Saturday, August 24, 2013

Musa Update II

It is with a heavy heart that I write this blog.  The irony of the situation I’m in is not lost on me.  My last blog post was about my little friend Musa.  You can read about his story here and here.  I was boasting about how well he was doing!  Unfortunately, Musa has taken a turn for the worse. Literally one or two days after I posted that blog, his illness returned.  Or some kind of illness returned.
He was over at my house one evening and started complaining of left sided pain.  I didn’t take it too seriously because people here tend to complain about aches and pains quite frequently.  However when he mentioned his pain again the next day, along with another symptom that he wasn’t “peeing freely,” he caught my attention.  I asked him some questions and tapped on his kidneys to see if he was in pain.  When I touched him, he jumped back and gave me a look like “why in the world would you want to do that to me?!?!!?”  Yup, definitely painful.  I looked at his face and noticed that his face looked a little puffy as well.

It was obvious that Musa had a kidney infection.  This is pretty uncommon in young men, but I began the treatment and he seemed to improve.  But then he got worse again.  He said he was having trouble urinating so we inserted a catheter to drain some urine.  Pus was noted in the urine.  We encouraged him to drink plenty of fluids.  These symptoms went on for about two weeks. I discussed this case with the doctor we have here and we started a couple other medicines to try and treat any other possible causes of an obstruction that was causing his inability to freely urinate.
I discussed his condition with the surgeon who did his initial surgery as well as with our doctor here.  It seemed that we had done everything we could for him and needed to take him to Freetown to obtain some more studies. Unfortunately in the last six months or so our ultrasound machine has broken, our xray maching is broken, and we no longer have the capacity to check necessary lab tests.  The decision to take Musa to Freetown for further studies was unanimous.  When I told Musa, he started crying. This poor boy has been through so much, for so many years and this was very discouraging news for him.  I left him Saturday afternoon at the hospital with a nurse who was going to reinsert his foley catheter to drain some urine.

Sunday morning I was working in the OB ward when Musa’s mother came to get me. She said that Musa was just lying down, wasn’t talking, and was chewing on his tongue.  I figured that he was just discouraged about the news I’d given him yesterday and told his mother that as soon as my friend Peter (also a friend of Musa’s) and I got back from church we would go talk with him.  She said it couldn’t wait and asked me to come see him now.  So I went.  When I arrived at the house, Musa was laying on the floor in severe respiratory distress. His face was twice as swollen as it had been the previous afternoon. No!!

I asked if there was a motorbike that would be able to take him to the hospital, as there was no way he could walk. They went to arrange one and I set off at a trot to be able to meet them at the hospital.  They beat me there and as soon as I walked into the hospital the nurses started saying “Emily! Your friend Musa has returned!” (Everyone in the hospital knows him). 

When I listened to his lungs, I heard quite a bit of fluid in his lungs.  I inserted a foley catheter (they were unsuccessful the previous afternoon) and gave him some medicine to try to drain some of the fluid off his lungs.  40mg of Lasix….no urine output.  I gave him another 20mg.  Nothing.  I gave him another 20mg and he finally started putting out some urine.  This was a hefty dose of Lasix we had to give him in order to get some urine. It appeared that for some reason, his kidneys weren’t working.  Had his cyst returned and was somehow interrupting his kidney function? Was it truly kidney failure?  We had no way of knowing. As I mentioned above……everything is broken. 

I called the doctor and he met me at the hospital.  We continued the treatment, but neither of us had a good feeling about him.  We were flying blind, and even if we weren’t, we had such limited capabilities.  Frustrating.

That night I decided to sleep at the hospital.  I’ve been with this kiddo for so long.  I was in the OR with him during both surgeries, visited him at least once a day every day he was in the hospital and after he was discharged he made it a habit to come to my house every day.  If he was going to die tonight, I wanted to be with him to the end. 

Praise the Lord for some good friends who kept Marie for me that night.  It was a long one. His breathing was so labored and every time he stirred in the night I awakened to see what was going on.  His mother tried to go home to rest but returned a short time later stating she just couldn’t stay away from him.  One of the sweetest things of that night was watching Musa’s older brother. He didn’t sleep a wink. Anytime I looked up he was doing something to help his brother. Adjusting the sheet, fixing the oxygen cannula, helping him to the bathroom or applying Vaseline to his dry lips.  It was precious. At 5:30 I got up to go home to shower before a meeting I had at 8.  He asked where I was going and I explained but asked if he wanted me to stay.  He said, "Yes. Stay." So I stayed. Thirty minutes later he awoke suddenly and started asking, "where's Emily? Where's Emily?"  "Look me! Look me!," I said. 

