Worst Losses…
We've clearly not been doing the greatest job on frequent updates, however we do have new pictures, some exciting developments and stories to share in this update! We have enjoyed a few months at home after finishing our tour of the 13 original colonies (you can find some pictures from our trip at the bottom of this post). We had an enjoyable time traveling from Dallas to Maine and enjoyed seeing dear friends and family members and some amazing historical sites. We enjoyed some amazing ethnic food at several hole in the wall places in New York, Boston and Washington D.C. and had fun hanging out with Kris, Melissa's sister, who joined us for about half our trip.
We spent Thanksgiving with my family where we had almost 70 people come to my parent's home for the annual flag football game, Thanksgiving meal and post-meal Cowboy game watching - accompanied by plenty of cheering courtesy of my aunts! The kiddos took their annual break during the time we were traveling up the East Coast but have since resumed their homeschooling. Karuna continues to amaze us with the vigor with which she devours books - often requiring multiple trips to the library each week to keep up with reading material for her! Luke has started working on learning to read which has been exciting for him since he desperately wants to read now that Karuna is always reading. Vivek of course tries to destroy the house as Melissa works with the older two in their schooling. We have also enjoyed this past month because Melissa's sister, Kris, moved down to stay with us at the end of November as she is searching for a new nursing job in Dallas - the kids have definitely enjoyed having their aunt here and enjoyed her two dogs and cat.
After much prayer and discussion we decided in the last few months to commit to serving at Duncan Hospital in Bihar, India with the plan to return to India in the latter half of 2013 after my board certification process is done along with student loans being paid off. We are excited to have committed to Duncan Hospital because it gives us a greater sense of direction as we prepare for our return to India. We felt that strategically Duncan is located in a part of India where we can be part of a team to help train young physicians while at the same time use the hospital as a platform for sharing the great news of Christ by providing compassionate and loving care to the poor in northern Bihar and southern Nepal.
Life as an Attending & Humorous Stories from the ER
It's been nearly two months since I started my new job working at Hunt Regional and Presbyterian Kaufman. It has been a great couple of months so far with wonderful staff, sick patients and much more time off to spend with family. Melissa and the kids have kept on homeschooling through most of the summer so that we can take some time off in late September/early October to take a three week road trip from Dallas to Maine to explore the East Coast in the fall. I've enjoyed being able to have a lot more time with the kids since I'm working only about 14 shifts a month although I'm not sure if Melissa knows what to do with me when I'm pacing around the house looking for another project to keep me busy!
We had shared with some of you the difficulty Vivek had been having with his speech especially after he turned two. He had barely 10 words he could speak around that time and so we had started to meet with a speech therapist to help him with his language acquisition. Thankfully God had worked amazingly in his life and the switch seems to have flipped - in the past two months he has amassed a several hundred word vocabulary and started to put sentences together. In fact in early August he graduated out of speech therapy and I think he has been a much happier kid since he can communicate with us. Thank you to all those of you who had been praying for him! Luke is so excited about finishing his Pre-K workbooks and starting his kindergarden school work which includes teaching him how to read - something he has been desperately wanting to do since Karuna learned to read. Karuna has continued to do well in school and seems to show quite an aptitude for math and reading. Often times we'll find her reading chapter books in her room if she wakes up before everyone else to pass the time. We also know for sure we've produced nerds as her one request when we had our last daddy-daughter date was, "Daddy, can we do some of the X problems? (referring to some basic algebra I was teaching her)." So we pulled out a napkin and worked on 2x +2 = 10, (solve for x) while we ate dessert and in the end her love bank was full - she is a funny kid!
I've loved my new job so far! Perhaps the best part of my job when compared to residency is that I now have a scribe who follows me around whenever I work. For those of you who have never had a scribe, it is usually a student who is finishing undergrad and is interested in medicine who works with us to help us with our documentation.
Transitions
As evidenced by my lack of posts for several weeks, we’ve been in the midst of two busy months with the end of my emergency medicine residency and starting a new job working in the ER at Hunt Regional and Presbyterian-Kaufman. We do have some final pictures from our last days in Herbertpur and our time in Delhi posted along with this post – just scroll to the bottom to view the slideshow with music or click the pictures to see them individually.
My last month of residency was a bittersweet experience. I have loved my experience at Parkland and the wonderful staff who work in the ER. But I guess after 10 years of school and in training it was finally time to have the cord cut and be out on my own. Transitioning back to work and life in America has been with its challenges. Although we serve a very sick population of patients at Parkland who use the emergency room to get much needed healthcare in comparison to the dire medical need of the places we worked in India, the contrast was striking. We dealt with death on a far more constant basis in India as compared to the US. Here the expectation of most patients is that they come to the ER and they will get better – in India it is often that patients come to the hospital with the expectation that they could well die.
