10 days ag
o was orientation. 5 days ago was our first days of call. 3 days ago was our first c-section. 2 days ago was our first cast. Today was our first death.
Our team
Here in Togo we are for the most part, not including visiting doctors, 3 family doctors, 1 surgeon and 1 pediatrician.
Our shifts
We (my wife and I) each have 15 twenty four hour shifts to work. One works and one stays at home with Noah. Depending on the day, the shift could start at 7:30 / 8 or 9 am. Depending on the day, we could be responsible for just the OB floor and or the whole hospital – Peds, Adults, Intensive Care and OB – 50 beds in all.
Our patients
We see patients from all over. People travel from the capital Lomé to see us. We do refer patients, however, rarely. These are patients who are beyond our ability to treat with the caveat that if for whatever reason they are unable to get help, they can come back to see us and we will try.
Saturday August 3, 2103 – A typical 24 hour day?
I started the day grumpy as rounding started early. First stop pediatrics.
Dr. K was signing out 9 kids to me before heading to Ghana for the day. 5 kids going home, 4 staying. The sickest of the bunch has cerebral malaria and suffering from seizures. The night before the child had required 3 doses of valium and 1 of Phenobarbital. Instructions: if the kid seizes give her pheonbarb. Check.
Next stop, Miss B, a nurse practitioner. Our task, round on the 6 medicine patients in the hospital. The sickest patient was a 21 year old female with what is believed to be post partum congestive heart failure. My wife had admitted her yesterday and from all reports she was on deaths door. Working together with Dr. G (another family doctor), we had come up with a treatment plan that consisted of easing the load on the heart. Today she looked amazing. Win 1, Losses 0.
Next stop OB, 5 post partum patients to round on and 1 laboring patient. In between rounding on the patients, I got to deliver the laboring patient, and I was made aware of an admit to the hospital with congestive heart failure. His vitals were stable, labs pending, and medications given. I’ll see him after lunch I thought. Win 2 Losses 0.
As I was leaving the hospital, I noticed a young man laying on the gurney struggling to breathe in the triage area. I stopped by the nurses’ station to inquire who he was. They handed me the file, 19 y/o males admitted for congestive heart failure! This was the admit I was made aware of while on the OB floor. He’s definitely not stable. Lunch will have to wait. I hit him will all we had lasix, nitro paste, dopamine, and fluids. I called for advice. He never got better. I watched him die. Win 2 Losses 1.
The evening was topped off with 4 more admits, 2 of them had HIV, 3 of them had a Hematocrit of 15% (normal is above 36%). I got to bed around 11 pm.
The phone rang at 4:30 am. “Hello” I said. “This is the OB floor. We have a transfer from an outside clinic of a lady in labor with BP of 202/110.” “OK” I said, “I will be right over.”
Entering the OB ward I noticed there were a lot of people on the floor, more so than when I had left a few hours ago. In approaching the nurses’ station I was politely told that we have 5 active laboring patients! 2 are stable, 1 is breech and will require c-section, 1 is a VBAC that a doctor must delivery, and 1 has BP of 202/110. Starting with the worst, I rounded on each patient assessing them and writing orders as I went. After realizing the true scope of 5 laboring patients, 1 who was potentially very sick, I called in my wife. Leaving Noah at a fellow missionary’s place, my wife came in and did the c-section. Meanwhile I delivered 2 of the patients vaginally, including the VBAC patient. I left the hospital at 9:30 am while my wife stayed to start her 24 hour shift.
Some Thoughts
After praying with the family who lost there 19 year old boy, the father simply said to me, “Thank you for all you did.”
“Naked I came from my mother’s womb, and naked I will depart. The LORD gave and the LORD has taken away; may the name of the LORD be praised” (Job 1:21).
In thanking me, I am left wondering what I did! Did I make the right decisions? Did I give the right medications? Did I run the right tests? Did I cause his death? Am I competent? Should I be here?
