Hi All:

Well, it has been 5 weeks since the surgery, I have been a bit disappointed in myself, as had hoped to be up and about a lot more than I have been able to tolerate so far, but thankful for the progress I have made. The small meals persist, we have some protien supplements that we try to stick in my morning oatmeal and bran (2 portions for the first 2 hours of the day), then we work on whatever will slide down with fortification. For some reason, milk, which I have loved and consumed a couple glasses of daily for years, doesn’t seem to agree much, more aggravating as one side effect of the extensive gastric resection will be osteoporosis due to reduced calcium absorption, plus the milk always seemed soothing to my stomach, another change not for the better. Also, trying to get more iron down is a struggle, as it both irritates the little pouch left behind and is constipating, but that also is needed as my hemoglobin has refused to rise more than it did after 5 units of blood and remains at 9.1 (normal being 12.6 to 17.7) and again is a difficulty aggravated by the stomach resection. So, working on creative alternatives, the operative word for trying to feed my face frequently but most carefully. I have at least 30 extra mothers in the form of coworkers, whether they be nurses or a host of other employees at both Georgetown Med Center and Sunset Manor, who check up on my work habits and make sure I get my meals squeezed between patient visits. That being said, I really do feel blessed to have such a supportive group of friends who care that much for me and my health, but eating does become a chore at times.

I have been able to see patients from 10 am to about 4 pm on Mondays and Thursdays at Sunset, which has been a great relief for me, to get back there and help the ones especially who cannot easily get anywhere out of the building. I also have started seeing patients on Tuesday mornings, part of my regular GMC shift, will try Saturday this week and see how that goes. I wish someone could find some more batteries for the Everready Bunny, the replacements don’t seem to have anywhere near the zip the presurgical ones did. Dan and Kim Boerman arranged for my Assistant Medical Director, Dr. William (Telusma) to come to the US on the 24th of April for a week to visit with me and be a great source of encouragment, which of course he is, but he worked with me at Sunset and on the way home, he wanted to find a SIM card for his camera, so we stopped at Walmart. I started out bravely, but didn’t realize that my gas ran out about half way back to the camera department (we did wander a bit trying to find it) and, by the time we did get back to the truck, decided that I would outsource further expiditions for a while. I have to get a number of medications for him to carry back, both for the hospital in the form of cortisone injections (we use them for keloid resections, much more common in blacks and often associated with heavy scarring from injuries, etc, so frequently a problem for us in Haiti) as well as meds for the lady that works with the Wrays at the camp and is the song leader for the 1000 plus children who come each Sunday morning in Renault for the service and feeding program.

After our jaunt through Walmart, Dr. William and I (plus Karen and James) went to a “small open house” for us both in the conference room at Dan’s shop, PVI Industrial Washing, where the Haiti building is and a gathering ground for a lot of the activities associated with the hospital work in Haiti. All of us were very much encouraged with the tremendous attendance of people associated with Haiti, many of whom had gone on a work project, but also others interested in helping us there, including the dear lady, Joyce Bolthouse, who, with her friends, has now finished a number of OR supplies for us. Over the years, the available supply of cloth (and thus washable and reusable) surgical drapes, gowns, other surgical covers, has been replaced with disposable paper materials. In fact, I requested a scrub pants for my jaunts around the University of Pittsburgh Hospital as I am not fond of flapping in the breeze even with the double gowns and was given some made of paper. They actually were great, lightweight and cool (the second not a desirable quality for the scrawny fellow I have become, though the first was great on my 46 staple incision) but not cheap in the long run and we could not begin to ship needed quantities down to Haiti. We are doing well with scrubs so far, but the second layer, the thick, impermeable OR gowns, are becoming hard to come by and these ladies, with the help of my dear nurse, Theresa Ragsdale, have found innovative ways to make durable OR cloth supplies for the hospital for years to come. Their sewing skills are impressive and greatly appreciated, so I was glad she could meet Dr. William as one of the recipients of their labor of love. Kim Boerman and friends had prepared a delicious meal for all who came, just another of the many encouragments our friends do for us and these are greatly appreciated.

