The Lord is not slow concerning his promise, as some regard slowness, but is being patient toward you because he does not wish for any to perish but for all to come to repentance. –2 Peter 3:9
From deep in the realm of the dead I called for help, and you listened to my cry. —Jonah 2:1
But the LORD replied, “Is it right for you to be angry? –Jonah 4:4
Eliu is a good boy. He is 9 years old. He is in the third grade, likes school, does his homework, and helps around the house. Quiet, cooperative, with twinkling observant eyes, he spends most of his time these days waiting, bored, and worried about losing his leg. Eliu lives with his Abuela, his Grandma, in a little house in a little village over near Olanchito. About a month ago, Eliu and some cousins were playing at a wrecked house.
Eliu jumped down from a fence onto a pile of broken concrete blocks, and somehow the block he landed on turned and pinned his foot as he continued his none-too-controlled landing. In the process, his foot and ankle of his right foot were kind of badly injured. I don’t know exactly how badly because his Grandma took him to the Public Health Hospital in Olanchito. They did pretty much nothing for 3 days, then sent him to the Public Hospital in La Ceiba. In La Ceiba they put him under some anesthesia, sewed up the deep soft tissue injury just below his ankle, put on a tight dressing and splint, and less than two hours later they sent him out the door back to the Public Hospital in Olanchito for some reason. I suspect that this was a crucial point of further injury to his foot due to post-op swelling inside the constrictive bandage because he remembers waking up along the way with excruciating and unrelenting pain in his foot. In Olanchito they again did… nothing for a day (not even loosening or changing the dressing), then shipped him again to the public hospital in La Ceiba, where again they did nothing for a day (not even loosening or changing the dressing), then they shipped him to the largest public health hospital in the country, Hospital Mario Caterina Rivas in San Pedro Sula (HMCR). At HMCR they again did… essentially nothing for 11 days, but finally told the Abuela that the plan was to amputate his leg.
Somewhere along the way, Abuela heard of Hospital Loma de Luz. She somehow got him out of HMCR and somehow got him to Loma de Luz, 17 days after the original injury. As best as we can tell, right after the accident, what he had was a viable foot with nondisplaced ankle fractures; by the time he arrived here at Loma de Luz, it was apparent he was going to lose most, if not all, of his foot.
“Pancho” (name changed to protect the guilty) is not a good man. He is 46 years old. His job is Regional Director of Illicit Appropriations, i.e.,”chief local thug” of both of the land invasions next to the Children’s Center. He has threatened the work and the workers, and he and the rest of the invaders are threatening to take over the land of the hospital’s water system. A few weeks ago two of the invasores (land -invaders) down in the invasion were having a big fracas regarding one having cheated the other. No surprises there. Rumor is that the one thug had cheated the other thug with violations of both the 7th and 8th commandments. The cheated thug decided to settle things according to his default nature, which means get some liquid courage and come back with a machete. An hour or so later, my good friend Dr. Wesley Harris, who was covering the E.R., got called in for another “macheteado” (someone chopped up by a machete, a not uncommon occurrence in this part of the world). After evaluating and stabilizing him, he called me up. This particular macheteado had a number of slashes to his head, his upper arm, and a few other places. But the worst of his injuries were to his right hand and forearm, and these were going to need surgery. The X-Rays showed that his ulna (the long bone on the little finger side of the forearm) was cut in two about a third of the way up from the wrist. He was bleeding a lot from the wound, couldn’t flex his fingers or his wrist, and he could not feel his fingers on the ulnar side of his hand. Wesley was able to stop the bleeding in his forearm with pressure, and he sewed up the superficial lacerations in the rest of his body. He immobilized the forearm and we added him onto an already over-full surgery schedule for the next day. This particular macheteado, was Pancho.
