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.
Dear Mr. Fingerly (my middle school math teacher),
Thank you for all that you did to help me learn the deep joy that can be found in doing math. I vividly recall the fun we had plotting catapult trajectories and testing the load bearing limits of our tooth-prick bridges. But moreover, I remember the class where you gave us just enough guidance before pushing us to discover the FOIL principle for solving binomials independently. I remember the moment it clicked, and how I understood without being shown, what needed to be done. I believe that single success and the joy that I found in that grappling and intuition, started the process of turning me into the geek-doctor that I am today – thank you.
I also want to let you know that about once every month or so I use the fraction cross-multiplication and unit cancellation that you taught us in 7th grade (You had us use very silly made-up measurement systems) to save someone’s life.
This morning for instance, I had a critical potasium on a septic baby right as I had begun working on making breakast for my girls. I promptly abandoned the omlet I was making to its fate (but Bethany saved it and got it to Ruthy’s plate), grabbed a #2 pencil and a blank sheet of paper and then started recording my data points to begin setting up my fractions. A 8.3 kg baby needs IV potasium. The dosing is 1mEqu/kg/hr. The potasium comes in 20mEqu/10ml. How much normal saline should the potassium be diluted into and at what rate should the pump be set…
Multiply denominators and then numerators,
check that units cancel,
cross-multiply to find the amount of dilutent and
Viola!
(I did send my calculations to a colleague for confirmation before starting the drip.)
This little guy thanks you too!
So thank you Mr. Fingerly, and all my other wonderful and profoundly influential teachers. I pray that you are richly blessed in the knowledge that your lives are being and have been well spent, that you have and are doing kingdom work as you labor to light a spark in your students.
Grace & Peace, Nathan Gilley
P.S. The title pun is especially for your enjoyment Mr. Fingerly
For simple sentences, especially with globalization, many western languages have one-to-one translatable words and constructs. Another words, if I want to say, “Give me the red ball.” You can generally find and put together that same meaning nearly word for word. But sometimes when you translate from one language to another you are presented with a choice (or robbed of a choice) that you did not have in the original language.
For instance in English I might say, “Take a deep breath,” to my patient. But in Spanish in order to give that command, I must choose whether I will use the formal or the more familiar conjugation of the command (there is no neutral). So rather than one-to-one, the meaning translates one-to-two. I used to think that most Spanish speakers were so gracious and appreciative of those who took the effort to try and speak their language that details like formal or informal conjugation were largely inconsequential.
But even though the cultures of Latin America are often warm, welcoming, and appreciative. Language does not simply speak to our rational brains. Language, with all its facets from grammar to tone, inflection to facial expressions communicates so much more than “Take a deep breath.” You can imagine how the same command can communicate respect or disrespect, affection or uncaring, frustration or “I have time for you.” Now imagine if your language had grammatical constructs that made you decide between respectfully distant vs chummy.
Case in point – I spent some time in Romania and Bulgaria where people typically shake their head side-to-side to mean yes. I quickly came to know this piece of information. But in my short time among the people there I never ceased to be at least somewhat confused each time someone would say “yes” or “da” and then shake their head in the pattern that my brain understood to mean “no.” Even though my rational mind knew that shaking the head back and forth meant “yes,” my ingrained subconscious perception could not be so easily changed.
So although I still appreciate how gracious the Honduran people are when I fumble my verb conjugations. I am becoming aware that a listener cannot always control their subconscious reaction to language patterns that are in-grained from early childhood.
This is a list of all the possible forms of a single verb ‘Hablar,’which means ‘to speak.’
There are other important language differences that are even more difficult for me to grasp than strict one-to-two vocab or grammar changes. These are the internal resonances and more abstract conceptual differences that cannot be taught by a dictionary or captured by a translation program. For instance, the other day I was sitting in Church and the sermon was being translated from English to Spanish. The preacher was relating how our Christian journey was so similar to the journey that the early American pioneers made in covered wagons to settle the West. How they banded together to protect and support one another, crossing treacherous terrain, deserts, and rivers to arrive finally in a place where they could be safe, settle and make a better living for themselves and their families.
