Tuesday, 3 March 2009

Tough decisions

I promise that not all of my stories will be heavy ones.  But I want to share about one more patient...

Joyce was brought into the ER my first weekend on call.  She was a student at one of the nearby Bible colleges, having recently moved to PNG from the Solomon Islands.  She was about 30 weeks pregnant (7 months) and was referred to our hospital because of very high blood pressure.  I evaluated her and gave the diagnosis of pre-eclampsia, or "toxemia" of pregnancy for the non-medical folks out there.  I admitted Joyce to B-ward for observation.  Lab tests and continued blood pressure readings confirmed that this disease was in the severe stage.  I did an ultrasound and there was very little water around the baby; this supported the diagnosis.  The only treatment for severe pre-eclampsia is delivery.

Back home in the States this would have been a no-brainer.  Let's the kid delivered and he or she will live in the NICU for a couple of months.  In fact, babies as small as 1 pound and early as 24 weeks can survive.  Not so here in PNG.  The smallest of babies cannot survive here without the incubators, ventilators, and fancy equipment of modern day NICUs.  Our nursery is a small and very toasty room where the premature babies share a couple of warming beds.  Oxygen is given by a tiny tube in the nose.  Mothers help to provide the care, feeding their babies expressed breast milk through another tube that goes into the stomach.  

So I here I was facing a difficult decision, though I knew the answer.  Do nothing and both mom and baby would become very sick and possibly die.  Inducing labor would save mom's life, but Joyce's baby was right on the edge of survival in our nursery.  I ordered medication that would start the contractions.  The next morning, Joyce delivered a baby boy who weighed only 1.4 kilograms, or about 2.6 pounds.  Baby Josh did surprisingly well for the first few days, breathing easily and tolerating feeds.  Then he took a turn for the worst:  pulse rate began to rise, breathing became labored, body temperature elevated.  Antibiotics were able to hold down the infection for a few days, but his tiny body was unable to continue the fight.  After just ten short days of life, Josh lost the battle.

Sometimes it is hard to understand God's plan in something like this.  The Father was watching as little Josh was being formed.  He knew that he would be born early and that he would only have ten days with his earthly family before going to heaven.  His love is so great, and I will trust in that love when things don't make sense.

"For you created my inmost being;
you knit me together in my mother's womb.
I praise you because I am fearfully and wonderfully made;
your works are wonderful,
I know that full well.
My frame was not hidden from you
when I was made in the secret place.
When I was woven together in the depths of the earth,
your eyes saw my unformed body.
All the days ordained for me
were written in your book
before one of them of them came to be.
How precious to me are your thoughts, O God!"
~ Psalm 139:13-17a


  1. Having an awesome understanding of God's Sovereignty will help make the decisions you made/make, I can see that from the scripture you chose. I don't think things like this every bcome "easy", but the they do become understood when you know that God is truly behind EVERYTHING! Blessings, Aunt Robin

  2. Praying for you as you make these daily decisions.

  3. Psalm 139 has been a blessing to me over the years. There is a beautiful song out of that Psalm that I have played and sung (to myself) when things were difficult. We will continue to pray for you and your patients daily.

  4. It must be so hard to make the transition to a place without the diagnostic tools, medicines, and equipment that we have in the States. These cases are hearbreaking, but I am thinking of Romans 8:28, and pray that God is working all these things for GOOD. I can imagine this woman will not soon forget the love and concern you had for her and her baby...the love that comes from having Jesus in your heart.

  5. As the adopted mother of a preemie, my heart is breaks for this family but I am thankful that you put this on so I can be more effective in praying for you. May God continually give you His wisdom, His peace, His comfort in what you must face. May He give you strength and courage to follow Him wherever He leads.