A Different Kind of Mission

One counseling model to describe times of transition is a long arching bridge, a bridge so long that even as you enter the bridge you cannot see where the far side ultimately lands. When we first left Honduras, we entered a very uncertain time of transition. We knew that we would seek and find God’s good plan for us, but we’d left the stable ground of the known and planned future that we’d worked out in Honduras.

We were on the bridge, and where it might land us, God only knew.

Unlike many people our age, Bethany and I had never faced this kind of uncertainty about our next step. Since we were called to medical missions as children, we have simply been putting one foot in front of the other, in deliberate obedience to that call. Every transition has been prayed about, considered, counseled, and then fallen into place clearly and well in advance of getting on the bridge.

So I apologize for not knowing how to respond during the last few months regarding our plans. For the first time in our lives, we weren’t sure what was next. We have been earnestly seeking God’s will for our family. But for a time, we had to wait on the Lord to make his way clear to us.

Thank you for continuing to support us through this uncertainty. Your prayers and financial support have been an immense blessing.

Without further adieu: we think we know what God has for us next. I have applied and been tentatively offered terms to work as a doctor who trains new doctors for their first years out of medical school at the family medicine residency where I was trained. A lot of considerations went into this decision, several which I will mention here:

  • The residency/training program is at Catholic facility that puts special emphasis on Christ-like care and ministry to all, especially the poor and marginalized.
  • As such, it ministers to many immigrant families and a large percentage of Spanish speakers.
  • We hope it will provide a rare opportunity to maintain my obstetric, inpatient, and newborn to elderly clinical skill set without sacrificing too much of our family time.
  • We hope that by working here for a time, near our families and our church homes, that we might create a godly home with good rhythms to be a safe home base for our family, from which we can go out in obedience, and return for rest and security.
  • This work could position us very well to continue engaging in medical missions in the short term, and potentially allow us to return to the field better equipped to train doctors (both local doctors from developing countries and missionary doctors) which is one of the most pressing needs in medical missions.
  • Finally, I love teaching and mentorship/discipleship, both of which I will likely be able to do in this setting.

We are in the early stages of working out contracts, privileges, licenses, and so forth. It is not uncommon for this process to take half a year, but we are trying to expedite this to allow me to start as soon as March first. Pray that if this is God’s will for us that things would once again clearly fall in place.

Your prayers are appreciated because, although almost all the individuals I’ve spoken with are enthusiastic about hiring someone fresh off the mission field, bureaucracy and insurers do not always look so favorably on the many check-boxes that long term mission work makes difficult to answer as desired (i.e. a large gap in my malpractice insurance).

We will let you all know if and when things are finalized.

Our time with Samaritan’s Purse, and its post-residency program, will end at the end of this month. They generously extended our contract for some time to help us through this time of uncertain transition. Thank you so much for your support through them. And a special thanks to awesome crew that run logistics and support for World Medical Missions. It has been an honor to be a Samaritan’s Purse missionary family.

Grace and Peace to you all,
Nathan & Bethany Gilley

Sing Praises unto the Lord; Selah

There is a mystery in the book of Psalms, a untranslated Hebrew word that occurs 71 times at the conclusion or transition between particularly weighty meditations dealing with God’s judgement, deliverance, faithfulness and salvation. It seems to be a call to thoughtful listening, and may have cued the musicians to bring attention to a point by pausing or coming to a crescendo.

You are a hiding place for me; you preserve me from trouble; you surround me with shouts of deliverance. Selah

Psalm 32:7 ESV

The mysterious contemplative call-word is Selah (Hebrew: סלה; pronounced: SAY-lah)

And so, without further adieu…

Selah Hope Gilley is the name that we have chosen for our 5th baby girl.

She came a little early (at 37 weeks and 2 days) after Bethany’s water broke at home. Our older 4 girls stayed home with Mimi and we headed to the hospital. Selah was born at 1:39 in the afternoon, at St. Thomas Midtown in Nashville, on November 15th, rather precipitously, but without complications.

We are so thankful to God for this reminder that he is still investing himself and commiting himself to bring light and life into this world.

I dusted off this prayer that I wrote for newborns and mothers before Ruth was born (who is now 4) and prayed it over Bethany and Selah.


