As I got out of our borrowed vehicle to pump gas at the gas station, Ruth, my 4 year old, watched in surprise and dismay as I began pumping our gas. “Why is no one coming to help us?” she asked my wife, bewildered by the very lonely gas pumps we’d pulled into. In Honduras, all gas stations, and generally each pump is manned by pump attendants who jump to fill up the vehicle’s tank, often clean your windshield, and accept your payment.
Can you identify which gas station is Honduran? Ruth can, and she hasn’t learned to read.
We stepped up to the busy counter at Mr. T’s Pizza restaurant and I prompted Ruth, “You can tell her (the attendant) what kind of ice-cream you would like.” She looked about in amazement, listening to all the conversations and bustle around us. Then she turned to me and asked, “Does everyone here speak English?”
In the crazy shuffle of suddenly moving our things back to the USA, staying with grandparents while trying to figure out what’s next, traveling and greeting our numerous supportive friends and family members, and generally facing a lot of uncertainty and change. Ruth told me in a quiet moment alone: “I want to go home daddy… back to Honduras.”
“I know sweetie, me too. But…” And I explained again, hopefully in a manner comprehensible to my recently turned four-year-old, how contracts end, situations change, and sometimes we suddenly find our future plans undone. For now, it looks like we will be staying in the USA for the foreseeable future.
As a family we are all experiencing our transition back to the USA differently. For myself, my wife, and our eldest girl, we are experiencing reverse culture shock – the odd and somewhat uncomfortable process of finding yourself with an outsider’s perspective as you re-enter your home culture. For my younger 3 girls, who have little to no memory of a home outside of Honduras., the culture shock is straightforward and shocking – for Ruth most of all.
For me, reverse culture shock is like when I first received prescription glasses for the first time. It’s like seeing the world anew, the beautiful and the distressing parts with renewed clarity and contrast. We are grieved to leave Hospital Loma de Luz, excited to be with family – especially grandparents, uncertain about what comes next, frustrated by first-world ‘problems’ that seem petty, overwhelmed with the sheer abundance that is the USA, and comforted to be planning our 5th child’s birth in the security of a US hospital with supportive family close at hand.
So please, keep us in your prayers. We need them.
At present we are primarily living with Bethany’s very generous parents who have essentially let us take over the top-half of their house (and most of the bottom half too), let us borrow their van, (stocked with car-seats), and have excitedly embraced the opportunity to help us love, feed, teach, and spend quality time with our girls each day.
I have a short-term, fill-in work opportunity with an Emergency Department that is starting this month with training shifts but will probably not really open up to regular shifts until after our baby is born in early December.
Meanwhile we are trying to faithfully determine what kind of long-term work I should do here in the USA. Based on that, we are looking into where we should live, where we can go to church, and how much house we should commit to buying. Finally, in all of those decisions we have a new baby soon to be born and we are also trying to determine to what extent we should be ready and able to move abroad again if and when God were to call us back to the majority (developing) world.
Please pray that God will give us clarity and direction in each of the above questions along with the patience to wait and the discernment to leap in accordance with His timing.
Our time at Hospital Loma de Luz on the north coast of Honduras has, for the foreseeable future, come to an end. In the past few weeks we have said many good byes, packed our home, been able to bless our community by genourously sharing many things we have been able to accumulate over the past few years. We are so greatful for the great work that we have been equipped and enabled to be a part of over the last two and a half years.
Numerically, I had the privelege of: delivering over 100 babies, seeing and giving care to more than 2000 clinic patients, attending over 700 emergencies, and providing more than 350 patients with inpatient care
A few highlights of our journey:
Countless signs of God’s covenant faithfulness witnessed.
20+ Sermons preached (with the help of the church children)
Many meaningful art projects created and shared.
15+ critically sick newborns cared for and discharge well, who probably would not have otherwise survived.100s of evil scorpions, spiders, kissing bugs, ants, and mosquitos vanquished from our home.Axel and 5 other children with nephrotic syndrome followed and managed into remision – Praise be to God.
20+ closed fracture reductions, casted and followed to healing.
Innumerous glorious sunsets and star fields enjoyed and contemplated.
My family and I are so blessed and thankful to have had the opportunity to live, work, and minister in Honduras, with an incredible team of doctors, nurses, and support staff, at a wonderful and well resourced hospital in a beautiful and loving community. This has been an immense priveledge.
I will never forget the special priveledge of baptizing a hospitalized patient dying of AIDs, and the solemn work of helping many other families and patients prepare for immenient death spiritually, relationally and medically.
We are so thankful to Samaritan’s Purse and its Post-Residency Program that has made this time possible, and continues to offer us support through our transition.
Please be in prayer for our family as we: -Prepare for Bethany to give birth to our 5th child at the end of this year. -Seek to discern God’s next mission for us as a family.
Thank you for following us on this journey to Honduras and back again. We will plan to keep updating our blog as we discern whatever good plans God has in store for us.
