Find the fracture

-Gunshot wound. Ouch.

Don't really need an xray to see this one.

"Nightstick" fracture. What badguys get when trying to block a nightstick blow... or ladies get when trying to block a blow from an angry husband.

Random radius fracture.

This is what happens when fractures don't get mananged well. Actually, this isn't too bad, because she's pain free and has a functional arm. It just doesn't look right, which is a sad deal for a sweet little girl.

This is the first real jaw fracture I've seen. Hard to miss, both clinically and on xray.

Another Nightstick fracture. This was dude on dude violence if I remember right.

Bennett's fracture from previous blog.

Hope you enjoyed the show. I've seen several more, but this is a good smattering. On a side note, I saw paraphimosis for the first time tonight. When I saw it, I knew what it was from reading about it in med school, but I'd never seen a picture, couldn't remember the medical word for it ,and didn't really know what to do. (In the States this is really uncommon, and you just call a urologist.) I called up Scott Dooley, my backup for the night, and we worked on this thing for at least a good 30 minutes before finally reducing it. But now I'm getting "ahead" of myself. You see, paraphimosis is when the glans of the penis is stuck outside the uncircumcised foreskin. The longer it's out, the harder it is to get back in because the blood keeps pumping in, but no blood is getting out. The glans on this kid was hugely swollen, and the outer ring of his foreskin was reeaally small. It was like trying to shove a golfball back through a straw. I shot the kid up druggie style with 50 mg of ketamine with some valium, then another 50 of ketamine when he started waking up after 20 min or so of work. Poor kid! The good news is that (1)he won't remember any of his time in our ER and (2) we finally got his tallywhacker all put back like it should be. Unfortunately for him, he just might need a circ to keep this from happening again. Double ouch!

Week 3 pictures

Just a few more pictures to take a look at from last week.

Softball and Progress... I think

This past Sunday, a bunch of us went out to a field here on station and played a game of softball. It was a pretty good game, with its fair share of highlights and bloopers, and I think everyone had a pretty good time. While we were all playing softball, though, all the kids were running around, exploring, and having their own fun. When it was time to go, we gave the kids their "two minute warning" while we rounded up our stuff.

So, I see Caleb out of the corner of my eye walk up to Olivia. Now, Olivia is a really nice girl about Caleb's age who really gets along with Caleb pretty well, in spite of his occasional social awkwardness. When it's time for them to part ways, she usually wants to give Caleb a hug, which he usually fights, and we all quietly get a laugh at their expense. This time, however, Caleb holds out his arms to Olivia and asks for a hug! In my mind, I'm thinking, "Breakthrough!!"

Olivia responds, "I already gave you a hug, Caleb." What? He wants another one?

"Can I just have another one?" Seriously?

Olivia gives him a big smile and an even bigger hug. I was amazed! However, I must have been gawking a bit too much, because saw me and got a kind of sheepish then panicked look on his face. Being the quick thinker that he is, he begins almost shouting "Poopy Bear! Poopy Bear!" (or was it Poopy Frog?) at poor Olivia. When she gave him a confused and a bit hurt kind of look, he softened considerably and said "Poopy Bears give lots of good hugs."

I wasn't sure what to make of this whole interaction, but it's clear Caleb has entered the wonderful/terrible/confusing world of female relationships. On the up side, he is actually making friends and having a good time, just being more social in general. On the down side.... Poopy Bear?!? Really? We've got some serious work to do.

Wonder where he gets it from?

I uploaded some more pictures to another facebook album. You can follow the link here. Lots of the pictures are either on this blog or Stephanie's, but there's a few you haven't seen.

In other news, Thane has his first ear infection. He's been feeling crummy, not eating much, fevers, for about one week now. Stephanie took him to Dr Erin, who took a good look in his ears. I popped my head in her room a few minutes later after they had left and the conversation went something like this:

"How'd it go?"
"Left ear's red, right looks great. Otitis. Gave him some Omnicef."
"Sounds good."

I think Erin is maybe the most efficient doctor I have ever met. Unfortunately, Omnicef won't do much for Stephanie, who has caught whatever it was Thane's deal started out as. She is feeling pretty puny, but a mom just doesn't get a day off. Hopefully she feels better soon!


