Dispatches

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.)

Mission Family Life

Since getting back to Honduras after our visit to the USA in July, our family has faced several challenges.

Two of our great full-time clinic doctors had to leave the work here for kingdom building elsewhere.  That leaves us somewhat short staffed on the clinic and call side of things. Which has been hard for our family-work-time balance. But I am thankful for the time they gave here, the things they taught me, and the legacy and contributions to our mission they both left behind.

Another difficulty our family faced was having multiple bouts with an unknown febrile illness (we tested negative for the infectious diseases our hospital can test for, including COVID). It left Bethany and I barely able to function for a few days at a time, then after a slow recovery it or another illness struck again. As I started writing this, Bethany and Lydia were febrile and resting together on the couch facing a third bout. We are thankful to be presently fever free and well.

Thank you friends and family who have written in or called to check up on us. Thank you prayer warriors who pray for us daily.

A few nights ago we had a hot-potato style thankfulness game. Here in Honduras my family and I are thankful for things we didn’t even realize were important to us in the USA.

  • My kids are thankful for electricity (we have had several weeks of near daily power outages lasting 2-12 hours).
  • They are also thankful for generators, and rechargeable things.
  • We are thankful for air-conditioners to cool our rooms down at night and for fans by day.
  • My girls are thankful for lychee, nance, mango, coconut and Popeye’s biscuits.
  • I am thankful for 4 healthy children who all breathe, eat, drink, move, poop and pee (yes, I used those all individually in our game- and won).
  • We are thankful for a great dependable vehicle.
  • A faithful God.
  • Wonderful supporters who trust us with generous support. 
  • Internet access.
  • Ruth said, “I’m thankful for Daddy, no… Daddy’s phone, no Daddy’s phone and Daddy.” (She really likes the wood turning and glass blowing videos we watch together on my phone.)

The work here is good. There are opportunities to minister to the sick, to heal in the name of Jesus, to offer comfort, wisdom and prayers.

Please continue to pray for us.

I was recently trying to thread a central line catheter through a newborn’s umbilical artery – to deliver IV antibiotics and preempt another newborn sepsis case. The process is very delicate and one has to push and twist just hard enough to get the catheter to pass through the natural twists and turns the artery takes, without pushing too hard. When (not if) you push too hard, you push through the wall of the artery and begin creating a false track – a path that will go nowhere and eventually dead-end. As I was attempting yet again to feed the catheter I said, “It’s so easy to create a false tract!” to Carolina, our Nurse-Midwife who was assisting me. She replied, “In life too.” Eventually, praise the Lord, we got the line placed and were able to get the baby his antibiotics and then discharge him home a few days later.

Picture borrowed from a great step-by-step guide to Umbilical Vein Catheterization by the Australian Government. Given the variety of conditions I see and treat, I often read step-by-step guides such as this.

In that vein (or artery), we are seeking and trying to carefully discern God’s will for our future – because it is so easy to go our own way and believe it is right (until we hit those dead-ends). Things have been hard lately, and it would be easy to take that to mean we should head back to the USA. Conversely, it would be easy to let our pride and the expectations of others guide us to keep on keeping on. Come July our contract with Samaritan’s Purse will be ending and we will have to decide if and with which organization we will commit to further time.

  • Pray that God will give us clarity regarding how long he wants our family to stay here in Honduras.
  • Pray that more doctors, nurse practitioners, and physician assistants will feel called to come and work here (and then do so).
  • Pray for the country of Honduras, with its upcoming presidential election in November.
  • Pray for Bethany and I as we face the challenges of parenting and homeschooling (which can be hard no matter where you are).
  • And continue to pray that I would have wisdom, grace, humility, and love in my role as a physician.

Grace and Peace,
Nathan Gilley

Homeschooling

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

Yesterday

Yesterday, my 4 year old little girl, turned 5! And we celebrated that blessing with a sticky bun breakfast and promise of further celebration when I would be off call.

Yesterday I rocked my two year old to sleep in our hammock, and then went down to the hospital and held the life of a 1 year old in my hands as I kept him breathing by squeezing and releasing a bag over-and-over, during my 4 hour turn with a little boy named Alan.


I’d like to give you glimpse of what our days here are like. It’s hard to capture the differences, the beauty and the pain that we see here each day. But maybe a simple run through my clinic list can give you some insight into what we do here.