[I layed hands on Bethany and Selah]

Naked we come from our mothers’ womb
And naked we will depart;
Blessed be the name of the Lord,

Blessed be the name of the Lord, who with this mother, and through this labor,
has brought forth this miracle of life;

[I made the sign of the cross on Selah’s forehead during the blessing below]

Blessed be the name of the Lord, may he bless you and keep you;
The Lord make his face to shine upon you and be gracious to you;
The Lord lift up his countenance upon you and give you peace.

[I prayed this over Bethany]

Blessed be the name of the Lord, who knitted this child together in your womb, who creates and sustains all things. May He uphold you and go with you in the good work of motherhood that you have begun. May He fill you with all faith, hope, and love; causing you and your family to delight yourself in Him, forevermore.

Blessed be the name of the Lord,

The name by which we are saved- the Lord Jesus Christ,


Amen.

May she remind us all to “Selah.” To reflect deeply on how God has been at work and to live in hope.

Love,

Nathan Darrell Gilley & Bethany Joy Rudge Gilley

And our Daughters:

Elizabeth Grace Gilley
Lydia Joy Gilley
Ruth Love Gilley
Hannah Faith Gilley
& Selah Hope Gilley

Ruth’s Culture Shock, Grief, Waiting

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.

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.

Thanks,
Dr. Nate

We All Like Schizophrenics Have Gone Astray

I have a patient who has never seen seen me in our hospital. He lives with his mother in the community just down the road a ways. Mark (a pseudonym) is the youngest of five kids, now a young adult, but unlike his siblings he has not and probably never will leave the nest.

One time when he was in his early teens, he disappeared from home during a torrential rain storm. His family searched late into the night but could not find him. The next day, after the storm subsided, he was found far up in the mountains, wandering aimlessly. When asked what he’d been thinking, leaving in the middle of the storm and going into the mountain jungle, he said, as if it were the most obvious thing in the world, “I was chasing the iguanas.” (There was no iguana to be seen, and he had captured no iguanas)

Large iguanas are often caught to sell and/or eat in rural Honduras

Since that infamous iguana chase he has never been quite normal. He often doesn’t make sense in his reasoning, is very suspicious of just about everyone around him, shows little emotion, and has trouble learning and engaging in normal work. He consistently says and does things that make it clear that the way he views reality is broken. He has a mental illness called schizophrenia.

Mark is a bit of a legend at our hospital. I haven’t been able to establish a clear chain of factual events, but these are the stories that I’ve heard:

Once, years ago, our hospital had a jujitsu master who, because of his cross training as an emergency room doctor and his community involvement, noticed a teenager with unusual and potentially dangerous behavior. Seeing this, he endeavored to help Mark by providing him with a medication that could help control his hallucinations and calm his delusions.

Mark refused to take any such medications by mouth. And after noticing his mom had attempted to mix a pill into his food, refused to eat food anyone else has touched for months.

So an expensive injectable medication that could last for 4-6 weeks at time was ordered. Once that was acquired things quickly escalated. Mark was not willing to allow anyone to give him an injection and he began to bolt for the door, hurdle fences, and hide in jungle anytime the jujutsu master came near or visited.

This went on for some time, and to my knowledge Mark remained out of grappling range and thus unmedicated.

Sometime later another doctor at our hospital became aware of Mark’s plight and began a series of home visits that finally ended, with the help of Mark’s mother, in Mark groggily allowing himself to be injected early one morning before he got out of his hammock. And thereafter continued an unbroken series of injections every month or so for almost two years.

When the time came for that doctor to leave Honduras he assigned me the job of going to Mark’s house once a month and giving him his medication. Once a month comes around often, and receiving this responsibility was kinda like filling-in for the last few throws of the egg toss. No pressure, right?

I managed things well for about 6 months. But a few days before I was planning to give Mark his injection, I heard from one of our hospital staff that Mark was starting to act strangely again – I was a worried that Mark might not be as willing to allow the injection as previous. As soon as I could, I made time to draw up the injection and head down to his house. But Mark, upon hearing my Landcruiser, bolted for the mountains.

Over the next several weeks I made many trips early morning, late evening, sneakily, and openly. After every attempt my girls asked me, “Did Mark let you give him his medicine????” (I have 4 girls, thus four question marks is grammatically correct.) And every time my answer was a somewhat dejected, “No, he wouldn’t.”