I added links to a few blogs down on the right. The one by Jordan and Rachel has some funny stuff about PNG but especially a good blog about John Ope you can check out. Cool story about a genuinely nice guy, not to mention a really good guide.

The Bat Cave

I know you're all thinking Bruce Wayne and the Batmobile, but I'll just stop you right there. This is the entrance to what the locals call "The Bat Cave."

It's owned by the pastor of the Konduk Church of the Nazarene, who is a cool guy and loves taking the missionaries and visitors to Kudjip Station (like us) up to his cave. Konduk has a special place in my heart, as it was the jumping off point of my last cave adventure here in PNG. See my post about it here. Rest assured, this trip was much safer. If I (and about 10 other people) hadn't been able to assure Stephanie of that, there'd be no way I was going!!

I went with David (my bro-in law), Jordan (here 2yrs helping with construction while his wife teaches in the MK school), Ethan and Josiah (missionary kids). We met up with John Ope and Pastor David at Konduk and headed up to the cave. All in all, the hike up there started at 7:30am and took about 3 hours and 20 minutes. I couldn't tell you the elevation we climbed, but it seemed like a loooong way for this thin blooded white skin! John Ope was our guide on our trip up to the Flying Fox Cave, and it was fun to reminisce with him about it on the way up. Here's a picture of John and I at the top of Mt Topi (sp?) on our way to the cave. Just to the right of my elbow are the shiny tin roofs of Kudjip Station off in the distance

The hike was even more beautiful than I remembered, but as Jordan said, it's a shame so much of it was spent looking at our feet! The path wasn't the straitest, widest, or best kept, so vigilence was essential. A good portion of it was through grass-covered mountain like this, but the last third was through some fairly dense jungle/rain forest, which was a little more difficult. I was thankful for the walking stick that John cut for me with his ever-present bush knife, a.k.a. machete. It was great for walking (of course) but imagined it more as a spear something the midieval pikemen would use after John told me that the red stuff in the middle of this picture is cassowary poop. And fresh!

Thankfully, there were no cassowary sightings and we all made it safely. Once inside the mouth of the cave, we traveled maybe 20 yards to a 10 foot cliff/waterfall. Normally, the missionaries bring some climing rope to go down, but unfortunately none of us did this time. It was a bit dicey, but we all made it down safely, albeit slowly and soaked! From there, the cave was nothing but cool. There weren't any super claustrophobia inducing areas, though there often wasn't a whole lot of extra room. We saw some cave sparrow nests which were pretty cool, only one of which still had a chick in it. There were all the regular cave attractions: stalactites, mounds of bat guano I think everyone accidently stuck their hand into at least once, and, of course, the bats. Now, unlike the bats in the Flying Fox Cave, (named for the size of the bats - which I can definitely attest to!) these bats were pretty small and harmless. Their body is about the size of a mouse. Anyway, we all brought sticks into the cave to whack down bats as they flew out towards us. So, when we got to this particular part of the cave, Pastor David got the bats all riled up and, seriously, thousands and thousands of bats came flying and screeching right at us! It was an absolute free for all trying to smack down as many of these bats as possible and give them to John Ope to stuff into his pants pockets. They are evidently very good to eat, and John is known to say how hungry he is when he smells the bat poo! The best sticks had lots of little branches at the end to act essentially as a rake to gather bats out of the sky. This picture is after things had settled down and we were waiting for the stragglers to fly by.

The cave sparrows' nests... at least that's what I think they are. Feel free to correct me anyone! Also, there is no flash on that picture, so you get a better idea of what we were seeing inside the cave.

Just a typical cave passage. Not too bad from a headroom standpoint at all.

After the bat frenzy, we explored the cave for awhile longer. Josiah was getting a little sick from the bat poop smell, so John, Josiah and I went back out while the rest of the group went on another 30 minutes or so into the cave. The three of us found a little ledge to go up and around the waterfall, which was nice since we were a bit chilly from being down in the cave for so long. After a nice little snack and some relaxation, the rest of the group came out and we snapped this picture. We ended up with literally hundreds of bats all together. By our count, 87 of those came from us white-skins.

All in all, a pretty good trip. On our way back to Konduk, we stopped at John Ope's house. His wife had cooked some sweet potato which he graciously shared with us. We were all pretty hungry! The color of these were like our potatos (they also have a more orange variety) but definitely had a different look and flavor. They were cooked essentially by throwing them in/around/under the fire. It tasted great!