My last month of residency was a month of night shifts, which in some ways made the switch between India to America easier because I essentially stayed on the same schedule. In many ways caring for so many sick patients in India made me feel so much more comfortable taking care of patients at Parkland because I always thought – it could be a lot worse than this! I did find it somewhat amusing that my last night at Parkland was also one of the busiest nights we had had in a while – very similar to my last night on trauma call as a 2nd year resident when I had 5 gun shot victims show up in the ER within one hour. I worked a POD 3 shift my last night (this is the section that works primarily with the trauma team) and we got a call from Biotel (our prehospital EMS system) informing us that that a bunch of motorcycles were racing at around 120 mph and there was a big crash and that three of the people who were critically ill were coming to us. The first one to arrive was the worst, a young man in his 20s, ejected off the motorbike and then landed head first with no helmet.
Pictures from Mussoorie & Herbertpur
The dog days of June...the heat and lack of rain in Texas since we returned back to Texas have been intense. The kids seem to have recovered from jet lag fairly well although our whole family seems to still be suffering from GI problems. I think similar to what happened the last time we were in Assam, we might have all picked up Giardia again and so it might be about time for us all to get a course of tinidazole in our system.
Work has been going well - working a month of nights after coming back from India has been easier due to not having to worry about jet lag. However, there has been a lot of paperwork that needs to get done to finish my residency and so I've spent several days these past few weeks working all night and then spending most of the day getting things done for the residency which has led to several 3-4 hour sleep days. On top of that, I had all 4 of my wisdom teeth removed yesterday which was actually a much more pleasant experience than I thought it would be. I was quite amazed by the effect of nitrous oxide, midazolam, fentanyl and propofol in my system! I don't remember much of the surgery and for most of the day yesterday was in a narcotics-induced stupor. Today has been a little more painful but quite bearable and if it was not for the side effect of dizziness from the narcotics I would feel like I was back to 100%. Here's to praying for no dry sockets in the next few days and being able to go back to work on Monday night!
I also had my orientation with the organization I'll be working with for the next few years - Emergency Medicine Consultants. I was so impressed with them during my orientation and feel they really have both the physicians and patients's needs at heart much more than the survival of the company. They have put together a wonderful group of support staff that I think will make my life as an ER doctor as manageable as possible so that I can focus on the most important part of my job which is caring for patients well. EMC helps to coordinate my scheduling, keeps track of my credentialing at different hospitals and contracts with another company to get all my billing done. I'm excited to be part of this group (about 120 physicians all together serving at 12 hospitals in the area). They have several contracts which they have held for over 35 years! They seem very family centered and we were excited to see so many staff members who have stayed with this group for several decades which I think speaks to the quality support they provide. I'll find out soon for myself as I work my first shift on July 5th. Right now I'm planning on working primarily at Hunt Regional Medical Center in Greenville and Texas Health Presbyterian Hospital Kaufman with about two shifts a month as an attending at Parkland Hospital. We chose these two hospitals because they are rural enough that I'm often on my own without much in the way of subspecialty support and thus we thought it would help prepare us well for long term work in India when we'll be in a similar situation.
Finally, we wanted to share some final sets of pictures from India. The following are pictures from our visit to Mussoorie to see Landour Hospital where we met Joe and Sima Weaver and from our last weeks at Herbertpur Hospital. I wanted to try a different way to show a slideshow and so have created a video with music on animoto which I've posted below. Let us know if you like the slideshows better this way as opposed to previous versions. Also at the bottom of the post are individual pictures you can click on in case you just want to look at a few pictures. Have a wonderful week!
Final Two Weeks at Herbertpur
The following is a delayed entry from a day ago...we could not find a way to update the blog prior to us arriving in America this afternoon. We have safely arrived back in Dallas this afternoon with all our luggage and children! Will write more about the trip once we get over jet lag.
So it is our final morning in India. We arrived in Delhi two days ago from Herbertpur Christian Hospital and have been exploring the city a bit before we head back to the US this afternoon. The day feels bittersweet – we are excited about being back in the US to see our families and getting back to home but also sad to leave India and the tremendous needs it has – both spiritually and physically. Thankfully this is not a final goodbye but instead it is the beginning of a process whereby we will, God willing, be back in India in late 2013 to work here long-term. In this post you will hear about some of the patients at Herbertpur and our time in Mussorie. There are also some pictures from Hyderabad and a village church we attended in Bihar at the bottom of the post (I’m still several weeks behind with regard to getting picture edited so hopefully by early next week you will be able to see the pictures from Herbertpur). Here are the highlights:
Praises:
- Safe journey from Dehradun to Delhi.
