I once heard a wise person say, “Your life can either be an example...or a warning.” The fact that I cannot remember who said this may tip you off to the way this story will turn. After an intense ping pong match of opposing opinions, all housed within my soul, I have chosen to pull back the curtain of my own story a stitch and share an anecdote from my week that will illustrate this quote nicely. The reader is allowed freedom to decide which side of the sentiment it falls upon. In Tarantino fashion, let me start with the ending and reverse engineer the scenario.
Sitting in a plastic chair that looked like it was meant for a patio and not a place for the practice of emergency medicine (says who?), I found myself perhaps two feet from the place where this all started. I rolled up the sleeve of my right arm and placed it on the desk beside me, antecubital side up, for inspection and removal of blood samples. A collection of white coated staff members with whom I have been working stood in a row before me, saying any number of things to each other in languages I did not yet understand. Mocking? Sympathizing? I will never know. The last twenty four hours had seen the providence of God bring me and my pride full circle in spectacular fashion, with no less zeal than a Narobi roundabout. Glancing over my shoulder to the left, I recalled the split second that stutter stepped me to this position.
I have not had a formal role in healthcare for several months since we left for our training in the states. Most days at work in the ER were very full and being a charge nurse presented many unique challenges to work through. All that to say, I’ve been a little restless just to do something since we got here, especially in light of ongoing preparations facing coronavirus. This, despite Tracy and our team leaders’ reminders that our worth does not come from what we do but from our identity in Christ. I am not a driven person, but I’m no slouch either. Our main goals for the first number of months have been to build relationships with the community, work on our Swahili and begin orienting in the hospital. Well, in due time, the corona pirates pillaged this perfectly reasonable plan. We have been going out only to the store for necessities and occasional exercise outside of the house. Our language helper wanted to take a covid break and see how things go after a while. We are each still going two days a week in the hospital, most of which are spent wandering around in a cloud of Kiswahili and Kipsigis dialects, just trying to figure out how things work. (I will tell of my attempts to function in triage another time. It is amusing.) Even this was put to a stop when we self quarantined for a week after traveling to Nairobi to sign and send papers for the sale of our home in Illinois.
The Monday following our isolation found me quite eager to return to the Accident & Emergency Department. I was assigned to help in the casualty area, as opposed to triage, dressings or injections. Purposing to be more helpful today than prior times, I inserted myself into situations where I could get to work silently, without the need for much direct patient communication. I took vitals, helped situate and transport a trauma patient to xray and back, etc. Then, as I was noticing a gentleman sitting with greatly swollen eyes and upper lip, one of the nurses slid an IV catheter across the silver top of the med cart and asked, “Can you fix an IV line for me?” I had declined doing this the first couple shifts for various reasons, aiming to get my bearings before doing more invasive tasks. But today was different. I wanted to be of more use and so I readily agreed. I greeted the man with the toddlerish Swahili that I know and commenced to start the IV in his right hand. To my relief, it went in fine and I was already feeling a little satisfied, even though it was really a small thing. This feeling was to dissipate as quickly as morning mist in the East African sun.
I removed the bare needle from the catheter, holding it with my left hand (no safety needles, here mind you) Because I had not yet placed the cap on the catheter, it began to bleed a little. The man, noticing that his hand was bleeding, jumped to avoid getting it on his pants. In eighteen years of starting IV’s on patients, I have never once been stuck by a dirty needle. But on my very first stick in Kenya, it happened. It could happen to anyone, anywhere in the world, and it happened to me. I’m often smart enough to know a thing but dumb enough not to admit a thing, so at first I wanted to ignore what had happened. After finishing the line, I went to work scrubbing my bleeding hand and internally running all of the scenarios that may now happen.
I could not possibly deny that it had happened. But, and this is where my train began to careen off of its tracks, I decided to keep this little tidbit to myself. For one, I did not think they had an established process for this kind of thing. Wrong. Two, I am new here, attempting to prove myself, build rapport with staff and find a place on the team. I thought that fessing up would be an incalculable blow to this desire, and, more truthfully, my ego. I was angry that I had done it and worried about how the staff would look at me if I reported it. Wrong again. Instead, I would try to nonchalantly obtain this man’s medical history and talk to my team leader about the incident later that night. I turned around and he was gone, having received his medication and moved on. This is not unexpected as people pop in and out of casualty from the outpatient area in order to receive acute treatment and then leave to be re-evaluated, receive meds from the pharmacy and go home. “Where is the patient we just saw,” I asked the nurse who invited me to start his line. “He went home.” I quickly found out that he knew nothing of the man’s background, nor did he know his name or patient ID which could be used to find out his history. The nurse agreed to speak with the provider who saw the patient and find out his information. He did not ask why I wanted it and I did not tell him. Hope (not her real name), the casualty supervising nurse, was in and out but still I chose to wait and see, not telling her about the incident. Insert screeching train sound here.