Unbeknownst to the preacher, any decent translation of that story into Spanish in present day Honduras resonates inescapably with the language of undocumented immigrant caravans fleeing Honduras, banding together, traversing deserts and rivers, to try and find a better life in the USA. This was an unintentional parallel, completely invisible to anyone who has not been immersed in Spanish language conversations and news pieces about the issue.
Finally, I think you have almost enough background to understand why I am writing this blog. Let me explain to you one more Spanish grammar difference: Spanish has very specific rules and ways of expressing something called moods. Moods convey whether you view what your saying as fact or possibility, question or command, etc.
In Spanish, we almost all begin by learning the indicative mood- statements of fact. “The patient has pneumonia.” “Your child has a fever caused by a virus.” But to communicate one’s own emotional perception (desires, doubts, wishes, and possibilities) you have to incorporate specific grammatical structures that change each verb in slight but distinctive ways (and this change is dependent on the individual verb, so each and every verb can change in its own special way)
As a doctor I unfortunately, rarely get to deal in absolutes (meaning the indicative mood). The questions that I get almost always demand a more complicated answer. Questions such as: “Is there any chance he could get worse?” “Are there any symptoms that should make me bring my baby back to hospital?” “Does this medicine have any effects?” “Will this treatment cure me?”
The best answers to each of these questions includes the use of the subjunctive or conditional verbs (because the answers refers to things that are not yet known to have happened). I will answer each of the above questions as I would in English:
-I think he will get better, but in rare cases people can worsen.
-Your baby appears healthy and I expect she will gain weight, grow, and develop normally. But if she isn’t gaining weight, has a fever or a seizure bring her back immediately.
-Yes, all medicines can have side effects. But I doubt that you’re likely to experience any side effects if you take the medicines as I have prescribed them.
-I hope and pray that this treatment will cure you. But I cannot tell you for certain what the future holds.
This is brain defect I recently diagnosed in a 3 year old boy who came into our ER with seizures. I had to tell his family that most children with this defect stop developing at around 3 and need continuous care and anti-seizure medicines for the rest of their short lives, but occasionally children develop near normally despite the defect.
My problem is that all those answers are still really hard for me to put into Spanish in a fluid and clear way. I have work arounds and I can often make myself understood. But these are critical grammatical points, that can make the difference between what sounds like a compassionate, callous, confused, or confident reply. When dealing with particularly delicate what ifs and generally sad possibilities I don’t want to sound heavy handed (indicative used incorrectly) or confusing.
Case-in-Point: Imagine if you were very worried about your child and your pediatrician in a tone of compassionate reassurance said, “He will probably get better, but will not.” Even if your rational brain knew what the pediatrician was trying to say. Your subconscious reaction would be at best confused, and at worst distrustful.
Perhaps you will remember, that we started our journey with Samaritan’s purse a little more than two and a half years ago. We traveled to the Spanish Language Institute in Honduras, with the intention of studying Spanish for 6 months.
The walk to language school in Siguatepeque, Honduras
Six weeks into those studies, we traveled across the country to Hospital Loma de Luz because Bethany was nearing her due date and we wanted to give birth with providers we knew and trusted. Unfortunately, the day after Hannah was born COVID shut down the world. Including travel within Honduras. Due to the needs of our Hospital and our inability to return, I began working.
The birth of Hannah at Hospital Loma de Luz
As we near the completion of our contract with Samaritan’s Purse they have agreed to let us go back to language school for the month of July. We are excited and thankful for this opportunity to improve our Spanish and prepare ourselves for longer-term work at Hospital Loma de Luz.