We are working on gathering funds for the chapel project, including the memorial gifts of our cousin, who passed away in his early 50′s of leukemia on Wednesday, April 24, 2013, despite an 8 month hard fought battle. Jeff and Kiersten Baker have often encouraged us as they struggled with his cancer and always kept their eyes focussed on God’s goodness throughout the difficulties. Many times, Karen would read me the emails through tears as we realized the great hardships they were enduring, yet always thankful to our Heavenly Father for His care and strengthening of them through His Word. It sustained me through my days of struggling with the pain, medication adjustments and extreme weakness to remember that Jeff also was going through similar (and probably worse) difficulties, yet keeping things in eternal perspective. So, as we start this project with fund raising on this end, it reminds me of my own fragility and need to devote our energies to serving Him, both here and in Haiti. In many ways, the last few months have made me more desirous of getting this project done, so that all who come to our hospital will see that we offer the best medical care we can to all in the Name of our Lord and Saviour, as we will place the chapel in a prominent spot next to the clinic and visible from this vantage point as people come through the village of Simon to our hospital.

Dr. Jim Webb, retired surgeon friend from my years of moonlighting in the Gerber (Fremont) ER during my residency, has graciously agreed to leave the 3rd of May for a week of working with Drs. Moise and William in Haiti and hopes to repeat that in June. Jim had made two trips to Haiti to provide coverage for me after the earthquake, along with others like Dr. Luke Channer from Montana and Dr. Dan De Cook from Holland, MI, so we are delighted that he is willing to help out again, as he knows the ropes and the limitations out there, yet is willing to work with us. I will see the oncologist in GR on May 8, so hope to have a reasonable idea as to my ability to go, hopefully in July (Dan Boerman loves to sweat and has agreed to accompany me, these are the hottest months of the year, one sweats just thinking of being in Haiti). Dan picked up Dr. William from the airport the evening of the 24th and said he had the heater in his truck at 85 degrees and all the vents pointed at Dr. William who had his hoodie zipped to his chin and still was shivering. William said he now understood why the Michigan folks sweat as soon as they arrive in Haiti. It was a brisk April night, but still, not winter, though the Lord provided a brief glimpse of snow the next morning for William to look at (he didn’t use the term enjoy even when they tried to squeak it out of him). So, Haiti is stable for the time being and, after brainstorming with William for the next couple days, will send him back energized to continue the work in my present absence, knowing that it is the Lord’s work after all and we are just His servants, entrusted to serve Him at Centre de Sante Lumiere. Pray for all of the above requests, as usual, all intertwined in my ramblings.

In His Service,

Bill, Karen, Rachel, James and Jenn (and the rest of the Haiti crew)

Part One of this report ended with: “Dr. Bartlett told my family that, although he took 3/4 of my colon, I had “a lot of redundant sigmoid colon” so he was hoping that I would have enough left to control diarrhea reasonably in 6 months or so of adjustment.” Now the next part of the story, as of Sunday 4/7:

I have always had a chronic problem keeping the “ministry of the interior” moving along, so this would be a major adjustment to me. However, I was willing to make this adjustment, maybe even getting to like a pleasant change in scenery. As I have mentioned to some people, I am finding out that I am both wired and plumbed differently than most of my patients, who tend to become sleepy with narcotic pain meds and develop diarrhea with the operation I underwent. When I woke up from the anesthesia and the sedation the next day after being kept on a ventilator all night, the thing that struck me most was the overwhelming pain, closely followed by the number of tubes coming out of my body, a total of 8 (one more than I have places to put things in, so they just stuck one in a man-made hole in the right side of my abdomen to drain the pancreatic area). As they had stripped the pericardial lining of my heart, my heart responded by being irritated and kicking up my pulse to 185 range with corresponding wild blood pressure changes, so now I am on meds for the time being to stabilize that. The patient controlled pain pump running Dilaudid into me was a great pain reliever, especially when they pulled the epidural pain lines after 3 days, but my body seems to be unable to sleep on narcotics, much to my dismay. I really was confused at times, to the point that, I wasn’t sure which side of the verse I took with me into the hospital to sustain me (Eph 1:21 – “For me to live is Christ, to die is gain) I wanted to have happen. After 15 days of only catnapping, first blaming it on the fact that some sort of hospital personnel was in the room as often as every 40 minutes, which makes it hard to sleep, I was dismayed to find that this persisted even after I was discharged. I went home on Vicodin and had the same problem at the Family House so I figured I had to stop the heavy pain meds all together. There was a period of withdrawal, but I am now only on Tylenol and an occasional Ibuprofen. It still hurts, but sleep is a needed entity for health, it seems.

