Dispatches

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

Good-Byes

Our time at Hospital Loma de Luz on the north coast of Honduras has, for the foreseeable future, come to an end. In the past few weeks we have said many good byes, packed our home, been able to bless our community by genourously sharing many things we have been able to accumulate over the past few years. We are so greatful for the great work that we have been equipped and enabled to be a part of over the last two and a half years.


Numerically, I had the privelege of:
delivering over 100 babies,
seeing and giving care to more than 2000 clinic patients,
attending over 700 emergencies,
and providing more than 350 patients with inpatient care

A few highlights of our journey:

Countless signs of God’s covenant faithfulness witnessed.
20+ Sermons preached (with the help of the church children)

Many meaningful art projects created and shared.

15+ critically sick newborns cared for and discharge well, who probably would not have otherwise survived.
100s of evil scorpions, spiders, kissing bugs, ants, and mosquitos vanquished from our home.
Axel and 5 other children with nephrotic syndrome followed and managed into remision – Praise be to God.

20+ closed fracture reductions, casted and followed to healing.

Innumerous glorious sunsets and star fields enjoyed and contemplated.

My family and I are so blessed and thankful to have had the opportunity to live, work, and minister in Honduras, with an incredible team of doctors, nurses, and support staff, at a wonderful and well resourced hospital in a beautiful and loving community. This has been an immense priveledge.

I will never forget the special priveledge of baptizing a hospitalized patient dying of AIDs, and the solemn work of helping many other families and patients prepare for immenient death spiritually, relationally and medically.

We are so thankful to Samaritan’s Purse and its Post-Residency Program that has made this time possible, and continues to offer us support through our transition.

Please be in prayer for our family as we:
-Prepare for Bethany to give birth to our 5th child at the end of this year.
-Seek to discern God’s next mission for us as a family.

Thank you for following us on this journey to Honduras and back again. We will plan to keep updating our blog as we discern whatever good plans God has in store for us.

Grace & Peace,
Nathan Gilley & family.

A Math-er of Life and Death

Dear Mr. Fingerly (my middle school math teacher),

Thank you for all that you did to help me learn the deep joy that can be found in doing math. I vividly recall the fun we had plotting catapult trajectories and testing the load bearing limits of our tooth-prick bridges. But moreover, I remember the class where you gave us just enough guidance before pushing us to discover the FOIL principle for solving binomials independently. I remember the moment it clicked, and how I understood without being shown, what needed to be done. I believe that single success and the joy that I found in that grappling and intuition, started the process of turning me into the geek-doctor that I am today – thank you.

I also want to let you know that about once every month or so I use the fraction cross-multiplication and unit cancellation that you taught us in 7th grade (You had us use very silly made-up measurement systems) to save someone’s life.

This morning for instance, I had a critical potasium on a septic baby right as I had begun working on making breakast for my girls. I promptly abandoned the omlet I was making to its fate (but Bethany saved it and got it to Ruthy’s plate), grabbed a #2 pencil and a blank sheet of paper and then started recording my data points to begin setting up my fractions. A 8.3 kg baby needs IV potasium. The dosing is 1mEqu/kg/hr. The potasium comes in 20mEqu/10ml. How much normal saline should the potassium be diluted into and at what rate should the pump be set…

Multiply denominators and
then numerators,

check that units cancel,

cross-multiply to find the amount of dilutent and

Viola!

(I did send my calculations to a colleague for confirmation before starting the drip.)

This little guy thanks you too!

So thank you Mr. Fingerly, and all my other wonderful and profoundly influential teachers. I pray that you are richly blessed in the knowledge that your lives are being and have been well spent, that you have and are doing kingdom work as you labor to light a spark in your students.

Grace & Peace,
Nathan Gilley

P.S. The title pun is especially for your enjoyment Mr. Fingerly

Language School Again

For simple sentences, especially with globalization, many western languages have one-to-one translatable words and constructs.  Another words, if I want to say, “Give me the red ball.” You can generally find and put together that same meaning nearly word for word. But sometimes when you translate from one language to another you are presented with a choice (or robbed of a choice) that you did not have in the original language.

