Pages from the Philips Seeking God's leading in medical missions

Best Saves…

It’s feels like spring in Texas which means wonderful weather and plenty of time outdoors with the kids!  We have been blessed these past few months with lots of time together and further leading from God with regard to several decisions that needed to be made before we leave for India in hopefully 18 more months.

Praises:

• Christo found out that he passed the written portion of his emergency medicine board exams.  One of our big goals for the time after residency before we returned to India was to have the board certification process completed before our departure.  Christo will be taking his oral board exams on October 27th of this year.  Keep that in your prayers so that the last step can be done before we return to India.
• Halfway done with paying off student loans! Our goal was to have student loans paid off before we left for India because that would leave one less burden we need to raise support for and free us up with regard to which missions organization we will join to go to India.  We thank God for a wonderful place for Christo to work that has provided for our needs and allowed us to work on these goals!
• A great trip to Key West, Florida with our family and Kris (Melissa’s sister).  Christo gave a talk on High Risk EKGs for the EMC annual conference which was well received and we enjoyed getting to explore the Florida Keys and Everglades National Park

Prayer Requests:

• Wisdom with regard to choosing a mission organization to go with back to India.  We are meeting with one prospective organization this week to help us with that decision.
• Our home group.  We are co-leading a home group with some friends from church.  Pray for God to draw the right people to come to the group and that we would be mutually encouraged through this group.
• Time management.  We are taking the Perspectives course (which we highly recommend to those of you that have never taken it – its a semester long course offered at multiple churches around the country on the world Christian missions movement) which requires an intense amount of reading along with trying to keep up with home schooling and work.  Please pray for us to get much out of the course but at the same time not feel too overwhelmed with all the other things that need to get done.

For the longer version…at the end of January we made a 3800 mile road trip from Dallas to Key West, FL and back.  We enjoyed stops in New Orleans, Miami, Key West, the Everglades, and Tampa on this trip.  Once I finish putting up all the pictures from our East Coast Trip (look at the end of the post for pictures from Boston and New York) I’ll try to get the ones from Key West done.  We especially enjoyed trying out wonderful seafood from the Gulf Coast and even got to be at Cafe Du Monde when they were filming a new movie called, “Now You See Me” with Woody Harelson and Morgan Freeman!  We enjoyed Key West but really loved Everglades National Park.  Since it was winter at Everglades National Park the weather was wonderful (in the 60s-70s) and because it is the dry season there all the watering holes were concentrated and so we would often see 10-15 species of birds hunting near each watering holes along with plenty of alligators – including an 8 foot alligator which was about 2 feet from us.  Yikes!

Melissa and I also went to an adoption conference (Empowered to Connect) last weekend which we would strongly recommend to anyone considering adoption.  It was a two day conference that helped us to really understand the complex emotional and developmental issues faced by kids in the foster care/adoption system and it gave us much insight into the issues faced by adopted children and how to most effectively help them deal with it as a family.  It is taught by Dr. Karyn Purvis, a child psychologist from TCU, who is world renowned for her work with at-risk children.  She wrote a book called the “The Connected Child” which we would highly recommend as well.  We have always felt lead to pursue adoption since we got married but we’ve been seeking God’s leading with regard to when would be a good time to add adopted children to our family.  We had finished foster care training while we were in Minnesota and had provided respite care for a toddler when we were there.  We recently started considering adopting through the foster care system in Texas but after prayer and attending this conference we decided to wait until we return to India before we add to our family.   Our hope is that when we return to India we can pursue adoption again especially since India has almost 25 million orphaned children.  India has historically been extremely difficult to adopt from due to national laws that prevent adoption of children by Christian parents but we pray that God would open those doors to allow us to adopt when we return to India so that we can add to our family.  We will need your prayers that God would work to allow that to happen so that we can get through all the red tape after when we return to India.

