A Tale of Two Babies

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).

X-ray of a baby’s distended abdomen due to nec

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..

Grace & Peace,

Nathan Gilley

Walking by Faith through Dark Valleys

The doctors at Hospital Loma de Luz, take 24 hour call 1-2 times a week. That means that from 7am to the next morning’s 7am, any emergency or obstetric problem that comes into the hospital will be primarily the responsibility of the on call doctor. For my first 2 months here, each time I was on call I had someone assigned to back me up and show me the ropes. This is necessary because the norms of treatment, follow-up, and getting things done are so different from how things are done back in the USA that you need someone to walk you through a lot of different scenarios before you can really work independently.

For instance, if you need to give your patient a medicine through an IV at a specific rate in the US, you simply enter the order and wonder why it takes the pharmacy and nurses so long to do it. Here you go to the pharmacy, retrieve the medicine or find an adequate substitute for the medicine you wanted but don’t have, find syringes and fluid bags, then mix the medicine into solution at a concentration that will allow you to run it through a pump (A lot of moderately complicated math). Find a IV pump, place an IV if the patient doesn’t have one, hook it all up and program the pump to run at your desired rate… and then wonder what happened to the last few hours.

After about 2 months of call with back up, I recently started taking call independently. My first two independent call shifts were rough.We have an awesome team that is very supportive of one another, but we also try to take care of each other by handling anything we can independently, and only calling for help when it is absolutely necessary (especially during the night). During my first shift I had about 6 medically complex admissions topped off by a young man who came in with 4 gunshot wounds – 2 to the neck, 1 to the chest, and 1 to the abdomen – whereafter I promptly called and received help. But all of the patients did well, and were pretty clear cut from a diagnostic and treatment perspective.

My second independent call shift was not so clear cut.

Things were generally okay during the daylight hours, but as dusk settled I started getting calls.

Hospital Loma de Luz at Night

Out of the several ER patients that I was called to come in and see, I can now only remember two. At about midnight I saw an older gentleman brought in by his son because he was having trouble breathing. I was able to determine that he was fluid overloaded due to advanced liver failure and a recent medicine change. This was based on the history that I obtained from his son and my physical exam because we do not have lab or X-ray available during the night (except for clear life or death decision points that prompt us to call staff to drive in from the surrounding community during the night). So I talked with his son about our treatment plan, his good short-term but poor long-term prognosis, and then started the treatment which I would modify based on the labs that could be done in the morning.

I went back up my house, but before falling asleep I was called again. It was about 2am…

A 21 year old girl with abdominal pain and nausea was brought into the ER in middle of the night. Her blood pressure was too low but she was conscious and it was not worsening, her abdomen was rigid, her blood sugar was too high for our machine to read and she was becoming deathly pale. She had a strange history of going to a different hospital the previous night, going home, resting, eating, then coming into our hospital for the same unbearable pain that had sent her to the other hospital.

I began to treat her identified problems individually, but was not sure of her unifying diagnosis. As I was trying to decide if I should call for help or lab, one of the nurses asked me to come quickly. I followed and she took me hastily to the room of my patient with liver failure explaining that she had just gone to check on him and found him dead. I entered the room where the patient’s son was by his bed – unaware that anything was out of order. I confirmed the patient was dead and then tried to gently but clearly explain to the son that his father had just died unexpectedly. After taking as much time as I felt I could, I went to check on my 21 year old female patient and found that her oxygen saturation was dropping. With my confidence shaken and my patient doing worse, I promptly called for help from the more experienced physcians.

Ultimately, we determined that she had a very dangerous condition called diabetic ketoacidosis (DKA) coupled with the even more deadly condition called sepsis. As we tried to treat her, we came to an impasse. The treatment for DKA is to rapidly but carefully lower the blood sugar while simultaneously addressing the acid-base and electrolyte disturbances created by both the disease and your treatment of the critically elevated sugar. To do this right, one needs to monitor and replete the electrolyte called potassium, while monitoring and correcting the acid-base status, and constantly titrating your insulin to lower the sugar (in the USA most hospitals purchase a proprietary software uses a complex computer model to anticipate the patient’s blood sugar responses and guide insulin titration).