-Please pray for our family as we strive to improve our Spanish, and communicate well with our friends, neighbors, and patients. -Pray for our children that they will have receptive and eager attitudes towards learning Spanish. -Pray for Nathan, that he would be able to memorize and consistently apply grammar rules (which can be so important) -Praise God that Axel (my 4 year old patient with refractory nephrotic syndrome is almost completely off medicines and doing well) -Praise be to God I was able to give my schizophrenic patient his long-acting antipsychotic injection early this morning. -Pray that he will be willing and able to continue receiving these injections- and more importantly that by God’s grace and good medicine that he will be able to sleep normally and be helpful rather than destructive in his home and family. -Pray for our Hospital and its leadership, that we would have wisdom, grace, and kingdom focused purpose as we work and serve together. -Praise God our Hospital is coming up on its 20th anniversary operating here in Honduras -Pray for our family and Bethany who is pregnant with our 5th child (this is your reward for reading all the way to the last prayer request – Thank you for your prayers and willingness to be with us in spirit).
Grace & Peace,
Nathan Gilley & Family
Gilley Family Photo by Stephen Rudge
The views and opinions expressed in this blog are not the views of Samaritan’s Purse or World Medical Mission.
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
Christopher Columbus, as you may have heard, opened up the Americas to European exploration with the patronage of the Spanish monarchy at the end of the 15th century. What you probably did not know, is that on his fourth voyage in 1502, he sailed along the very coast that I look over every day from our porch.
Legend has it that after exploring the area between the bay islands and the mainland he proceeded southeastward, where the water become very deep immediately off shore. There he was caught in a tropical storm (something we are very familiar with of late). Finding refuge in a eastern cove he exclaimed “Gracias a Dios que hemos salido de estas honduras! [Thank God we’ve escaped these treacherous depths!]. From that exclamation, the area where he took refuge became the Departmento known as Gracias a Dios and the entire territory, later an independent country, came to be called Honduras.
Now you know how Honduras got its name. Which probably has something to do with why the name Cristofer is popular to this day in Honduras. In fact, the six year old boy currently on my inpatient service for the last week and a half is named Cristofer. And he, like his namesake is going through a harrowing time. I would like to tell you his story so you all can pray with us, help support him as you feel led, and hopefully in 3 or 4 weeks be able to say, “Gracias a Dios – Thanks be to God, he has made it out of danger!” as we send him on his way home.
Cristofer came in to our emergency room a little more than a week ago. His parents were at their wit’s end and knew with a parent’s intuition, that something was very wrong with their youngest son’s abdomen and that his time was running out.
The story of Cristofer’s abdominal problems began when he was 2 years old, Cristofer had to have an abdominal surgery due to an intussusception, a problem caused by bowel sliding back into itself and getting stuck – like a telescope collapsing down. The surgery was successful and he went on to live and grow normally till he was 4 years old. At that time, his intestines became knotted up due to the scars left by the first operation. This required another surgery, and the removal of some of his intestines. Once again, the surgery was successful and he went on to live and grow up normally for a further 2 years -until about 2 months ago.
2 months ago, he started to have belly pain, nausea, and vomiting. He was hospitalized and found to have another knot or bowel obstruction. this time the surgeon told his parents that part of his intestines had turned black. Further bowel had to be removed, and the surgeon was confident that he had removed the problem and repaired the remaining bowel. Cristofer was discharged home. But over the intervening weeks he never seemed to get better. He continued to have vomiting and belly pain, and then he started to lose weight.
When he was brought into our Emergency Room, he was still able to walk and talk, but it was clear that his body was very malnourished. His body had consumed whatever fat stores he had, and now had begun to consume his own muscles.
This is Cristofer 2-3 months ago walking down the road and 1 week ago
After talking his case over with our surgeon and other doctors, and doing several tests including sending him to the nearest large city to have a CAT scan, it became clear that Cristofer has a small bowel obstruction that almost completely blocks his food from going more than a few feet past his stomach (the small bowel typically absorbs nutrients over the course of about 20 feet of looping intestines).
