The Haitian Donkey Earns Himself a Trip to the Hospital

Hi all, Jenn here.  I am going to try to pick up where Bill left off in his last update as I’m sure you are all wondering on his status.  Thank you for the prayers, we can tell they are working!

The team returned from Haiti around 1:00 AM Sunday morning and Bill went straight to bed.  He was wobbly on his legs from gaining 30# of water weight since he left for Haiti, and ongoing neuropathy in his legs.  He was restless but managed to get some rest.  Sunday was much of the same, difficulty walking, labored breathing, low grade fevers, etc.  His nurse came to draw blood in the afternoon and results showed what he expected – elevated congestive heart failure (CHF) levels and white blood count.  We still didn’t have his cultures back at this point.  Monday rolled around, and despite his best efforts and intentions, he was unable to go to work.  He had gained another 10#, and prelim cultures came back that his line was infected with a gram-negative bug, i.e. a really nasty bacterial infection, and not the “normal” bug he has gotten in the past.  He started a new antibiotic around 5PM Monday, but a short time after that developed rigors again and we couldn’t get them to stop.  With his low oxygen levels from CHF, he just could not catch his breath, which was very scary.  Suddenly he was facing a trip in an ambulance, so he made the decision to go in on his own and we were able to drive him to Metro ER.  They got him in and assessed right away and then covered him with warm blankets. 

The hospital staff was faced with treating the CHF by removing fluids and potentially making the infection worse, or treating the bacterial infection with fluids and potentially making the CHF worse.  Because Bill’s BP was dropping and lactic acid levels indicated he was already septic, they moved forward with fluids to treat the infection.  Immediately his BP started improving.  He was also given an Oxygen mask at 40% and a “big gun” antibiotic.

Today, Bill had an esophageal echo as his symptoms indicated there may be vegetation (infection) on his heart valves, which is very serious.  We were encouraged by the results that didn’t indicate vegetation, but the mitral valve is thicker than normal.  This could be calcification or vegetation, so they are going to treat it aggressively as if it were infected.  He also had his line changed over a wire to clear the source of the initial infection.  At this time, he cannot take anything orally or through his TPN, and the already skinny donkey (less water weight) cannot afford to go long without it.

While these problems are very serious, Bill is otherwise stable and resting comfortably.  His life continues to be a miracle, though the Donkey is somewhat discouraged by all he has had to endure.

Thank you to all his friends and family, you all mean the world to him!  Please keep praying for him and for the difficult times and decisions which lie ahead.

Jenn, for Dad, Rachel and James

The Haitian Donkey Struggles With Infections But His Friends Save The Day

Hi All:

As always, the week has flown by, and it is now Friday.  We have had a fair amount of progress on several fronts, including working on reintegrating Dr. William into the hospital rotation when, hopefully, he returns to us about October 1, 2020.  He has to do an oral discussion of a research topic and then defend it.  Since nothing in Haiti is written down, plus all times are on Haitian time, which is quite fluid, we cannot be totally certain of his return time.  But, we seem to be getting some ideas as to what things we can accomplish. 

We also have discussed adding an orthopedic surgeon, Dr. Lamy, to the staff on a part time basis, to allow us to do a variety of more complex orthopedic cases that are beyond my skill set, but will need to see if we can find some equipment to do orthopedic reductions internally (ORIF).  He is a local man who is the son of a pastor but did all his medical school and orthopedic residency in Venezuala.  He is trying to build a practice in town, but would like it to be at CSL.  He seems very congenial, a solid Christian, but he did marry a Venezualan while there and they have 2 kids, so that may be a complicating factor. 

Dan and Margie did a lot of physical projects, making some progress on the repair of the fence that the government made us move to allow them to widen the road, but they took more than their share of the road, there are no written laws here and we could not do anything but move our fence line back more and reinforce it from the water that would wreck it during our heavy rains and hurricanes.  They helped fix up the PT, which, thanks to Ulrika Schaller, a German PT who has been here for years doing similar work in Port a Piment and we rejoice and thank the Lord for her help.  They got the washing machine going, organized several projects and made good headway.

The Donkey, on the other hand, made good progress until Wednesday pm, when he started having rigors and chills with fevers as high as 104 F (39.9 C) and that has slowed him down considerably. I have started on another injectable antibiotic and will get blood cultures as soon as I get home to try to track this down and start on appropriate treatments.  Tabitha and Margie have helped me tremendously with keeping my flooding to a minimum with regular changes in my colostomy bag. Tabitha also has helped a lot in the OR and clinic, helping a lot when I was a bit slow on my wobbly Haitian Donkey legs.  I think we got 50 cases done, 8 of them hysterectomies and an anterior repair on another patient, who had surgery elsewhere but her work was only done half way.

This weekend is Mardi Gras/Carnival, so things have become increasingly violent and dangerous, including kidnappings.  The folks leaving one church had 5 children nabbed as they left to go home.  The church raised the rather large ransom and sent it by one of the members.  They took the money and killed the messenger but did let the children go.  So, we are flying on a newish Haitian airline, not my favorite thing to do, but it seems the safest route to go tomorrow.   We hope to arrive at 1 am on Sunday, the only possibility at this time. 