Pastor David then invited us to have some of the sugar fruit growing next to the Konduk church. It was delicious! Kind of like pomegranate in terms of the seeds and juice, but definitely different.

By the end, we were all exhausted but had a great time. We got back close to 4pm, cleaned up, and made it down to the Dooley's for Olivia's 5th birthday party. What a great day!

Caleb in PNG

Playing in the mud... in his pajamas!

"Why are we here?"

Stephanie touched on this subject in her Mother's Day blog, and it's something I've given a lot of thought to as well. This is a long post with lots of reflection. Consider yourself warned.

I think it was 24 hours plus into our trip here when Stephanie asked me this question with tears in here eyes: "Why are we here?" By that point, we had been puked on, peed on, cried on, and slept on (and wishing we had been slept on a LOT more). We were finally in Papua New Guinea, and taking off on the final leg of our marathon trip up to Mt Hagen from where we would drive another hour to Kudjip, where the mission station is. There in the airplane, poor Stephanie was at her wits' end on a journey half way around the world that, in a lot of ways, she wasn't very excited about. With an exhausted child on her lap, I just put my arm around her and told her it would be okay. For me, the answer to "Why are we here?" starts back several years. I won't bore you with all the details, but here are some high points:

-Around age 4 or 5, I "ask Jesus to come into my heart." I didn't know what that really meant, and to this day I don't really know how significant those words were at the time. I've certainly had to make multiple decisions to follow or not follow God in my life since then. I kind of like to think of this event as the beginning of a journey, which is really what a relationship with God is.

-Age 16, my mom dies. I get pretty serious about figuring out the whole God thing, making sure He's really around, figuring out how I fit in to His plans, etc. Thanks in part to a great mom, I decide that God really does care about me (and everyone else), and I really want Him to be in the driver's seat in my life, even if I have no idea where I'm headed.

-I go to college to follow some girl named Stephanie. (This ends up working out pretty well for me.) There I meet a some guys that become my best friends and accountability group. They have had a pretty big influence on my life, and always for the better.

-My sophomore year of college, after previously ruling out any sort of extended education, I decide that medicine is kind of intriguing.

-That summer, I hear a guy named Phillip Parks speak at my church. He is a Korean guy who was training to become a missionary to China. Listening to him talk about God's call on his life and the way life can be... it really kind of grabbed me. He talked about the needs in our own backyard and all over the world, and what we can do to meet those needs. I think it was then that I decided to try to be a doc, so that I could put myself to good use no matter where I was.

-In medical school, I hear about an opportunity to travel internationally for a month or two. I also get ahold of a list of mission hospitals that take rotating med students, and lo and behold, there is a Nazarene Hospital in Papua New Guinea that catches my attention. Stephanie says no way is she going there with a two year old child. So, after much discussion, we go, along with Josh and Sara Adams, one of my best friends from college who is also in med school.

Now, I don't think I can really underestimate the magnitude of impact that trip had on our lives. I got exposed to medicine in a pure sense, without all the fancy tests, fear of litigation, wanting to make lots of money, wanting to look better than the guy you are competing with for grants, grades, a residency slot, etc. I got to be around a group of people who were/are doing what they love to do because they love the people they are serving and the God they are serving. We also got to experience life outside of "western culture" without TV, super fast internet, fast food, cell phones, and sexually charged advertising bombarding us. It was a great experience. Life was not so much harder or easier, but definitely different and much simpler. After a few weeks of adjustment, Stephanie and I both loved it. I knew after this trip that I wanted missionary medicine to be a part of my life, be it full-time as a career (still a bit intimidating), a month or two out of each year (pretty appealing), or something in between.

But, I guess all that only partly answers the question: Why am I here, now, in Kudjip, Papua New Guinea?

1) I really believe this is where God wants me to be right now. I know that sounds hokey to a lot of you, but it's true. Now, I'm not one that believes that God has every second of every day planned out for you. Would it have made a difference if we had come a couple months earlier? Later? For only one month instead of two? Probably not. I don't even know if it would have mattered had we chosen to serve and learn some place else for a month or two. Hard to explain, I guess, I just know us being here is right.