One of our visiting family medicine residents1 called me late in the evening to report on a child she was admitting to the ICU. She had an 8 year old patient to whom she had already provided all of the standard treatments for asthma (multiple albuterol nebulizations, steroids, and oxygen) yet he was still breathing very fast, requiring too much effort, and his oxygen saturations remained low. She was working her way down the treatment algorithm and getting near the bottom where it recommends: “transfer for resource and time intensive interventions available at your pediatric referral center,” “Admit to your PICU for specialized consultation and care.”
I have two principles that I use to help me weed-out and avoid pediatric disasters. 1) Sick children look sick. 2) Children are very resilient, so they crash with minimal warning signs.
This patient was scaring me on both fronts. He looked sick to the resident physician, he was breathing in a way that was burning through his reserves, and at some point his body would get too tired to sustain breathing like that. If that happened he could very well die.
So I went down to the hospital and asked a visiting veteran physician to meet me there so we could put our heads together and assess the situation. On arrival I had a strange reaction from the family. Even as I determined that we were at or near maximum intervention and their child was not responding satisfactorily, they started to relax as I spoke with them. When I then told them things were very serious and I was worried they started calmly discussing their plans for the evening, including me in the discussion. (The father was thinking about going home to watch the other kids and wondered if he would be ready for work the next day.)
I was confused by their reaction. Was I unclear? So I stepped up my communication of the situational gravity by asking if we could pray together for their son.
As we prayed for their son’s life and breathing, with his chest rising and falling too rapidly, sweat beading on his brow, I looked at his face which was slightly obscured by the non-rebreathing mask and recognition slowly dawned on me. I had had an unplaceable sense of familiarity with this family since walking into our ICU, and suddenly I began to understand why this family had relaxed after I took charge of their son’s care. This 8 year old was one of our church kids, he and his parents were semi-regular attenders of our hospital church.
(One my biggest social anxieties is meeting someone out of context. I think it has to do with the way my male brain compartmentalizes things – but outside of whatever social or geographic location which I typically associate with you, let me apologize now, I don’t remember your name or how I know you… Sorry. If it’s any comfort, your face is vaguely familiar. So without my wife in the ICU to remind me who this family was and how we knew them- I was very slow on the uptake.)
I preach at our hospital church about once a month. And my normal style is to invite all our kids (10 to 20 kids) to the front of our sanctuary and have them help me present and talk through the scripture reading and its application before the entire congregation.
My insufficiencies aside, they had trusted me to preach at our church and to lead their kids, they knew my heart and knew I would do everything our hospital could do with God’s help to save their boy. They were able to relax, despite the terrifying possibilities, because they trusted the doctor and more importantly the God, who held their child’s fate in his hands.
With such trust, I sent off a text to my wife and the head pastor of our hospital church (he is also our hospital CFO and children’s sanctuary home co-director) asking for prayer and got to work with the resident, the visiting veteran physician, and our head of nursing putting together a plan and multiple tubes and older machines, to create a pediatric Bipap, continuous nebulization, 100% oxygen delivery system.
If you had asked me prior to that night if such a system was feasible at our hospital I would have said no. Each of those 3 things is possible at our hospital, but combining all three to work safely and effectively together on a kid was miraculous.
We receive tons of great donations that keep our hospital running. But sometimes for less frequently needed application all we have are well meaning donations that do not quite fit the bill. Sometimes our tubing is incompatible, a seal dry-rots, the quality is one-time or home-use grade, a motor is burned up by erratic electrical power, or we never found or received the specific tube, plug-cord, or what-have-you that is absolutely needed to make things work together.
In addition to the miraculous way we were able to put together a system to help this boy keep breathing. The resident who had admitted him stayed up through the night watching him and giving him various carefully dosed IV medications, monitoring his responses and staying vigilant for signs of decompensation. Furthermore our nurses broke open countless glass vials and refilled his nebulizing chamber every 10 minutes through the night (using almost our entire hospital supply of albuterol). Finally, as the morning dawned, it became clear that he was turning the corner for the better. A few days later he was discharged well enough to go home. Praise be to God!
This story brings two thoughts to mind: 1) I come into contact with so many new people each day, that I can easily fail to recognize the value of each person and the potential importance of my interaction with them. C. S. Lewis (as usual) says it best for me:
There are no ordinary people.
You have never talked to a mere mortal.
Nations, cultures, arts, civilization—these are mortal, and their life is to ours as the life of a gnat.
But it is immortals whom we joke with, work with, marry, snub, and exploit—immortal horrors or everlasting splendors.
2) Being a medical missionary gives me many opportunities to be anxious. Its easy to lay in bed at night thinking through endlessly looping problems that I cannot solve. I want my prayers to be like this this boy’s parents conversation and trust in me. Even when bad things are getting worse, I want to be able to trust God, relax, and plan out my next steps knowing that He is trustworthy and faithful. As the serenity prayer says,
God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference.
Reinhold Niebuhr
A Serene Sunset that happens many evening right off my porch
1 In the USA a resident is a physician who has finished the theoretical and practical exams and training necessary to be awarded a doctorate in medicine but is undergoing a further intensive multi-year training to acquire a board certification such as Family Medicine, Pediatrics, Internal Medicine, General Surgery, Anesthesia…
The views and opinions expressed in this blog are not the views of Samaritan’s Purse or World Medical Mission.