Problem #1: Our acid-base test is so finicky it cannot be trusted.
Problem #2: Our electrolyte machine broke 2 days ago.
Problem #3: The country is shut down for COVID-19 so getting the replacement part will take at least a week.
Problem #4: Septic shock is the body’s final, unregulated and often devastating response to an overwhelming systemic infection. It’s treatment is to give copious fluids, broad-spectrum antibiotics, and start life-support measures like pressors and a ventilator while rapidly determining the source of the infection.

This is the tight rope we were walking:

If she becomes to acidotic she will die – and both DKA and sepsis create acidotic states.
If we leave her sugar that high she will die of sepsis – if we drop her sugar too fast and she goes too low – she will go into a coma and likely die.
If we do not give her adequate potassium near the time when her potassium begins to drop due to our treatment of high sugar – her heart will not be able to keep pumping – if we give her too much potassium, well, potassium is the drug of choice for lethal injection.

With these limitations, we did everything we could to help this young lady. We prayed for wisdom and healing and made our best educated guesses on what to correct – when.

Ventilator

For a while the patient was stable on two forms of life-support: pressors and a ventilator. I had spoken with her mother and our chaplain about the gravity of her situation (she had already required chest compressions and life saving medicines once that morning, which decreases the odds that she would survive to be discharged). I then went and saw my clinic patients. I checked on her several times throughout the day and I started to be hopeful that she might pull through. We arranged to split shifts to run her ventilator between 3 doctors who were not on general call that night (we do not have any respiratory techs or dedicated ICU nurses). I went home, explained to my girls in very basic terms why they hadn’t seen me for so long, and we said a prayer together for my patient.

That night, my patient’s blood pressure started dropping and despite chest compressions and meds, she died.

The next morning my 5 year old asked me how my patient was doing, the one for whom she was praying. I told her that she had died during the night.

“Why?” she asked.

“I don’t know.” I answered. And I don’t know. I don’t know why she died.

Medically, I don’t know if she died from an infection for which I wasn’t covering, an electrolyte imbalance I caused or didn’t correct, or something I had no control over. Spiritually, I don’t know why God didn’t answer our prayers for this 21 year old girl, when other times he so miraculously intervenes (like in my previous shift when the man who was shot 4 times, twice in the neck and head, walked out of our hospital after prayers and surgery).

I understand the philosophical arguments for why bad things happen. Abstract discussions of love, free-will, the effects of sin on creation. But I don’t believe there is a simple or straightforward answer to my daughter’s question. I believe the best answer is either silence or “I don’t know,” followed by an example of continued faith and prayer that mourns and wrestles with what happened while faithfully doing the next right thing. The Bible says we walk by faith and not by sight. Despite what we see or cannot see around us, we keep walking in faith.

I was hurt and saddened by the loss of two patients from the same call shift. But I keep walking by faith. I trust that God is good and faithful.

Nevertheless I went into my third call shift with some trepidation and prayer that God would give me a little more time to recover before my next medical disaster. And I am happy to report that my third call shift was rather uneventful. That morning, as I was nearing the end of my third call shift, I gave thanks to God that instead of severely ill patients I had the opportunity to be on the other side of things. I helped a mother deliver a healthy baby boy into the world in the wee hours of the morning. And as I went home, I stopped at our overlook and took in this view:

Clearly to me, God is at work in our world. I don’t always understand how He chooses to work, nor do I always know how I should pray. But I hold onto the faith of Jesus Christ and trust that He will not allow us to be tested beyond what we can bear.

Blessings on you all,

Nathan Gilley

Please pray for our family as we continue to settle in, push through culture/COVID shock, and the newborn phase of sleep deprivation.

And please pray for the preemie baby in our hospital. Bethany provided breast milk for her until her mother’s milk came in, and the baby has survived almost a week now, but she has several more weeks before she’ll be out of the woods.

A Brief History in Snapshots

 

This is a brief overview of our recent time here in Honduras.