When the news came out that this particular macheteado (the chopped-cheater-thug) was
Pancho, there was a bit of tension out there. This is the head bully of the invasion that stole and occupies the Dodson property… the one who has threatened the Children’s Center and is organizing the invasion to take over the Hospital’s water source saying, “We don’t need a hospital!!” Which is of course true ….until you do. Would the hospital care for him now? Would Rosanne and I operate on him to put all of the pieces back together? I wondered the same thing…. for at least a couple of nanoseconds. Though I wasn’t planning to place a complementary chocolate on Pancho’s pillow, of course we would have to operate on him. And, of course we would do pretty close to the same job we would for a loved one. You don’t offer medical/surgical care according to how much the injured or sick deserves it. You do so because through calling, education, training, and experience, that is the operating system God has deeply imbedded in your mainframe. In the final analysis, you pour yourself out for the sick and injured as an act of worship and obedience to God.
So Pancho was admitted from the Emergency Dept. that night, awaiting surgery the next day. When Wesley learned who he was (information which Pancho wasn’t exactly forthcoming with in the E.D.), he went and talked with him on the ward prior to surgery. He told him, “You know, anywhere else they would probably just cut your arm off, or they would not be able to fix this… but here maybe we can fix all of the injuries… And, if there is anyone who would not want to show you mercy, it should be Dr. McKenney… but he is showing you mercy because he has received God’s mercy.”
Pancho at least listened to him witness about sin, grace, and salvation. And, of course, Rosanne prayed with him in pre-op holding; she does that with every patient. And, of course, I prayed before starting the case for the best outcome, and that God would be glorified through it. I do that with every patient. So, neither of these little stories is too remarkable; in fact they are commonplace… up until the point where Pancho gets touched by the supernatural. I think this requires a little more detailed explanation. Then you decide.
By Pancho’s X-Ray it is clear that the machete divided the ulna at the mid-third/distal-third transition point.
By both mechanism and angle of the attack, and by physical exam, it was also clear that essentially all of the flexors to the wrist and fingers were divided, and that the ulnar artery and the ulnar nerve had been divided. I told Pancho and his wife this when I examined him before surgery. I also told them that we would put back together whatever we could… but that even in the best of outcomes, to expect it to take several months or more, if ever, before regaining nerve function. You
see, when a peripheral nerve is cut, it immediately stops working… like an electric wire when it is cut. Distal to the cut, the nerve undergoes what is called Wallerian degeneration, i.e., it dies. In order for a cut nerve to ever work again, the nerve sheath has to be repaired well and, ideally, with the (nearly microscopic) nerve fibers lined up just where they were before being cut…. Then the nerve has to re-grow down the nerve sheath once it heals… at a rate of about a millimeter a day, about an inch per month. From where Pancho’s ulnar nerve is cut to the finger tips, you’re looking at ~ 9 months to recover sensation to the fingers… if it recovers at all. In surgery, this is what I found. Of course, his ulna was divided, as was the ulnar nerve and artery, and about 10 different flexor tendons to the wrist and fingers. I put them back together in that order, first the bone to stabilize, then the artery, then the nerve, then tendons and musculotendinous junctions. I put him in an extension blocking splint, and that was that… until the middle of that night.
When I made rounds the next morning, Pancho told me this crazy story: In the middle of the night following surgery, everyone, including Pancho, is asleep. He is awakened by an excruciating cramp in his forearm and something like an electric shock going down to his fingers which makes him scream…. And immediately after that, he had regained all sensation to his ulnar distribution…. a complete recovery of the nerve, and a recovery which has been sustained up to the present time.
Did I make a mistake and just think I was repairing the ulnar nerve? No, I have operated on or around nerves thousands of times, and just by virtue of the pre-op exam, the mechanism of injury, and the anatomy of all of the surrounding structures divided, that just didn’t happen. And if by some incredibly statistically unlikely serendipity, I lined up all of the axonal endings exactly, the distal ends of the cells would still die off so that 3 days later and three weeks later you would not have normal sensation. This is not a “miracle” as defined in Littlewood’s Law (“an exceptional event of special significance occurring at one in-a-million frequency”). No, although less dramatic, this is in the category of something which just does not happen naturally. Like a man blind from birth recovering his sight. I explained all of this to Pancho and to his wife and mother, how God gave him a supernatural miraculous healing, how he is in HIS debt all the more. I challenged him to consider what he is going to do with this hand God gave back to him. They listened and nodded their heads. We’ll see if he changes his behavior.