Since getting back to Honduras after our visit to the USA in July, our family has faced several challenges.
Two of our great full-time clinic doctors had to leave the work here for kingdom building elsewhere. That leaves us somewhat short staffed on the clinic and call side of things. Which has been hard for our family-work-time balance. But I am thankful for the time they gave here, the things they taught me, and the legacy and contributions to our mission they both left behind.
Another difficulty our family faced was having multiple bouts with an unknown febrile illness (we tested negative for the infectious diseases our hospital can test for, including COVID). It left Bethany and I barely able to function for a few days at a time, then after a slow recovery it or another illness struck again. As I started writing this, Bethany and Lydia were febrile and resting together on the couch facing a third bout. We are thankful to be presently fever free and well.
Thank you friends and family who have written in or called to check up on us. Thank you prayer warriors who pray for us daily.
A few nights ago we had a hot-potato style thankfulness game. Here in Honduras my family and I are thankful for things we didn’t even realize were important to us in the USA.
My kids are thankful for electricity (we have had several weeks of near daily power outages lasting 2-12 hours).
They are also thankful for generators, and rechargeable things.
We are thankful for air-conditioners to cool our rooms down at night and for fans by day.
My girls are thankful for lychee, nance, mango, coconut and Popeye’s biscuits.
I am thankful for 4 healthy children who all breathe, eat, drink, move, poop and pee (yes, I used those all individually in our game- and won).
We are thankful for a great dependable vehicle.
A faithful God.
Wonderful supporters who trust us with generous support.
Internet access.
Ruth said, “I’m thankful for Daddy, no… Daddy’s phone, no Daddy’s phone and Daddy.” (She really likes the wood turning and glass blowing videos we watch together on my phone.)
The work here is good. There are opportunities to minister to the sick, to heal in the name of Jesus, to offer comfort, wisdom and prayers.
Please continue to pray for us.
I was recently trying to thread a central line catheter through a newborn’s umbilical artery – to deliver IV antibiotics and preempt another newborn sepsis case. The process is very delicate and one has to push and twist just hard enough to get the catheter to pass through the natural twists and turns the artery takes, without pushing too hard. When (not if) you push too hard, you push through the wall of the artery and begin creating a false track – a path that will go nowhere and eventually dead-end. As I was attempting yet again to feed the catheter I said, “It’s so easy to create a false tract!” to Carolina, our Nurse-Midwife who was assisting me. She replied, “In life too.” Eventually, praise the Lord, we got the line placed and were able to get the baby his antibiotics and then discharge him home a few days later.
Picture borrowed from a great step-by-step guide to Umbilical Vein Catheterization by the Australian Government. Given the variety of conditions I see and treat, I often read step-by-step guides such as this.
In that vein (or artery), we are seeking and trying to carefully discern God’s will for our future – because it is so easy to go our own way and believe it is right (until we hit those dead-ends). Things have been hard lately, and it would be easy to take that to mean we should head back to the USA. Conversely, it would be easy to let our pride and the expectations of others guide us to keep on keeping on. Come July our contract with Samaritan’s Purse will be ending and we will have to decide if and with which organization we will commit to further time.
Pray that God will give us clarity regarding how long he wants our family to stay here in Honduras.
Pray that more doctors, nurse practitioners, and physician assistants will feel called to come and work here (and then do so).
Pray for the country of Honduras, with its upcoming presidential election in November.
Pray for Bethany and I as we face the challenges of parenting and homeschooling (which can be hard no matter where you are).
And continue to pray that I would have wisdom, grace, humility, and love in my role as a physician.
Grace and Peace, Nathan Gilley
Sunsets and cloudy skies as seen from our house, Rivenhalt, perched on the costal mountains in Northern Honduras.
Ruth’s magnitile creation (Left), Lydia’s mixed media artistic collage (Right)Homeschooling
We are well. We are in Nashville with family for a previously scheduled vacation. We had planned to fly out today, but by the grace of God we had to move our flights a few days earlier due to hurricane Eta flooding the main airport that we use (San Pedro Sula). This was good because flights are probably grounded throughout Honduras due to the latest incoming hurricane.
SPS Airport after the Hurricane Eta
Pray with us for our hospital, community, and Central America as they are faced with a second hurricane, Iota, making landfall today and tomorrow.
This year has been blow upon blow against the already tenuous Honduran economy that was largely based on tourism followed by agriculture (industries deeply affected by covid and hurricanes respectively). Our hospital has been increasingly busy as the strain of COVID, travel restrictions, and various sector shutdowns have left many Hondurans without access to healthcare for everything from diabetic management to cancer resection.
Pray for our missionaries and our national staff, who continue to model incarnational Christ-likeness by being physically present to care for and minister to our patients (despite the risk of COVID and the hardships and dangers that hurricanes bring).