Bethany (with baby Hannah showing) learning to make pupusas during her last language class before we left Siguatapeque, Honduras for our trip across the country to our mission hospital for Hannah’s delivery. We left in the first week of March and Hannah was due March 26th.
Elizabeth and Lydia finishing up the Spanish alphabet in their last Spanish class -before what was meant to be a short 2-3 week trip to deliver Hannah and then return.
Days after our arrival at our mission hospital – Elizabeth, Lydia, Ruth and I are making a morning trip through the mangrove forest to the beach (letting mom have some peace and quiet). Our mission hospital, Hospital Loma de Luz, is strategically positioned in the midst of several underserved communities along the northern coast of Honduras.
Ruth is backpacked on me, because the walk from our guest house above the hospital to the beach is very steep. The mountains pretty much rise up immediately out of the coast and our houses and hospital are terraced up the side.
The beach is beautiful, and if you swim out a few hundred feet you can even find a coral reef.
The ocean side of this beautiful house on the left is where we get to live and weather the COVID19 pandemic. Shortly after our arrival at Loma de Luz, COVID19 began to spread across the globe.
Not long thereafter our food supply became a little bit irregular. This is a picture taken by one of our fellow missionaries and sent to us via Whatsapp meaning – Get down to the vegetable stand in Lucinda quickly – they have some veggies while supplies last.
I like to tell Elizabeth, “Be careful, it’s a jungle out there.” It took some explaining, but now she thinks its a little funny.
We have quiet time in the afternoons, but most of the time its too hot to really sleep, or even lay against mattresses and pillows The occasional ocean breaze is always welcome. And we are thankful for fans and the beauty of our enviroment.
This is the view from the water tower above the houses. Its fed by spring water. Our whole family hiked up to the water tower. One of many treks in the final week before Hannah came, trying to hurry things along. 🙂

On the day before Hannah was born my kids and I completed this video project with several of their friends.

10pm – Bethany at our house: “I’m having contractions.” Nathan: “Okay.”
11pm – Bethany at our house: “I think we need to get ready to go to the hospital.” Nathan: “Okay.”
12am – Dr. Anne at our hospital, “You’re pretty much completely dilated, are you ready to push?.” Bethany, “Yes.”
12:45am – Baby Hannah at our hospital, “Aaaaaaaaaaaaaaaaaaaah Aah Aah!”

2 hours after delivery, we’re heading back up the hill to the house! (Our next door neighbor is Dr. Anne, and there are some advantages to not having an epidural)
Lydia loves holding babies.
She’s pretty indiscriminate.
Elizabeth also loves to hold babies and help out. Its was hard for the girls to just let Hannah sleep so much of the day away when they had so anticipated her birth.

Getting the girls out of the house so mom can just think about taking care of herself and Hannah for a moment. This was one of our last truck trips as a family before Honduras began enforcing general quarantines, travel bans, work bans, beach bans, and strict curfews.
Fortunately, staying off the roads and not gathering together does not prevent us from going on hikes, visiting our neighbors in the hospital compound, and playing outside. 
Our front porch looking out at the ocean.

COVID19 in Honduras: on the left is a bleach spray down/check-point to enter the nearest major city. On the right is our hospitals COVID19 isolation/triage area where we were doing a practice run recently. (We haven’t seen any confirmed COVID19 cases at our hospital yet.)

On Good Friday, Bethany’s birthday, and Hannah’s 13th day of life, Bethany carried on our family’s tradition of hosting a passover seder during Holy week. This year we did the whole ritual meal and story telling in English and Spanish. Bethany made matzah from scratch (in addition to all the other feast foods, for our 14 place settings). We also had to substitute ginger for horseradish. My wife is incredible!