- Thankful for relatively being healthy – most of the serious diarrhea is gone and we seem to be improving.
- A very good clinical experience at Herbertpur with lots of sick patients and procedures
- An amazing opportunity to teach several great residents and share with them about our life and call to missions
- A wonderful weekend to rest in Mussorie and get to know Joe and Sima Weaver
Prayer Requests:
- Prayer with regard to making a decision about where to join staff in two years
- Wisdom with regard to where to do intensive Hindi study when we return to India
- Pray for us adjusting to life back in America after being away for several months
- Endurance to finish a month of nights and lots of paperwork when we return with regard to Christo’s residency before he graduates at the end of June
Our last two weeks at Herbertpur were better than the first two weeks in terms of our health and all of us seem to have recovered from whatever bug was causing us to feel so bad. I’ll start off with a story I shared with the residents prior to us leaving. The last few weeks have been difficult for the kids especially because they have been missing our families, pets and just the normalcy of their life back in Dallas. For two weeks in a row we have had several nights where both Karuna and Luke have gone to bed bawling their eyes out for 20 minutes with nothing being able to comfort them because they missed family so much. We tried multiple things to calm them but nothing seemed to work – by the end I had tears in my eyes as I heard them cry. Then a few days ago I was working in casualty when I heard the sound of women wailing.
Hyderabad & First Week at Herbertpur Christian Hospital
We are about half way through our time at Herbertpur Christian Hospital. Hopefully we can give you a little perspective about our time here so far and about our week in Hyderabad in this blog post. For those of you who like the bulleted version here we go: (Some final pictures of Duncan Hospital are at the bottom of the post)
Praises:
- Lots of opportunities to teach residents and interns at Herbertpur.
- Wider exposure to trauma care in India since there are a lot more motor vehicle accidents that present to Herbertpur when compared to Duncan hospital.
- The kids seem to be adjusting well to the routine at Herbertpur.
- A fun drive with Dr. Daniel and his family to the mountains outside Herbertpur for a few hours to get a better sense of where we were and for us to see the Yamuna river.
Prayer Requests:
- Pray for endurance. It has been difficult being away from home and a normal routine for over 6 weeks. I think we have all become fairly weary of living out of a suitcase.
- Pray for more laborers for Herbertpur. They are short staffed especially with regard to OB-GYN and surgical care – Dr. Daniel is taking his first vacation with his family in four years later this summer.
- Pray for discernment regarding a decision about where we should join staff long term – there are multiple pluses and minuses to each hospital and we need to approach this decision very prayerfully.
- Healing from sickness – Melissa, Luke, Vivek and I have all gotten a horrible case of dysentery and are not feeling well. I took off a day from work for the first time in the last 7 years of medical school and residency because I felt so poorly.
We’ll begin with our time in Hyderabad and then move on to some highlights from our time so far in Herbertpur. We had a much-needed week of rest in Hyderabad and got to spend time with Elvin, my cousin, who works for the US consulate in Hyderabad. We were excited to be able to eat more than dal, rice and chapati for a couple of days while we were there and the kids thoroughly enjoyed being able to eat at McDonald’s again! We were quite amazed by Hyderabad and how developed the city is. Its roads are amazingly well designed and you can find almost everything we find in the West in the city. We made a trip our first weekend to Inorbit mall – the first mall we had gone to in India. We are not the typical mall people and rarely during our time in Dallas have we gone to malls but it was nice to be able to do our shopping in one location rather than visiting 10 different stores in various parts of the city.
Early that week, we met with Dr. Varghese Philip (VP), the managing director for 4B Healthcare, an organization that seeks to make failing mission hospitals viable again by infusing capital and management expertise.
Changing Minds, Cultures & Lives
So we have finished the first part of our journey and are done with our time at Duncan Hospital. We arrived in Hyderabad, located in the state of Andhra Pradesh on Thursday night. We spent two days traveling by road from Raxaul to Patna with stopovers in Motihari and Muzzaffarpur to visit several Indian ministries that work among the people of Bihar to get their perspective on what God is doing in Bihar before flying to Hyderabad to commence on the second part of our journey.