At several points, after a busy day of seeing patients in clinic and the ER, I really just wanted to get home and be with my family rather than try, again, to give Mark his injection. At our hospital we have so many patients that want to be evaluated by a doctor that part of my job is prioritizing who we see and who we turn away. So with a seemingly endless line of patients crowding to see me in my office each day, it’s extra frustrating to spend a further 30 minutes to an hour going out to Mark’s house and trying to convince an unwilling patient to let me please give him the injectable medicine that will make him think more coherently, and be more reasonable and generally safe.

But each time I think to myself that my time could be better spent either going straight home or seeing a few extra willing patients who actually want to be seen and helped, I’m reminded of what Jesus said, about going out of his way, leaving the flock behind, and searching for the lost sheep.

Mark, sheep, and I, all have something in common. We don’t know what’s best for us and left to our on devices we make poor decisions. I am so thankful for the grace of God in my life, that helps me turn back to Him and His life giving ways. Please keep Mark in your prayers as we work on a solution to help him get back on his medicine.

General Updates:


-We will be going back to in person language school for 1 month to improve our family’s Spanish and cultural understanding. Please pray for our whole family to learn and grow in every way that God has for us there.
-We will be completing our contract with Samaritan’s Purse in September (they have graciously extended our contract)
-We will be onboarding/training/transitioning to another long term missionary sending agency and then plan to return to Loma de Luz as soon as we complete the transition and have funding. Please pray for a smooth transition.
-For those of you who are supporting us financially, please continue to give in the same way. Samaritan’s Purse will transfer and forward all of your donations once we’ve completed our orientation, training, and vetting. After that we will give direction for how to continue supporting us.
-I have been given the roles of clinic director and biotech equipment manager- please pray that God will bring someone to take one of these roles from me.
-Bethany, in addition to homeschooling and discipling and homemaking on the mission field, is taking up once a month ophthalmology clinic

Grace & Peace to all of You,
Dr. 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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An Essay on Death; An Unrelated Boa Constrictor Tale

Death, the Enemy

As a doctor working at a mission hospital in Honduras, death is, unfortunately, not an uncommon event.

Whether, it’s a teenager in a motorcycle accident with a terrible head injury, a newborn baby with underdeveloped lungs, or an elderly patient with terminal cancer, kidney disease, or severe COVID, we do our best to help everyone, but all too often in such cases, death comes on relentlessly. Sometimes, by the time a patient comes to us, the damage or disease is so far gone that no hospital anywhere could change the fact that the patient will shortly die. Other times expensive and resource intense things like dialysis, targeted chemotherapy, or an advanced-image guided intervention could be used to buy a patient more time if only the patient or their family could afford to go and get them (but they cannot). So between resource limitations, the remoteness of our hospital, the scarcity of preventative care, and the inevitability of death itself, at Hospital Loma de Luz we are called to discuss death and dying with unfortunate frequency.

Ever since my mother died of metastatic breast cancer; dying well, specifically equipping my patients to do so, has become very important to me. My mother had great doctors, great support, and she had clear spiritual insight. Ultimately she died in a way that my brother described best- victoriously. As I’ve said before, if life is a long distance foot race, she held the pace throughout and sprinted the finish.

Because my mom taught me to value finishing well, giving my patients the opportunity of dying well is important to me. Because of this, I talk very clearly about medical prognosis. If they have a relationship in disrepair or spiritual work that needs to be done, they need to know if there’s a time crunch. I do not want my patients or their families to be caught unawares because I faltered in speaking the truth with love.

I realize this urgency is a cultural and personal value. I try to be sensitive to when it might be best to not force this conversation, nevertheless it’s very rare that I haven’t talked about death clearly beforehand.

So imagine my surprise when time after time a family member with whom I have spoken many times about an imminent death, begins hysterically crying and screaming after a slow and clear process of dying ends in death.

For a time this frustrated me. Had I not communicated clearly enough what was going on to allow the patients and their families time to prepare? What could I do differently?

Then, one night, watching a mother sobb as she cradled her dead newborn, I had an epiphany. We were not created to know death. When God shaped our first parents, Adam and Eve, death was not part of His design. Whether we show it outwardly or not, we have a primordial reaction when death comes near. Something inside us screams, “This should not be!” And that reaction – is right.

As Christians we can intellectually accept that Christ has taken the sting out of death for those who believe. But we must confess, we long for that last enemy, death, to be utterly defeated, for death and sickness to be no more.

