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Small Things that Make an Eternal Difference

As her face turned suddenly cyanotic, her very last literal breath approached and she lost consciousness.  She was already on the very maximum amount of oxygen we could give her, 15 liters by a non-rebreather mask, yet her oxygen saturation had fallen from the 80’s into the 30’s within moments.

I was not facing the moment as some “life-saving third-world missionary doctor,” there to “save the day”.  In fact, I wanted to run from the moment.  I didn’t want to have to make the decision that was being thrust upon me in the middle of night.  Should I intubate her and try to mechanically ventilate her (connect to life support) or should I let her go?

Stella, the patient, was a 58 year old female who was in multi-organ failure. Her kidneys were failing (Creatinine of 3.2).  She was septic (WBC 38.0) and febrile (T=102) and tachycardic (P=115).  Her potassium was so high it was causing changes on her EKG (hyper acute T waves and widened QRS, K=6.8) and she had a severely low sodium level (Na=122).  Her liver enzymes were acutely elevated, demonstrating signs of the effects of sepsis.  She had developed an arterial clot in one of her legs which was pulseless, cold and dead, with necrotic black toes.  We thought that was the likely source of the sepsis. Furthermore, we had been concerned that the extra strain of the sepsis might have caused a heart attack and subsequent heart failure.  Now, she was in respiratory failure.

 

She was not stable enough to go to the OR for a below the knee amputation (BKA).  But the question remained, if we could remove the source of infection, would she stabilize?  She was already on multiple IV antibiotics and getting worse.  But the thought kept nagging me, even though she was so sick, that there might be a quick fix to her illness (amputation)?  Should we mechanically ventilate her?  Or would that only prolong her death and cause her harm?  Was she so sick that we should let her go?  I absolutely in that moment did not want to be the one answering that question.  I hadn’t had enough time to think about it and give an educated opinion.  But the time to decide was upon me in the middle of the night on a Friday.

In order to buy myself time to think, I ran to the OR and quickly grabbed the things necessary to intubate her.  I had to leave my options open for that moment, keep thinking, and so I proceeded as if I was going to do it.  As I went, I literally prayed to God that somehow I would not have to use the very things I was collecting.  I still hadn’t made a decision on whether to use them, but I desperately wanted lightening to strike with a decision from the Lord.  I didn’t want to have to be the one to decide it.  It actually even crossed my mind that maybe she would be dead by the time I got back to the room, making the decision easier for me.  I was ready to take it as a decision from the Lord.

As I returned to the room, she was still barely alive, and I recognized that she was taking her last breaths.  I saw the Bipap (V-PAP or similar to CPAP) machine next to her.  We had tried it earlier and it hadn’t helped her.  I thought I would give it another chance.  I put the mask on her face, turning it on, just as her eyes were rolling back into unconsciousness.  Her respiratory rate had dropped to about 6 per minute, on its way to 0. The pressure support on the Bipap kicked in, supplementing her breath’s minimal effort. She had evidently given just enough effort for the machine to even sense her intrinsic breathing.

The bipap/vpap machines in Stella’s room

Within about a minute of breathing on the machine, she came back.  By 5 minutes later, her saturation was back above 90 percent.

Stella’s husband had stood by and watched everything unfold.  At one point, when she went cyanotic, he stepped out of the room.  I think he couldn’t bear to watch her die, and was seeing what both of us thought was inevitable.  When she came back, neither of us could believe our eyes.

The next day, I told Stella that she had almost died.  I don’t think she could recall all the events, but she knew I was telling her the truth.  She nodded in affirmation.  She knew I was not being exaggerative or melodramatic; I was giving her unvarnished truth.  I asked her, “Are you sure you know who Jesus is?”

Stella gradually improved.  She stabilized enough that we were able to take her to the OR and amputate her dead lower leg, removing the source of infection.  She subsequently rapidly improved, weaning off oxygen completely, and her multiple organ failure resolved.

The night before I knew I would discharge her from the hospital, I sat down in her room to talk to her again.  I knew I needed to make it clear to her that it was the Lord who saved her, not anyone at our hospital.  But before I was able to get as much as a word out, Stella told me that the day I told her she almost died was the same day she was born.  I was a bit taken aback.  I could sense she was speaking with depth.  I wanted to confirm what I suspected, that she was telling me the truth, not just trying to flatter us with words.  So I asked her, “But you told me you knew Jesus when you first arrived to the hospital?”  To which she replied with a smile, “Yes doctor, but I only knew Him a little…now I know Him.”

As we sat there, I told her that I prayed the Lord who had saved her body would also save her soul.  I told her that the Bipap (V-PAP) machine that had saved her life had just been donated not long ago to us, only a few months ago (by the Jarabek family).  The Lord had provided what we needed.  I think it very possible that Stella wouldn’t be alive today had that machine not been present.

I’m guessing that when that machine was donated (VPAP) there was at least hope that it would “help” a few people.  Did they know it would save a life?  Did they know that eternity might have changed? It doesn’t always take that much sacrifice to make a big difference.  If the Lord blesses it, the yield will be blessed.

We wanted to thank everyone who supports us and the ongoing work of the hospital, and may the Lord bless you.

ISAAC

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