On Human Suffering and God’s Sovereignty

I received a phone call from the surgical resident-on-call last Monday night, concerned about the x-rays of a young, 12-year-old girl. “She had a fracture of her right femur last May and was treated in an external fixator,” he said. “Now her leg is huge, unlike anything I have ever seen before.” When I saw the x-rays, my heart sank. Her femur bone was completely destroyed, missing all the way up to the hip joint, and the hazy appearance of the huge soft tissue mass around it told the real story. Likely, the fracture last May was because her bone was weak from cancer, and a quick review of the old x-rays showed this to indeed be the case. When I met Chebet the next morning, I could not believe the size of her thigh. She weighed only about 60 lbs, half of which was tumor. The mass was literally sucking the life out of her, the large blood vessels of the leg hugely engorged, shunting nutrition and vitality from the rest of her body to feed what was slowly taking over. She was extremely malnourished, emaciated and lifeless, without any hint of emotion, but unable to even move in bed because of pain. When I questioned her parents why they had not sought medical treatment earlier, their concern was finances. I explained that their bill would not be an issue…but now, the only way to treat the cancer would be an amputation at the level of hip joint. Bone cancer usually metastasizes to the lungs, thus a chest x-ray was ordered. Given the massive size of the tumor and her late presentation, we were not surprised to find three golf-ball sized densities behind the heart…

Orthopedics was called to evaluate a 20 year old patient in Casualty with multiple fractures. When Tommy, a visiting medical student from the University of Cincinnati, went to evaluate the patient, he noticed he was not breathing well. A pulse-oximeter (which measures the percent oxygen saturation of hemoglobin) was applied and found to be 50%, a very low value. Getting more of the history, we found that two days prior, he was riding a bike when he was struck by a high speed vehicle, and was originally “treated” in a nearby government hospital. He was referred to Tenwek only after his condition “worsened.” When I came into the room, our anesthesiologist was working, with difficulty, on intubating the patient, straining to see the opening into his trachea through blood and pus. Amazingly, Joel was able to intubate the patient, and his oxygen saturation improved somewhat. An orthopedic review showed an open femur fracture on the right, a closed femur fracture on the left, and a near complete traumatic amputation of his left foot which was conveniently neglected at the outside hospital, and now smelling rancid. Because of the injury to his lungs and overlying pneumonia, we had to perform “damage control orthopedics,” in order to avoid further pulmonary injury. A quick amputation of the necrotic leg, and two tibial traction pins were applied until we could “nail” his femurs at a later time. However, the next day, the patient passed away in the ICU because of pulmonary failure…

Later that afternoon, we were called to evaluate a 43 year old man who was assaulted by some friends, struck in the back of his neck with a “rungu” (large wooden club). He was not moving his extremities, and was noted to have a dislocation of his cervical spine. On review of the x-rays with a visiting radiologist from the University of Louisville, the patient was found to have bilateral jumped facets (similar to the young woman told of previously). However, in this case, the patient was completely quadriplegic. Attempting to reduce the dislocation with tongs and traction, we were successful with relocating one facet, but the other side remained dislocated because a fracture completely sheared the facet from the rest of the vertebrae. The chance of recovery, apart from a miracle, is very slim…

Please keep our patients in your prayers, that God would give us, as their providers and advocates, wisdom and skill in their treatment, and that God’s healing power would be present, especially when the outcomes are well beyond our human ability or resources. We remain so dependent upon God for grace to persevere, for wisdom, for strength, for love, and care...for the benefit of our patients. We do our part, believing, in faith, that all is according to the plans of a sovereign God, who holds our patients' lives in his hands, and determines the number of their days, so that we may confidently say that nothing happens, whether good or bad, outside of His loving and perfect will.

1 Peter 4:19: So then, those who suffer according to God's will should commit themselves to their faithful Creator and continue to do good.