In the USA it would be different. A 19 y/o male with CHF would not be left to a generalist with a book and a phone but with a specialist. Would it mean that the actual treatment would be necessarily different in the end? . . . No. It would simply mean that today I would not be crying and wondering what else I could have done.
“In their hearts humans plan their course, but the LORD establishes their steps.” Proverbs 16:9
God Bless
Your letter is so discriptive that I can picture your day and, also, realize how desparately you need lots of prayers. I cannot imagine such a schedule, yet how rewarding to be in God’s will, at God’s place, at
God’s timing. Love you and I will be praying. Aunt Elaine
I was in tears as I read…and finished reading…and yet for you two this is a daily kind of experience. As you work and pray through such challenging “ministry” days there, may we be diligent about our “ministry” of praying and praying and praying (for you and those to whom you minister).
As a well-known missionary of years past, William Carey, said, “We will go down into the pit to bring people out–but you must hold the ropes.”
Know we are praying for you! Know also that our hearts are with you!
(And thanks for giving us a healthy dose of reality about the needs for prayer there!)
I’m so thankful for an ever-present, almighty Lord to sustain and empower you through the many challenging hours! May He also grant you both rest and peace!
Much love,
Ann
THAT IS A VERY BUSY SCHEDULE… HELLO TO ALL AND HOPE YOUR GOING TO GET SOME REST….BEST WISHES, MARGARET B…. PS…..EVEN THE LORD RESTED ON THE 7TH DAY…
You are such a gift to so many, Fred and Lydia.
Frank and I are thankful for your note. It was very descriptive and helps us know what you’re doing and what to pray for. It’s a long list. It sounds like one of you works one 24-hour shift and then you’re off 24 hours while the spouse works. Is this right? Maybe you’ll write a book someday.
Frank and Pat Hart
Yes, that is right. We do have one day a week when both of us are off, but otherwise one is working a 24hr shift while the other is home with Noah.
Thanks for your prayers -we’re finding out how much we’re going to be relying on them!
Well said Ann Childress. Fred and Lydia God has you where He wants you because you said yes to the call. Just like Mary and Joseph said yes, you are in the midst of the battle field. The front line between life and death. Our prayer is that God would sustain you, keep you and continue to give you wisdom and discernment on treatment as well as spiritual food. Thank you for being so transparent. Thank you for allowing us to get a bird’s eye view of a day in the life of a Dr. in Togo. We would like to encourage you to continue to be humble, cry out to God as He want’s us to Cry out to Him. It is interesting that word cry out… Because if we don’t, He will make the rocks cry out. Read Psalm 23. Read it slowly and emphasize the words as you sit in the valley. One thing we have learned a long time ago, it’s not about numbers, because it just takes one. One to lead to Christ where there, they will have eternal life. Press on. We love you and know that you are in the palm of His hand. Give Noah a squeeze. We will continue to lift you up and stand in the gap on your behalf. We have your back…
Anne and Chuck
Thanks so much for your words of encouragement! Thanks for covering us in love and prayers!
Fred and Lydia, I could almost smell the hospital as I read your blog. It was no different in Democratic Republic of Congo. There were always needs, many wins and many losses. But you did what you could, and yes, the people were thankful. Your schedule sounds grueling. I didn’t see where you had time off or a day where you as a family are together. I pray that you fit that into your schedule. A Sabbath is important no matter where you are. Thank you for taking time out to give us an idea of what you are facing. Do you have house help? I did, and I was single…there were too many things to do that one doesn’t have to deal with in America. I’m sure those things exist in Togo.
You are in my thoughts and prayers,
Margie
We do have one day a week where both of us are off. Also Wednesday afternoons the clinic is closed making things lighter. We would appreciate your prayers for our time of relaxation -this will come with time, right now it just seems hard to relax -as even when one of us is off, we don’t necessarily feel like it, especially if the other has a lot going on at the hospital. Also, there will be some visiting OB’s and a midwife coming out who will be able to take some of the OB call giving us a little bit more time off.
