The Beach...

I am in Ventura, CA! I am renting a room from a very nice older lady. She has a cute country like house. Walking into the house today, I passed by the trickling water in the garden, through the kitchen that's filled with the smell of freshly baked lemon bars and apple casserole in the oven, then by the living room with soft jazz of the Titanic theme song playing, into a very clean room with 2 beds. After I met the 2 baby orange tabbies (Lewis and Clark), introduced myself to the African-gray parrot named Mona, I decided to take a bike ride down to the Ventura Pier. It was a lovely ride.

Leaving the Burn Unit in Phoenix, I felt a little sad. It is the combination of 1) leaving all the patients that I've come to feel so much for, 2) leaving the OR, 3) I won't have another surgery rotation for the rest of the year, 4) and, out of all the surgeries I've done, I like burn surgery the most. I wanted so bad to see the patients recover and heal. Perhaps one day God would use me to help people in that situation again.

Turning over a page... I am excited to start a rotation here with the Ventura County Medical Center's Family Practice residency program. I am doing ICU and Peds this month. Along with In His Image, I am ranking these 2 places at the top of my list. Oh, did I tell you? I have finally decided to choose Family Medicine as the specialty I want to go into. Though I had wanted to be a surgeon for awhile, I feel there are many advantages of becoming a Family Doctor:

1. Get training to take care of obstetrics/gynecology, pediatrics, medicine, minor surgeries, emergency care.
2. Additional fellowships trainings in wilderness medicine, tropical medicine, sports medicine, and osteopathic manipulative medicine.
3. Family doctors are very well suited to work in the mission field.
4. Family doctors see everything first, then decide who gets what types of specialty care... so a good family doctor could potentially 'try' to do as much as possible before referring. So, a family doctor could potentially be all that a patient would see in their life time.
5. I am very well suited for those things mentioned above, because I am very interested in a broad training program.
6. Family doctors has more time to spend with family and hobbies... more vacations!
7. Family doctors can offer spiritual care in a much thorough way compare to any other specialty.

So, I have many reasons of why I want to be a Family Doctor... I know there are many that have encouraged me to do something else, but after much evaluation, I still think that Family Medicine would be the best fit for me. Thank you for all your prayers... this process has been very difficult, so, thank you for your supports and prayers.

(*) Mirror Mirror on the Wall

I went to a Barlow Girl concert last night, it was very good. I know, there were more tiny-boppers there than adults, but, I agree with their message. They are all about purity and not to date anyone before marriage; just wait for God to provide the right one. They are also supporting a ministry called 'Mercy Ministries' that helps girls to deal with eating disorders, depression, self harm, abuse, abortion, addictions, and more... They offer a residential program free of charge to those who are selected! The following song touched me, I have a person in mind, I hope it ministers to you. You are FREE in CHRIST! You are loved and you are redeemed by His Love. You are New. You are Pure. You are Sanctified. You have to choose Him. Christ already has chosen you!

Mirror, Mirror on the wall, Have I got it?

'Cause Mirror you've always told me who I am

I'm finding it's not easy to be perfect

So sorry you won't define me

Sorry you don't own me

Who are you to tell me

That I'm less than what I should be?

Who are you? Who are you?

I don't need to listen

To the list of things I should do

I won't try, I won't try

Mirror I am seeing a new reflection

I'm looking into the eyes of He who made me

And to Him I have beauty beyond compare

I know He defines me

You don't define me, you don't define me

5 hour surgery... "Cultured Epidermal Autografts"

