Monday, November 1, 2010

Baby Miguel

By all accounts, baby Miguel looked to be a hopeless case.  Nine days old and septic (from pneumonia), his parents had walked some five hours down the from the mountain community of Nueva Esperanza to bring their child in to Hospital Loma de Luz.  Missionary Pediatrician Dr. Sharon Yount told us that this was one of the sickest babies that she had ever seen and prepared the family for the worst almost from the outset.    Being believers in Christ, these simple mountain parents seemed able to put their trust in Christ (the concept of a person or a situation being “in God’s Hands” is an important one here and a phrase that is often used in conversation and in prayer).   By yet another miracle of God’s timing, there were several visiting North American nurses here that were able to fashion out a sort of rural infant ICU for Baby Miguel.  Because I’d had experience as an EMT in the past and due to our desperate need for help in caring for Baby Miguel, I was allowed to help a bit with his medical care.  His condition seemed to go from grave to far worse…. with intense difficulty breathing and “gurgling” breath sounds, it really only seemed a matter of time before Miguel would go on to be with the Lord.  At one point, his breathing was so labored that the decision was made to intubate him.  For those of you with any medical experience, you must be saying – “why hadn’t you done that earlier?” Well, you see – we do not have a respirator here at Hospital Loma de Luz and so the decision to intubate comes with it the awesome responsibility of “breathing” for the baby by bag valve mask – every breath – around 80 times per minute, every minute of every hour of every day until he gets better or until God takes him home.  And so the very weighty decision was made and a small team of nurses and doctors “bagged” baby Miguel for a period of over two days as we watched for any sign of improvement.    

One thing that can definitely be said for Baby Miguel is that he is a fighter.  In fact, he seemed to fight the tube that had been placed in his lungs constantly.  The nurses lovingly put mittens around his hands and tried to constrain his flailing arms so that he wouldn’t pull out any of the many tubes that were coming from his poor little body.  Unfortunately,  through his efforts, he was able to extubate himself (remove the breathing tube) and the decision was made at that time to “put him in God’s hands” and pray that God would heal him.  It seemed that we had done all that we could with our limited resources.  He was placed into his parent’s arms with the hope of a miracle, but with the grim realization that he would most likely die.  But he didn’t die.  In his father’s arms, he started to get better.  In fact he got so much better that Dr. Sharon began to try and formulate a new treatment plan based on the reality of the seeming miraculous turn around.  She began to talk about the possibility of transporting the child to a facility with a respirator – an easy task in the States – but almost impossible here.  As the days progressed after this miraculous turn around, Miguel started going downhill again.  Eventually, Miguel had to be intubated again and we had to reinstate the round the clock breathing program.  This time, everyone involved was so tired that we began to feel like we were running out of options.

It was my privilege to watch caring Christian doctors with some pretty strong differences of opinion in how they should proceed with treatment – whether or not to transfer, for example – talk through their options.  One of the things that they talked about during this time was that Baby Miguel was more than a little body, he was also a soul.  Although his body seemed very insecure indeed, we knew that his soul was secure in “God’s hands”.  They agreed that sending these simple mountain folk into one of the biggest cities in Honduras to try and fend for themselves and their baby in the midst of a very complicated Honduran medical system would have been difficult at best and probably only lead to the death of their child in an unfamiliar place very far from home with no resources to get back home and care for the rest of their family.  Hence, the very difficult decision was made to, once again, put Baby Miguel in “God’s hands” and pray for a miracle.  I am told that the doctors met to consider, one last time, transporting Baby Miguel and started to pray for wisdom and for a clear indication from God as to which way to go.  At almost that exact same moment Baby Miguel stopped breathing.  Wow, it seemed that God’s will at that time was to take Baby Miguel home to be with Himself.  Miguel was revived and did continue to breathe, albeit very very poorly.  Dr. Sharon met with the parents and all agreed that it seemed time to discontinue our life saving efforts and allow God’s will to be done.  I happened to be the one that was “breathing” for Baby Miguel using a bag valve mask when this decision was made.  I took the little body (and soul) and placed them, for the second time now, into the father’s arms.  I prayed with him at that moment that God’s will be done.  We “put Him in God’s hands” for about the one thousandth time in prayer to the Father and began to watch the pulse oximeter to indicate what seemed to be the conclusion of this beautiful baby’s time here on earth with us. 