The Boa

Anyways, enough profound thoughts (but speaking of primordial things and our first parents)… The other night our chickens were squalking with unusual frequency and panic so I went out to investigate. To my horror, I found this seven foot boa trying to decide which chicken he wanted to eat after enjoying their eggs. With a valiant will I immediately ran inside to grab my blow gun, a machete, and a putter. I also asked my wife to come and bear witness to my bravery. With such skill you might think I was raised in a rain forest – I encapcitated the terrible foe with my blow gun from point blank range outside the coop (thank you, Carter Whittier and all my college roommates, for your help in my mastery of this skill). Immediately, (we’ve been reading through the Gospel of Mark and his constant use of this word is rubbing off on me) I entered the coop warring against my inner revulsion for the slithering monstrosity that writhed with impotent anger due to the multiple metal darts running through his head, jaw, and body. After taking the picture below, I used the putter to pull the constrictor’s surprisingly heavy coiled body from my chicken’s nesting box. Then I stuck with my machete, bringing to bear all my force – about sixteen times – and I mostly decapitated him (let’s say my machete was dull). My wife bravely illuminated the prolonged conflict and offered pointers and witty critique of my technique.

We have a rule on the hill. We do not kill obviously non-venomous snakes. But there are two exceptions to this rule:
1) If the snake is big enough to strangle and or eat a small child – it shall be killed.
2) If the snake comes inside the house – it too shall be killed

Snake trivia:
True or False – Boa constrictors give birth to live young

Rainy season is here and the rivers are a-risin’. We are thankful for an awesome sturdy vehicle to get us wherever we need to go.

Grace & Peace,

Dr. Nathan and Family

Trivia: True is the correct answer. Most constrictors along with vipers and few other snake species give birth to live young rather than hatching eggs.

P.S. The presidential election in Honduras occurred this past Sunday and we are very grateful that thus far things have remained peaceful. (The weeks following the last election 4 years ago were quite tumultuous.)

Water, Chicken, Insulin, Horse, Humility

Have you ever visited one of those countries where you can’t drink the tap water? Honduras is such a place (Try to keep your 1 year old from drinking any shower or bath water sometime – it’s pretty much impossible).

Fortunately, for us, we have clean tap water at our hospital (our patients are always a little awestruck when I tell them- not only can they drink the water straight from any hospital sink (without boiling or filtering it), but that my family and kids do so every day.

But for the rest of Honduras, there is a difficult choice: one can buy a Sprite or Coke at the corner store or bring river water to one’s house, boil it, wait for it to cool, then drink it. As you can imagine, it is a pretty easy win for the Sprite. Even though they can buy a bag of water cheaply (instead of boiling river water), its like convincing yourself to get a water when your combo comes with a drink- it is a hard choice. (Coke, to my shame, generally wins – fortunately for me I live 2 hours away from any fast food restaurants.) Given this reality, and the strong link between sugary drinks and diabetes, you can understand that diabetes and its complications make up a lot of our patient visits.

I was recently laying down the law, with a lovely elderly woman with mild dementia whom I had brought out of diabetic coma (thanks be to God). Her coma was the direct result of what we call poor compliance (a fancy way of saying the patient is not doing what we want them to do). Her blood glucose had been approaching one thousand- meaning she had so much sugar in her blood that is was becoming a syrup and shutting down her brain.

https://cdn.diabetesselfmanagement.com/2020/01/dsm-what-is-insulin-shutterstock_240701866-1000×667.jpg

So as I was explaining to her, for what felt like the 10th time, how important her insulin was, I went for the straightforward simple explanation: if she did not allow her adult children to check her glucose and give her insulin on a regular basis, she would shortly die. She giggled a bit, and said, “Well I don’t want to die.”

“Doctor, I need something,” she said with a shrewd look.

“Okay.” I replied with slight hesitation.

“I need you to give me your phone number, so I can contact you any time I have questions or problems,” she gave me her most winsome geriatric smile and may have even winked at me.

I explained carefully but firmly why I would not give her my phone number, about 3 times before she gave up on charming me (for that time). Afterward she gave me a big hug and I discharged her home.

On the day of her follow up visit, her family was hanging around right in front of my door while I was trying to work through a extra long list of patients. I had seen several patients already, and was bringing back a different patient to discuss some bad news. Now, hanging out in front of my office door is a common strategy to try to get seen before others. So I was a bit short with them when I said, “Buenos dias.” And tried to slip around them without further ado.