2) I'm here to learn my trade. It's no secret, I've got a lot to learn about medicine. I'm just completing my second year of residency, and there's a lot I haven't seen and even more I haven't actively taken care of. This hospital is really pretty ideal for that, in the sense that I get tons of hands on experience, and people come from all over to this place with all sorts of weird and sometimes classic pathology. There aren't any specialists, and to refer someone means them traveling a good distance, so we take care of just about everyone. I also get great experience with tropical diseases that just don't exist in the States.

3) I'm here to learn about life. Like I said, life is different here. In some ways harder, as I think about hopping in my truck and making a quick Wal-Mart run for whatever we need, and being far from family. But in other ways, life is much easier. I love the slow pace of life, the lack of cell phones and TV that distract and divert attention so easily from more important things. And, in terms of family, everyone here on the station does a great job of filling that gap, with the kids even calling other adults "aunt" or "uncle." It's a pretty cool thing.

4) I'm here to serve. The people here are pretty incredible. It seems like around the world, that happiness and wealth are inversely related, that is, the less a person has, the more likely they are to be happy. The stories of the suffering of folks here would break your heart, but you wouldn't know it by seeing them live their life or the big smile on their face. It is a great privilege to help these folks physically and share with them some of the love that God has shared with me.

5) I don't want to get too comfortable. Coming here was a bit of a big deal in terms of leaving our life in Nebraska, even for a short time, as well as just plain spending the amount of money needed to get here. At times, the choice was a bit uncomfortable. I realize, though, that there will never be an easier time for us to come. One function of this trip is to remind us of how much we love it and how right it feels, so that we can continue to make the uncomfortable choices in the future that will put us where we need to be.

Settling into a routine

As expected, things are settling down here. The boys are adjusting to a new schedule and general way of doing things, and not a moment too soon! Caleb is making friends with the other kids, and Thane... well, he's still throwing rocks into puddles. At least he stopped trying to eat them.

Our typical day starts around 7 with the kids waking up. We make them breakfast, try to get Thane to eat, try to get Thane cleaned up, then I take a shower and head off to the hospital.

Everyone gets there around 8, which is a nice change from the 6am start time in the States! I round on my half of the Pediatrics Ward, which typically takes about an hour and a half or so, then go to the outpatient clinic and start seeing patients. We take an hour lunch break around noon, and go back at it until all the patients for the day are seen, which averages around 4pm. Not too shabby!! My favorite part is probably getting to walk home for lunch. I love seeing Stephanie and the boys in the middle of the day.

The evenings are usually comprised of some sort of walk or activity (like ultimate frisbee or touch football with the other missionaries), then eating a great dinner Stephanie has cooked, cleaning up, and putting the kids to bed. The past few nights, Stephanie, David, and I have been playing cards, which has gotten pretty competetive! It's a good way to pass the time, though, and a lot more enjoyable/interactive than sitting in front of a TV or surfing the web. It's a really nice change of pace.

A bit of a boring post, I agree. I think we are all really enjoying it here though. I'm on call tomorrow, so I'd better get to sleep -- it's 10:45pm here. Hopefully I'll get some pictures added soon.

PNG pics

For some reason, posting pictures here is not going well. However, I've had some luck (with a lot of perseverance!) getting them up on Facebook. Try this link to my photo album. You shouldn't have to have a profile to look at them. I'll hopefully be posting more pictures pretty frequently.

Happy Mother's Day! (tomorrow)

I would like to give a public shout out to my wonderful wife Stephanie, who just so happens the be the mother of my two super-cool boys. She does a great job with them, and I think I picked them a pretty good mom. When we're at home in Omaha, it seems like she is doing something fun and interesting with them every day, be it the zoo, the children's museum, going to the park, taking a walk/"exploring", or whatever. In fact, on a couple of occasions, while putting Caleb to bed, he says, "It can't be time for bed yet, Daddy, we haven't done anything FUN yet!!" When I ask him what he thinks is fun, he rattles off the above list and says Mommy ALWAYS does something fun before it's time to go to bed. It's true, part of that is just another one of Caleb's schemes to avoid bed, but I think you get the point.