For instance in English I might say, “Take a deep breath,” to my patient. But in Spanish in order to give that command, I must choose whether I will use the formal or the more familiar conjugation of the command (there is no neutral).  So rather than one-to-one, the meaning translates one-to-two. I used to think that most Spanish speakers were so gracious and appreciative of those who took the effort to try and speak their language that details like formal or informal conjugation were largely inconsequential.

But even though the cultures of Latin America are often warm, welcoming, and appreciative. Language does not simply speak to our rational brains. Language, with all its facets from grammar to tone, inflection to facial expressions communicates so much more than “Take a deep breath.” You can imagine how the same command can communicate respect or disrespect, affection or uncaring, frustration or “I have time for you.” Now imagine if your language had grammatical constructs that made you decide between respectfully distant vs chummy.

Case in point – I spent some time in Romania and Bulgaria where people typically shake their head side-to-side to mean yes. I quickly came to know this piece of information. But in my short time among the people there I never ceased to be at least somewhat confused each time someone would say “yes” or “da” and then shake their head in the pattern that my brain understood to mean “no.” Even though my rational mind knew that shaking the head back and forth meant “yes,” my ingrained subconscious perception could not be so easily changed.

So although I still appreciate how gracious the Honduran people are when I fumble my verb conjugations. I am becoming aware that a listener cannot always control their subconscious reaction to language patterns that are in-grained from early childhood.

This is a list of all the possible forms of a single verb ‘Hablar,’which means ‘to speak.’

There are other important language differences that are even more difficult for me to grasp than strict one-to-two vocab or grammar changes. These are the internal resonances and more abstract conceptual differences that cannot be taught by a dictionary or captured by a translation program.  For instance, the other day I was sitting in Church and the sermon was being translated from English to Spanish.  The preacher was relating how our Christian journey was so similar to the journey that the early American pioneers made in covered wagons to settle the West. How they banded together to protect and support one another, crossing treacherous terrain, deserts, and rivers to arrive finally in a place where they could be safe, settle and make a better living for themselves and their families.

Unbeknownst to the preacher, any decent translation of that story into Spanish in present day Honduras resonates inescapably with the language of undocumented immigrant caravans fleeing Honduras, banding together, traversing deserts and rivers, to try and find a better life in the USA. This was an unintentional parallel, completely invisible to anyone who has not been immersed in Spanish language conversations and news pieces about the issue.

Finally, I think you have almost enough background to understand why I am writing this blog. Let me explain to you one more Spanish grammar difference: Spanish has very specific rules and ways of expressing something called moods. Moods convey whether you view what your saying as fact or possibility, question or command, etc.

In Spanish, we almost all begin by learning the indicative mood- statements of fact. “The patient has pneumonia.” “Your child has a fever caused by a virus.” But to communicate one’s own emotional perception (desires, doubts, wishes, and possibilities) you have to incorporate specific grammatical structures that change each verb in slight but distinctive ways (and this change is dependent on the individual verb, so each and every verb can change in its own special way)

As a doctor I unfortunately, rarely get to deal in absolutes (meaning the indicative mood). The questions that I get almost always demand a more complicated answer. Questions such as: “Is there any chance he could get worse?” “Are there any symptoms that should make me bring my baby back to hospital?” “Does this medicine have any effects?” “Will this treatment cure me?”

The best answers to each of these questions includes the use of the subjunctive or conditional verbs (because the answers refers to things that are not yet known to have happened). I will answer each of the above questions as I would in English:

-I think he will get better, but in rare cases people can worsen.

-Your baby appears healthy and I expect she will gain weight, grow, and develop normally. But if she isn’t gaining weight, has a fever or a seizure bring her back immediately.

-Yes, all medicines can have side effects. But I doubt that you’re likely to experience any side effects if you take the medicines as I have prescribed them.

-I hope and pray that this treatment will cure you. But I cannot tell you for certain what the future holds.

This is brain defect I recently diagnosed in a 3 year old boy who came into our ER with seizures. I had to tell his family that most children with this defect stop developing at around 3 and need continuous care and anti-seizure medicines for the rest of their short lives, but occasionally children develop near normally despite the defect.