All of this means that Cristofer needs yet another operation. But with an abdomen that has a proven track record of forming problematic scarring and a very recent surgery – the chances of long term or even short term success are not good. If we were to operate immediately, cut open the problem portion of bowel and stitch it back together; at his current level of nutrition he would be unable to heal the wound before the sutures dissolve, at which point he could die from a bowel leak. To improve these odds, our surgeon has asked that we buy Cristofer time (so that the abdomen can heal up and calm down from the most recent surgery), and give him the best chance to respond well and recuperate after the next surgery.
To that end we have begun the arduous process of giving Cristofer TPN (Total Parenteral Nutrition- nutrition put directly into the bloodstream). This is a sterile custom mix of the basic building blocks of proteins, sugars, fats, and electrolytes recalculated every 2 days to meet Cristofers day-to-day nutrition needs. Our TPN has to be ordered from San Pedro Sula (half-way across the country), made up and shipped on ice via busses and couriers and whoever we can beg- so that it can be hung in a chilled box and pumped at a set rate through a UV proof tube.
Rather than belaboring how time intensive, detail oriented, and relatively expensive this process is- simply understand that my children and my wife think that I have adopted a fifth child named Cristofer with whom, or on whose behalf I am spending more time than I am giving any of them.
I am writing this to include you in the ministry that we do here. To ask that you pray for the upcoming surgery in 2-3 weeks. And to ask if any of you would like to help us pay for some of his care. Each bag of TPN costs a little more than $200 USD, and a bag lasts for 48 hours. So we are probably looking at around $5,000 USD just for the TPN.
Nevertheless, please don’t take this as a desperate plea for help- Cristofer will get the TPN, and our hospital will figure out how to eat whatever cost his family cannot pay. But if you feel led to give, we’ll be happy to put your money towards this or similar direct patient care projects. If you already give to support us, know that you’ve already taken a massive chunk out of all our patients’ bills – because they didn’t have to pay anything to their doctor.
I am sorry to tell you that the little boy Alan, who I wrote to you about previously, died a few day after my last blog. We believe that his brainstem- which controls things like heart rate and breathing rate was severely damaged during one of the times when he stopped breathing, and so he continued to worsen until he finally passed away.
Axel, the 3 year old with the life-threatening kidney problems, has had mixed results. His kidneys seem to be doing better sometimes and then go back to letting protein slip through. He is on a medicine that is not good for him long-term, but cannot be decreased or stopped unless his kidneys stop letting protein slip through. Please continue to pray for him.
Today I received my first ever live chicken gift! (I have long dreamt of this day.) He was given to me by a very thankful, and very poor family of a patient that I took care of in the hospital a few weeks ago with a diabetic coma.
Hannah Faith Gilley, our little baby girl, born here in Honduras several weeks after we came here, is turning 1 year old this week!
Grace and Peace to all of you. May the Lord richly bless your upcoming Holy Week and Easter.
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).
Warning: The following story may prompt incredulous laughter and children to ask uncomfortable questions.
Dear Dad,
Maybe I should have followed in your footsteps and become a better baseball player, you know, to make me a better doctor.
Nevertheless, I am happy to report that the secret playroom kickball matches that Jerod and I played allowed me to develop the skills necessary to become a competent physician. You see, just a few weeks ago, as I started my morning rounds, my very unpracticed sliding-into-homeplate manuever was put to the test:
I heard a yell in the hallway leading to surgery and went to investigate.
Arriving there I saw a pregnant woman, waddling towards me. Her eyes were wide with the shock and terror of a person betrayed by their own body. And as I ran forward to assess the situation I quickly saw the reason; upon seeing my querying expression she hiked up her hospital gown to reveal her baby crowning.
Her family and a few nurses were trying desperately to help her get to our labor and delivery room. But I determined this baby was going to come before we could possibly get her to a bed.
“We’re going to need to deliver the baby here,” I said with authority.