Now, to be truthful, I’m a bit put out with God that once again He just won’t stay inside the lines I’ve drawn for Him. I’m a bit irritated at God for wasting this miracle on a Ninevite like Pancho when He didn’t do a miracle for so many others, like Eliu for instance, who needed it more and certainly deserved it more. My friend Wesley would say that both the gift of life and the free gift of salvation to eternal life are costly miracles….and all miracles coming from God are good. Who knows? God may use this miracle to save Pancho from eternal death. But Wesley is a lot more like Daniel than I am. And I’m a lot more like Jonah than Wesley is. And I can understand why Jonah was PO’d when the Ninevites repented. They had probably done terrible things to his friends and family, mocked God, and didn’t bathe very regularly…Am I right?
I have another good friend, Rick Reichert. If we were Paul and Silas, he’d be Paul, the smart one.
I’d be Silas, the good looking one (a claim which I think I might get away with since we have no idea what Silas looked like). I asked Rick (the smart one) what he thought about it, and he wrote back with a treatise referencing; Augustine, Plantinga, Hitchens, and C.S. Lewis, Rom. 8:28, Isa. 55:8-9, and John 9:3b. He makes a good case that God, all-knowing, all-powerful, and all-good, always has a morally sufficient reason for what miracles He performs… or doesn’t. He ends with “I simply don’t know why God appears to overlook the righteous in pain, while offering mercy and succor to the wicked. I just know that such miracles are still good and display God’s grace, even to the least deserving of us.”
That’s all good. That is helpful… up to a point. We Jonah characters of this Kingdom, we agree with the
Daniels and the Pauls, …with our heads at least. In our hearts we’re not so sure. We may even, like Jonah, get angry about it. God still puts up with us apparently. But there is one thing my heart is sure of, and this brings me to a workable degree of peace even when Pancho gets this cool miracle, and Eliu doesn’t. It is a heart lesson I’ve learned a few times from “deep in the realm of the dead,” from inside the belly of “a great fish.” Even when I don’t understand God, I know I can trust Him. Sometimes you just have to leave it at that.
Jefferson McKenney, M.D.
News and Needs
We are grateful to see God’s hand of guidance and provision continue to work at Loma de Luz. It has long been our hope to see more Honduran national Christians of good education and high character taking their place in middle- and upper-level management. It is a beautiful thing to witness the Lord accomplishing His plans in this in His timing. This shift toward a much greater degree of Honduran-nationals in leadership is one of the big themes of this past year and the year coming up. Yet there is still–and will continue to be–a place for and a need for foreign-nationals as long-term missionaries.
Current clear long-term missionary needs include these:
*A couple of mature, fully trained and experienced Primary Care doctors with a heart to serve the Lord and to invest in young Honduran physicians.
*A couple of mature and experienced Craftsmen (or women) good at building and fixing things.
*A couple of mature and experienced businessmen (or women) good at Operations Management and Administration.
*A Surgeon and an Anesthesia provider.
*The Cornerstone Foundation is also carefully, prayerfully, and thoughtfully looking for the right Chief Operations Officers, one for the US as well as one for Honduras
*Teachers for the El Camino Bilingual School
There are signs that the Honduran Government is coming under sufficient extra-national pressure to actually deal with the Land Invasion Crisis instead of just making soft speeches about it in public and actively supporting it in private. In recent weeks, a number of large land invasions have been evicted (with a great deal of fanfare by the Administration). Most of the country is beginning to gain a little hope that these actions will continue, and locally the communities at Loma de Luz are hopeful that the invasion across the fence from the Children’s Center may also be evicted. So please keep this in prayer. Many of you have been praying for this, and we are so very grateful. Please continue to pray.
May God–who sees Eliu and Pancho,
and even the livestock (Jonah 4:11)
and sparrows (Matthew 10:29)–remind you that He sees you as well. Please keep praying for us, as well as for Pancho and Eliu. Lord be with you.
–Sally Mahoney for Cornerstone