My problem is that all those answers are still really hard for me to put into Spanish in a fluid and clear way. I have work arounds and I can often make myself understood. But these are critical grammatical points, that can make the difference between what sounds like a compassionate, callous, confused, or confident reply. When dealing with particularly delicate what ifs and generally sad possibilities I don’t want to sound heavy handed (indicative used incorrectly) or confusing.

Case-in-Point: Imagine if you were very worried about your child and your pediatrician in a tone of compassionate reassurance said, “He will probably get better, but will not.” Even if your rational brain knew what the pediatrician was trying to say. Your subconscious reaction would be at best confused, and at worst distrustful.

Perhaps you will remember, that we started our journey with Samaritan’s purse a little more than two and a half years ago. We traveled to the Spanish Language Institute in Honduras, with the intention of studying Spanish for 6 months.

The walk to language school in Siguatepeque, Honduras

Six weeks into those studies, we traveled across the country to Hospital Loma de Luz because Bethany was nearing her due date and we wanted to give birth with providers we knew and trusted. Unfortunately, the day after Hannah was born COVID shut down the world. Including travel within Honduras. Due to the needs of our Hospital and our inability to return, I began working.

The birth of Hannah at Hospital Loma de Luz

As we near the completion of our contract with Samaritan’s Purse they have agreed to let us go back to language school for the month of July. We are excited and thankful for this opportunity to improve our Spanish and prepare ourselves for longer-term work at Hospital Loma de Luz.

-Please pray for our family as we strive to improve our Spanish, and communicate well with our friends, neighbors, and patients.
-Pray for our children that they will have receptive and eager attitudes towards learning Spanish.
-Pray for Nathan, that he would be able to memorize and consistently apply grammar rules (which can be so important)
-Praise God that Axel (my 4 year old patient with refractory nephrotic syndrome is almost completely off medicines and doing well)
-Praise be to God I was able to give my schizophrenic patient his long-acting antipsychotic injection early this morning.
-Pray that he will be willing and able to continue receiving these injections- and more importantly that by God’s grace and good medicine that he will be able to sleep normally and be helpful rather than destructive in his home and family.
-Pray for our Hospital and its leadership, that we would have wisdom, grace, and kingdom focused purpose as we work and serve together.
-Praise God our Hospital is coming up on its 20th anniversary operating here in Honduras
-Pray for our family and Bethany who is pregnant with our 5th child (this is your reward for reading all the way to the last prayer request – Thank you for your prayers and willingness to be with us in spirit).

Grace & Peace,

Nathan Gilley & Family


Gilley Family Photo by Stephen Rudge

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


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Status Asthmaticus

One of our visiting family medicine residents1 called me late in the evening to report on a child she was admitting to the ICU. She had an 8 year old patient to whom she had already provided all of the standard treatments for asthma (multiple albuterol nebulizations, steroids, and oxygen) yet he was still breathing very fast, requiring too much effort, and his oxygen saturations remained low. She was working her way down the treatment algorithm and getting near the bottom where it recommends:  “transfer for resource and time intensive interventions available at your pediatric referral center,” “Admit to your PICU for specialized consultation and care.”

I have two principles that I use to help me weed-out and avoid pediatric disasters.
1) Sick children look sick.
2) Children are very resilient, so they crash with minimal warning signs.

This patient was scaring me on both fronts.  He looked sick to the resident physician, he was breathing in a way that was burning through his reserves, and at some point his body would get too tired to sustain breathing like that. If that happened he could very well die.

So I went down to the hospital and asked a visiting veteran physician to meet me there so we could put our heads together and assess the situation.  On arrival I had a strange reaction from the family.  Even as I determined that we were at or near maximum intervention and their child was not responding satisfactorily, they started to relax as I spoke with them.  When I then told them things were very serious and I was worried they started calmly discussing their plans for the evening, including me in the discussion. (The father was thinking about going home to watch the other kids and wondered if he would be ready for work the next day.)