“Doctor, can we have a moment of your time?” Hondurans can be maddeningly indirect.

Si.” I replied trying to make it obvious that I had a list of patients queued up to be seen, they would be seen in that order, and this would all go much faster if my process wasn’t interrupted. (It sounds like I may not have had my coffee that morning)

“You remember my mother, she had the sugar coma and you saved her.” The daughter stated, leaving a pause for me to acknowledge.

“Yes, I remember.” I replied tersely.

This seemed to deflate the daughter, who said, “Well, uh, here.” And with that she thrust a large feed sack in my direction.

I eyed it questioningly. I did not want to take it without more information, but I didn’t want to be too rude either. So I moved closer to the bag and cocked my head to prompt a bit more explanation before I accepted.

“Its a chicken.” She stated with an uneasy smile, trying to regain her enthusiasm

“Is it alive?” I asked with morbid curiosity. She shook the sack a bit as if to find out for herself and the lump began moving and clucking indignantly. At this point the patient whom I was trying to bring to my room start laughing quietly at my predicament.

“O, thanks! Um, Could you hold it for a bit while I finish talking with this next patient?” I motioned to indicate the laughing patient I was trying to bring into my office.

“Yes, I can… But just so you know, its kind of hot, its a little hard for it to breath, and it pooped in the bag already. It really needs to be let out quite soon.” She stated awkwardly still holding it out for me.

“Okay. Thank you so much. I’ll take it as soon as I can.” I said as I retreated to my room to try and have a serious conversation with the patient I was bringing back.

After I had seen my next patient Bethany and the girls came down and somehow got the chicken up the hill to our house, out of its bag, and tethered to a bush.

Later that day, at their mom’s appointment, after thanking the family for their chicken and telling her it wasn’t necessary but was very appreciated (the poorest of the poor are often the most generous of people). We revisisted the importance of medical compliance (them following my directions regarding insulin). The family and little old lady who was sweet on me, broke down for me why it was sometimes hard to give her the daily insulin. First off it’s expensive, but they were choosing to make the needed sacrifices to purchase it. Secondly she was sometimes stubborn and decided she wasn’t going to let anyone stick her with needles. But mostly it was difficult because they have to send someone, usually her grandson who is 12, every other day to get ice to keep the insulin cold. Her grandson takes the horse to the pulperia (little store) where he can buy ice. Unfortunately the closest pulperia with ice is a 30 minute horse ride from their house. They then put the ice in the thermos (they were very proud to show me their insulated thermos) which keeps the insulin cool for another day or so.

https://www.flickr.com/photos/lonqueta/3531669881

“Do you not have a neighbor with a refrigerator?” I asked. Because typically, at least for medicines, neighbors will share refrigerator space with those around them who do not have a fridge.

They laughed good naturedly, “No, we don’t have any electricity in our community.”

And so I was humbled twice in one day by the same family. First for assuming they were trying to selfishly cut in line when really they were trying to selflessly give me one their best chickens. And second, when I tried to get the family and patient to take more responsibility and be better about giving insulin regularly- only to realize they were already taking this responsibility very seriously and putting more effort into their mom’s care than I had ever expected.



Prayer Request & Praise

  • Pray for my two little patients with kidney problems that are not responding well to medication (steroid resistant nephrotic syndrome):
  • Axel, 3yo, is stable and taking a medicine that will hopeful remove or decrease his need for steroid.
  • Maritzah, 2yo, is gradually worsening. She had an infection a few weeks ago, and nearly died. She has no clear options, and continues to have almost no response to medicines. She is very swollen. Pray for her comfort, our wisdom, and her mother’s breaking heart.
  • Praises: Cristofer Daniel is doing great, eating well, and putting on some healthy fat.

P.S. We will be in United States for most of July. As of now our plans are:

Sunday July 4th – Chattanooga Valley Church of the Nazarene, Flintstone Georgia

Sunday July 11th – Judson Baptist Church, Nashville Tennessee

Sunday July 18th – Reallife Church of the Nazarene, Murfreesboro Tennessee

Grace and Peace to you all!
Nathan Gilley

Her Prayer Request Became a Praise

Recently, during missionary fellowship, I asked all the children to share just one prayer request. Elizabeth seemed to be carefully weighing her options, then chose, “That Daniel will get to go home soon.”

“Good news!” I said, “Daniel went home today, your prayer was answered and now it’s a praise.” Elizabeth, Lydia, and Ruth were delighted.