So, with some persistent pain, the narcotics are off the scene, but now we are trying to figure out how to feed this concentration camp survivor, at present at 148 pounds and unable to eat more than an ounce of the savory Ensure each hour. Almost everything I eat more than this causes severe cramps and nausea, so after a couple of days of this, the hospital did a repeat CT scan on Monday, the 1st of April, all of us expecting to see perhaps a blockage somewhere. We all had our April Fool’s joke when we saw that instead, I was mega constipated. I received a suppository with impressive results, got up the next morning to have my nursing student repeat the suppository with no results, so thought I would do some laps around the ward x 3, then had results. I took a shower and had my wound redressed, a bit more action than my body tolerated that morning, so as the nursing student came in with a scale to weigh me, I totally blacked out and the next thing I remember was the poor student calling for someone to help him haul my carcass to the bed. All the furor that followed almost derailed my discharge, but I was determined to escape my prison by now and managed to downplay everything and got past another EKG evaluation, multiple positional BP checks, etc, even doing an extra victory lap to prove to my new replacement doctor, a Doctor Melissa Hogg, that I could flee the scene. These doctors are “fellows,” i.e. doctors who have done a full surgical residency like I have, but then choose to do an extra year or several in a surgical subspecialty, like in this case, a couple years to be a specialist in cancer surgery; you do a “fellowship,” thus are called a fellow. Of interest is that everything in the hospital is following the Mr Obama mandated electronic medical records, so that mistakes will be minimized and I got nothing done without having my wrist band scanned, no meds, no labs, no IVs, etc. However, the proverbial left hand didn’t always know what the right seemed to need to do and it was an interesting, albeit at times a bit scary, learning experience. To give a few ideas, I always had labs drawn at 4 am, of course with a bright overhead light so would be awake, and learned to politely ask the nurse what the labs were for each day, as it was always a CBC and BMP and Magnesium level. I also knew how many tubes I needed to have drawn from the daily experience. More than once I asked them to recheck our EMR (Electronic Medical Record – the magical government mandated cure all for our record woes) as I didn’t want the nurse having to poke me again later if we did need more lab tubes drawn. One morning she told me she needed to get my potassium level rechecked as it was low and they needed to see if the additional oral potassium they had given me was helping. Even at 4 am, I had enough brain function to kindly inform her that I had not received any potassium supplements. She showed me that the EMR verified I had but, after a gentle verbal debate, she checked with the pharmacy and found out that it had never left that department, but they would send it up pronto. Yikes.

As I was getting ready to depart, my nursing student came in with a handful of syringes and asked me if I was allergic to eggs. I asked why and he said that it was hospital policy that I get a pneumovax shot after having my spleen removed and the EMR mandated I get this, also a flu shot, a tetanus/diptheria update, etc, so he was here to give these. I told him that I had already had these updates a month BEFORE I had my spleen out, knowing, as a surgeon, that the best time to give these shots is at least 2 weeks BEFORE the spleen comes out if you can do this on an elective removal. Incidentally, no one had informed me of this even when the surgery was scheduled over a month before it was done. I had obtained the vaccinations in Grand Rapids and sent a letter from my office informing them, but apparently this did not make it into the EMR. The nice student and his supervising instructor thus asked me if I was refusing the recommended injections. I told him I was not refusing, just did not need them as I had already taken them at the more appropriate time before I lost the spleen that would normally help my immune system fight off the infections. I will now be more susceptible to these without its presence. I think I left my caregivers more puzzled than when they came as to what to do with my responses. Seems a bit scary to navigate the complicated system we have installed to protect our patients?