Bethany’s mom always bakes her a red velvet cake for her birthday. Also, Bethany’s mom also always comes and lives with us to help us through the first several weeks of the sleepless newborn period. But, a few days before Bethany’s parents were to come to Honduras to be with us, the borders closed due to COVID. Ergo, Bethany baked her own cake this year (the day after her birthday due to passover preparations)- and this is what happens when you let a red velvet cake cool to room temperature before icing it – but room temperature is 95 degrees fahrenheit. Thankfully – if you close your eyes (or leave them open) it still taste great. Ruth, “Yuuuuuuummm”
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On Easter morning we had a small open air gathering with our neighbors in our mission community. I read the resurrection account from John, and several of the children acted it out as we went. This is John (Josiah H) looking into the tomb, while Peter (Elizabeth G) catches up. (Ruth is dressed as an angel, ready to be popped into the tomb shortly)
Ruth somehow got something stuck in her left eye. And for nearly a week it did not move and we were unsuccessful at flushing it out with water. Ultimately with prayer and a little trepidation we took her into the hospital where Dr. Jeff and Rosanne sedated her and removed the foreign body without any complications. Thanks be to God.
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Most work in Honduras has been halted for almost a month now. In the communities around our hospital, this means people have run out of money and are running out of food. The hospital and the local churches are pooling resources to give out food bags to the families in need, to supplement the government’s relief efforts. Elizabeth, Lydia, and I went up into the mountains behind the hospital to this community to help give out food.
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As in the USA, all schools have been closed in Honduras. This is the mountain community’s one room school house that my kids were exploring with the neighbor kids and some fellow missionary kids
I hope you all get a glimpse of what life here is like for this time. I have began working in the clinic and taking call at our hospital during all this to prepare for whatever future God has for us. We don’t know when or if we’ll return to language school, so we’re trying to take things day by day and grow where we’re planted.

I am Thankful – A Million Times Over

If a picture is worth a thousand words, could a thousand pictures express my gratitude to God for bringing baby Hannah out of her mother’s womb and safely into the world in the wee hours of this morning? I don’t think so.

Nevertheless, I’ll try to capture these moment and my heart that is heavy with gratitude:

 

This is our entry in the Family book for Hannah’s birthday.

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Thank you for your thoughts and prayers.
Keep us in your prayers as we add Hannah to our family life.
Grace and Peace to you all.

Nate Gilley

For I Know the Travel Plans I Have for You

For I know the travel plans I have you

The last weeks have been a rich outpouring of love, goodbyes, encouragement, blessing, and gifts. We know that the church universal and through them, almighty God, loves us. Thank you for the letters, donations, carbon-composite violin, blessings, prayers, hugs, and tears.

I know that many of you have been praying for us today, thank you. Please continue to pray for us as we keep you posted.

The morning was interesting. We set off to the Nashville airport with all of our children and luggage, ready to depart for Honduras. In the airport we found ourselves surrounded by family, friends, and our pastor. But at the ticketing counter we encountered an obstacle.

“A travel embargo is currently in effect for all luggage going to Honduras,” The lady behind the ticketing counter said, with no small amount of concern as she looked at our luggage.

But we had already read about the embargo in the fine print and having reviewed the criteria with our travel agent we confidently explained, “We understand, but we only have two checked bags per person, all less than 50 pounds, all less than 62 linear inches.” Knowing the embargo was in effect for the duration holiday travel, we had planned to only move with our family’s essential luggage in this first trip. With great care, my wife had packed every square inch of 7 action-packer totes and each one weighed approximately 49.5 pounds (literally, and that requires a lot of repacking and weighing).

But apparently, the awesome rugged totes into which we packed our most essential earthly possessions, fell in the category of box rather than typical luggage, and the ticketing agent as well as her co-workers and supervisor could not allow us to check our totes. We called Samaritan’s Purse and our travel agent and began working our options:

No fee or fine could be paid to wave the restriction. No other luggage, of even half the size, could be purchased for us to transfer and repack. We had friends and family check in every direction: No at every other airline desks, no at the gift shop, no at the unclaimed luggage area downstairs, and finally our pastor even made a Walmart run to see if he could get to and from Walmart with enough luggage and spare time for us to repack and board. (Apparently a group of about 20 short term missionaries had bought out all the luggage they could purchase in the airport to get around the same problem.)

In this scramble, the peace of God transcended our group, and we began to step back and realize that we were not going to make our flights with our luggage, and that was okay. With a baby on the way, a 1 year old, 3 year old, and 5 year old – going without our luggage was not an option (there are no quick or straight-forward shipping options to Honduras either).

In that moment I quietly quoted Jeremiah 29:11 aloud to my Father-in-law and children, “‘For I know the plans I have for you,’ declares the Lord, ‘plans to prosper you and not to harm you, plans to give you hope and a future.'”