Praise be to God, Daniel was able to advance his diet to solid foods, and keep everything down and working. For several days of post-op observation.

His family’s bill for their prolonged stay, TPN, surgery, and meds, (about 3,000 USD) was largely taken care of by your many generous donations. Thank you all for your help.

Daniel and I just before his departure.

Please continue to pray that Daniel is able to keep gaining weight, and avoid future bowel problems.

Also be in prayer for Axel who is 3 years old and Maritzah who is 2 years old. They both have nephrotic syndrome, which is a kidney problem that crops up in some kids for no clear reason. Almost every time this type of problem responds to simple steroid treatments. But when it doesn’t, as in both of their cases, things become significantly more grim.

For Axel, pray that the new medication that we’re going to try will help put him in remission. For Maritza, pray for a miracle, that God might heal her kidneys, and barring that, that he would shower his love and grace upon her and her family- transcending their suffering.

Grace and Peace,

Dr. Nathan

Daniel’s Surgery

Dr. Dave, Daniel’s surgeon, spent a lot of his day yesterday cutting back adhesions (old internal surgical scars) and confirming the anatomy, cause, and best solution for Daniel’s intestinal blockage.

By the grace of God, the power of prayer, and Dr. Dave’s meticulous skill, we found what seems to have been the problem and a new route for things to flow through was created, bypassing the problem.

Daniel is recuperating, but for now he can’t eat or drink- until it’s clear that his bowel has woken back up and started functioning after the shock of being pulled out and cut open. It will be several days before we can do the ultimate test of letting him try solid foods.

Above is a picture of me, drawn by Daniel. As you can see, I apparently have no problem getting nourishment. To the left of the picture, you can see Daniel and his sister. He gave me this right after his operation.

Thank you for your prayers.

And thanks to all of those who reached out and sent donations to help cover some of the expenses of Daniel’s stay.

Grace and Peace,

Dr. Nathan

Cristofer Daniel Update

On Easter Sunday my patient with the belly problems, six year old Cristofer, came to church with us and his family. During Sunday School after 3 weeks of spending hours each day caring for and getting to know him, imagine my surprise when he introduced himself to the Sunday School class by his second name, Daniel.

So let me give you an update on Daniel. After almost three weeks on TPN (a customized liquid nutrient solution that is put directly into the blood stream), Daniel gained nearly 10 pounds, has lots of energy, and has become a professional at getting various hospital employees to buy him popsicles and ice cream.

In the days leading up to Easter, all of Honduras goes on vacation. During that time it became nearly impossible to get the TPN delivered across the country so we were forced to try and see if Daniel could absorb his nutrition orally. Unfortunately, although he has been able to mostly maintain the weight gain that was won through the TPN, his belly has become distended again and proven him unable to handle any non-liquid diet (and it’s really difficult to get a healthy mix of protein in a kid-friendly liquid diet).

Despite this setback, he is remains very happy, playful, and much better than when he arrived.

Daniel, his sister, and my two eldest daughters playing on the hospital playground

Tomorrow (or today if you are reading this on Thursday morning) Daniel will be going to surgery. Please pray:

  1. That Daniel and his family will have peace before, during, and after the surgery. (Daniel is feeling a bit scared because of all the bad experiences he has had.)
  2. That Dr. Dave, our surgeon, will have wisdom, insight, dexterity, and divine guidance in the midst of what could be a very complex surgery.
  3. That Dr. Isaac, our anesthesiologist, will be able to help Daniel get to sleep, keep him from vomiting/aspirating, and wake Daniel back up again without problems.
  4. That Daniel’s body will heal well and recover quickly, such that he can get back to eating normally and have no further obstructions.
  5. That Daniel and his family will experience Christ-like love in a way that transforms their lives forevermore.

If you thought you might want to give to help cover some of Daniel’s rather large inpatient bill, but have not yet done so, please consider doing so now. You could Venmo or Paypal us, or give through Samaritan’s Purse. We’d be happy to send you directions for how to do so – just email us: nathangilley@gmail.com

So far, outside of the regular support that we get, we have not had any funds given specifically to help Daniel. The main reason he is a special case, with an unusually high bill is because we had to give him TPN for 3 weeks, which is a very expensive and time consuming process.

Grace & Peace,

Dr. Nathan

Cristofer

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.

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.

In other news…

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.

Dr. Nathan