I was confused by their reaction.  Was I unclear? So I stepped up my communication of the situational gravity by asking if we could pray together for their son.

As we prayed for their son’s life and breathing, with his chest rising and falling too rapidly, sweat beading on his brow, I looked at his face which was slightly obscured by the non-rebreathing mask and recognition slowly dawned on me.  I had had an unplaceable sense of familiarity with this family since walking into our ICU, and suddenly I began to understand why this family had relaxed after I took charge of their son’s care. This 8 year old was one of our church kids, he and his parents were semi-regular attenders of our hospital church.

(One my biggest social anxieties is meeting someone out of context.  I think it has to do with the way my male brain compartmentalizes things – but outside of whatever social or geographic location which I typically associate with you, let me apologize now, I don’t remember your name or how I know you… Sorry. If it’s any comfort, your face is vaguely familiar. So without my wife in the ICU to remind me who this family was and how we knew them- I was very slow on the uptake.)

I preach at our hospital church about once a month. And my normal style is to invite all our kids (10 to 20 kids) to the front of our sanctuary and have them help me present and talk through the scripture reading and its application before the entire congregation.

My insufficiencies aside, they had trusted me to preach at our church and to lead their kids, they knew my heart and knew I would do everything our hospital could do with God’s help to save their boy. They were able to relax, despite the terrifying possibilities, because they trusted the doctor and more importantly the God, who held their child’s fate in his hands. 

With such trust, I sent off a text to my wife and the head pastor of our hospital church (he is also our hospital CFO and children’s sanctuary home co-director) asking for prayer and got to work with the resident, the visiting veteran physician, and our head of nursing putting together a plan and multiple tubes and older machines, to create a pediatric Bipap, continuous nebulization, 100% oxygen delivery system.

If you had asked me prior to that night if such a system was feasible at our hospital I would have said no.  Each of those 3 things is possible at our hospital, but combining all three to work safely and effectively together on a kid was miraculous.

We receive tons of great donations that keep our hospital running.  But sometimes for less frequently needed application all we have are well meaning donations that do not quite fit the bill. Sometimes our tubing is incompatible, a seal dry-rots, the quality is one-time or home-use grade, a motor is burned up by erratic electrical power, or we never found or received the specific tube, plug-cord, or what-have-you that is absolutely needed to make things work together.

In addition to the miraculous way we were able to put together a system to help this boy keep breathing. The resident who had admitted him stayed up through the night watching him and giving him various carefully dosed IV medications, monitoring his responses and staying vigilant for signs of decompensation. Furthermore our nurses broke open countless glass vials and refilled his nebulizing chamber every 10 minutes through the night (using almost our entire hospital supply of albuterol). Finally, as the morning dawned, it became clear that he was turning the corner for the better. A few days later he was discharged well enough to go home. Praise be to God!

This story brings two thoughts to mind:
1) I come into contact with so many new people each day, that I can easily fail to recognize the value of each person and the potential importance of my interaction with them. C. S. Lewis (as usual) says it best for me:

There are no ordinary people.

You have never talked to a mere mortal.

Nations, cultures, arts, civilization—these are mortal, and their life is to ours as the life of a gnat.

But it is immortals whom we joke with, work with, marry, snub, and exploit—immortal horrors or everlasting splendors.

2) Being a medical missionary gives me many opportunities to be anxious. Its easy to lay in bed at night thinking through endlessly looping problems that I cannot solve. I want my prayers to be like this this boy’s parents conversation and trust in me. Even when bad things are getting worse, I want to be able to trust God, relax, and plan out my next steps knowing that He is trustworthy and faithful.  As the serenity prayer says,


God, grant me the serenity to accept the things I cannot change,
courage to change the things I can,
and wisdom to know the difference.

Reinhold Niebuhr
A Serene Sunset that happens many evening right off my porch

1 In the USA a resident is a physician who has finished the theoretical and practical exams and training necessary to be awarded a doctorate in medicine but is undergoing a further intensive multi-year training to acquire a board certification such as Family Medicine, Pediatrics, Internal Medicine, General Surgery, Anesthesia…


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


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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.)

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