With relief the mom stopped trying to move forward and immediately began to sink to the floor. Fortunately her family members promptly stepped up to support her as she began sitting back. Unfortunately, as soon as her knees bent and she began to squat, her baby took advantage of the more open pelvic outlet as well as the increased abdominal pressure generated by her squat.
Noting this, I dove forward, my arms reaching out to catch the slowly falling baby and mother. The amniotic fluid on the tile floor helped me to slide easily into position at the mom’s feet. With my right hand I worked to catch the baby that was slipping rapidly out for a head first dive. And with my left hand I tried to push up and away on the mom’s buttocks that was coming down to land on top of her baby.
When the proverbial dust settled, we’d managed to all land safely in a somewhat slippery and slightly bloody pile, with a joyfully screaming little baby cradled in my arm connected by his umbilical cord to his mom who was slightly shocked and somewhat on top of me.
All we needed was an umpire to stare down at our strange pile and then after a pregnant pause, dramatically yell, “Safe!”
Love, your son, Dr. Nate
Dear Mom,
Remember one New Year you asked Dad, Jerod, and I to each tell about a miracle that we’d seen. Ultimately that led to a discussion about miracles, because for you, every day was filled with miracles: from rainbows to children to happenstance meetings- you saw Divine fingerprints everywhere; for Dad, Jerod, and I the world was a significantly less miraculous place. We weren’t sure we’d ever seen God reach down and definitively perform a miracle.
Well, I’ve decided that your view of the world is the better one, and I would like to tell you about a miracle I recently witnessed.
You see, the little baby that I caught in the story above (Yes, the story above is totally true, and yes Jerod and I did secretly play kick ball in our playroom, frequently, and without ever breaking a window), that baby started to turn yellow 12 hours after he was born. Now that’s not too uncommon, he was jaundiced, and we can treat that. We put him under some blue lights that convert the yellow, problematic bilirubin to a form that can be disposed of by most any liver.
I say, “most any,” because on rare occasions the drainage system of a liver is incompletely formed or the infant’s liver cells are genetically incapable of doing some basic function that causes excess production or diminished disposal.
I say all that because, after we put the baby under lights, instead of turning a beautiful Honduran brown and going home, he turned green. He turned green because his liver had one of the two problems detailed above.
When I investigate what could be done to help this little fellow, I found myself running into dead ends (grim pun intended). In Honduras, you do not want to be a green baby. Most likely you are stuck looking for an expensive, risky surgery that only a handful of hard to get to surgeons can do (to repair your drainage system). The other, equally tragic etiology, for our low resource patients, is that this disorder could arise from a super rare genetic problem that will be almost impossible to diagnose and likely will be equally untreatable.
As I often find myself doing, I first explained the poor medical prognosis. In this case I explained to baby’s mom that from strictly a medical perspective her baby had a serious and life-threatening problem. As stated above, the most likely cause was a problem with the liver’s drainage system. Untreated, this often results in death after a few months. So we would do further investigation and begin reaching out to arrange for treatment if necessary and possible. (We would also be reaching out for help from our donors because just the trip to see the surgeon in the big city would have been cost prohibitive)
Then, I concluded with your perspective, mom. I reminded this mother that we believe in a God who is all powerful and can do miracles. So even as we do everything we can medically, we also pray. The mom and I prayed for healing multiple times, specifically for God to allow this little boy’s bilirubin to get out of his system.
I have prayed many such prayers, and most of the time God either answers those prayers through the medical care being provided or the patient dies. But, occasionally, Divine fingerprints are a little more overt. Like this time, where visit by visit the little boy’s color, weight, and labs improved with no treatment beyond earnest prayers of hope and thanksgiving. A few days ago he came in for a check up and was totally normal.
Whether this was God directly altering the baby’s physiology or not, I do not know. But one thing I do know, he was a sickly-appearing, green baby and now he is healthy and brown.
And at that visit I praised God with his mother for the miracle of her son’s life.
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..
Kingdom Outpost - The Gilley Family 