleaned the specks off my glasses). In another case, could I handle that kind of pressure with the poise and skill that Chelsea did? I can only hope, at this point anyway.
I went to talk with Chelsea after dinner that night. I was feeling like it may have been a bad idea to come here to work in the clinic, uncertain if I have the ability to respond to needs like Sandra’s. I feel so deeply for other people, but I can’t be immobilized by someone else’s pain if I’m going to help fix it.
That conversation encouraged me. Ultimately, responding to emergencies successfully comes back to a theology of sovereignty. At the end of the day, do I trust that God is in control? You do your best, you give your best, and you trust that God is God and you are not. He is in charge of healing. You do what you can, and you move on, doing your best yet not to let the worry of “What if?” cloud your ability to help someone else.
There is a place to weep with those who weep, but that isn’t the exam table. That is the place to fix what’s broken – with compassion, but with enough emotional detachment to do the job. Cry later, if you have to, but fix the problem that’s in front of you.
And every suture job isn’t like that one, for which we can all be grateful.