We do have house help for which we have already become much appreciative of! They make wonderful fresh bread and cookies! (these are wonderful especially on the way into the hospital!) Part of our learning here is also knowing how to have them work for us. When your so used to “running your own house” it can be some what of a challenge to figure out what to ask them to do and what you do yourself. This also should come with time -just one of the “small daily challenges.”
Thank you also so much for your words of encouragement! Psalm 23 is a simple but wonderful passage to be reminded of!
I read Anne and Chuck’s comment and now I want to add another comment. This morning we heard a sermon on Psalm 23. In brief, we all live in the valley. That is where life takes place, that is where production happens, that is where the crops grow. The mountain tops are wonderful, but that is what they are, “mountain tops”, times of amazement, refreshing and refueling. After that, we return to the valleys where reality sets in. But we will not fear, He is with us. What a Shepherd we all have. Be encouraged. Margie
Wow! You are already fully living the life of missionaries! It IS one of the greatest sufferings of medical mission work to know that in other places people would not die from things they will die of in poor countries. But trust in the designs of Providence…you are where God has called you to be. God’s love and strength will sustain you through it all.
Thank you Sister Kay. God seems to be speaking through you and others and to confirm to us that this is where He would have us to be -sometimes easier to see then at other times. 🙂
I am in awe of the work that the both of you are doing over there. Makes me feel like I have one of the cushiest jobs in the world! Praying for and missing of you guys!
Helping to impact the thoughts of those who will someday be the leaders of our communities, states, and country is also very important!
So comforting to know that God knew the number of days for the 19 year old and that he’d be using you two to touch his people in Togo. My prayers are with you.
Thank you!!
The patients, and the families, under your care are truly blessed. You both are competent, compassionate and above all loving physicians who will always do “the right thing”. However, despite our best efforts we cannot heal everyone we care for and that is when God’s deepest work in us begins. Much love and prayers to you and your precious Noah. Thank you for taking the time to blog and keep us updated on your work. I love you both dearly.
Thanks so much for your love and prayers and words of encouragement! Often times we pray for the patients, but don’t always think of God working in us at the same time. We miss working with you and the team the team there -might be emailing/calling you for “consultations.” Thank everyone there for their prayers for us -we really do feel and appreciate them!
I got goose bumps just reading about your day! You are doing Kingdom work! You are doing God’s work, helping God’s people. He has equipped you with the heart, compassion, and the SKILLS to be exactly where you are. You are His hands and feet. What a privilege!! Thank you for allowing God to use you both ( and Noah) in His service. You make a GREAT team. You are in my prayers.
Thank you Avril! Your words are a good dose of encouragement! We miss working with you!!
You are both precious and Joshua 1:9, Duet 31:8.
“Have I not commanded you? Be strong and courageous. Do not be afraid; do not be discouraged, for the Lord your God will be with you wherever you go.” Joshua 1:9
“The Lord himself goes before you and will be with you; he will never leave you nor forsake you. Do not be afraid; do not be discouraged.” Deut 31:8
Thanks Wendy! These are two very good verses!
wow, where do i start? first of all, convicting for me stressing and complaining over grumpy kids and handling the house on my own while brian is out of town for business! definitely puts life in perspective! ouch, i needed that!
and then wow for how desparately those people need you and for how God is using you both in such awesome ways. i can’t imagine how hard it must be to lose a patient and feel like ‘what could i have done?’ but remember God has our days numbered. He knows when we are supposed to go home so you can’t blame yourself, it was his time. All you can do is do the best you can with the knowledge and skills God has granted you and trust HIM for the rest. and whatever the outcome is, you have to trust it was HIS doing. may that comfort you.
you two are amazing and we are so proud of you. we just can’t even fathom the load you are carrying and yet the miracles you are witnessing and lives you are touching. wish we could be working alongside you!
as always, we love you and pray DAILY for you.
rees family 🙂
Praying for you tonight as well, Fred (and Lydia). I am dumbstruck by the magnitude of your work and the intensity of your schedule(s). I will keep repeating as a prayer for peace in your spirits and a calling out to the Lord, “His eye is on the sparrow….” Much love to you!