My Thirteen Year Old Patient Weighed 800 Pounds (By Hannah McDowell)

This will no doubt be the last newsletter from my mother that I will be able to post. My parents and little brother Jeffrey will be flying home tomorrow from 10 weeks in Honduras. I'm sure that they would appreciate your prayers as they travel home and then try to recuperate from a jam-packed trip before jumping into the Penn View school year. Oh yes, my mother was able to deliver the Melton's baby and the Robberts' baby (both EFM missionaries serving in Honduras) in the last couple of days, which was an answer to prayer. The fact the two missionary ladies were willing to have their babies delivered in the little mission clinic in the mountains of Honduras has left a very positive impression with the community.


Br. Hight wrote: Eleyna was also born in our clinic, making two North American missionary babies to "come to light" in the clinic in less than a week. They tell us that the nationals are buzzing with the news, and are proud that these ladies are "humble" enough to have their babies where many little Hondurans have been born. It may have done more for public relations in the San Luis area than anything else since the actual opening of the clinic! Congratulations, Zack and Sarah. May Eleyna bring you great joy. Here's a picture of the two new MKs, courtesy of Zack Robberts. That's Kenton Daniel Melton on the left and Eleyna Ruth Robberts on the right.



And now for my mother's last newsletter...

The afternoon was another hot and humid one, and my head nodded in a brief doze more than once as Rex and I sat in the study, working on translating material for our upcoming marriage seminar. I barely heard the tentative knock on the door above the soft whirr of the fan by the desk. Glancing through the screen, we saw Edgar, one of the Bible Institute teachers, leaning against the door frame. “I’m sorry to disturb you, but could you please take the pickup truck and trailer to help me get Estella home?” he apologetically requested of Rex. “She’s terribly hurt and can’t walk. I think maybe her left leg is broken.” He grimaced as he shifted his weight, carefully easing his own left leg with its blood stained and torn trouser into a more comfortable position.

“I’m all right,” he assured me. “I banged up my knee pretty badly when we fell, but caught myself with one hand and kept from slamming my face into the gravel as we hit the ground. I’m worried a lot more about how she’s doing. We were running really fast uphill, and I still can’t figure out whether she tripped over something or what, but her face and knees are all torn up. Do you think you could stitch her up for me when we get back?” he anxiously inquired. I gulped. "I’ll do my best to help her," I promised, wondering what in the world I was getting myself into now!



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Two hours later Rex slowly pulled the truck and trailer to a stop by our gate and I hurried out to get a good look at my patient: the thirteen year old, 800 pound, not-very-happy, Bible Institute horse whose work of carrying various students as well as staff to their respective country churches to hold services is invaluable. It was nearly 7:00 p.m. and dark by this time, so the inspection of her wounds had to be done by flashlight. Edgar had good reason to be concerned. Both front knees were torn open, but the left one was so badly pulverized it looked like raw, albeit very dirty hamburger. Peeping through the mangled flesh was the white glint of bone. I gulped again. “Well, Edgar, I know about suturing wounds on people, but I’ve never had to do it on a horse before. Let’s see what we can do.”

Understandably, Estella (“Star” in English) was not particularly enthusiastic about backing off of the rattling, noisy metal trailer, and it took many minutes of coaxing, cajoling, and tugging on her rope halter before Rex, Edgar, the Institute night guard and two students finally maneuvered her down to solid ground. Meanwhile, I’d gone to the clinic to collect my supplies. “Your guess is as good as mine on how much local anesthesia to give her,” the nurse on duty replied to my question. “I sewed up one of our chickens when she got caught on a wire and tore open her face and neck, but I didn’t numb it any.” Figuring it was better to be over rather than under prepared, I stuffed a plastic bag with a nearly full bottle of 2 % Rapacaine, a 20 cc syringe, sterile suture instruments and cloths, a large bottle of iodine, metal bowl, lots of gauze, disposable gloves, three packages of 0-0 gauge nylon suture, (the thickest the clinic has), and one package of absorbable catgut suture.

Thus armed, I returned with some trepidation to the mare. “God, please guide my hands and help me to do this right,” I silently pleaded. Holding aloft a borrowed flashlight, I examined more closely the gaping wounds on Estrella’s knees, hind leg, nose, and above her eye as she stood trembling, refusing to put weight on her obviously extremely painful left front leg. “I don’t think I’d better try to do anything to her while she’s standing up,” I decided. “Do you think you can get her to lie down?” Estrella was not as convinced of the necessity of that plan of action as I was, but with four men with ropes pulling her back legs out from under her, she didn’t have much choice. I winced as she dropped to the grass with a thud, and the watching crowd of students and fellow missionaries drew back slightly while she tossed her head and struggled to get back up. There was no lack of manpower to help hold her down, but I was still pretty nervous as I gingerly hitched my step stool close to her and drew up a full syringe of the local anesthetic. Edgar crouched beside her, his own injured leg held out stiffly at an awkward angle, and caressed her neck while keeping up a steady stream of reassuring words while I firmly grasped her left front leg and began slowly injecting the medication that I hoped would give her enough relief from her pain to allow me to thoroughly clean the worst of her wounds.