We will be in Hyderabad for a week as we visit a second hospital in Nandyal (about 4 hours from where we are staying now) to see the work of an organization called 4B Healthcare which seeks to make mission hospitals viable again by infusing capital and management expertise. We will spend a few days visiting that hospital before traveling on to Herbertpur Chrisitan Hospital in the state of Uttarakhand where we will spend our final three weeks before returning to the US in June. I hope to cover some of the specific areas where there needs to be change in Bihar and about some of the work Duncan Hospital is doing to promote that change. Melissa will soon write some about the community development work that has been started in the East Champaran district of Bihar in the next post but first for those of you who want to get to the highlights (pictures are at the bottom of this post):
Praises:
- Safe travel through some very difficult roads from Raxaul to Patna.
- Great conversations with Indian missionaries serving in Bihar as we saw how powerfully God is working in Bihar to changes lives and communities.
- Safe arrival in Hyderabad with no missing luggage even after we barely caught the flight out of Mumbai since our flight was delayed in Patna.
- Wonderful time of fellowship with many families at Duncan to hear how they felt called to missions and to the work at Duncan Hospital.
- A wonderful farewell party where we got to spend time with the junior doctors and other friends we had made during our time at Duncan.
- An amazing time of worship with local villagers on Easter at one of the village churches near Raxaul.
- A great day of visiting about 7 villages with the CHETNA project to see the many ways Duncan Hospital is helping to reach the poor and marginalized in Bihar.
- Provision of an amazing place to stay and great company in Hyderbad as we stay with Christo's cousin, Elvin.
Prayer Requests:
- God would bless our time in Nandyal as we see a different model for medical missions and to see if this model might be a possibility for how we might be involved in medical missions in India.
- God would continue to increase the number of people that hear about Christ in Bihar and that He would transform the lives of individuals and their communities.
- God would use this week of rest in Hyderabad to rejuvinate us before traveling on to the third mission hospital at Herbertpur.
- Provision of much needed staff from different backgrounds to consider working at Duncan Hospital to make it a place of great training and teaching for medical professionals in North India.
Our second week at Duncan was largely spent working at the hospital during the days and during this week I took pediatric call every other night (splitting the responsibility with Dr. Blessy, the pediatrician at Duncan) so that she could have a break. We also had the opportunity to meet in the evenings with many of the senior staff at Duncan so that we could hear their stories and how they felt led to serve at Duncan. Those conversations were a great opportunity to hear about the myriad ways in which God has worked to put together an effective team at Duncan. The kids especially enjoyed getting to play with the many kids on campus and have stuck with this even after getting plenty of mosquito bites in the evenings.
The lack of good medical care in this region of north Bihar was especially impressed upon me during this past week. Although there are many so called doctors and pharmacists in the area, the medical advice and treatment given to a large majority of patients is suspect at best.
Facing Our Limitations & God’s Healing Hand
The cost of healthcare is a huge issue faced by most of the families we care for. Because there is little outside funding of the mission hospital with regard to daily expenses the hospital has to charge enough to break even. So even in the emergency department, unless the patient is critically ill, we write out a list of IV supplies, catheters, and medicines we need to help their family member which is then used by the family to go and buy those supplies from the pharmacy. They return back with the supplies and only then the treatment begins. Of course there are many families we care for that cannot even afford the basic supplies and so the staff make a quick judgment about whether they can really afford supplies or whether they are lying to us. If the determination is made that they really cannot pay then the care is still provided but on a charity basis. I thought this would be an extremely difficult thing to do but even in a week it is fairly obvious which families are genuinely poor and which ones are just pretending. Duncan Hospital has a standing policy to never refuse care because of an ability to pay but most patients still don’t function under that mindset. In fact the vast majority of the patients we care for here come in only when they are so ill that they really cannot fathom any other options because they are worried about cost and they first want to give a chance for their local medicine men to do their treatment. This explains why I took care of six-month-old child this week who had been having a fever for 2 months and only after she became comatose did they come in. Her investigations showed severe acidosis and a new leukemia causing a white cell count of 90 thousand (normal is less than 10 thousand). Or the case of the elderly man who came in after his family noticed he had not eaten or drank anything for 15 days. He was so dehydrated and in such bad renal failure that his creatinine came back at 5 (normally less than 1) and his blood urea nitrogen was 326 (normal less than 20). When patients come in so late, other than God performing a miracle there is little else we can offer them.
Probably the two best success stories of this week were two women in their fifties – one who came in with a massive heart attack and the other came in 3rd degree heart block. The first was a woman who was working in the fields when she developed sudden onset of severe chest pain. She came in crying and moaning and the ECG done here showed a massive ST elevation myocardial infarction of the inferior part of the heart. The family did not have the money to take her to a bigger heart center where they might be able to get stenting done and so they asked us to care for her. Her heart rate was in the 30s when she first arrived because the vessel that fed her AV node was blocked – she barely had a blood pressure when she arrived. We got her moved quickly to the ICU where she was started on a medication called streptokinase (a drug we used in the US about 15-20 years ago which can be purchased here for about $50). This medicine helps to break open clot and within about 3 hours her EKG was returning back to normal. Of course we also faced the second problem of her extremely low heart rate. The defibrillator here does not have a pacemaker function and thus there is no way to temporarily pace someone while they have severe bradycardia. So I put her on a medicine that I had never used before called isoproterenol, which finally got her heart rate high enough to give her a measurable blood pressure. She was discharged from the hospital three days later under her own strength.