Pray for our family as we rest up, and spend time with family- that we would be blessed and a blessing as we visit and rest. Our children are now 8 months, 2 years, 4 years, and 6 years old- pray for them and for the challenges that they face as our family seeks to follow God through all this.
2yo Ruth
Schedule:
We plan to be at Chattanooga Valley Church of the Nazarene for Christ the King Sunday (November 22nd) for the Sunday morning service and an informal evening gathering.
We also plan to be at Judson Baptist, Nashville on the first Sunday of Advent (November 29th) for the Sunday morning service.
Bullet Prayer Request:
-For all those in the path of the incoming category 5 hurricane, Iota.
-Hospital Loma de Luz’s water, electricity and internet supply (and their respective back ups)
-Pray for our return trip, especially with all the uncertainty of hurricanes and ever changing COVID restrictions.
-The hospital’s food supply (the roads and bridges to La Ceiba)
-The safety of our patients and staff who have to come in to the hospital during this storm (think of women going into labor, children with epilepsy, and our essential nurses and lab technicians, as well as doctors who have to come in terrible weather or no).
-The long-term recovery of Honduras, especially the poor who are always hit the hardest by these types of events.
-Our family and especially our children as we seek to put God first, and rightly prioritize their formation and education.
Support:
-Thank you to all of you who have and are supporting us financially. If you would like to send aid to the hospital and surrounding community to help with hurricane relief, we would make sure that 100% of what was given goes to the local needs. See our support page or email us if you’d like more information about supporting us financially or making a one time gift (please send as an email specifying what your gift is designated for if relevant)
-Also, for those of you who might prefer a different avenue, I’ve put together a short Amazon wish list of things that are needed or would be helpful in our hospital and clinic (that we can bring back in our luggage).
It was the best of times, it was the worst of times… it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair…
These are some of the opening lines of Charles Dickens’ classic novel, A Tale of Two Cities. They capture the not infrequent juxtaposition of very good things and very bad things in our lives, without giving either more weight than the other. It reminds me to hold the two in balance – and allow myself to feel and know the bitter sweet reality of life between the first and second coming of Jesus Christ.
Case in point, we have recently had two babies who required intensive care in our hospital; one has done very well, and one did not do well. The first baby is named Estephanie, and the majority of her medical care was provided at the direction of Drs Anne and Isaac Hotz. This is also the infant that I previously mentioned for whom Bethany has supplied breast milk. She was born premature. And while that may not seem like a big deal – it is.
Imagine being in a rocket ship, and telling ground control that “All systems are not go for launch, repeat, multiple critical life-sustaining systems are not functioning.” Only to hear, “We are go for take off.”
Premature delivery shares a similar level of disaster potential as the above scenario. Our lungs, skin, eyes, brain, gut, and fat reserves, are all essential systems that don’t come fully on board till late in a pregnancy. And being born without anyone of these systems can result in a cascade failure reminiscent of Apollo 13.
With Estephanie, we knew from her mom’s first prenatal visit that she was at risk for early delivery, because Estephanie was sharing the uterus with a birth control device called an IUD.
Anyways, with advance notice that the baby might be born premature we were able to give the mom timed steroids to rush the baby’s lung development. We do this whenever we suspect preterm delivery because once a mom’s body goes into true labor, there is precious little that doctors can due to stop the process (especially in rural Honduras).
Ultimately, Estephanie was born at 29 weeks and 3 days of gestational age. At that stage of developmental, with our resources, it was a Herculean task to keep baby nourished, breathing, and avoid sepsis. Remember the brain and fat reserves that aren’t fully developed yet? That means that most premature babies don’t have the coordination or energy to consistently breath or eat independently. So we place a tube down the mouth to allow us to put food directly into the baby’s stomach, and a CPAP over their noses to augment and remind them to keep breathing
But tasks such as feeding, breathing, and keeping baby warm are easy compared to the biggest hurdle that Estephanie faced. About a week after birth, when the basic problems inherent in preemies began to seem surmountable, Estephanie suddenly started showing signs of sepsis or an abdominal emergency called neonatal necrotizing enterocolitis (nicknamed nec). The only known preventative medicine: breast milk (having had Bethany’s milk may be one the reason this baby went on to survive).
The treatment for Nec: no feeding, support the baby, try antibiotics, and wait. The treatment for sepsis: remove any possible sources of infection, give antibiotics, support the baby, and hope. In the case of Nec, if you have to wait more than a day or two you need to order a custom tailored formula called TPN that can be put directly into the baby’s blood stream (bypassing the gut completely which could rapidly necrose and kill the baby if food is put through it). This must be given through a central line (like an IV, but going through a major vessel dumping directly into the heart).
In the case of sepsis, any central line that you have in place is a potential source of infection. So we pulled the old line, ordered the TPN, and tried to put in a new central line. “Tried” being the operative word. Over two days, we tried every possible access point, multiple times, for hours at a time. We prayed, we dripped sweat, we got frustrated with each other, frustrated with ourselves, frustrated at having ordered and transported the expensive TPN from the across the country only to be unable to deliver it the final few inches.
