Medical Evacuation on Sabbath

If there is one thing we are known for in this community of Indonesians, expatriates, believers and non believers is that we keep the Sabbath. From Friday sundown until Saturday sundown we try to stop all our work and rest and focus on God and relationships and renewal. We LOVE this 24 hours of intentional set aside time to BE STILL.  People admire us for it and misunderstand it, are confused by it, hate it, love it, embrace it, and have a lot of questions and misconceptions about why we would continue this ancient practice.  It is known that at 5:30 p.m. (the sun sets approximately the same time year round here) the Boyd family will leave the Friday night games.  Even if our kids are playing in the games.  Even if our son’s class is selling a meal to 200 people.  We simply walk away…..

I know to many of my readers this is very odd that we would do this.  It is something I rarely mention on my blog because I don’t want to focus on religious practices.  I want to focus on heart relationships.  However, I finally felt impressed to write about Sabbath because this Sabbath  I WORKED.

It had been a very long week.  Our medical doctor  (Dr. Di) had left town for the unreachable interior early Thursday a.m. (or at least that is when we got the last quick instructions from her).  I knew trouble was brewing when nurse midwife, Fiona, calls me at 6:50 on Thursday morning, requesting that I help her on a case.  Dengue Fever.  Day 6.  Young Aussie Mom of 3 children.  Bleeding mid cycle.  We asked the patient to meet us at the clinic at 8:00.  I was shocked when she got out of the car, escorted by her husband.  Her extremities were a deep bright solid red.  She came into the clinic ever so slowly and with only the smallest flick of life in her eyes.  We got her comfortable on the clinic bed and started doing vitals.  I catch Fiona’s eyes across the bed.  No words were needed.  We were both deeply alarmed. 

Dengue fever is carried by a day biting mosquito.  This mosquito has very distinct stripes on its legs.  There are 4 different types of Dengue, and once you have had one type you can’t get that type again.  It is felt that the different types have different levels of severity.  Some cases being milder then others.  Though some cases are so bad that the patients feel like they are going to die (this is a very real feeling) and from time to time patients do.  Usually they die from going into shock.  The dengue fever affects the platelet count (this is what clots the blood).  A normal platelet count is around 250.  We start praying a bit more fervently when the platelet count drops to 60 and below that we add some anxiety in there also. Usually the patient gets a light rash on the extremities and trunk, pain behind the eyes, all joints hurt and ache, especially the feet.  The treatment is to simply rest and drink 4 liters of fluid.  Both are critical.  Also we need to keep tabs on what the blood counts are doing and treat other symptoms that might arise.  In the last two months we have had at least 5 or 6 cases just amongst our mission community, which is higher then normal.  Everyone groans when they hear someone has dengue fever because it is tough and usually wipes the person out for a good week and a half.  Often the complete recovery time can affect the patient for months if not years in terms of feeling “100%”.

Now that you are educated on Dengue Fever…..back to our patient.  Of course the power went out right when she arrived (yes, this is the mission field).  We worked on doing what we could with no power.  Including sending an email to an expert doctor in Singapore on Dengue fever to ask about the mid-cycle bleeding.  Also praying with the patient, because she verbalized that she felt like she was going to die and honestly, she looked like she was. Her blood pressure and pulse were stable, which encouraged us.  After about an hour the power came on and we were able to run a blood count, showing that her platelets had dropped to 44.  We also heard back, ever so quickly from the Singapore doctor, confirming the medicine we needed to give to stop the bleeding.  Ben and I both attempted to put an IV in and failed.  I drove to Michelle’s apartment and asked if she would come try put a line in?  We scooped up her babies and headed out the door…..giggling at being missionary nurses.  Michelle gets a line in.  Life giving fluid drips.  We now feel that the patient is “safe” to go home and rest.  Her husband will change the IV bottles. 

Friday morning….Michelle (with her babies in tow) spends the morning with our patient.  The patients husband and children have to go to immigration.  We didn’t want her alone.  Michelle reported that the patient, though still weak was more stable and her outlook had improved.  Bleeding stopped. Texts with other patient questions and needs beep into my phone.

Friday afternoon I met the patient in the clinic to recheck her platelet count.  Her rash had become more deep in color.  Though still very weak, this young Mommy was now mustering up a smile and sat for her whole appointment with me.  We discussed even though she was feeling better the importance of still resting (hard for mommies to do) and drinking 4 liters of fluid (or using IV’s).  Fiona, Michelle and I all saw her and were encouraged.  Platelet count increasing.

It was 5:30p.m. Friday evening and we were rounding up our scattered family to leave the International school when a missionary Mom who lives interior, but was in town, stopped me in the parking lot.  “Ruth, I have a quick medical question.  I know it is almost your Sabbath, but can you help me?”  she asked.  “Of course.”  I could tell that this “quick question”, needed an accurate diagnosis and so taking her little girl into the clinic and doing a quick urine dip revealed a roaring urinary track infection.  The little girl was in tears she was so miserable.  What a gift to give the right drugs for the right diagnosis and know that this little patient was going to get almost immediate relief from the medicine given.  We leave the parking lot at almost 6.  Fiona sees us and calling out encourages me to enjoy my Sabbath day rest and refer any medical calls to her or others.  We pull onto campus well after sundown, but enjoy a lovely evening together.  Comfort food.  Our traditional Friday night meal.  Potato soup.  Pumpkin bread and bagels.  An extra special treat, because Darron is home, TRIFLE.  Candles.  Sometimes massages, but not this night.  Mom is too tired.

