Monday, April 20, 2015

Injured Elephant Driver

At the age of 64, I volunteered to work at a Thailand hospital for nine months, while its only doctor, Phil McDaniel, was in America. I closed my office in Idaho and semi-retired. For the next eleven years I would work whenever I chose, as a locum tenens or “rent-a-doc”, filling in for doctors who were on leave for one reason or another.
Kwai River Christian Hospital has 30-beds, complete with lab, X-ray, and operating and delivery rooms, and some very competent Thai nurse-midwives. It's in a rural setting much like other Asian hospitals I have worked in. I am not a fully trained general surgeon, but have had a couple of years residency, plus forty years experience. At KRCH, it would soon be tested.
Many Thai sawmills still employ elephants to move the logs. The driver sits astride the animal's sturdy neck, steering it by jiggling his bare feet behind its ears. One night, after I had been at KRCH a month, a sawmill's pickup truck brought in a 25-year-old Karen man who had fallen off his elephant, striking his left lower ribs on a log. He had severe left-sided bellyache.
The situation is the same as a car accident in USA: any ER doc knows that left-sided rib fractures can signal a tear in the spleen, a delicate, fist-sized organ serving as a filter for the body's blood supply. The treatment is emergency surgery to remove the torn spleen and stop the internal hemorrhage. Trouble is, I had never done that operation, and had only seen it done once.
In such emergencies, I have found it useful to quietly pray as I work, and this seemed like a good time to do so. “Please, God, don't let this be a ruptured spleen! I've never done that operation, and there is no anesthetist; if I operate, he'll die on the table!” As I took his blood pressure again, the next unwelcome words came to mind unbidden:
He'll die if you don't.
That made me realize that I was stalling for time, and I gave the orders to call out the team. (No phones, but the night watchman knew which houses to go to.) A lab tech to get blood ready, three extra nurses, one to scrub and assist, and one to circulate, and one to monitor the man's vital signs after I injected a spinal anesthetic, and during surgery. The sawmill boss had brought the man and his family in; and he agreed to round up blood donors – no easy job in Asia. A nurse aide translated my Thai into Karen language, explained to the man what we had to do and had him sign the permit. She asked him if he had any medical allergies (Hkui hpae yaa rui plaaw?) He said no.
I operated, with a surgical textbook on a music stand nearby, opened to Removal of the spleen. Opening the man's abdomen, I found a belly full of blood and a torn spleen, still bleeding. I carefully clamped its blood vessels and removed it, avoiding damage to the nearby stomach and pancreas, conscious of God's help in remembering the steps I had once learned. (Readers wanting the details of the drama can find them in my novel Flame Tree, chapter 8. . . . fiction is often based on fact.)
The operation was successful, and a week later, after 3 pints of blood, the man went home. When they left, his wife had her small son place palms together, the Thai way of saying thank you. He had his daddy back.
So why am I adding this chapter to a book about pure chance versus the presence of God?
I do it to add my testimony that I believe that God exists, cares about us humans, and offers help when we ask and are willing to listen. In my experience, that seems far more likely than a mythical lady luck, or blind chance, or what-have-you. If that is true, we ignore him at our peril. Granted we have freedom of choice, our insisting on choosing our own path is arguably the cause of much of our ills, and those of the world's.

One postscript: On a coffee break last week, I chanced to get to know an acquaintance better. As often happens to a retired doctor, he turned the conversation to a recent health episode of his own. He has been diabetic for years, taking a modest dose if daily insulin. He described a recent personal “aha moment”, when he discovered that his bed-time blood sugar tested 380 for no apparent reason. He was debating how much insulin to take, when he received an unbidden thought: Sit on it. Puzzled, he continued to prepare his shot. Again came the emphatic thought, Sit   on   it. Not knowing why his sugar was that high in the first place, he interpreted the thought to mean Wait. He laid the insulin aside and went to sleep. When he tested his blood sugar again next morning, he found it to be 40, very low. Neither of us could discover any reason why it was so low, but if he had taken the night dose of insulin, his morning blood sugar level might well have been even lower, low enough to produce coma (a.k.a. “insulin shock.) Potentially fatal.
The question arises, how do we tell the difference between a presumed message of God's Spirit, or some other source? The first thought that comes to my mind is, prayer and practice.