Ultimately, we were unable to get a central line. Without a central line we had to decide when we would allow the baby to have tube feeds- the sooner we fed her, the higher the risk of complications from nec, the longer we waited, the higher the risk of complications from starvation. In the end because baby made a quick turnaround soon after we stopped feeding her we were able to compromise between the two ideal intervals and resume feeds after 48 hours We started slow and praise be to God, Estephanie was able to tolerate tube feeds.
Today, by the grace of God, Estephanie is doing well. She’s coming up on 36 weeks gestational age, and has been discharged from the hospital after almost 50 days. She is no longer needing help breathing and she is able to take a bottle. She is the youngest preemie to have survived at our hospital. Praise be to God.
Our second baby, would have been named Genesis. She was brought in late one evening when I was on call. I was already in the emergency room, monitoring a young boy I had just medicated for an ongoing seizure. I looked up to see a mother being shown in to our ER with a silent bundle in her arms. Typically I let out nurses locate a patient’s chart, get initial vitals, and ask basic questions, but something in this mother’s defeated demeanor prompted me to make the initial evaluation.
I quickly, explained to the parents of the boy with a recent seizure how to monitor their now sleeping son, and crossed the room. The baby’s mom seemed reticent to put her baby down, and when she did I saw a frail, pale, recently born baby girl who appeared dead. She was floppy and unresponsive as she laid in the bed, and I thought she might be dead. But on further evaluation she was taking shallow breaths had a weak pulse.
I urgently called for 2 other doctors to help, and tried to obtain vital signs and figure out what had happened.
The baby’s diaper was full of black and coagulated blood, and her mom said that her baby was 8 days old and had been doing well until she suddenly began vomiting and stooling blood that morning. Immediately her mother started trying to get her baby daughter to the hospital. (She does not own a vehicle or know how to drive, almost all taxis and public transport are not allowed to operate due to COVID, and road blocks are set up all throughout the country to decrease the spread of COVID)- so it took most of the day to get her baby to us.
When my colleagues arrived, and verified that the baby was still alive despite appearances we had enough information to determine that we had a baby on the brink of bleeding to death- who we might be able to save. We called ‘CQ Belfate – Rapid Response to the ER’ over the radio – signaling all available clinical staff to come in and help.
As help came pouring in, we inserted a needle into the baby’s leg bone to begin giving fluids and as soon as our lab personnel arrived we drew off some of her precious remaining blood to check her blood type. More than anything else, the baby needed blood, we later estimated that she had bled out three quarters of her blood volume, prior to arrival.
Under ideal conditions, after attaining her blood type we would simply request the appropriate purified and pre-screened components (packed red cells, platelets, or plasma) from our blood bank, cross match those to insure she would not react, and then transfuse. In our case, we do not have the $20,000-30,000 centrifuge needed to separate blood products. And our blood bank is a list of all hospital personal and community members under their respective blood types (We also test all willing family members who come with a patient to see if we can use them first).
As we were waiting on blood typing, we gave the maximum amount of IV fluid, continued to give oxygen, and, as it seemed likely she was still bleeding internally with an undetectably low blood pressure, we decided to try for a central line (medicines that force the heart to increase blood pressure are called pressors and must be given through a central line).
This was only about a week after our failure to get a line on Estephanie. But miraculously, Dr. Isaac managed to get a blind subclavian line in with one of his first tries. The baby and her uncle were a blood type match so we drew a unit of whole blood from him and started giving the baby 4 teaspoon boluses of blood at a time.
Honestly, we were all a little shocked that she survived that first few hours, and not only did she survive, she awoke to start fussing and kicking soon after her transfusion! Nevertheless, that night I explained to her mother that Genesis was not yet out of the woods, and that if she did survive it would be a miracle from God.
On days 1 and 2, we continued to be amazed at Genesis’ resilience, and started to hope that God might heal her. After her first transfusion, we gave her her first vitamin k shot. We became more and more convinced that Genesis had gastrointestinal bleeding due to at least a vitamin k defeciency (pretty much all babies are born with some degree of vitamin k defeciency).
You know those 2 shots that we give babies right after they’re born? One is a Hepatitis B shot that prevents fulminate liver failure in case of infection, and the other is a Vitamin K shot that prevents rare but terrible events like this one.
Unfortunately, Genesis had been born on the way to our hospital rather than in our hospital. As she was born precipitously in the vehicle before arrival and their family had no money to spare, they turned around and went home, never recieving the vitamin k shot.
The next morning showed that although Genesis’ brain, heart and lungs had bounced back remarkably well, her liver and kidneys were not so quick to bounce back. Those organs showed signs of severe shock and only time would tell if they would recover quick enough to allow her to live.
On day 3, Genesis had completely stopped bleeding into her belly, and her liver seemed to be making a slow recovery, but her blood pressure and oxygen were wavering and she still had not made any urine. Her mother was exhausted from staying by her baby’s side, and afraid to hold her daughter with all the tubes, lines, and devices we had afixed to monitor and respond as needed. At one point, while my colleagues and I were discussing her poor prognosis and worsening situation, baby Genesis had several very low blood pressure and oxygen saturations, her belly was swelling ominously, and I along with Dr. Isaac and Dr. Anne decided to prioritize allowing mom to comfortably hold and love on her baby who seemed to be dying.