I was involved in a surgery today skin grafting a patient who had a lot of body surface areas burnt in a horrific accident. So, I learned something new... CEA = Cultured Epidermal Autografts. So, there are several types of skin grafts: autograft (from self), allografts (from a cadaver or another human), and xenografts (from another species, most commonly a pig). The main purpose of grafts is to provide coverage for open wounds and to protect patients from fluid loss and infection. So, CEA's are a type of autograft. It was approved by the FDA on Oct 25, 2007. To make CEA's, the company that culture them and produce them takes a biopsy of the patient's skin. Then, they prep and place the parts of skin in a culture medium to 'grow' the new skin. The new skin is consisted of about 10 cell layers thick of keratinocytes and takes about 12 days to grow. (10 cell layers is about 1/2 of the thickness of the grafts harvested from the patient) Each of these new 'autografts' swatches are about 2''x3" and costs about $1,280 per swatch. So, in a person like me, I probably need about 300 to cover my entire body... so, you do the math. Let's say we use 300 of them... it would be about $384,000 for just the autograft swatches alone. This does not include surgeon fees, OR fees, and all the material that goes into it. The surgery took about 5 hours and a lot of swatches!

Then you can ask, why CEA's? Well, when patients have more than 30% of total body surface areas burns, they may not have enough of their own skins for autograft harvesting. So, one way to go around that and still have your own skin coverage is to grow them in a lab then transfer them to your body.

Then you can ask, how much of this CEA are we expecting the body to take and incorporate into the tissue and have it survive? Well, the literature supports the success of CEA grafts to have a mean graft survival rate of about 65%. Some studies state the graft survival rate up to 80-90%. There are several good studies out there: French Study from 1997, Slovenia Study from 2001, Pediatric burn from 2000, and Recent Study 2006. There are lots of good articles in the scientific journals, but they all require subscriptions.

Here is the package insert from Genzyme, the company that produces the CEA's we used today: http://www.genzyme.com/business/biosurgery/burn/epicel_package_insert.pdf

So, I think the surgery is going to give this particular patient much benefit. I do pray that her body incorporate these new cells. God is the healer, we just do the best we possibly can.

(*) Bruchko: Walking the trail of Saymaydodji-ibateradacura, Bari

While reading this book, I have quickly become endeared to the life of Bruce Olson and the Bari people. Amazement, laughter, tears, sadness, triumph, unbelief, and awe, were some of the feeling that journeyed me through this book. I loved this book, and I have a lot to share, so this is going to be long post.

Bruce, called ‘Bruchko’ by the Bari people (aka Motilones = “Short hair,” named by the Spanish invaders), has chronicled his life of 40 years as a messenger of God to the Motilones in this autobiography. His journey started with an inspiration of God to go minister specifically to the Motilones when he was 19. He decided to follow that inspiration and forsake all that is comfortable in the US. Motilones has been a Stone Age appearing people, who hunt with spears and arrows, who defended their territory fiercely and killed many outsiders and other Indians and each other, and who, upon seeing Bruce for the first time, attempted to kill him and shot him with an arrow. He was captured.

Under captivity, Bruce gained strength from God and sought wisdom in how to show the Bari people who Jesus is. Little did he know, there was an ancient Motilone Legend which said, “A tall prophet with yellow hair will come to us carrying banana stalks. Knowledge of life and God will come out of those stalks, and God will show us the way back to Him.” One day, as the Motilones were shaving the banana stalks, Bruce had noticed a revelation from the Lord: as the roots of these stalks were split, the layers within spills open as pages of a book like opening the Bible, the Word of God. So, excited with the new inspiration, Bruce told of God incarnate in human flesh, who came to live amongst us, and we can know Him if we follow in His steps to walk His trail. The name of Jesus Christ, their Lord and Savior was: “Saymaydodji-ibateradacura = God incarnate in human flesh.”

Bobarishora, aka Bobby, was the first of the Motilones to become a follower of Saymaydodji-ibateradacura, and in time he became Bruce’s bestfriend and ‘pact brother.’ He said to Bruce before being killed by outside intruders for following Jesus, “He [Jesus] is God, yet we can know Him by walking in His steps.” “Bruchko, I want Christ to be foremost for me. I want to yield all to Jesus.”

I hope you didn’t missed what I have just said! It is amazing. After the Motilones started following the steps of Jesus, they started changing. They became a group of people who have given up their violent ways, even up to the point of giving up their lives in the name of Christ.

