Brain Parasites, Yellow Babies, Holy Hitchhiking, River Crossings, and Waterfalls

It's hard to believe I have been in Honduras for more than two months now- I have officially been outside of the United States for the longest period of time in my life. And though I can hardly claim this new land as home, I can say I have mostly acclimated to the warmer and more humid climate; one morning this week I could have even used a blanket when it was a "blistering" sixty-eight degrees!

This week brought with it a handful of complex medical cases and some exciting adventures- I reflect on how the people and experiences of this world continue to teach me about the complex human condition and remind me of the beauty of creation.

Not Right in the Head.

For those of you who have studied parasites, you know that they have no respect for the human body and will find any place they can to take unwelcome residence- and sometimes that place is the brain. This week an adult patient came to see me for follow up for seizures that started a few years ago. Not uncommonly in areas of Central America, patients will present with new onset of seizures as adults, and the most common cause is actually a parasitic infection called neurocysticercosis. This disease is caused by ingesting the eggs of the infamous pork tapeworm. This patient had already been treated for the active stage of the infection, so his most recent brain scan showed only calcifications (the bright white spots in the brain scan), a sign that this parasite had made a temporary home in this man's body. Unfortunately, he is still at risk for having seizures, but at least he can be rest-assured that the parasite has been evicted. 

Sacrificial Love. 

As I walk by the pediatric hospital ward, I see the typical blue lights of phototherapy shining through the door, and I think to myself: "another routine case of a newborn with jaundice." But even with a quick glimpse, something about this infant quickly catches my attention. She is much larger than a newborn baby, and there is no way she only recently descended the birth canal in a magical act of metamorphosis. A few conversations and one physical exam later, it becomes apparent that this baby is actually five months old, that she is so yellow the whites of her eyes have been stained by a toxic level of bilirubin, that her belly is filled with so much fluid that her lungs forcefully oscillate against the rigid wall that is her diaphragm, and that her liver is quickly failing as it battles the demands of extra fluid and bilirubin in her body.

During my time with her this week, I only get a small glimpse of her arduous journey in this life. She had been hospitalized for over a month in the capital city of Tegucigalpa where she was diagnosed with a rare liver disease. Unaware of the unwanted changes going on in her body, however, she continues to behave like any normal baby with her frequent cries for breast milk, diaper changes, and a warm embrace. Over the next few days her body continues to reject efforts to remove fluid from her body with medications. Even after I place a needle in her belly and drain half of a liter of fluid, her body manages to replace it all again within a day. This infant's condition can only be cured with a liver transplant and that is not an option here. It breaks my heart to tell her parents that her disease is progressing despite our efforts. It breaks my heart to tell her father who has been waking up at three every morning to work extra in order to pay the hospital bills. It breaks my heart to tell her mother who sleeps by her child's side on a hard tile floor every night in order to sustain her child's life with the food only she can provide. And after witnessing their sacrificial love for their daughter, it breaks my heart to watch them walk out of the hospital while holding their daughter whose life will be too short.

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For those who observe Lent, you know that this special time of personal transformation which has been gifted to us began recently on Ash Wednesday. On this day, we receive a sign of the cross with oil and ash as a reminder that "[we] are dust, and to dust [we] shall return." Though these words might sound grim upon first hearing them, and especially in light of the story I have just shared, they actually give us freedom- freedom from the trivial things of this world that take away from those things that are most valuable in our lives. In this heart-wrenching experience of two parents giving completely of themselves for the sake of their daughter, I am reminded that true freedom lies in self-sacrifice and caring for others; only in this way are we are able to see what and who is shaping our identity. Once again, I have learned more from my patients than the help I could provide.

Speaking of Ash Wednesday, I can now cross "hitchhiking with a priest and two nuns" off of my checklist. While walking back from church in the middle of a hot and sunny day, some of us had to quickly get back to the hospital to see patients, so we flagged them down and asked if they could give us a ride back to the hospital. We jumped in the back of their truck for a blessed and bumpy ride back to work. You might consider it "holy hitchhiking."

Nature's Beauty.

This week ended with a trip to Rio Bambú. To get there, we had to cross a wide and rocky river- good thing most of the long-term missionaries here have Land Cruisers to make these jungle adventures more accessible. And though some of the locals also have trucks or SUVs with four-wheel drive, most people cross by other means. This may entail hopping on the back of a horse or taking a ride on a wooden boat tugged by a youthful teenager who wades through the water hoping to make some extra money. While at the river crossing, I finally understand what patients mean when they tell me, "I couldn't come to the hospital earlier because the water level was too high" or "I know I missed my appointment, but I couldn't cross the river." This is especially true during the rainy season when a steady deluge acts as nature's traffic control. Many times during the rainy season, people living in remote communities lose access to transportation that otherwise would take them to town to get food and supplies or to the hospital to receive medical care.

We set out on a short hike to a beautiful, roaring waterfall. From the top of the rocks, one can jump into a deep, refreshing pool of cool water to escape the jungle heat. Above the waterfall, one can even enjoy a natural water park where rock slabs serve as giant water slides and hanging vines serve as swinging ropes that propel you into the water. Beauty is everywhere here- in the raging waterfall, in the multi-colored toucan flying from one tree to the next, in the sun setting over the mountains, in the infinite deep blue sea on the horizon, in the multitude of colorful butterflies that drift during the day and the fireflies that signal oncoming night. But above all, there is one beauty that transcends the limits of my senses- the beauty of human connection that is unique to my role as a physician. In this beauty which is invisible to the naked eye, I am trusted to enter the life of another, and, in turn, I leave fulfilled.