30 cc’s of local anesthetic later, Estrella lay quietly as I washed her knee with copious amounts of diluted iodine, and strained to see well enough by the flashlight's beam to painstakingly pick out the grass and embedded bits of dirt and gravel. To everyone’s profound thankfulness, my probing fingers did not discover any bone fragments or obvious fracture. I carefully maneuvered the large sterile drape under her leg, spread out my instruments, and reached up for the pack of suture that one of my helpers dropped out of its envelope into my gloved hand. The first suture, deep into the lacerated muscle, went in smoothly, and I started to tie it off. At that moment, Estrella decided she wasn’t comfortable with her restricted position, and lashed out violently with her hind leg, in spite of the ropes that were tied to it and held by two students. She connected solidly with Edgar’s stomach, sending him flying several feet backwards onto the ground. In my haste to jump up from my footstool and scramble out of range of her iron clad hooves, I caught my heel in the hem of my skirt and ended up flat on my back in the grass as well. The frightened mare surged up and limped a few steps away, suture and needle dangling from her knee, as I felt around through the tall grass for my scissors and needle holder.

And thus it went throughout the remainder of the job. I would kneel in the grass, put in a couple of stitches, then jump back out of the way as she persisted in heaving herself up and moving to a different spot. She didn’t seem to be in pain from the suturing so much as she was jittery from having her head sat on and her feet pulled out from under her. I can’t say as I really blame her, can you? At one point, she opened her mouth, grabbed the by-now-no-longer-even-remotely-sterile drape in her teeth, and began vigorously chewing away, once more scattering all my instruments onto the ground!

Not only was she the most uncooperative patient I’ve ever had, she had the TOUGHEST hide I have ever had the misfortune to try to stick a needle through. Her skin was split open on the left knee from one side to the other, with only a small intact portion in the back, necessitating sewing first one side and then the other closed from back to front. I would take a “bite” of hide with the needle, putting all the force of strength from not only my hand and arm, but my whole upper body as well, into muscling the needle holder with its cargo through the incredibly resistant skin on one side of the wound and out through the equally tough hide on the other side. Rex did a great job of directing the flashlight beam where I needed it most, and a time or two added his superior strength to the task of piercing the needle through. Twice I had to pause to bend the needle back into its normal “C” curve, rather than the fish hook shape it assumed after a particularly tough insertion. As an extra precaution, I tied off each stitch five times, rather than the normal three. I was incredulous that the stitches were staying intact, in spite of the repeated times she had convulsively kicked with that leg in her attempts to get back on her feet.

Her right knee was not nearly as badly mutilated as the left, and I felt like a good cleaning, in addition to the heavy duty antibiotic injection I had given her part way through the evening, would be all that needed to be done for that injury, as well as for the cut on her hind leg and nose. When I finally got to the repair of the deep hole on her forehead, she rolled both eyes alarmingly and nickered fearfully as I oh-so-carefully injected the local anesthetic, being extremely cautious not to prick the too-close-for-comfort eyeball itself. But by this time, nearly three hours had passed, and she had had enough. After only receiving three of the needed six stitches, (thankfully the ones that were most urgently necessary to close the worst of the wound) she once again scrambled to her feet, and this time no amount of coaxing could convince her to let me finish the job.

Somewhere around 15 spectators had been closely following the proceedings, some of them helping hold the horse, others the flashlight, and even one of the girls giving my by now aching back a good firm massage part way through the job. We collectively had prayer for Estrella’s healing, asking the Lord if it could please Him to take over where human attempts could not continue, and heal the terrible wounds so she could continue to be of service to His work. My very large patient limped away and began tugging off and chewing up mouthfuls of grass, the neat bandage on her knee gleaming white in the darkness.

Wearily, I gathered my equipment from the various spots on the ground where it had been scattered, and trudged back to the clinic to clean up the instruments. I also pulled off and smashed the three ticks that had taken advantage of my kneeling position on the grass, and thirstily fastened themselves to my arm. Once more back in our house, a long, hot shower and hair wash had never before felt so good, and I tumbled into bed for a few hours of rest before my next clinic shift.

Where, I ask you, but on a mission field, can a nurse midwife care for an 800 pound equine patient one night, and after four hours of sleep, deliver an 8 pound, 2 ounce beautiful baby boy the next morning? I’m having a wonderful time, when I’m not too exhausted to realize it!