She is also an incredibly good sport to go trouncing around the globe with me while having two small (and very stubborn!) kids in tow. She just ups and learns how to cook from scratch, how to grocery shop in a 4th world country only once a month, and how to deal with tropical bugs everywhere including cockroaches crawling out of (freshly bought) cereal boxes. I love the way she supports me and at least lets me believe sometimes that I'm able to call the shots! Seriously, though, she is a great, smart, funny lady and I'm glad that she's my partner in life and the mother of my boys. Happy Mother's Day Stephanie!

I'd also like to take this opportunity to thank my dad for picking such a great mom for my brothers and sisters and I. She was always the first to listen, the last to lose her temper, and wanted nothing more than for her kids to know Jesus and succeed in life. She was a real tender, sensitive lady, and while the world has been worse off these last almost 12 years without her, heaven is even better. Love you Mom! Can't wait to see you again and introduce you to the mom of my kids!

On a lighter note...

Man, that blog last night was pretty depressing. Sorry guys! Really, our time here has thus far been marked mostly by hanging out with great missionaries and enjoying the beautiful scenery while getting adjusted to life at the other end of the world. 4 different families have had us over already! They make a habit of taking turns fixing dinner for people who are either just getting on station or getting ready to leave on furlough so they don't have to worry about not having groceries, etc. It is also a nice chance to get re-aquainted and remember just how nice it is to be among these people.

Also, as you can read about in Stephanie's blog here, Caleb, Thane, and the Riggins boys went to the hospital to hand out toys and blankets to the kids there. I was able to step away from my duties for a minute and watch them in action. It was great! I couldn't tell which the patients liked more: getting the stuffed animals and crayons/paper, or watching 4 little white-skin kids run around the wards! Either way, it brought a lot of laughs and smiles to kids and their parents who were a little short on things to smile about otherwise.

In other news, I have now officially first-assisted on two C sections, and got to close fascia on one! Not a big deal to most of you, but cool to me none the less. I have really been struggling in my mind whether C sections was something I wanted to learn, especially with 4 years of no CS looming in my post-residency future (not something most family docs do in the AF). These two went really smoothly, though, and were pretty fun! We'll see how things go. Last time here, I helped in a CS that ended up pretty tragically, but let's not rehash that now. I think I'm going to try to get in on as many as possible, and see what happens from there.

Again, so much for the short blogs! Oh, well, gotta leave room for improvement. Now to have a glass of my fresh squeezed lemonade and off to bed. Have a good weekend all!

p.s. still waiting for images to upload, and I'm sleepy, so if you'd like, you can see some of them at the end of the wife's blog about the boys sharing in the hospital.

Death and Dying

Last time in PNG, I learned a lot about death and dying. I saw a handful of kids die of preventable things like diarrhea, malnutrition, prematurity. Pretty sad stuff. I managed to escape the sad kind of death to a large extent back in the States, but here it has reared its ugly head already.

You may be wondering what I mean by the "sad kind" of death. Well, I don't really consider death a sad thing when it is better than the life being lived. Folks who work in health care have a good understanding of this, I think. Sometimes, we just do so much only to extend pain and suffering. One of my attendings back home calls it "Taking away their ticket out of this world." What is sad to me is folks, especially kids, dying or suffering when it just doesn't have to be that way.

At any rate, yesterday I saw a lady who was pregnant, just a few weeks from her due date. Only problem was, she hadn't felt the baby move... for two weeks (reported durations of time are not always too accurate, but she was pretty believable). At this point, you pretty much know what is going on, but don't want to believe it. So, I took her into the ultrasound room and began searching in vain for a heartbeat. Nothing. No movement at all. Cranial bones overlapping a bit. Definitely not good. Hoping that I had become totally incompetent, I asked one of the other docs to have a look and speak with this poor woman, since my Pidgin is still not up to the task of such a delicate subject. Alas, still no heartbeat. Dr Susan talked with her about waiting for labor vs inducing now, and she decided to wait. We prayed together and sent her on her way with some Tylenol for the labor pains that would soon be coming.

Tonight, since I am on call, I was clearing some patients from the ER when a very sick gentleman I had seen earlier in the day coded (stopped breathing) and died. Since I was the only one around this time, I asked a nurse to translate for me as I prayed for the man's family.