Its odd, is it not? The paradox of our faith. Moments like today are polarizing, they force you to either lean in and trust God, or pull away and distrust God. We chose trust. Over and over God has shown me that he does have a plan, and a much more comprehensive planning and purposing strategy than I could ever imagine. I do not understand why I’m writing from Tennessee instead of Honduras tonight, but I trust that He has His reasons.

So we wait. We came home to Mimi and Poppy’s and we are resting and beginning another round of logistical considerations to determine when we will take our next steps of faith, be it tomorrow or next week. We’ll keep you posted.

As we were leaving the airport Lydia said, “I don’t want to go back, I want to go to Honduras.”

The Peace of Jesus Christ be with you.
-Nate

 


The views and opinions expressed in this blog are not the views of Samaritan’s Purse or World Medical Mission.


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Thank You for Spending Yourself

Advent is upon us. The first season of the Christian year. A season of preparation to make ourselves ready for the dawning of a light in our darkness – the birth of Jesus celebrated at Christmas. The call of preparation for my family this season is to pack up our things, say our good byes, and board a plane for Honduras in about thirty days.

Thank you for equipping us and helping us get set. With your donations we have been able to fully pay for our first flights and all of our travel vaccines – that’s around $6,000. To all of you who gave cash gifts, paid far too much for a t-shirt, or went online to give- May the Lord bless you (and if you’ll read this blog to the bottom – Elizabeth will bless you too!)

Lately I have been reading and studying Isaiah 58. It is a prophecy of rebuke with a promise of blessing. I hope you will hear the context and then receive its blessing. In this section Isaiah is prophesying to Israel’s uppermost class. They had been carefully doing all the religious motions of sacrifice and fasting while at the same time neglecting and abusing pretty much everyone else. Yet they were confused by the way God seemed distant, even angry. They thought doing all the right worship ceremonies, prayers, and fasts was supposed to automatically equal God blessing them – no matter how they acted toward their neighbor. So God rebukes them through the prophet:

Is not this the kind of fasting I have chosen:
to loose the chains of injustice
and untie the cords of the yoke,
to set the oppressed free
and break every yoke?

Is it not to share your food with the hungry
and to provide the poor wanderer with shelter—
when you see the naked, to clothe them,
and not to turn away from your own flesh and blood?
Then your light will break forth like the dawn,
and your healing will quickly appear;
then your righteousness will go before you,
and the glory of the Lord will be your rear guard.
Then you will call, and the Lord will answer;
you will cry for help, and he will say: Here am I.

If you do away with the yoke of oppression,
with the pointing finger and malicious talk,
and if you spend yourselves in behalf of the hungry
and satisfy the needs of the oppressed,
then your light will rise in the darkness,
and your night will become like the noonday…

This Advent and always, may we spend ourselves on behalf of the hungry and the oppressed, may we loose the chains of injustice, and may the Lord Almighty bless us with a light dawning in this darkness to heal us.
May you know the ultimate joy of loving God and neighbor: of being with and for the wanderers and outcasts among us, so when the glory of the Lord comes among them (even as He came forth many years ago – an infant that was naked, bloody, and crying – God almighty saying, “Here am I”) may you be in the right place at the right time to behold His glory, bow before Him and say, “My Lord and my God.”

We pray and believe that God will make us an instrument of his light and healing as we go. As you give and have given, you are spending yourselves on behalf of the poor, injured, and hungry – to bring light and healing through Jesus Christ.

To the elderly couple nearing the end of their sojourn, giving 100 dollars a month out of their modest retirement- thank you for spending yourself on behalf of the hungry.

To the young doctors still under the weight of massive educational debt giving regularly – thank you for spending yourself on behalf of the hurting.

To the children who gave up half of their hard earned lawn mowing wages – thank you for spending yourselves on behalf of the less fortunate children.

May the Lord bless you, draw near to you, and may the light of his face shine upon you.

If want an opportunity to receive this blessing – good news! We still have opportunities for partnership. The majority of what we have been given so far has been one-time gifts. Thank you for getting us off the launch pad, now we need regular gifts. We estimate we’ll need about $3,000 dollars a month and we have about $1,000 dollars committed (If you’d like more details click here or email me at nathangilley@gmail.com).

Giving online is easy – you should go ahead and do it right now by following the instructions below (if you prefer to give by phone or mail learn how by going here).