First Week at Duncan Hospital
We’ve now been in Raxaul almost one and a half weeks and life finally seems to be getting into a routine. Melissa and kids have settled into a daily routine and I’ve settled into the work at the hospital along with teaching the junior doctors. More details in the paragraphs to follow but I’ll highlight our first week at Duncan with the following praise and prayer requests.
Praises:
- The kids and Melissa are all feeling much better. Gastroenteritis seems to have run its course in our family and the kids have gotten their appetite back.
- The kiddos are all over jet leg and sleeping well through the night which means better sleep for us as parents.
- I’ve been getting some amazing opportunities to see clinical cases that I’ve never been exposed to in my emergency medicine training including measles, organochloride and organophosphate poisoning, TB meningitis, pericardial tamponade necessitating pericardiocentesis, and neurotoxic snake bites.
- The opportunity to teach many of the junior doctors some key emergency medicine principles and to share with the staff some of my insight to their clinical problems from an emergency medicine perspective.
- Getting to meet with several families on campus so that we could hear about their call to missions and their vision for Duncan Hospital.
Prayer Requests:
- The town of Raxaul – one of the least developed and polluted cities we have visited in India. Pray that Christ’s redeeming work would also extend to this city and transform it.
- Work/life balance – it can be very easy to get completely overwhelmed by the work and lose time with our families and time with the Lord.
- The plight of women in Bihar – there is little societal value to women and thus their lives are filled with sorrow and grief.
- The opening of the new hospital – happens in early May, pray that all the necessary details would come together to make this a reality.
- The junior doctors at Raxaul – that God would give them a clear sense of calling so that they might seek to serve Christ long term.
- Strategic vision – pray that God would use Duncan as a strategic center to train providers for many parts of North India.
- Provision of some more ventilators to care for intubated patients in the ICU so that they do not have to be hand ventilated.
Now for the longer version – we spent the first few days at Duncan with sleepless nights and sick kids. Thankfully in a few days the GI bug we had picked up had left our family. Karuna and Luke adjusted fairly quickly to sleeping through the night but we continued to have problems with Vivek waking up at 3 AM until we finally converted our kitchen into a bedroom to allow him to sleep there and he finally seems to have gotten into a routine with regard to his sleep.
Arrival in Raxaul
So we have finally arrived in Raxaul – the site of the first mission hospital we’ll be working at for the next three and a half weeks. We arrived here three days ago but have been in convalescence since because all of our children are ill. I’ll write in more detail about our trip so far on the next couple of paragraphs but for those of you who want the highlights here they are (pictures from our trip can be found at the bottom of the post as well):
Praises:
- Arrived safely in Raxaul after 24 hours on the train and 24 hours in flight
- No problems with getting through customs in Delhi with our medical supplies
- Big help from one of our family friends, Levi Paulos, who helped us navigate Delhi
- Extremely kind people on the train who went above and beyond to help us as we struggled with sleep deprivation and two very sick kids.
- Drs. Philip and Leeja have been great hosts and helped us immensely as we have tried to settle into life here at Duncan
Prayer Requests:
- Vivek, Luke, Karuna and most recently Melissa are all ill with gastroenteritis - pray for a quick recovery
- Melissa and I are extremely tired from multiple sleepless nights with sick kids and jet lag. Pray for recovery so that we can be useful here
- Christo would learn the hospital system at Duncan quickly since he will start taking call next week.
- Building relationships with the families here at Duncan so that we have a better sense of the community here and whether this would be a good fit for us long term.
For the longer version…we were able to get the second flight directly from Paris to Delhi after we missed our connecting flight to Bahrain. We flew on Air India and they were extremely helpful to us and moved seats around to allow us enough space to have a place to let our children sleep. After arrival in Delhi one of our family friends, Levi, met us at the airport in Delhi to help us get to the hotel. By the grace of God we went through customs without a hitch – in fact they did not even ask us to stop and just waved us through. That was a huge blessing in terms of being able to bring in the donated medical equipment we had with us. Also we had become a little wiser with regard to dealing with the porters in Delhi and so our total bill to get our bags from the luggage carousel to the car was a lot less than when we were in India last.