We explained to the mom what we felt was inevitable and she was agreeable to not prolong her baby’s suffering. With heavy hearts we disconnected several lines and took off the blood pressure cuffs and pulse oximeter. We were able to comfortably put Genesis in her mom’s arms. Mom asked that we discontinue the oxygen-CPAP so she could just hold her baby and see her beautiful face. I prayed with mom while holding mom’s arms as she cried and gently rubbed Genesis’ head with my other hand. I prayed for God to be with us and baby Genesis. I prayed and cried, I had several words of comfort and hope I wanted to offer, but those words wouldn’t come out. So I swallowed down a sob and simply concluded, “Help us Lord, Amen.” And then waited in silence for a time with mom and Genesis.
But, about one hour after we moved to what we call comfort care (stopping everything that doesn’t make baby more comfortable including oxygen, fluid, and pressors), Baby Genesis went from gray back to pink, from struggling to breathe back to breathing comfortably, and started becoming more active. Genesis really liked being in her mom’s arms!
With such an improvement we talked with mom about keeping the priority of her holding her baby but at least giving some fluids and oxygen to keep Genesis confortable. Mom agreed and Genesis did much better over that night. But still Genesis did not urinate.
I remember coming home that evening to find Ruthie running around with a diaper so wet that it was sagging under its own weight. As I changed that diaper I thanked God that my babies make lots of wet diapers.
The next day I didn’t know what to do. Should I continue to pursue the goal of comfort care, or should I revert to full active treatment? I prayed for wisdom, but didn’t feel like I received any. Ultimately we felt we owed it to this baby who kept hanging in there to give her every chance to survive. Even though she still hadn’t urinated, we were approaching the limit for how long a newborn can survive without nutrition.
She agreed (with some relief), so we again needed TPN (baby probably had a gastric ulcer and was uninterested in eating). TPN takes time to custom formulate and ship, so we had to order it ASAP that morning. After ordering it we needed to change out our central line to prevent sepsis. Given our recent frustrations, Dr. Isaac and I decided to use a process that uses a guide wire to hold the old line’s position while the old line is removed and a new one is placed. In the midst of this procedure the guide wire slipped out of position because it wasn’t quiet long enough.
But mom was in favor of comfort care, mainly because she was concerned that her family would already be unable to pay for what the hospital had already done. (This is a sensitive cultural intersect- in the developed West we are blind to the cost of our healthcare, and never speak about money as part of developing a care plan, in Honduras people want to know how much a life saving surgery will be before they are rolled back). Trying to compromise between the two worldviews, we asked mom to give us one more day to give Genesis every possible chance and we promised to work with her to bring the cost of the hospitalization down to something she could afford. (Our prices are set to be manageable by most Hondurans, keep our lights on, and pay our Honduran staff – for instance a 24 hour hospital admission costs about 20 dollars.)
We were crushed, literally I felt God-forsaken. Once again we had TPN ordered and we’d lost access. We tried briefly to get another line in but in a baby who could not easily stop bleeding who already had a very low chance of survival, we did not feel it was safe or right to keep sticking her.
When I explained the situation to the mother she was incredibly gracious. Her response more than anything else that day assured that we were not forsaken by God. He was right there. In the mother who bore the roller coaster of her infant’s hospitalization with dignity and grace. Even though this was her second child and her first had died mysteriously a few days after birth; she was kind and appreciative of all our efforts, thanking us and praying with us. Shortly after, she asked us to discharge Genesis so she could take her home to die.
The day after Genesis’ mom returned to our hospital to tell us that Génesis had died and to start making payments, we celebrated the discharge of Estephanie to her home, in good health.
It was the best of times, it was the worst of times..
Lydia was crying again, it was 3 o’clock in the morning and her crying broke through the heavy silence of our home rousing me from sleep. I slowly woke up, even as I made my way to her bed, where I knelt tiredly and spoke to my still crying child, “Lydia… Lydia…”
I paused to allow her time to respond but her crying did not calm. So I reached out to pat her back and called out quietly (her sister slept in the upper bunk), “Aravis.”
Aravis is Lydia’s favorite imaginary character to pretend to be (the heroine from The Horse and His Boy, one of the Chronicles of Narnia) and she is almost always motivated to listen and cooperate if we engage her as Aravis.
Suddenly she broke off crying, and began taking a deep calming breath before looking up at me – her lips quirking into a smile – spent tears still on her face.
“What’s going on?” I asked
“I had a bad dream and I was afraid,” she answered in a pitiful little voice.
I stroked her gently as I thought about how to encourage her. I had a similar period in early childhood, lasting about a year where I had regular terrifying nightmares as a child. This came very soon after I felt called to be a missionary (see previous post), and through it my mother taught me, with steadfast love and patience, to pray; in the darkest and most scary places – she taught me that prayer is how we cling to and know God’s presence – even when we feel alone.