Later that morning the doctor and I discussed our options.  He was sick.  Really sick. And that was our problem.  We knew that there wasn’t much we could do for him here. But could they do anything for him in Freetown?  If he truly was in kidney failure, do they have a dialysis machine? If it was the cyst that was somehow impeding his kidney function, could they do anything for it? He certainly wasn’t a candidate for surgery!  And the biggest question of all. Would he even survive the journey?  Do I take this kid and his mother away from their only support system if he’s just going to die anyway?  Ugh!  Decisions, decisions.  We finally decided that if he was the same or improved the next day, we would take him to Freetown. If he was worse, we would keep him here and let him pass away near his family.
That night I decided to sleep in my house. I didn’t think I’d be able to make the 7 hour drive on two nights of no sleep, so with strict instructions to call me if his condition changed at all, I went to my house. The next morning I was pleased to see that his condition looked slightly improved. We decided to go. I already had my bags packed so I took care of a few remaining things and we loaded him up into the car.

The journey down was brutal for him. I don’t know if I’ve discussed the condition of the road to my village before, but it’s one of the worst roads in the country. And it’s rainy season, which always makes the roads worse. Although I went much slower than usual, I still had to stop several times just to give him a break from the jostling. When he told us that he had to have a bowel movement, I thought the strain of getting him in and out of the car might be the end of him. He just had no reserve for his respiratory effort. 

We reached Waterloo where the rest of my NGO lives. We had arranged that I would drop Marie off so she could get to bed. I met them at the turnoff for the house and passed Marie off. As I went to get back into my car, one of my co-workers told me her husband was going to come with me. I started crying. I know they were concerned with my safety, traveling at night like I was doing. But they also didn’t want me to have to do this by myself.  I am SO blessed with the team I have here. I can’t even express it.

I drove us the hour and a halfish to get to the hospital. When we got there they brought a stretcher and took him straight to the ICU. I met with the doctor and explained the whole complicated situation, beginning from the first surgery.  Families aren’t allowed to stay with the patients in the ICU so after we said goodnight, I took his mom and dad to their family’s house and I went home.
We came here on Tuesday. Today is Friday.  The doctors and staff here have been wonderful.  They are hopeful, but realistic.  This is the best hospital in the country, but there are still limitations. I talked with his doctor about intubating him (putting a tube down his throat to breathe for him) but they don’t have the lab tests available to make sure the settings are correct. We talked about dialysis (putting him on a machine that will essentially do his kidneys job for him) but the doctor said that the one and only dialysis machine that was donated to Sierra Leone is at the government hospital and until now has never been used.  So we were left with managing him as best we can with medicines. And prayer. Lots of prayer.

Yesterday Musa looked bad. When I left him at about 7pm his breathing was worse, his heart rate was up, and he was confused. All very bad signs.  I went home and had a breakdown with my friends.  I figured he’d probably die today or tomorrow.  You just can’t keep breathing as hard as he is without tiring out.  Every day I’m sitting in 5-6 hours of traffic to travel to and from the hospital, but I just can’t stop.  I need to be with him until the end.

As I walked into the hospital today I got the same sinking feeling I always do.  Just wondering what I’m going to find.  Today however, I was encouraged!!  His heart rate was down, his breathing was easier, and he was fully conscious.  Thank you Lord!!  I know he is still critically ill.  I’m afraid to become hopeful, but I can’t help it.  Yesterday I was mentally arranging how I would get his body back to the village.  Today I dare to hope that he might go back to the village alive!  One of the saddest things about yesterday was that he still has such a strong will to live!  He told me to please tell the doctors that he is seriously sick. He asked me if we were going to do an operation on him to make him better. He told me he was tired of being sick and really wanted to go back to the village with a “well body.”  It was heartbreaking. 

So we wait.  Once again I am SO incredibly thankful for my teammates. I honestly don’t know what I would do without them. I’ve been leaving the house at 8am every morning and returning around 10pm.  These would obviously be very long days at the hospital for Marie, so my friend Robin has graciously agreed to watch her for me.  What a relief to be able to leave her with people that she loves and love her so much and not have to worry about her.  It makes my load so much lighter!!

