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!