This is late in getting out as the fevers have taken its toll on my work output.  We always thank you for your prayers for our safety, ability to get things done and attitudes to be sure God gets the glory for all He allows us to do for Him here in Haiti at Centre de Sante Lumiere.

In His Service, Beth, Bill, Dan, Jo, Margie and Tabitha

The Haitian Donkey And Friends Prepare For Another Trip

Hi All:
In 6 days, we hope to be back on the road to the hospital.  It sounds like things are starting to calm down some, thankfully, though we are glad that our friend, Ken De Young, will take us to and from Port.  We are hoping that things will remain calm and that we can plan further ahead and bring some construction/repair teams during the year again.  The Donkey himself has been struggling a lot with his revised GI system.  Since my last surgery, Jan 17, 2020, my 4 intestinal holes were revised so that they all go out a common crater, about 4 inches wide by 3 inches long and about an inch deep (so I cannot see much except with a mirror), so that the largest ostomy pouch will barely fit over the hole with a bit of a rim to seal the insides in.  Since I have not gone to the bathroom since that time, I tried to drink a little bit of tea and a cup of soup on the weekend but the leaks I have sprung makes me wonder if it is worth it. 

I had a major equipment malfunction (I think that is the proper name for it?) while at work yesterday.  I try to empty the bag every 2-3 hours to minimize buildup inside and weight on the adhesive holding the pouch to my body, but an elderly gentlemen came with a couple significant lacerations of his head from a fall.  Since he is our regular patient, seemed with it without residual from the fall (though he blacked out for a bit) and is on 2 blood thinners, I undertook to repair the lacerations before they got out of hand.  Midway through, an unpleasant odor arose and I could only blame myself for the smell.  I finished and had him headed for a CT scan and visited the bathroom as soon as possible.  I always carry a complete set of clothing with me everywhere these days, but it is hard to wash yourself in a small lavatory and feel clean.  Jenn volunteered to come and change the ostomy, which had come loose below and thus the flood) but I finished the day without drinking anything more (just had a “spot of tea” only) and made it home without a second deluge.  However the skin was rather inflamed from 6 hrs of being bathed in intestinal juices.  So, I guess I will wait til I come back from Haiti to try anything oral again. 

Part of the problem is that, without at least a few drinks of water and few calories by the mouth, I can never get hydrated and continue to lose weight, neither a good long term course desirous of being followed by an already scrawny donkey.  I have my IV feedings at maximum calories, but still drift down.  I also am struggling with leg neuropathy pain that is there all the time, tolerable during the day, but keeps me awake at night.  My legs have been like lead from my groins to my feet for 7 years now, since the oxaliplatin chemotherapy regimen, but for the most part they were numb.  Now, it seems like the left one is waking up some but then it is painful and throbbing.  Before the last surgery, I would take a Tylenol regularly and several Tramadol throughout the day.  The Tramadol is constipating, a positive problem before the surgery, but I have stopped it since as would like some downstream flow.  Will see if can up at least my IV water (Lactated) to work on the hydration part, even though no calories in it.  Tabitha (our nurse friend from Africa and Wisconsin) and my sister Margie will go with Dan and I this trip and they can handle all the flood control, hopefully.

I spoke to Dr. William several times (via email) and he seems to be doing well, thankfully.  Can hardly wait for October, 2020, when he will finally be done with the residency and can come back to us full time.  Will have to work on getting him reintegrated and working on how the two pillars of the hospital can work together best.  Pray for wisdom for us all and good attitudes that we may make God honoring decisions.  Dr. Jose and Dr. Kevin (Jose, who is more slightly built, states that the former Florida State lineman makes about 3 of the normal sized Haitians) did a bunch of surgery that went well, for which we are thankful. 

So, Lord willing, Dan, Margie, Tabitha and myself will leave on Friday afternoon, overnight in Miami and be joined by Dr. Jo Marturano (psychiatrist who comes for severe weeks twice yearly) and Beth Newton, who most of you know as the nurse practitioner who has been in Haiti x 30 yrs, home taking care of her elderly (95 range) parents, as we fly out in the early morning of Saturday, the 15th and then up to the hospital with Ken De Young.  Beth and Jo will stay for 2 weeks, so that will help, as she has been unable to get in for quite a while due to the unrest.  We are hoping that things stay calm enough for Jean Eddy to drive them back to Port.  Pray that all will go smoothly, especially with my ostomy. I will eat and drink nothing except a sip of water with my pills to reduce flooding risk, but also that with having to go through TSA in Miami, that things will go smoothly and allow my IV food to remain cold (they are slick and quick in Grand Rapids, but have done it for years and are friends, Miami may not be as accommodating and know what they are dealing with). 

As always, we appreciate your prayers, support and encouragement as we serve our Lord at Centre de Sante Lumiere in Les Cayes.