Last month I had written about a patient I cared for who died after a prolonged resuscitation in the ER but I wanted to write this month about another patient with a much more positive ending.  I cared for this patient about two years ago.  She was a young Hispanic woman in her early 30s who came in with her husband with a headache and fever that had been there for several days.  She first went to a local clinic a few days earlier where they had sent off some blood work and gave her some medicines for pain and then sent her home.  They called her about two days later telling her that she needed to go immediately to the ER because her blood work had come in abnormal.  Her hemoglobin came back at 6 (normal around 12-15) and her platelet count was very low at 9,000 (normal between 150-400K).  I walked into the room and I could see that she did not feel well.  She had her head buried into her husband’s chest while she gently sobbed.  Her husband gave most of the history.  She had developed a headache about a week ago and a couple days ago she started having a low grade fever up to about a 101.  She had not traveled anywhere, no one else was sick and before this she had been healthy.  Her husband said that she had not traveled outside the country for many years and that she stayed at home to care for their two children who were in elementary school.  I asked if I could examine her and her husband gently laid her down in the hospital bed.  Other than looking uncomfortable her neurological exam was normal.  She did not have any neck pain when I moved it (I was thinking that perhaps her headache and fever was likely from meningitis).  The only thing I found were multiple petechia on her arms.  I started running through the differentials as I walked back to the doctors station with the lab results from the clinic in my hand.  Was this meningitis with no neck pain?  Maybe she just had (idiopathic thrombocytopenic purpura) ITP and she was just chronically anemic?  Maybe it was Evan’s Syndrome?  However the more I thought about it and the symptoms she had I was pretty sure that what I was most worried about that I needed to rule out was (thrombotic thrombocytopenic purpura) TTP.  She seemed to fit most of the symptoms – she had thrombocytopenia (low platelet count), anemia, headache, and fever.  The only thing that did not fit was kidney failure.  I could feel my mind racing as I sat at the computer and started flying through orders – a repeat blood count, coagulation factors, a blood smear, an ADAMTS13 enzyme level, LDH, haptoglobin, and blood cultures.  I prayed that God would allow us to find out what was wrong and get the right people involved before she got sicker.

Her headache improved after a couple doses of morphine and because I was so worried about this lady I called lab about 45 minutes later to see if they had done the blood count.  They said they had gotten back a low platelet count and low hemoglobin but that they were having trouble getting some of the other values because of how the blood looked and so they were having the pathologist look at it.  I called the pathologist and she confirmed that she did indeed see multiple schistocytes (fragmented blood cells) consistent with microangiopathic hemolytic anemia.  The remainder of the lab results confirmed that she was hemolyzing – her haptoglobin was low and her LDH was high.  The next call was to the hematologist who seemed surprised when I told her that I had a case of TTP out of the emergency department (its not one of our usual diagnosis that is made out of the ER).  I reviewed the smear results with her and within 30 minutes the fellow and the attending were down in the ER examining in the patient and we had her admitted to the MICU to start plasma exchange therapy (where we remove a patient’s plasma and replace it with donor plasma to remove circulating antibodies that cause the thrombosis).  Unfortunately in order to do plasma exchange it requires a large multi-lumen catheter called a Quinton catheter which is usually placed by surgery.  Thankfully the surgical resident was was on surgical call that day was a wonderful doctor who realized the gravity of the situation and within 30 minutes the Quinton was in place and she was transferred to the MICU.  They started plasma exchange as soon as she arrived in the MICU and about 15 minutes later she had her first stroke where her entire left side of her face and arms went limp.  Neurology was consulted and unsure as to what to do – should they give tPA (a medicine to lyse blood clots) or just keep her on plasma exchange since her primary problem were these circulating antibodies that were causing her to form clot.  They decided that giving tPA would increase her chance of bleeding and to just continue with plasma exchange.  A few hours later her stroke symptoms improved and they kept doing plasma exchange.  She spent several weeks in the hospital and had 28 plasma exchange treatments but walked out of the hospital alive and with no functional deficits!  I was so excited when I read her follow-up notes showing her progress.  It was one of those once in a lifetime cases where the right data gets to you in time and all the physicians involved in the care realize the gravity of the situation and move forward even before all the confirmatory tests are back and because of that we made a difference in the life of this one woman!  I think I glowed for weeks after caring for this patient!  Next time some stories of caring for the psychiatrically ill…