2) Scroll Down and type “Gilley” in this text box:
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3) Click on the “Gilley, Nathan and Bethany” box that comes up under that text box
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4) Type in the amount that you would like to give each month then mark “Monthly” to the right of “Donation Type.
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5) Click “Checkout” then follow the instructions to designate where the funds come from (bank account, credit card, debit card, etc)


These are two video clips that I hope will bless you. They are of my eldest two daughters acting and reciting relevant scriptures in the last few years.

May you love God and your neighbor:

May you be found among the outcast when and where God shows up:

In Christ,
Nathan, Bethany, Elizabeth, Lydia, & Ruth


The views and opinions expressed in this blog are not the views of Samaritan’s Purse or World Medical Mission.


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The Countdown & FAQs

Well friends, the countdown has begun. The flights are booked and we have an official departure date less than 50 days from now!

We’re all getting extra vaccines to make sure we’re protected from any diseases that we can minimize the risk of getting.

VaccinesTravel

Our moving bins have been purchased and we are deciding what makes the cut to come with us as airline luggage.

We’re compiling a newsletter / Christmas card list to keep people up to date on our status.

God is good. He continues to show Himself faithful to us. This season is a hard season of letting go and goodbyes, but God has been present and is comforting our hearts.

We are trusting in His provision for our needs which seem to loom so large right now.

If you would like to be a part of God’s financial provision for our family you can give at

www.samaritanspurse.org/wmmgiving

Find the ‘Support a Missionary Doctor’ and type ‘Gilley’ in the blank. Choose one time or monthly gift.

We are so grateful for those of you who are already supporting us.


Frequently Asked Questions (FAQs):

  • When are you leaving?
    We are leaving in early January. For security reasons we’re not posting the specific date publicly online, but if you’d like to know so you can better pray for us or make plans just send us an email or text and we’d be happy to give you specifics as needed.
    Email: nathangilley@gmail.com, Cell: 423-785-7626
  • Are you ready?
    Physically: Not yet, we are just moving into the actual packing stage. Nathan is moving to a more part-time schedule of urgent care shifts. And we are finishing up our fundraising visits. And the holidays are upon us with our departure immediately thereafter. Pray for us to make time for the important things and work quickly and wisely with the time we have left.
    Mentally: Our family is struggling with the process of simplifying and the upheaval of our rhythms and norms in this time of transition. But we are looking forward to creating a new more simple rhythm in language school and beyond.
  • How are you feeling?
    Mostly excited and a little scared! A little overwhelmed with all the details to be juggled and remembered.
  • How are you doing with the fundraising?
    We only get updates once a month to tell us how many people have given one time donations or started/continued monthly giving to the Samaritan’s Purse Project Account. And as of last month we had about 1/5 of our monthly goal ($3,000/m) coming in to the fund as recurring gifts. With our recent vaccines and paying for our family’s 2-way flight we have used up all the money in the fund and most of the one-time gifts that we have been given. So that’s a little scary. But since receiving that statement we’ve had several fundraising pushes and many pledges, so we hope and pray that we are a lot closer to our goal. We know that God is faithful, and we have been encouraging our children to pray for his provision.
  • Where are you going again?
    Central America, The country of Honduras. Ultimately to a rural area on the northern coast, the closest large city is La Ceiba. The Hospital we will live near and serve at is called Hospital Loma de Luz. But for the first 6 months we will be in language school in the middle of Honduras.
  • What kind of medical practice will you have?
    As a family medicine doctor Nathan will be doing full-time clinic work, inpatient hospital work, emergency visits (for all ages), and limited obstetrics (I’m not ready to do C-sections independently). At Loma de Luz we will see everything from acute trauma to chronic conditions, and newborns through end-of-life care. Bethany is not committed to doing clinical work as a Physician Assistant at this time. For now she feels called to first oversee our home and the girls’s upbringing and formation. Once we have had our next baby, completed language school, and settled in to life at Loma de Luz, we will be praying for God’s direction in how to be faithful ministers in our home, in our hospital, and beyond.
  • What will you be doing for the girl’s schooling?
    Bethany and I are excited to home school our girls. If other opportunities arise or we feel God calling us to supplement or change that plan, we will do our best to obey.
  • You’re having another baby??? Is it a boy or a girl? When? Wait, where will you give birth?
    -Yes we are excited that God has chosen to bless and entrust us with a fourth baby.
    -Ultrasound indicates she is another little girl.
    -We are due in Late March. (Yes, that is after our departure date)
    -Provided the pregnancy continues to goes well and God does not direct us otherwise, we will plan to leave language school a few weeks before baby is due and go to Loma de Luz where Bethany can be delivered. On that carefully made decision and final note, I’d like to leave you with this quote, “There are no ‘if’s’ in God’s world. And no places that are safer than other places. The center of His will is our only safety – let us pray that we may always know it!”Corrie Ten Boom