In His Service, Beth, Dan, Jo, Margie, Tabitha and Bill

Donkey Update

Hi All:

Surgery went as well as expected, as Dr. De Cook says, “we are operating way out of the box,” but I am so appreciative of his efforts to do innovative things to keep me going.  Another way he put it is “doing missionary medicine in America.”  He has done his share of this, having been to all 3 countries doing surgery where I have been, and is a wonderful friend and colleague.  He cleaned up all that he could, as a large part of the mass that kept giving us grief is globs of my cancer (mucous balls might be one way of looking at it) that have worked their way out of the belly into the open areas.  He has converted all of the holes into one 4 inch hole, though of course, due to all the scar tissue, cannot make a proper, protruding ostomy that would help nastiness make it’s more natural way out. 

Again, he has been gracious enough to give me some blood as he finds me too gray to his liking and we did lose some blood and still are losing some due to the extensiveness of the dissection to clean up all the undesirable stuff and this has left a lot of open areas to ooze.  So, stayed in last  night and got 2 units and when he came in this morning, my Hgb was up to 9.3 (from 8.5 before) after the 2 units, so I am staying a while longer to get 2 more.  Getting blood as an outpatient is more like pulling teeth out of a donkey, not a lot of cooperation, so this is most wonderful.  He asked the nurses to run it in on the fast side of the rules so can get home not too late with the storms we are having.  So, very thankful for all he has done to encourage my recovery.

We heard that Dan, Duane, Jose and Kevin (if you notice, I always try to put people in alphabetical order, so that we are objective?, ha) made it to Haiti yesterday, so should be at the hospital this morning.  Several people have been concerned as a lot of the area airports have cancelled flights due to the weather.  Because of the unrest in Haiti, they left a day early and beat the rush of snow, ice and rain. 

Thanks again for all your prayers for the Haitian Donkey’s health and the team’s efforts to serve our Lord in Haiti.

In His Service,

Bill for Dan, Duane, James, Jenn, Jose, Kevin, Rachel and Tabitha (at hospital, learning my tricky ostomy procedures)

Brief Update On Haiti And It’s Donkey

Hi All:

The Haitian Donkey has been quite busy trying to stay healthy, so a bit behind on other things.  I have mentioned the distasteful flooding that has bothered me for the last month on an increasingly frequent basis.  I also have had a central line (for my TPN feedings) infection, again the fungus, likely the same species (they didn’t do the complete testing this time, not sure why).  So, back on the Sporonox, have 3 weeks down and 6 to go.  It is very tough on my already feeble intestinal tract, but no alternatives.   I had my central line changed last Friday, that went well, thankfully.  My 3 holes that are the cause of the flooding have been a struggle, Dr. De Cook took out the drain that has been there since the last surgery in August right after I got back from Haiti in December but the volume has not diminished and we are working on trying to put ostomy bags over them with varying amounts of success.  Rachel and Jenn have accompanied me to the Holland Hospital Wound and Ostomy Clinic to learn the technique as they give me a mirror but it is below the tiny bulge of my belly and hard for a donkey to do.  The largest hole has developed a fair amount of infection in the tissues around it, so Dr. De Cook is planning on trying to clean things up in hopes that the ostomy will be more manageable.  I have to be at Holland Hospital at 12:30 tomorrow, so likely will start the operation about 2 or a bit after, if all goes as planned.  For a time, I will have a larger yet hole, but hoping it will heal up and be smaller and more able to be sealed in the future.  Pray for wisdom for Dr. De Cook and healing for the Haitian Donkey. 

It has been a bit hard to juggle other activities around the work schedule and my at least weekly visits to Holland Hospital for the changes and adjustments to the ostomy.  Jenn has been doing the changes at home between the visits, she has a real aptitude and is greatly appreciated, though she is not enthused about the smelliness of the affair and, at times, we have to do this daily on one or both bags.  Hopefully things will smooth out over time, both in the irregularity of the belly wall (so the bags will stick better and not leak) and our skill in keeping the fluids where they are supposed to be.  I have eaten very little as the Sporonox inhibits any appetite, but we still have enough drainage from the sites to make it unpleasant. 

Dan, Duane, Jose and Kevin (another surgeon friend of Jose’s) will leave tomorrow for a week in Haiti.  It seems things are starting to settle down and we are praying that will continue and they can do the work they would like to get done.  Dan, Margie, Tabitha and I plan on going on the 14th of February for our week there, again, most delighted that our friend, Ken De Young, is willing to fly us in and out as he will be there with a team on their projects there.  What a blessing.  In addition to the other jobs she will do in the OR, Tabitha (and maybe Margie will need to help some) will do my ostomy changes and teach Miss Lisberthe and others to do them when I make my future trips. 

By God’s grace, we already have had some money promised towards the Solar Project and we are excited that things are progressing for that also.  Will keep you updated on all aspects of our work as time and new developments come out as we greatly appreciate all the prayers, support and encouragement you all are to us daily as we strive to serve our Savior at Centre de Sante Lumiere, Les Cayes.

In His Service,

Bill for Dan, Duane, Jose, Kevin and the rest of the Haiti Team