So now we are home, trying to gain weight with a tiny remnant of stomach left and unable to put much down volume wise without nausea and cramps. I have to limit carbs (no shakes, smoothies, these would really stimulate things) as a carb load gets dumped into my small intestine, as I no longer have 80% of my stomach and no pyloric sphincter to meter out the flow into the intestines, so it all “dumps” into the instestine, this then draws a bunch of fluid into the intestines and I get severe cramps, lightheadedness and the shakes and feel worse than dirt for the next 40 minutes or so. So eat lots of small, protein meals and no water for 30 minutes afterwards and am trying to limit the nasty side effects. Incidentally, when I was finally started on some jello postop, my nutritionist wife, who had had a running (but losing) battle with the first “fellow,” the predecessor of Dr. Hogg, concerning my need of IV nutrition, checked the label and noted I was getting sugar free jello. Asking why they were giving a starving patient sugar free jello we found that I was being given “gastric bypass”diet, and thus was on the prescribed diet to jump start my postop continued weight loss after my bariatric surgery. The nurse was able to change some of these orders, and Karen also added sugar to other things like cereal. For someone who has always been able to consume large quantities of almost anything remotely edible, and desperately needing to gain weight to heal and begin my IV and oral chemotherapy, this is frustrating, though my loving wife is putting all her years of training and experience to work with sometimes good results (not her fault, just an uncooperative body). My strength returns slowly. Due to no padding and lying for days bloated to “Pillsbury Doughboy” proportions after surgery, when they gave me 5 units of blood and 22 quarts of IVs, I also have 2 bedsores on by back side and heel, so need to feed the body something reasonable to help heal them.

Overall the pathology was encouraging and Dr. Bartlett felt he got 100% of the visible tumor, and we hope the 2 hours of cooked chemo in my belly killed residual cells. However the final evaluation of the aggressiveness of the cancer cells changed from low grade after the needle stick in my side (done at St. Mary’s in GR) to high grade on the surgical specimen, so it is advised that I undergo chemotherapy as soon as I can withstand the side effects. I will probably undergo an infusion each 3 weeks and also a pill twice daily for 6 months each, concurrently, if this is worked out/at least partially reimbursed by the insurance, which so far has been a pistol at paying ANYTHING? So, need to gain weight and undergo that in the near future. This, of course, will determine my work schedule in the US and my return to Haiti, but I hope to undertake all these things on a limited basis as the Lord gives me strength, ? soon. So pray for the ability to figure out innovative ways to do low carb nutritional hourly little meals that will be tolerated and achieve the desired results. As my friend at church and part of the Haiti teams, John Harlett, reminds me, himself a two time melanoma survivor, I have been given a second chance at life. We want to make it count for “our good and His glory.” Pray for wisdom for prioritizing the days, weeks and months that He will give us to accomplish that properly.

Finally, most of you know that I don’t know much of contemporary music, as have little time to sit and relax at home and don’t even have a radio in my “basic truck,” much to my children’s dismay (also no AC, etc). I love people and interacting with them, etc, but after I do it all day, I like my few moments of peace and quiet driving home from work and so never listen to the radio. Recently, I learned a new song at church that stuck in my head all the days and weeks when I couldn’t focus enough to read anything. I will end with words that have sustained me through this time, especially during the Easter season in the hospital, having only the dust bunnies flying around my room to entertain me.

How great the Father’s love for us,

How vast beyond all measure.

That He would send His only Son,

To make a wretch (me) His treasure.

How great the pain of searing loss,

The Father turns His face away,

As wounds which mar the Chosen One,

Bring many sons to glory.

Behold the Man upon the cross,

My sins upon His shoulders,

Ashamed, I hear my mocking voice,

Call out among the scoffers.

It was my sin that kept Him there,

Until it was accomplished.

His dying breath has brought me life,

I know that it is finished.

I will not boast in anything,

No gifts, no power, no wisdom,

But I will boast in Jesus Christ,

His death and resurrection.

How can I gain from His reward,

I cannot give an answer,

But this I know with all my heart,

His wounds have paid my ransom.

In His Service, With Thanksgiving to Him and You All,

Bill, Karen, Rachel, James and Jenn

Hi All:
This will be an update on things here and in Haiti, hopes, plans, dreams and a goodly dose of reality all mixed/churned up. Such is usually the case with me, I suppose. I have now been home for a week and it is truly blessed to be home, able to sleep in my “home hospital bed,” one of many headed for Haiti when we have a space on our loaded containers, so I borrowed it to have a bed on the first floor of the house that I can get out of easily, etc. Believe it or not, is is MUCH more comfortable than the one I had in Pittsburgh, so thankful. I still spend some time each night in the recliner, as the sore spot on my back side at times is more at ease in that position.