Through the guidance of Bruce, the Motilones gained ways of sustaining themselves. They set up co-ops to raise crop and cattle as a way to make sure all their members have food. They even started to supply food to the neighboring tribes and foreigners, because of their love for God. They started also forming missionary teams to go to other tribes to share with them the love of God. They formed clinics, schools, language programs, and also sent many Motilones to universities. With Bruces support, many Motilones became trained at large Colombian university and graduating as physicians, lawyers, teachers, etc… And to Bruce’s surprise, all of these students came back into the jungle to serve their own people. None of them stayed to enjoy the new way of life.

With these advances, they were able to work with the government to protect their own land, even got to be invited to the United Nations and offices of presidents for dialogues. The Motilones moved from being a Stone Age people group to being able to work with and survive in the 21st century without changing their cultures and traditions. When they are back into the jungle, they still wear loin cloths and sleep in hammocks in communal longhouses. In his own words, Abaydora, a Motilones Chieftain, “At our weakest time, God brought us salvation. We met Jesus in the mountains. We were in anger, but with Him we found love.”

Bruce never tried to convert them, but always discerned to share God’s love with them, and have always allowed them to make their own decisions. Motilones has learned to pray to Jesus when they need to make a decision. Saymaydodji-ibateradacura had became central to their lives even without Bruce around.

Also chronicled in this book was Bruce’s journey of becoming a person that God used to change an entire nation, through a self sacrificial life. It also talked about being captured and tortured by guerillas to denounce his faith and his adopted family, the Bari (Motilones). He also shared his pain of losing two of his beloved, his pact brother Bobby, and his fiancé, Gloria. There are pains in life that we cannot ever understand. There are pains in life we have to live with and constantly asking for God’s grace and love to help us through.

Bruce is loved by the Bari people. He is Bari. This love, even to an outsider like me, made my heart and eyes so warm and moist. I wanted to be there. I wanted to feel the warm embrace. I want to know of that genuine and pure love. I wanted to be loved and to belong.

“Yado [Bruce Olson], wherever you die, I will recover your body and take you back to the jungle. Then we will wrap you in a hammock and lift you into the jungle canopy, so that you can travel beyond the horizon as one of us.” – Araybachira.

The following are excerpts in Bruce’s own words on being a missionary:
“The purpose of entering the mission field is to share the redemptive works of Christ. It starts when the Holy Spirit works in the hearts of the person who is going to share the gospel. Then the compassion for the people should help that person share His message in a way that does not strip the people of their autonomy and self sufficiency and turn them into beggars who depend on benevolent organizations to survive. Many people hear the word missionary and equate the term with someone who is trying to destroy native culture, but that is the last thing I want to do. What I have tried to do is to give the Motilones tools so they can forge their own future and help them discover that Jesus is not a God who has come to take away their traditions and culture, but a Savior who walked and still walks with them on the trail of life. He is a redeemer who will be with them as they journey beyond the horizon.”

“I too am a weaver. My “art,” has been to live among the Indians [the proper term for addressing the Bari people] so that together we could weave a tapestry that is pleasing to God. It has produced a colorful, rich work filled with history, warm relationships, and takes of lives opening up to the Savior. It too is a story of love.”

““I want to know Christ and the power of his resurrection and the fellowship of sharing in His sufferings.” (Phil 3:10). It’s an experience that allows us to know Christ intimately. It is terrible to suffer, and I certainly would not seek it out. But when it comes, I trust in God’s sovereignty. He does not toy with our lives. I have learned not to judge Him. We tend to accuse Him when awful things happen. But we are His creations, fully dependent on Him. It is not our place to judge. This, I think, is one of the great discoveries I have made during my life with the Motilones.”

I loved this book. I have learned so much on how to walk in the foot steps of Jesus through seeing how genuine the Motilones are. Jesus’ transforming love is REAL! I think we have a lot to learn from the Motilones. I also have a lot to learn from Bruce, to love a people to the point of death in absolute obedience and reverence for our Lord Jesus. I have to learn that to love someone is to completely give them over to God for Him to lead and guide them. Love makes us give sacrificially for other's advancement not our own. Love is to relinguish our control and just let Jesus in. Soak us in your love and grace, burn us up in your holy fire of the Spirit, guide our steps and our lips to bring glory to You no matter what our circumstances may be.