Yesterday in my clinic…

  • I saw a 3 year old girl with a cough and fever.
  • A forty year old man recovering from falling off a roof and landing head first on a machete (he had a large scalp laceration and a severe concussion- those are improved, but his left sided facial weakness may be permanent)
  • A boy who has been having dizziness and headaches at school, that could be secondary to struggling in school or to an anti-tuberculosis medicine that he has to take until his father completes the full treatment course for tuberculosis (that usually takes about 6 months)
  • A 16 year old, pregnant with her first baby, who came in for a routine visit, and on my ultrasound was found to have too much fluid around the baby. This puts her at risk for complications, and means we have to do further testing to see if there is a reversible cause.
  • A 70 year old woman with severe arthritis in both knees and severe high blood pressure.
  • A 52 year old woman who began to have a severely itchy rash around her eyes 8 days ago, and despite seeing several doctors and receiving multiple treatments has continued to suffer.
  • A 2 year old boy who was feeling totally better after receiving an anti-parasitic medication 1 week ago. (Unfortunately I never think to take pictures of the well and happy children I see and discharge.)
  • A 30 year old with a stomach infection called H. pylori, who also suffered from hemorrhoids.
  • A 15 year old young lady, pregnant with her first baby, coming in for labs and an ultrasound that showed normal development and no complications thus far.

It is unusual that a day goes by when I don’t diagnose cancer or diabetes, and the deadly complications thereof, but yesterday was one such happy day.

Below are some of the dermatologic problems that I’ve recently seen (avoid looking too closely if you are queasy). Medical people challenge: can you name the weird warty lesion in the top middle position. It was on a 40yo man’s abdomen, RLQ, itchy, persisting for months, no inciting event.

Thank you so much for your ongoing support. We love the work that God has given us to do here. The needs, great and small, are countless. But the people here are gracious and thankful for any help.

Grace and Peace,
Nathan & Family

This is me preaching recently with the help of the kids.
This is a picture of our whole family taken during our recent vacation to Roatan with PapaBear and Gigi.

Please be in prayer for:

-Axel, a 3 year old boy with something called nephrotic syndrome, which will likely destroy his kidneys unless he begins responding to the only medication we have.

-Alan, a 1 year old boy who is currently not breathing on his own, due to a large amount of inflammation in his lungs, that is likely due to something he swallowed that went down the wrong way.

-Our family, as we look to the future and pray about our long-term plans.

Quick Hurricane Update, Prayer, Support

Dear concerned friends and family,

We are well. We are in Nashville with family for a previously scheduled vacation. We had planned to fly out today, but by the grace of God we had to move our flights a few days earlier due to hurricane Eta flooding the main airport that we use (San Pedro Sula). This was good because flights are probably grounded throughout Honduras due to the latest incoming hurricane.

SPS Airport after the Hurricane Eta

Pray with us for our hospital, community, and Central America as they are faced with a second hurricane, Iota, making landfall today and tomorrow.

This year has been blow upon blow against the already tenuous Honduran economy that was largely based on tourism followed by agriculture (industries deeply affected by covid and hurricanes respectively). Our hospital has been increasingly busy as the strain of COVID, travel restrictions, and various sector shutdowns have left many Hondurans without access to healthcare for everything from diabetic management to cancer resection.

Pray for our missionaries and our national staff, who continue to model incarnational Christ-likeness by being physically present to care for and minister to our patients (despite the risk of COVID and the hardships and dangers that hurricanes bring).

Pray for our family as we rest up, and spend time with family- that we would be blessed and a blessing as we visit and rest. Our children are now 8 months, 2 years, 4 years, and 6 years old- pray for them and for the challenges that they face as our family seeks to follow God through all this.

2yo Ruth

Schedule:

We plan to be at Chattanooga Valley Church of the Nazarene for Christ the King Sunday (November 22nd) for the Sunday morning service and an informal evening gathering.

We also plan to be at Judson Baptist, Nashville on the first Sunday of Advent (November 29th) for the Sunday morning service.


Bullet Prayer Request:

-For all those in the path of the incoming category 5 hurricane, Iota.

-Hospital Loma de Luz’s water, electricity and internet supply (and their respective back ups)

-Pray for our return trip, especially with all the uncertainty of hurricanes and ever changing COVID restrictions.

-The hospital’s food supply (the roads and bridges to La Ceiba)

-The safety of our patients and staff who have to come in to the hospital during this storm (think of women going into labor, children with epilepsy, and our essential nurses and lab technicians, as well as doctors who have to come in terrible weather or no).

-The long-term recovery of Honduras, especially the poor who are always hit the hardest by these types of events.

-Our family and especially our children as we seek to put God first, and rightly prioritize their formation and education.


Support:

-Thank you to all of you who have and are supporting us financially. If you would like to send aid to the hospital and surrounding community to help with hurricane relief, we would make sure that 100% of what was given goes to the local needs. See our support page or email us if you’d like more information about supporting us financially or making a one time gift (please send as an email specifying what your gift is designated for if relevant)

-Also, for those of you who might prefer a different avenue, I’ve put together a short Amazon wish list of things that are needed or would be helpful in our hospital and clinic (that we can bring back in our luggage).

Grace and Peace,

Nathan Gilley

Continue reading Quick Hurricane Update, Prayer, Support

Dear Dad and Mom…

Warning: The following story may prompt incredulous laughter and children to ask uncomfortable questions.


