When there is nothing more to do…
It was early Sunday morning and our team had been up late the night before operating on a premature infant with an intestinal blockage. I am usually grateful when there is just one big problem to handle during a weekend of call, but that was not to be this weekend. At about 4:00 am, I was informed by the senior surgical resident that a woman with extensive burns had just arrived to Casualty (our ER). I briefly contemplated taking a shower, but instead prioritized coffee intake, then walked up the hill to the hospital. It was easy to find the patient…her burns extended onto her face which was not hidden by the white sheet which covered the rest of her body. The resident, Valentine, filled me in on the story: The woman lying in the bed was a mother to two young children who were playing inside of their house around an open fire. An open fire is a common enough occurrence in Kenya since it provides the means of cooking in most homes, but what evolved into an uncommon situation was that the two children began playing around the fire with a container of kerosene. Fortunately, the mother quickly recognized this and took the container from them. Unfortunately, the kerosene spilled onto her shirt, soaking it thoroughly which was then ignited by the fire. The fire was quickly extinguished, but not before burning the majority of the skin on her body. She travelled to a nearby hospital and then was sent on to Tenwek, now some 8 hours after her injury.
Together, our team examined her. She was completely awake and alert and was able to have a normal conversation with us. As expected, she was in some pain, but it was reasonably well controlled. Her burns were extensive…her back, chest, arms, and face were covered in second and third degree burns. In total, just over 60% of her skin was burned.
In the U.S., a patient with a 60% body surface area burn is a challenge…so much so that these patients are usually transferred to a specialized burn center to be cared for by burn specialists. Surviving a burn that involves 60% of the skin is possible in the U.S., but even with specialized care about half of these patients (depending on age) will ultimately die from their injury. In western Kenya, where there are no burn specialists and where hospitals are not equipped to take care of a patient of this complexity, the chance of survival is close to zero. And so, as we are assessing Mary, the extent of her burns and the reality that she will almost certainly die from these burns becomes clear.
As a missionary surgeon, I am charged with displaying Christ in both word and deed to my patients. The deed part comes naturally to us as surgeons. We like to fix things. We like using our hands and minds to correct a problem so that we can see a person healed. This paves the way for us to sometimes share, by word, who Christ is. Often times at Tenwek this is done by our Kenyan chaplaincy staff who can speak into spiritual matters with better cultural and language insights that I can. I am always grateful for our chaplains because, quite frankly, I am at times uncomfortable doing their job. I do not want the patient or family to think that the only way that I, the white guy, will provide care for them is if they agree to my religion. The reality is that there is an imbalance of power between us as physicians and our patients. We have knowledge, skills, ability, and resources that a desperate patient needs. Does my sharing of Christ in word coheres a patient? Possibly. Therefore, my approach is to display Christ primarily in deed by taking care of a patient’s physical needs. But on this morning, I have little to offer this patient this patient medically.
We explained to the patient and her family the extent of her injuries and the likely outcome. We give them the option of not doing any treatment, of just keeping her comfortable, but they refuse and ask us to do everything we can, to which we agree. We will need to intubate her- place a breathing tube- for which she will be sedated and communication will be difficult. Valentine, in Kiswahili, asked the patient about her faith. “Do you know Christ?” She does not, but after Valentine spends time telling her about who Christ is, she decides to give her life to him. We all pray together: the patient, her family, and our team. We prayed for healing and for comfort in the midst of a lot of pain. Tears flowed from her husband. After this we wheeled her to surgery…it was the last time she would talk to her family.
Skeptics might say that her faith was not genuine. They might say that she was scared for her life, or rather, her coming death. Some might even say we took advantage of this to achieve our own desires to “win people for Jesus.” However, the only place where we can fully see Christ is when we are stripped of everything. Only when we realize the frailties of our flesh, the briefness of this world, and the passing of material possessions can we truly see our need for the cross. And so, very likely, this lady came to know Christ in deeper ways than many of us who have followed Christ for years. But my role is not to be a judge. Instead, I am called to be a witness in a time of great need- a need that cannot always be met by modern medicine or years of training.
All things considered, our patient did well over the next 3 days. We worked hard to replace liter upon liter of fluid that she was losing because of her burns. She remained on a ventilator. We kept her pain controlled with IV pain medication. On what would have been her fourth day in the hospital, I arrived to ICU rounds to find her bed empty. She had died during the night.
Generally, as a missionary, I want to tell of stories of success, stories of great healing where God used me as his instrument to bring someone back from the brink of death. I want people to applaud the medical work that is done at Tenwek. This is a human mindset- and one that is self-glorifying. While there are truly amazing things that happen here, I have come to understand more completely that not all acts of healing are physical. Not all great interventions involve the use of sterile instruments and suture. For Mary, healing was achieved apart from these things.