Off the pain meds (I only use Tylenol and an occasional Tramadol), my sleep is much better, though still not what it used to be and strength is returning. I am hopeful to start working 5-6 hour days in the clinic 3 days next week, including 2 of them at Sunset Manor, as no one has been there for a month, they tried to hire a fill in physician, apparently found no takers, so I feel a bit responsible to be sure the people are well. Many did go across the street to see my partners, but always this is a lot harder on the fragile folks. So, will slowly restart. As I am learning that my tiny stomach only allows 1/2 of a sandwich or 1/2 of a cup of soup each hour on the hour, I am planning on scheduling a short “eat break” each hour and then sipping some water 30 minutes later to keep hydrated. Even my beloved “Mountain Dew,” my one vice that I only allow myself one can daily, is reduced to a defizzed, diluted drink I can cherish in mid afternoon. Life has drastically changed, it seems. When I do break from the schedule, the 2-3 hours of misery, stomach cramps, runs to the bathroom, nausea and sweats remind me to be more careful with what and, more importantly, how much, is allowed down the hatch. But, am eager to get back to work some and look forward to seeing my patients, many of whom have, in a proper sense, also become my friends and am thankful for the privilege to have those relationships in my “job.” I get good pain relief from an occasional Ibuprofen, but it seems to irritate my already unhappy stomach, despite being sent home on both PPIs and H2 receptor blockers and antacids, yikes. So, have stopped that source of pain control, makes the nights a bit more restless.

Karen has come up with multiple ways to make these small meals tasty and cram protein into them, including protein supplements, etc. I do look forward to the day that I can enjoy more of a meal rather than the little snacks each hour, but then remember that only 2 weeks ago I was allowed nothing by mouth and had the nasty NG tube still down the nose for the 10th day after surgery (not sure much ever came out of it, but it was well ensconsed in my nose). So, am very thankful for the progress. Still have not made it to 150# on the daily weights, but at least the downward trend has stopped. The wound is doing well, thankfully, Karen still has to replace the wicks in the 2 open spots and redress it twice daily. Will not even think of removing the 46 staples any time soon, as healing seems to be slow with the two holes I do have, would hate to have the stem to stern incision open up in other places.

On the Haitian front, Jeff Berkompas, who was to accompany me there this month and fix machines, etc, while I did surgery, went with his parents instead and should be arriving home soon with them. Haven’t heard much from that front, but am actively seeking a couple more Christian general surgeons who are willing and able to take maybe a week off from their schedules and work in more primitive conditions. The anesthesia is done totally by my Haitian doctors and nurses, they really do a great job (I am a bit biased, I suppose, as I trained them), and Dr. Moise and William can do most surgeries with minimal direction/supervision from a surgeon, but legally we need someone there and also we are still training them and there are no specialists to call if you damage something or run into a surprise. So, one has to be a bit more flexible than may be required in the US. I obviously am NOT trying to scare anyone away, just being realistic. Surgery is a great help to the people and also financially is one of the few ways we can help keep the hospital solvent, so am carefully actively recruiting help. Feel free to contact me if you have good leads.

Also, with the onset of my cancer, it seems the Haitian staff have been much more zealous to attend our morning Bible studies and prayer meeting, for which I am thankful, of course. They faithfully pray that God would heal me and that is appreciated. However, my smallish chapel does not hold the group and I am wanting to move building a larger room for a chapel (it also would be used for staff meetings, a place for patients to be able to spend some quiet time with the Lord if they so desired, and other uses) up the construction timetable. I am glad to have the problem, but still need to raise funds to accomplish the resolution. Pray that funds will be donated to help with this project. If the Lord directs you to help with this (as I don’t want to cut into the general funding of the hospital work, especially the Poor Fund, etc) please designate gifts to the “Chapel Fund,” and will try to begin that building as soon as we have a reasonable amount in hand. The roof will not cost us much, as we will use the used steel roofing we obtain from Lamar Construction in Zeeland and mainly need to just pay the shipping of that in containers, but we still have to put the floor and walls up, hopefully in the near future.

Am waiting to hear when oncology will begin chemotherapy, I see Dr. Pawl on the 8th of May, and what poisons he will administer. This will, of course, determine much of my future ability to work both here in the US and in Haiti. Dr. Sun, the delightful Chinese American oncologist at the University of Pittsburgh (rapid fire word flow that I didn’t catch all of) said it wasn’t a bad mix, but then, he is the administrator, not the recipient. Will see what he and Dr. Pawl decide on when they discuss my case. In reviewing the pathology, there definitely was a huge cancer load, so want to do our best to keep it from coming back in the near future (praying that God will heal me and it never return, if He so wills, of course). So, will keep you all informed when I know more.

In His Service,

Bill, Karen, Rachel, James and Jenn