As we prayed, and watched, Baby Miguel didn’t die, in fact he slowly got a little bit better……. and then he slowly got yet a little bit better.  His oxygen saturations went up without an ET tube and once we stopped breathing for him, an obvious contradiction – and an obvious miracle.  Instead of taking Baby Miguel home to be with Himself, God seemed to want to show us Himself through this process.  He seemed to want to remind us that we are all “in His hands” at every moment of every day and that even with the combined wisdom of some very wise doctors and nurses, His wisdom is supreme.  We watched in awe as Baby Miguel seemed to stabilize a bit.  As there were many care givers around, I decided to walk away for a bit and try and clear my head and get some fresh air.  I came back maybe thirty minutes later and Baby Miguel was nursing!  His mother had lovingly put him to breast, trying to squeeze one more moment of intimacy out of this miracle before her baby died and he responded by nursing.  Thus began Baby Miguel’s recovery.  I stand here now, several weeks later, still shaking my head at what we witnessed and still in awe of the God ‘s providence throughout the whole situation. 

Baby Miguel’s soul is still with his body, as far as we know, and he and his parents left the hospital some two weeks later and began the long walk back up to their mountain village.  Several of the nurses have made a pact to return one year from now and go visit Miguel at his home and celebrate his birthday with him.   While I don’t know if that will actually come to pass and I don’t know how Miguel is doing  today, I do know this:  Baby Miguel is in God’s hands.  All of our prayers didn’t place him any more in God’s hands than he already was, we were simply acknowledging the reality that we could observe about how much this was in fact true.  I know something else now more clearly than ever.  I too am in God’s hands and so are you.  We live and breathe only by His grace and He can show himself miraculously at any time.  Are we living each day in the reality of being in His hands, or do we deny this simple truth by our words, or deeds?  My prayer today is that you and I would live in the simple truth that we are in God’s hands.  Thank you Lord for miraculously saving Baby Miguel and thank you for the privilege of being present as it happened.  Amen.

Note,  here are a few more places that you can read about baby Miguel:

Taking a patient to Hospital Atlántida in La Ceiba

Note, the names of the victim and his wife in this story have been changed to protect their privacy.

As Brad and I pulled into the ER at Hospital Atlántida with Fernando lying across the back seat, head in his wife, Maria’s lap, I breathed a quick sigh of relief and a prayer for what we would find inside.  I hoped for the best, but would soon find out that we were to get something much less than that.  I walked into the ER with my transfer papers and presented them to the medical attendant sitting at the desk in the middle of the sea of chaos that is the ER at Hospital Atlántida.  I explained that I had a gunshot victim in the back seat of my truck, to which the very unimpressed attendant answered, “We have three other gunshot victims over there.  He’ll need to wait with them.”  My mind drifted back to the events of the evening that had brought me to this very surreal moment as I surveyed the line of three gunshot victims lying in a row and contemplated our chances of seeing a surgeon this night.