Several of you have asked me to mention any extra financial needs I may have.  This is one. Like I said before, this is the best hospital in the country, but that means it’s expensive.  Since he’s in the ICU, it’s costing a couple hundred dollars every day. I know it’s minute compared to hospital costs in America, but this is hungry season so the requests to me for help have been plentiful.  To be honest, I’m tapped.  If you’re interested in helping, just let me know. Thank you, thank you, thank you!!

Please pray. I know that God is the giver and sustainer of life so I’m trusting that His hand is in this.  Please pray for healing, and also that Musa would be encouraged.  No matter what the outcome is, my desire is that Musa will draw near to Jesus and that He will be glorified in this situation. THANK YOU!

Friday, August 9, 2013

Musa Update

I realized today that I never gave an update on the kid “Musa” that we did an operation on a couple of months ago.  Allow me to do so now.  You can read about the first half of the story here.  Musa finished the surgery and did pretty well. He was in a lot of pain but gradually started getting better. After a week or so he was ready to be discharged. He asked if he could take me to his house when he went home, so I followed he, his mom and his brother home.  I got a lot of “Musa, look your wife has come!” comments as we were walking. (Keep in mind, he’s about 14). 
Musa and I after his first discharge

We got to his house and the Imam (Islamic leader) for the community came out to greet me.  I sat down with the family and exchanged pleasantries for awhile.  As I was preparing to leave they dropped the bomb that they wanted to “give me Musa.”  Wait. What? Even though I’ve lived here for a while, I’m still not always up on what these things mean. Pay his school fees? Give him a place to sleep? Not sure.  So I do what I usually do in those awkward situations. Chuckle like they’re joking, say “oooohhhh Thank You…” like I thought they were kidding and slyly get up and walk away.  It’s an art form…. In awkwardness.  I’ve learned to embrace it.

The next night I got a call from one of the nursing assistants down at the hospital. Apparently he had seen Musa at his house and he’d taken a turn for the worse.  The family wanted to take him somewhere to get some medicine but the nursing assistant told them they should talk to me first.  I asked if he looked sick enough to be admitted and he said he’d be fine overnight. I told him to tell Musa to come to the hospital in the morning and I’d see him.

When I got to the hospital the next morning they had already re-admitted him. His abdomen was swelling again and he just didn’t look good. We started him on a week of antibiotics (virtually unheard of here as they are so expensive) and decided to wait and see.

After about a week he just wasn’t getting better. Or he’d get better, but then worse again, back and forth.  Finally we decided that we just had to take him back to surgery to find out what was going on. I was afraid. He was so weak and had lost so much weight, I was afraid he wouldn’t survive the surgery. But we just didn’t have another choice.

The next day I went down to the OR for the surgery. When they opened him up they found two things. One, the cyst that was his original problem, had started to grow back. He also had a big ole’ bowel obstruction (the poop got all stopped up and wouldn’t come out).  We had a different surgeon this time and he could see why the cyst came back and proceeded to fix it. He also fixed the bowel obstruction. Praise the Lord there was no dead bowel!!  (PS it was the first time I’d watched one of those repaired and it was gross!!!  I thought there would be a more high tech way to fix it but nope. Stick a hole in the bowel, squeeze out the poop that’s stopped it up….sew up the hole.  Gross).

This time after surgery, Musa did great!! I did have to run intervention one night when his mom called me in utter frustration because Musa was refusing to take it easy in his bed.  (This was the first day after surgery).  She was beside herself.  In his defense he'd felt bad for SO long and was just tired of laying in bed.  I went down to the hospital and had a little chat with them both and they became friends again.  Teenagers and their every culture. :)

Musa came over for science class one day.  We made....a green volcano.  Use what you have :)
His body still had zero fat on it, but over the last couple of months he’s really gotten stronger.  Since he had to drop out of school due to his illness he doesn’t have a lot to do during the day so he comes around my house a lot. He and Marie have developed quite a friendship with her idolizing everything he does and he graciously tolerating all her questions and bossiness. My favorite part is that during this whole thing, Musa developed a great interest in the Bible and in Jesus.  To be honest, I’m always a little hesitant when this happens in these kinds of circumstances because I don’t know if it’s genuine or if they’re just trying to please the person that helped him. I’ve explained to him many times that whether or not he chooses to follow Jesus will in no way affect our relationship, but he persisted that he was interested.  So my friend Peter and I have started meeting with him every Thursday night to begin talking about what it looks like to follow Jesus. I remembered last week how much I love teaching.  I don’t know how good I am at it, but talking to other people about how awesome Jesus is reminds me of all the reasons I love him. Win win!!