“I walk on the trail of life experiences to the horizons. No evil spirit can threaten me or take me from the security I know in Jesus. I am suspended in Jesus through my expression of faith.” --- Song of the Motilones.


Bruce Olson talking with another Bari

Hunters

Fishing and hunting

Singing in hammock; basket weaving

The Burn Unit

I am doing well in my Burn Surgery rotation. I am very much enjoying the rotation. I think it comes very naturally to me to be doing procedures, whether it be handling the knife, doing excision and debridement of burns, skin grafting, sewing grafts in, doing wound vacs, performing venous and arterial access and line placements, and anything I can get my hands on. I am absolutely loving it and very comfortable in the Burn Unit. I know the people I treat will most likely never recover their appearance 100%, but, to help them to be able to function with the least amount of disfigurement leaves me feeling very satisfied.

One thing about burn surgery that I didn't know is that usually the Operating Rooms are chilled and quit comfortable even under all the sterile gown and gloves. But, the Burn ORs are tuned to the patient's body temperature... because when we lose our skin, we lose our temperature regulating barrier. We also lose the water keeping barrier, so we dehydrates very fast. So, to keep the patients' body from dropping their core temperature, we keep the room at their temperature. Yeah, imagine operating in a room of 98 degrees F. I was totally drenched in sweat from head to toe!

I also have made some advances today on my own, I have successfully placed several arterial and venous lines today! Yay... I loved it. It is all for the patients' benefit. I am among some really good surgeons here.

That's all for now, don't forget to check out the Sarah Palin video in the blog below. Good night!

The Sarah Palin Fan Club

I got this link from my mom. If you like Sarah Palin, here is a video of her interview at the Wasilla Assembly of God Church in Wasilla, Alaska where she grew up. It is a very uplifting message, and if she does get elected, I think she will bring a new perspective into Washington.
http://link.brightcove.com/services/player/bcpid1766638341
Here is a link to more about Palin: http://www.cnn.com/2008/POLITICS/09/11/beck.palin/index.html

The Pilgrim's Progress

I finished this book today. I really enjoyed this book, though, it hasn't always been an easy read in the old English. I really felt that this book parallels and details what it is like as we follow the way of the LORD and walk in a Christian journey toward Christ. Though, it's not an easy read, it has made my top recommended list! If you wish to find out more details and background of this book, please read the post I made a few days ago: http://steamydeepthoughts.blogspot.com/2008/08/mr-great-heart-e-mail-from-400-year-old.html

Palin, the GOP VP nominee...

Wow, did you see her speech? That was comical! I want to vote for her as President! I am not sure I like Obama or McCain, and I definitely don't like Biden. So, I vote for Palin! Go Alaska! Hee hee...

(*) May God Take Care of Them...

Today was a sad day for me... because of confidentiality I cannot share anything other than: couple, plane crash, and burn survivors. I've learned a lot working as an assistant to the surgeon on all of these cases doing excision and debridement of wounds and then doing skin grafting. I am seeing how laborious the work is in caring burn patients.

The surgeries consisted of: taking a patient back into repeated surgeries to remove eschars and to keep the wounds fresh and viable for healing and growth; harvesting skin grafts, using allografts (from another human), using xenografts (from another species, usually a pig); doing the grafting; changing the dressings; maintaining the patients' vital needs (nutrition, respiration, etc...); tubes in, tubes out; releasing of contractures when wounds heal; escharotomies when eschars form during healing... the work goes on and on.

I am thinking, I have never seen patients as sick appearing and as acute as the patients I've seen in the burn unit. If you can be trained to help these patients, you can treat anyone!

When I was in the OR doing the surgery on one spouse today, I thought to myself, how can anyone sustain this much injuries? Then, when we finished her surgery and went to her husband's room, I saw all the pictures of them together and their beautiful family, it hit me. I, then suddenly felt really sad. They will never be the same, if they can make it out of the unit!