Do you have unanswered questions? Leave us a comment or send us an email: nathangilley@gmail.com

Grace & Peace,
Nathan & Bethany Gilley


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The views and opinions expressed in this blog are not the views of Samaritan’s Purse or World Medical Mission.

Go!

You hear the command, “Runners to your mark.” Your heart rate increases, and you try to relax as you step in front of the blocks, staying behind the line, while try to keep limbering up as all the other runners make their way to their positions. You focus your being on the run to come, carefully place your thumbs and index fingers just behind the starting line, you take deep calming breaths.

“Ready!”

You immediately shift your weight forward towards your fingers, loading your leg muscles for an explosive push out of the blocks and remain there, poised and completely still. With disciplined focus you push out the cheering and distractions to focus all of your being, ready for action, awaiting the signal. Wait… adrenaline flooding your system, wait… an eternity – a second, wait… for the gun blast.


Starting Blocks at Vacant Starting Line Before Event
Base image credit: https://www.flickr.com/photos/53370644@N06/4976494944

Bethany and I are getting into the starting blocks. We are selling and giving away our things, packing and storing what we must. Our family is being vaccinated for tropical diseases, travel plans are being finalized, plane itineraries weighed, my 90 day notice has been submitted. We are on track to go to Honduras this January and then serve the dire medical needs of Honduras in a mission hospital. But honestly, we do not have the funds necessary – we are obediently getting into the blocks – but it feels like our shoes are not tied and the blocks are set up wrong (its a terrible feeling in case you’ve never run track). We are set to take the next step of faith – to run the race set before us – but we need your help to start and run well – financially.

Right now we have $770 in our Samaritan’s Purse account, we have received a total of about $1700 dollar in one time gifts including what was raised with the t-shirts. But we only have one couple that has started giving us monthly gifts, they are giving $30 a month. Bethany and I have not been idle, we are working hard, stewarding our money, and seeking to faithfully present our calling and work to the body of Christ. With lean living, extra shifts, and the support of our family we have paid off school loans and are debt free – praise be to God. We similarly commit to stewarding your money well. We need you to commit to supporting us on a monthly basis. At a minimum, we need a total of $3,000 each month in support to meet our family expenses for this first year. (See detailed expenses break down)

If you can give $5 a month – please do so, we will treasure it. If your children want to donate some portion of their allowance or earned money – awesome. Our first commitment for ongoing support came from two boys who are pooling their lawn work earnings to give us 5 dollars a month for the first year.*

If you can give $50 or $100 a month – Wow, Thank you.

Many of you have committed to giving us support, and are just waiting for the appropriate time to start giving. The time is now. We need to be paying for our vaccines, plane tickets, and paper work out of our Samaritan’s Purse Project account rather than our personal emergency fund.

Please give now by click on the giving icon below, typing in “Gilley,” and marking your donation type monthly.

Give Icon

For more information on our needs and different ways to give, go to our Support>Give page.

The point is this: whoever sows sparingly will also reap sparingly, and whoever sows bountifully will also reap bountifully. Each one must give as he has decided in his heart, not reluctantly or under compulsion, for God loves a cheerful giver. (2 Corinthians 9:6-7)

Grace and Peace,

Nathan Gilley

*For those of you who are detail oriented, this sum is not included in our to-date-total because these two are waiting till the end of mowing season before they calculate and give a portion of their total earnings.


The views and opinions expressed in this blog are not the views of Samaritan’s Purse or World Medical Mission.


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Who is Worthy of Our Fear?

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.


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