Dear Dad,

Maybe I should have followed in your footsteps and become a better baseball player, you know, to make me a better doctor.

Nevertheless, I am happy to report that the secret playroom kickball matches that Jerod and I played allowed me to develop the skills necessary to become a competent physician. You see, just a few weeks ago, as I started my morning rounds, my very unpracticed sliding-into-homeplate manuever was put to the test:

I heard a yell in the hallway leading to surgery and went to investigate.

Arriving there I saw a pregnant woman, waddling towards me. Her eyes were wide with the shock and terror of a person betrayed by their own body. And as I ran forward to assess the situation I quickly saw the reason; upon seeing my querying expression she hiked up her hospital gown to reveal her baby crowning.

Her family and a few nurses were trying desperately to help her get to our labor and delivery room. But I determined this baby was going to come before we could possibly get her to a bed.

“We’re going to need to deliver the baby here,” I said with authority.

With relief the mom stopped trying to move forward and immediately began to sink to the floor. Fortunately her family members promptly stepped up to support her as she began sitting back. Unfortunately, as soon as her knees bent and she began to squat, her baby took advantage of the more open pelvic outlet as well as the increased abdominal pressure generated by her squat.

Noting this, I dove forward, my arms reaching out to catch the slowly falling baby and mother. The amniotic fluid on the tile floor helped me to slide easily into position at the mom’s feet. With my right hand I worked to catch the baby that was slipping rapidly out for a head first dive. And with my left hand I tried to push up and away on the mom’s buttocks that was coming down to land on top of her baby.

When the proverbial dust settled, we’d managed to all land safely in a somewhat slippery and slightly bloody pile, with a joyfully screaming little baby cradled in my arm connected by his umbilical cord to his mom who was slightly shocked and somewhat on top of me.

All we needed was an umpire to stare down at our strange pile and then after a pregnant pause, dramatically yell, “Safe!”

Love, your son,
Dr. Nate


Dear Mom,

Remember one New Year you asked Dad, Jerod, and I to each tell about a miracle that we’d seen. Ultimately that led to a discussion about miracles, because for you, every day was filled with miracles: from rainbows to children to happenstance meetings- you saw Divine fingerprints everywhere; for Dad, Jerod, and I the world was a significantly less miraculous place. We weren’t sure we’d ever seen God reach down and definitively perform a miracle.

Well, I’ve decided that your view of the world is the better one, and I would like to tell you about a miracle I recently witnessed.

You see, the little baby that I caught in the story above (Yes, the story above is totally true, and yes Jerod and I did secretly play kick ball in our playroom, frequently, and without ever breaking a window), that baby started to turn yellow 12 hours after he was born. Now that’s not too uncommon, he was jaundiced, and we can treat that. We put him under some blue lights that convert the yellow, problematic bilirubin to a form that can be disposed of by most any liver.

I say, “most any,” because on rare occasions the drainage system of a liver is incompletely formed or the infant’s liver cells are genetically incapable of doing some basic function that causes excess production or diminished disposal.

I say all that because, after we put the baby under lights, instead of turning a beautiful Honduran brown and going home, he turned green. He turned green because his liver had one of the two problems detailed above.

When I investigate what could be done to help this little fellow, I found myself running into dead ends (grim pun intended). In Honduras, you do not want to be a green baby. Most likely you are stuck looking for an expensive, risky surgery that only a handful of hard to get to surgeons can do (to repair your drainage system). The other, equally tragic etiology, for our low resource patients, is that this disorder could arise from a super rare genetic problem that will be almost impossible to diagnose and likely will be equally untreatable.

As I often find myself doing, I first explained the poor medical prognosis. In this case I explained to baby’s mom that from strictly a medical perspective her baby had a serious and life-threatening problem. As stated above, the most likely cause was a problem with the liver’s drainage system. Untreated, this often results in death after a few months. So we would do further investigation and begin reaching out to arrange for treatment if necessary and possible. (We would also be reaching out for help from our donors because just the trip to see the surgeon in the big city would have been cost prohibitive)

Then, I concluded with your perspective, mom. I reminded this mother that we believe in a God who is all powerful and can do miracles. So even as we do everything we can medically, we also pray. The mom and I prayed for healing multiple times, specifically for God to allow this little boy’s bilirubin to get out of his system.

I have prayed many such prayers, and most of the time God either answers those prayers through the medical care being provided or the patient dies. But, occasionally, Divine fingerprints are a little more overt. Like this time, where visit by visit the little boy’s color, weight, and labs improved with no treatment beyond earnest prayers of hope and thanksgiving. A few days ago he came in for a check up and was totally normal.

Whether this was God directly altering the baby’s physiology or not, I do not know. But one thing I do know, he was a sickly-appearing, green baby and now he is healthy and brown.

And at that visit I praised God with his mother for the miracle of her son’s life.

Love, your son,
Nate