As I tried to decide how to respond, I reminded myself that I want my own child to look back and remember the same steadfast love, patience, and power of prayer that I learned from my mother (but I also want to sleep and need to leave for work in 3 hours). We have tried Bible memory (Joshua 1:9), singing songs (Jesus Love Me), saying prayers, and all of those seem are hit-or-miss regarding whether or not she’s able to sleep well thereafter. Reflecting on a conversation Bethany and I recently had about anxiety being misplaced fear, and that our fear should be directed to God, I turned to my daughter and asked, “Aravis who is worthy of your fear?”
-No answer.
I elaborated, “Who should you fear most of all? Dragons, or Jackals, or bad men, or Aslan?”
“Aslan,” she said hesitantly.
“That’s right, Aslan is fearsome, he has sharp claws and a terrible roar, you have heard his roar and even felt his claws before, haven’t you Aravis?”
Lydia’s Wide-eyed little face, remembers, and slowly shakes her head to signal yes.
“Remember, ‘he is not safe – but he is good.’ So what should you fear: scary dreams, loneliness, darkness, or Aslan?”
“Aslan!” she said with fierce excitement.
“And in this world, when you are Lydia, and you awake from a scary dream, who is worthy of your fear here?”
A contempative pause then, in a solemn whisper, “God.”
“That’s right. Now lets pray to Him, because he worthy of our fear but he is also good and loves us…”
Good God,
Guard us in your will – in fear.
Keep us in your will – in love.
Till our love is your love,
and every fear abolished.
Amen
As my family prepares to abandon our positions of financial and physical security – and follow God’s calling on our lives to move to Honduras in a few short months. I have found myself reflecting on my own question, “Who is worthy of our fear?”
Luke 12:4-5 tell us what Jesus told his disciples – in regards to the danger and death they might face for proclaiming the gospel, “I tell you, my friends, do not fear those who kill the body, and after that have nothing more that they can do.But I will warn you whom to fear: fear him who, after he has killed, has authority to cast into hell. Yes, I tell you, fear him!” Jesus goes on to assure his friends that though God should be feared- He is a good and caring God who values and watches over them.
When a perfect, holy, all powerful God chooses to love and redeem insignificant sinners like you and me – the right response is both love and fear. The love part is palatable, but our culture rejects fear and its Biblical relationship to love (and so do we if we are not careful).
‘Fear of God’ expresses the depth of caution, respect, responsibility and carefulness for which our relationship with Almighty God calls. God’s forgiveness and intimacy should not abolish fear, it should enhance both love of the forgiver and fear of the forgiver – a holy God whose nature demands and extends such a costly grace.
Remember Jesus’s parable of the debtor who was forgiven so much by the King, and afterward went out and fearlessly ordered another man who owed him a small sum to be thrown into prison (Luke 7:36-50). It did not, and will not, end well for any man who is not moved to awe, loyalty, worship, and a desire to never disappoint the King. The German martyr Dietrich Bonhoeffer expressed a similar fatal disconnect, in The Cost of Discipleship:
Cheap grace is the preaching of forgiveness without requiring repentance, baptism without church discipline, Communion without confession, absolution without personal confession. Cheap grace is grace without discipleship, grace without the cross, grace without Jesus Christ, living and incarnate… Such grace is costly because it calls us to follow, and it is grace because it calls us to follow Jesus Christ. It is costly because it costs a man his life, and it is grace because it gives a man the only true life. It is costly because it condemns sin, and grace because it justifies the sinner. Above all, it is costly because it cost God the life of his Son: “ye were bought at a price,” and what has cost God much cannot be cheap for us. Above all, it is grace because God did not reckon his Son too dear a price to pay for our life, but delivered him up for us. Costly grace is the Incarnation of God.
So, fear has a good and appropriate place, it is a place holder in the seeker or maturing believer, it takes the place of displacing all other fears and reminding us of the cost of God’s love (for God and ourselves). In view of our fearsome God our earthly fears become weightless. When we fear and love God rightly our lives should beg these questions for others: ‘Towards what are they living? Where is their fear? Why do they love so vulnerably and recklessly?’ Christian hopes and fears are outside of the watching world’s purview, so they cannot quiet make sense of why we do what we do.
As an example, Samaritan’s Purse is one of only 2 organizations in the world that will respond to the Ebola pandemics. Franklin Graham, the president of Samaritan’s Purse, says, “We run to the fire.” Who but a follower of Jesus would volunteer, go to an epidemic hot zone – to work on quarantining an evil with unmatched virulence and a 50% mortality rate? To be Christ ministering to children and adults facing horrific death and disease? The movie trailer below previews the story of another Post-Resident Medical Missionary, Dr. Brantly who responded to God’s call on his life and contracted Ebola while ministering in Africa.