About four hours earlier a relatively peaceful Sunday night had been interrupted by the news that there was a gunshot victim down at the hospital.   This, in and of itself, was not entirely shocking news as we are a rural hospital in a very violent country.  I was asked to go to Balfate, a village a few miles down the road and retrieve Tomas, our X-ray tech so that he could come in and take X-rays of our somewhat stable gsw (gunshot wound) victim.  Further, someone had told me that this was Fernando, Maria’s husband.  The couple is known by us and known very well by our good friends the Aldens.  They attend church at a local church that many of us were connected to and Maria frequently works as a part time housekeeper for several of the missionary families.  In short, she is well known to all here and to hear that her husband had been shot gave us all more than a little extra anxiety.  As I raced out of the gate to get Thomas from Balfate a call came for me on our local Ham radio.  The ER doctor – Dr. Abby – had asked that I return to the ER and told me that someone else was going to go get Tomas.  Further, I was asked to get my firearm and return to the hospital to act as security.  We came to learn that the person who had shot Fernando was still at large and it seemed good to have someone around who was armed. All of my time in the states at the shooting range and my love of handguns has meant that I am one of the missionaries here at the hospital who is armed in times of security concerns.  Ok, I headed back to my house and retrieved my handgun and headed down to the hospital to hang out with Dr. Abby and see how I could help. 

I was saddened to see our dear friend Maria so distraught after having been through such a difficult time, but gladdened to see Fernando lying on the bed in the ER – mostly stable.  The bullet had entered into his back midway down on the left side and amazingly at that time – didn’t seem to have hit the spinal column or the lungs.  Ultrasound seemed to reveal some internal bleeding.  Dr. Jeff showed up about that time and reviewed the case with Dr. Abby.  Dr. Jeff – our leader and surgeon – was put in the unenviable task of having to make a tough decision about sending Fernando into La Ceiba for surgery due to lack of resources here at the hospital.  The next time you find yourself praying for Hospital Loma de Luz, please pray for a full time anesthetist for without one, we can (and do) have a very talented surgeon that can’t perform his duties and often has to send patients in to La Ceiba when we could otherwise treat them.  Dr. Jeff made the difficult, but obvious, decision that we could not operate on Fernando with the limited resources that we had at the hospital at that time and the decision was made to transfer him. 

While this assessment and decision was being made, I was able to spend some time praying with Maria.  I prayed that God would give her peace and we prayed together that God would touch her husband and heal him.  I was aware that another one of our missionaries (It is truly amazing how our little group of missionaries acts as a team when a critical case arrives) had gone to Balfate to get the police.  In our rural area, we do have police, sometimes, but they don’t have a car.  So if you need them, you have to go and get them.  We had done just that and on this Sunday evening, John had found our local constable enjoying a cool one at the local bar.  He brought the young man (couldn’t have been more than 20 yrs old) from the bar, out of uniform and smelling a little bit like beer, directly to the hospital.  Remember that I had told you that there was a little bit of concern that the shooter was still at large.  Well, the little bit of concern turned into a bigger amount of concern when a young man arrived at the hospital in street clothes, smelling a little bit like beer, claiming to be a cop and wanting to see the patient.  Penny, our dear friend and nurse, was ready to pummel the poor young lad right there in the hallway.  My role as guardian and protector quickly became one of protecting the young policeman from Penny as she was quite concerned that he was indeed the shooter, come back to finish the job.  Penny was raised in a Catholic school and let me tell you – the Sisters would have been proud of her.  I explained our policy that only uniformed police were allowed to be armed there at the hospital and asked the young officer to please surrender his weapon to me to hold  - for the comfort of “the nurse.”  He was only too happy to give me his firearm as long as it meant that Penny would stand down. 