As a doc, I guess I should be used to death and dying. I've watched my mom, kids, adults, sick people, and (relatively) healthy people all die in front of me. Still, when it's something unexpected or it just doesn't seem right, it gets to me a bit. If I've spent any amount of time with the patient's family, it gets to me a lot. In the movie Patch Adams, the head of the med school says essentially that they would beat the humanity out of the students and make them something better: doctors. Well, I guess Ohio State didn't do such a great job of that. In spite of the occasional heart ache, think I'm glad they didn't.

Bennett's Fracture

It is now the evening of MAY 5th, and we've been here in PNG a full 3 days. It is funny how quickly I've settled into a routine. Stephanie and the boys, I think, are still working on theirs, but coming along. I started back in the hospital the first morning after we arrived, which was my first time seeing patients in the new hospital. It opened this past fall, and let me tell you, it is a few steps up from the old place. For starters, it's bigger with more windows and lights. Also, there's no parts of the wall falling in, no leaking ceiling in the sterile utensils room, and the doctors' bathroom is no longer a scene from an old horror movie. The best part, though, is the folks there are still as friendly and helpful as ever. I got to see my friend Nickson, who is a native guy and a nurse in the ER, and he gave me a huge hug and proceeded to hold my hand -- a little weird to guys in the US, but a pretty typical and even manly expression of affection here in PNG. Brought me back real quick to cultural differences. Anyway, Nickson is great, and we've actually emailed several times since our last trip here. It will be nice working with him again. I was actually suprised how many nurses remembered me, and also how many I remembered. You gotta love familiar faces.

Speaking of familiar, or rather, unfamiliar, I had to get back in the swing of things pretty quickly treating parasites, TB, typhoid, and malnutrition. Still haven't seen a new HIV, but I've got a while! I have also seen a good amount of orthopedic stuff, which I definitely need to improve upon. Fortunately, it's pretty dummy proof here. If something looks/feels broken, take an xray:

Look it up and find the picture that matches it the best in a super-old ortho book by a guy named DePalma

And cast it up the way it tells you. By the way, that's casting with the old school turn-your-hands-white-and-make-a-huge-mess plaster. Last time I worked with that stuff was.... you guessed it, about two years ago in PNG! This fracture is evidently called a Bennett's fracture, involving the proximal first metacarpal (connects thumb to wrist). Never seen this particular fracture before, so I learned something new. Dr Jim (our general surgeon) helped me out on this one since DePalma actually recommended a little more aggressive treatment with pinning and traction. We're trying just casting first and will see how it goes. I have since completed this process solo with an ulnar fracture. I can only hope Dr Lau (cast clinic attending back home) will be proud!

I promised myself I'd keep these blogs shorter and just blog more often, but I can't help myself from sharing another story. There's this adorable little girl in the peds ward (where I'm currently spending my mornings) named Koli. She came in about a week ago with pneumonia, but also a strange neuropathy that caused weakness in her legs and hands, along with pretty severe pain in her legs. I had seen her for two days, and she was essentially stable or worse. We were/are wondering about perhaps polio versus some other viral/post-viral syndrome, but the good news was that it wasn't really progressing. Then today, I sit down on her bed and pick up her chart, and she smiles big at me and says "Jisas helpim mi!" (that's kind of my phonetic spelling of Pidgin - sorry to any real Tok Pisin speakers/spellers out there) which, of course, means "Jesus helped me!" There she was, playing with some yarn and moving her legs! She is still weak, but definitely improved. Pretty cool. Folks around here call the Lord "Papa God" which I really like. It's nice to have a Great Physician around to help folks out when I don't know what to do or can't do much. Please pray with me that He will help me to be His hands to the sick here.

Okay, it's now 10:30PM and long since time for me to get to bed. Hopefully I'll have more stories or pictures soon!

Safe in PNG!

It is now just after noon on June 3rd here in Papua New Guinea. We made it here safely yesterday late afternoon after a marathon day and a half of travel. I am so glad to be back here! I didn't remember just how beautiful this place is. The best part, though, is the missionaries and the way they have already made us feel welcome again. Stephanie, the boys, David (Stpehanie's brother who joined us this time) and I had a few rough spots during the travel, but we all made it safe and, just as importantly, sane. I'll tell a bit more about it and about where we're staying, etc. later. Now for lunch and back to the hospital!