There is a dear friend who recently lost a grand-baby to an automobile accident, and their kids were very seriously and traumatically injured... my heart goes out to you and to my patients and their families!

Then, finally, my mind took me to how amazing everything is. Think about it, as doctors and surgeons, we can do our best, everything we can, and be as proactive in treatment as we can, most people will live, but some will die. But, there is something else that is governing the healing of the body. We can give the necessary nutritions and the body will heal. We can give it the right environments, and the 'missing' pieces will attempt to grow back! ISN'T THAT AMAZING?! I think many of us in the health care field get so compartamentalized that we take the whole 'healing' process for granted. We doctors only attempt to put things back, but God had designed our bodies to do all the rest! Doctors are like good stewards of what's been given to them, and God is the one that heals.

Like the surgeon, Dr. Gawande, who I did a book review ("Better") on earlier, shared: as we enjoy medical and surgical advances, we are able to save many more lives. However, we haven't yet learn how to deal with the incredible kinds of disabilities by simply saving people out of their traumatic injuries. People who are missing all limbs, or missing a face, or permanently disfigured... how do we help them to function? When should we stop fighting for our patients and just let them go? How far do we go to save someone? Do we ever think about what they have to do if they do survive? I think, as a doctor, we always have to do our best as our profession prescribed.

Dear Father in Heaven, holloweth be Thy Name. Thank You for every blessings of a new day. Thank You for giving us health and providing for us. Thank You for always being Faithful and Loyal and loving. Thank You for always giving us HOPE for eternity. Thank You for Your PROMISE of an eternity in Your LOVE, without sorrows, disabilities, disfigurements, and disappointments. Thank You for Jesus Christ's death of atonement to redeem us from our sins so we can worship You in Your Holy presence. Thank You for blessing us with all Your beloved on this Earth as we walk this pilgrimage together. Father, please take special care for those who are in physical suffering. Please be their Comforter and their Peace. Give them strength to live through and face their future. Give them courage to face themselves and to share their incredible story to further glorify Your Name. May all your saints say... Amen.

My First Day in the BURN unit!

So, I have started my first day of the 4 week surgery rotation in the 2nd largest burn center in the USA: Arizona Burn Center at Maricopa Medical Center. This center admitted over 826 burn patients last year, cared for 1,500 patients in the burn E.R., and over 3,500 outpatient visits. This is also the referral center for areas including the entire state of AZ, western NM, NV, western CA, and northern Mexico. Let me tell ya, there is probably no better place to be trained in how to take care a burn patient than here.

As I started my first-day today, and considering how busy this place is, I was thrusted straight into the O.R. within about an hour of being introduced onto the service. Within 5 minutes in the O.R., I was holding up someone’s arm (skinless with escharotomies on both medial and lateral surfaces of both arms and forearms), the arm was oozing copious amount of serosanguinous fluids, while ripping out staples from the temporary grafts.

Ok, I am being really careful with my words here. I have to say that I have never seen anything in medicine that’s as graphic as this. I don’t have a weak stomach for things like this, and I am very eager to jump right in there and help with whatever needed help and to do surgery. However, I have got to remind myself that not everyone’s stomachs agree with mine. So, this is one topic I probably wouldn’t bring up around the dinner table!

I have seen what having skin grafts do to the patients, they are wonderful! Even though the surgery itself looks barbaric, the end results for the patients are life changing! I feel so interested in this work and at the same time feeling that I am contributing to these patients’ well-being that they otherwise could not have received. Simply Life Changing!!! Also, God really designed our body beautifully to heal itself, even at times under unimaginable traumatic stress!

My hours are very interesting, like all surgical discipline, they are long. I start tomorrow morning at 4:45am and the end of the day is “whenever.” Normally, I would start at about 5 or 6am, and ending “whenever.” No joke… this is how it appears on my schedule “0600 – whenever.”

I feel very privileged to be able to do a rotation here, because there is probably no better place to learn about burn surgery. And besides, I get to see people’s lives change right in front of my eyes. I have a lot of respect for these surgeons and the work they do.

Good night, I’ve got to catch some shut-eye before the rooster crows.