Saturday morning we gift ourselves with an extra hour in bed.  YES……REST!  Breakfast is served. I’m showered and slip into my all purpose missionary dress, ready for church.  We are encouraging the children to get into their church clothes and I hear a ding on my phone.  A text.  It’s from Fiona.  Begging my forgiveness for disturbing me.  Appealing for prayer, because our dengue patient had deteriorated.  My heart rate instantly picks up.  I’m compelled to go.  I can’t stay.  I know that it will take the team of us 3 nurses to get our patient situated and more then likely sent out by medical evacuation.  I call Fiona.  We agree on the pre shock symptoms that our patient is complaining of (abdominal distress, increased lethargy, and restlessness) and that we are going to alert the pilot that we are leaning toward evacuating.  I tell Fiona I am on my way.  She gushes her appreciation. 

We feel the weight of the patient deteriorating under our care.  Did we sign up for this?  Did we desire this responsibility?  Yet, it is our calling.  We don’t like it, but we face it.  Michelle, gets to the patient first and confirms that she is worse then the day before.  She also calls the pilot, to set in motion evacuation. Ben, her husband, keeps the babies.  Michelle gets a new IV line in.  Gives drugs.  Monitors.  Assesses.

I pass Fiona on the way to the patients house.  She has just picked up her husband from the airport from an all night flight.  She stopped to see the patient and take 2 of the patients children to watch at her home. She agrees with the assessment.   Then a million details have to fall into place.  I arrive and once I know Michelle is ok taking care of the patient I begin lining up the insurance, the paperwork, the communicated with the pilots.  Passports have to be tracked down, for the family.  They are all at the immigration office (on a weekend).  Nurses have to be chosen.  It boils down to who has a MERP (multiple exit reentry visa).  Fiona does.  Michelle does, but she has a nursing baby.  My passport is on some random desk at immigration.  Then it comes to light that Wendy and Gary (our new family here at Advent Aviation) have their passports in hand with MERP’s!!!  Both have years of experience as nurses in the mission field.  Fiona and Wendy will fly.  Mandy gets food together for everyone.  Indonesian neighbors come in and out.  Whispering concerns.  Expatriate friends drop by with food, to wash dishes, to run errands, to say good bye and whisper a prayer.  Close friends wipe tears from their eyes.  They are worried to see their friend so ill.  The husband moves forward with amazing calmness.  Packing for his family of 5.  Answering so many texts, checking in on his wife, talking with neighbors, friends, packing more, finding things that we need.

Meanwhile our patient keeps asking us if she is going to die.  Frailty pressed against the pillow.  Asking for us not to leave her.  The IV drips.  Her legs are now a deep purple red.  Vital signs are stable. Except for a fever.  We begin treatment for malaria.  Gary and Wendy arrive.  Wendy helps Michelle with patient care.  Gary works on passport stuff.  I go assemble the medical evacuation kit.  Mandy arrives to the home, relieving Michelle to go take care of her baby and sits with the patient while Wendy and I get all the charting in order.  Report called to the hospital in Australia.

At last we get word at 4 p.m. that we can come to the airport.  We are relieved that the patient is going to fly.  Michelle comes to see her off.  Along with the husbands of the flying nurses.  The children are reunited with their parents and load onto the plane.  The husband mentions to me that this is all surreal.  Prayer is offered.  2 pilots will fly the approximately 4 hour journey in the mission plane.  We snap lots of pictures.  We are smiling, because we feel that our patient is very ill but stable enough to travel and we are feeling the weight of the responsibility lifting.

“Handing over” the report and medivac kit.  Ruth (left) to Fiona (right).

Michelle (a relieved nurse!!!!)

Wendy.  Wow….only 2 weeks in Papua and on her first medivac.

It’s got to be scary to see your mommy so sick.

The husbands of the two nurses do the final transport into the plane.

The patient had just finished asking me, one more time, “Ruth, am I going to make it?”

Michelle and I will always treasure all our nursing memories made here in Papua.  The patient is loaded only minutes from take off.

Michelle ready to go home.

It’s 5 p.m.  I pull into our driveway.  I lay down on the couch.  The adrenaline of the day all leaving my tired body.  My phone rings.  The insurance company is waiting for my email with a medical report.  I ask them to  wait 2 hours.  I will enjoy the last hour of Sabbath.  Darron and I go for a quiet walk as the sun is setting.  My evening is spent summarizing the events leading up to the medivac for the insurance company.  I feel that my words are weighted to determine how they will pay.

I go to bed.  Relieved.  5:45 Sunday morning I learn that they arrived safely and Wendy spent the night with the patient.  By 10:00 a.m. Fiona has let me know that the patient is still extremely weak but no longer feeling like she is going to die.  And “she looks heaps better”.  : )  They  put her in an isolation room because her white blood cell count was so low.

I take a three hour nap this afternoon.  Trying to make up for the Sabbath rest that I didn’t get.  But in my heart, I am so happy that I was privileged to spend my Sabbath this way.  Serving.  And so grateful for the wisdom given, and that our patient made it back to her home country where now she can recover and get well.  Blessed to be working with such an incredible team of nurses (and doctor, who we are not going to let leave again).  Thankful for all the people and loving community that prayed, fixed food, watched children, etc. etc.   Jesus healed on the Sabbath and when he was questioned about his activities he responded in Matthew 12:12 “How much more valuable is a person than a sheep! Therefore it is lawful to do good on the Sabbath."