We call ourselves followers of Jesus. Jesus, who did not hold onto power or security, rather he gave it up and became a weak and vulnerable human – the incarnation of God (Philippians 2:6-8). When we follow Christ we may look like fools to the world, but the Bible tells us the proper placement of fear results not only in the displacement of earthly fears, but also in wisdom (Psalm 111:10). Incorrectly placed fear is paralyzing and stupefying. But when our earthly fears are displaced by the awe and fear we have for almighty God, and that fear is balanced with the knowledge that God is good and loves us, we will have the ability to gain true wisdom. Wisdom can flourish when we are equipped to face trials with discernment and peace – making decisions that draw from the precepts of God’s word, are guided by his Spirit, and rooted in the security of his providence.
As our fear of God displaces earthly fears, our obedience and love for God can grow, this allows development of our wisdom and maturity until the love of God grows perfect in us, in perfect love we know perfect peace and every fear is abolished (1 John 4:18).
Almighty God,
Displace our fears By filling us with fear of You,
Conquer our loves By binding us with love for You,
Disrupt our peace By giving us peace with You,
Overwhelm us Lord, By making us holy to you,
Amen.
The views and opinions expressed in this blog are not the views of Samaritan’s Purse or World Medical Mission.
Sometimes, I’m exasperated by the sheer number of times my daughter asks “why?”
Yesterday, after a long day, I asked her to go outside and play just before supper. She asked, “Why?”
Knowing my logical answer would be a bit raw I went the whimsical route (for sanity’s sake). I dutifully explained that over the course of the day, due to a lack of sunshine, argumentative imps had began growing and multiplying on her shoulders. At first whispering in her ears then climbing into her ears and finally crawling out her mouth and attacking her sisters. The only easy cure for this problem, I explained, was sunlight, which melts argumentative imps into nothingness.
This brought out enthusiastic and playful obedience as my daughter went outside with me and asked me to flesh out this new imaginary game.
And as I played in the evening sun with my daughters. Watching with my imagination as the little murky figures on their shoulders dissipated, and their attitudes and dispositions truly transformed, I wondered how much truth my fiction spoke.
Notice the lack of argu-imps on the subject’s shoulders!
In our missionary training we discussed how world view differences that can be so difficult to overcome. Particularly the gulf between the scientific and the animistic world views.
In general my culture adopts a scientific view of the world that is largely mechanical, and completely compartmentalizes the spiritual reality (when it allows for one). The animistic worldview is one of myth, magical thinking, and indivisible interplay between the spiritual and physical world, with all creatures, things, and ideas having spiritual essence. Christians who attempt to submit even their worldview to the truth of scripture have the tricky task of trying to look through the lens of their own worldview at scripture, spot the defects within the lens through which they’re looking, and correct it.
One such defect in my own worldview is an artificial compartmentalization of the spiritual – especially when it comes to medicine. In my worldview there is scarcely any overlap between the physical and spiritual causes and effects. But when that overlap does occur, when the physical and spiritual realities are obviously present together, (in a consistent manifestation of God’s grace) , as in the case of the Lord’s Supper or baptism, we call those nexuses sacrament.[1]
So what if sunlight is not just a calculable photon bombardment, what if it exerts a spiritual force. What if just as it catalyzes reactions in our bodies, triggering the release of chemicals in our brains, it’s does something at the soul level? Or what if, as in my imp explanation, it negatively affects the powers that war against us that are not flesh and blood?
Either way, as a doctor and minister, I recommend at least 10-15 minute of sunshine each day for its salutatory effects.
Whimsically Yours,
The Reverend Doctor Nathan
[1]- Sacrament can also be more specifically defined as specific actions that were instituted by the Lord, and commanded to his followers in perpetuity. Clearly, the sacraments that conform to this more narrow definition sacrament are to be performed and reverenced above all others.
The views and opinions expressed in this blog are not the views of Samaritan’s Purse or World Medical Mission.
Last night my family medicine residency came to its completion. My formal training as a physcian is done (at long last – praise be to God). It still feels surreal. I offered this blessing last night at the beginning of our graduation dinner and ceremony.
Father God,
We give you thanks:
For long hours, hard work, difficult patients, and demanding training,
For by them you have refined us into ready and resilient physicians.
We give you thanks:
For short days, simple tasks, grateful patients, and gracious teachers,
For by them you have freed us to be refreshed, faithful, and fun.
We give you thanks:
For 3 years of hospital food – that we may have neglected to bless,
For 3 step exams – we’ll never have to sit again,
For 3 years of family medicine residency – completed.
And now we ask your blessing:
On tonight’s food and friends –
may the calories be short-lived and the friendships eternal.
And on tonight’s graduates –
May the Lord bless us and keep us,
With grace, guide our service and attitudes,
With peace, guide our actions and our stillness,
With joy, guide our hopes and dreams,
With love, guide our hearts aright,
Send us forth in your spirit of healing and love.
In Jesus’s name,
Amen.
-Nathan Gilley, Murfreesboro TN, June 29th 2019
My Family – Celebrating the Completion of Residency.
The faculty and graduates of UT – St. Thomas Family Medicine Residency, Murfreesboro, 2019
Kingdom Outpost - The Gilley Family 