Hearing that the decision had been made to transport Fernando to La Ceiba, I asked if I could be permitted to take him into town in my vehicle.  I knew that the local Red Cross ambulance ride would be really hard on Fernando and I wanted to give him a more comfortable and secure ride into town.  I also wanted to try and be there at the hospital for he and Maria to try and help them secure the best care available.  And so the request was granted and we loaded Fernando into the back of my truck, lying on his side with his head on his wife’s lap.  He groaned loudly in obvious pain as I went over each bump (20 miles of hard, rough dirt road and then 40 miles of pavement with potholes the size of small ponds) and through each pothole on the hour and half trip to Hospital Atlántida in La Ceiba.        
And so here I find myself in the ER, being told to wait behind three other g.s.w. victims and worried sick about Fernando.  I was standing in the middle of an ER that simply defies explanation to anyone who is used to an American Emergency Room, clean and orderly.  There aren’t enough nurses to go around, so the family members become the primary care takers of the person in the ER.  To my left, an elderly mother tries to comfort a young man who has been shot in the chest and undoubtedly has a sucking chest wound.  He seems to be literally bleeding out in front of me.  Farther over to my left a very large woman (easily 300 lbs) is following some strange rhythm of scream, cry, vomit, repeat.  Occasionally adding brief pauses for emphasis, she doggedly sticks to her routine in a desperate attempt to get some attention.    An old man looks like he is dying.  A young girl looks scared and quiet.  There are no beds.  Fernando is still in my truck and I’m not really getting anywhere.  I say there are no beds, but there is one bed – off in the corner – broken and stuck in a 45 degree “reverse Trendelenberg” position with the head up and feet down.  Brad and I try and fix the bed in the corner, hoping to be able to straighten it out.  As we are working on it, I realize that there is a terrible smell in that corcer of the ER and look down to find that I am standing in a pool of blood and urine.  I give up trying to fix the bed and realize that I’m not about to put Fernando with internal bleeding into such a position (head up – feet down), so I complain to the nurses who walk by with a blank expression that gave up trying to explain their situation long ago.  I’m told that I can have the mobile bed (one with wheels) that the sucking chest wound is currently on as he is about to be shipped up for surgery.  I breathe a sigh of relief that he (sucking chest wound) will not die right there in front of me and that we will soon have a bed.  An orderly – (about 14 years old in appearance) rolls another bed into the room and the orderly and the elderly mother move sucking chest wound from the rolling gurney onto the other rolling bed and begin to wheel him out of the room.  Problem: sucking chest wound left about an inch deep pool of blood on the gurney that we are now supposed to use to get Fernando out of the truck with.  I look around in vain for someone to clean the gurney.  I ask the nurse where the cleaning supplies are and she points vaguely off to our left.  I wander around, looking on the shelves and find a likely looking bottle.  One sniff confirms that this is indeed bleach – perfect.  Now for some towels.  The best I can do is a pile of what I hope and pray (but doubt) is clean sheets.  I use one to soak up the one inch pool and then use the second one to put as much of the bleach as possible all over the bed and get it as clean as possible before wheeling it out to my truck.      Brad is a rock during all of this and dutifully hauls Fernando out of the truck and onto the bed.  We wheel him into the ER where we find a spot near the broken bed but far enough away as to be out of the pool of blood and urine.   We’re told to leave him there and that the surgeon will see him just as soon as he is out of surgery.  We pray with Maria, who is back in shock now given all that has happened since we arrived.   We leave feeling like we were leaving our friends in an impossible situation.  As we get into the truck Brad sums it up perfectly and says, “Well, if Atlántida doesn’t kill him, I think he’ll be ok”.  

We spoke with Maria the next day to find out that they still hadn’t seen a surgeon.  We started making plans to go back and get Fernando, not sure what we would do – but knowing that we had to do something.  Not too long after that, we heard that he was indeed being taken into surgery.  We later found that they had operated on Fernando and while in a considerable amount of pain, he seemed to be stable.  Several days later he was released and spent the next several weeks recuperating at home.  He is up and moving around now – well, mostly.  They are fearful that the man that they surprised down in the ditch alongside the road that night will come back.  They are afraid of the senseless, meaningless violence that almost ruined their lives.  The policeman all but told them that night that there wasn’t anything he could do and he was most probably right.  There won’t be any justice, this side of Heaven it seems; for Fernando – only gratitude that it all didn’t end that night for him and that Maria doesn’t have to try and raise their kids alone.  I wish I could tell you that everything is ok for them.  I know that it isn’t.  I know that they face unimaginable challenges amidst their fear and their poverty.  I’m told that Fernando is back at church and that he is speaking up and participating in ways that he wouldn’t have done before.  I’m hoping and praying that his close call brings him closer with God and that he heals emotionally, spiritually, and physically.