The day wore on, I started many more IV’s without incident. My concern continued to climb and after inquiring if any information could be found about the man, I was told “The provider who saw him has left. Maybe we can ask another day.” Not good. The reality of the situation fell hard upon me. I was in rural East Africa where HIV and hepatitis rates are mountainously higher than at home. I had stuck myself with a dirty needle that was just used on an unknown patient with an unknown history. Still, I said nothing about it and just slinked home feeling like the broad, blue African sky was about to fall down upon my head. Don’t worry, things get worse while they better. Understandably, I spent the day dejected, languishing in a pool of my own doing. Anger, concern, embarrassment, they all joined together in a game of red rover with my heart and mind. Of course I talked to Tracy about it and she was equally disconcerted. Ultimately, I landed on telling myself that God is sovereign and his story for me is good. I have learned that this is the only place to stand in moments such as these. The Rock of Ages, very true. But sometimes you find yourself on your face, on the Rock. You’re not going anywhere, but the ground is rough and jagged. The bitter providence of a good Father who disciplines his children for their own transformation. My thanks to the Walrus and Carpenter podcast for talking about Hebrews 12 on the day after this happened, helping me process it all (check it out here).
I am happy that one of our team leaders here is an ER doc, as we speak very much the same language. But he is also very much a loving brother and brings a big heart in one hand to the information delivered with the other. After a brief discussion, we both decided that post exposure prophylaxis would be the way to go, taking meds to decrease the risk of developing a life altering disease. It was the only way to be absolutely careful in the face of unknown risk. While on board with this plan, my growing concern focused on the reality of returning to the hospital the next day and potentially facing the same staff that I had avoided the day before. The train of my prideful thinking was now fully on its side, half on fire and the other half letting loose its cargo for the hazmat teams of my mind to attempt containment.
The next day, we set out early for the hospital with the idea that we would take care of this ordeal on the down low. Which is where things got considerably worse and better for me. Laughably so. Paradox is a fun idea. But not always a good time. We created a plan which looked like me signing in as a patient, getting my blood drawn for baseline labs and receiving the PEP meds from the outpatient clinic. Lower and lower my heart was sinking in the mud bath that I had created. Registration is the front door. Visibility is high. The lab is next to casualty. Equally high. But I would just slip in and out, right? This will be ok, I told myself. No better way to understand a healthcare process than to become part of the process, right?
After returning with my passport for registration purposes, I ran into Hope, the casualty nurse supervisor I mentioned earlier. I had wrestled with whether or not to tell her about the incident, eventually convincing myself it was the right thing to do. When I was a charge nurse, I would have wanted to know if a similar incident happened. I would have expected it. At this point I was beginning to lean more on my identity as God’s child than on my reputation as a professional, resigned to absorbing whatever scorn was to come my way. I was beginning to see the punchline in this whole story and, thankfully, laughing at it’s ridiculous unfolding. It’s a good thing too, be
cause I was about to be pummeled with the holy arm of irony.
I wanted to make a joke about the incident as I presented the information to Hope but, alas, the barrier of language yielded multiple blank stares from her in the past with similar attempts at humor. So, as forthrightly as possible I told her of the exposure, being sure to mention it was my first in an eternity of emergency medicine. “Don’t worry, we have a plan and will take care of it.” “No, I will help you,” she said in a tone that gave no room for dissent, the tone of a concerned and
professional leader. The same tone had come from my lips many times. She led me to registration, explaining why I was there, speaking in Swahili to those behind the counter and helping me get registered as a patient. The gloves were now off and the divine left hand made contact. My family and I are typically a spectacle wherever we go here. But this was another level of scrutiny and feeling exposed. “Come,” she motioned, “let’s get your samples.” She sped away and I knew immediately where she intended for this to take place, and it was not the lab.
Sitting in a plastic chair that looked like it was meant for a patio and not a place for the practice of emergency medicine (says who?), I found myself perhaps two feet from the place where this all started. I rolled up the sleeve of my right arm and placed it on the desk beside me, antecubital side up, for inspection and removal of blood samples. A collection of white coated staff members with whom I have been working stood in a row before me, saying any number of things to each other in languages I did not yet understand. Mocking? Sympathizing? I will never know. The last twenty four hours had seen the providence of God bring me and my pride full circle in spectacular fashion, with no less zeal than a Narobi roundabout. Glancing over my shoulder to the left, I recalled the split second that stutter stepped me to this position.
Nothing could have changed the fact that a dirty needle, dipped in the blood of myriad unknown risks was about to write a story fashioned to bring me low upon the rock of God’s steadfast love, mercy and grace. Nothing could have changed the outcome of that moment. I now carry anti nausea meds for the next 28 days to combat the effects of the prophylaxis meds and look forward a near future of serial HIV testing. What also does not change is the breadth of God’s steadfast love for us and commitment to inject His grace into the fray of our hearts to draw our eyes toward him and transform us into the image of his Son. Even if this means engineering a specific personal scenario spectacular in its potential embarrassment. I am thankful that the players in this story including my wife, teammates, Hope and other casualty staff members were kind and gracious about it all. They knew nothing of the work of the Spirit in my life in those hours, quarrying up some stony places in my heart so that I would trust in God rather than my reputation. In this is freedom from fear and freedom to serve in such a way that God is glorified, not myself.
What other hope does one have but to know that this God who did not spare his own Son but gave him up to die for the undeserving is also relentless in pursuing what is good for them? Is this story an example or a warning? The reader is free to choose. For me it is a tangible testimony of severe kindness - undeserved and unexpected. But kindness nonetheless.
“Rock of Ages, cleft for me, let me hide myself in Thee.”
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