Correspondance

-----Original Message-----
From: Daran Rehmeyer
Sent: Mar 28, 2007 8:51 AM
To: "'David H. Beyda, M.D.'"
Subject: help

Dr. Beyda: havn't heard anything from your side. Hope all is well: stones and all. I've found I'm losing weight without all the extra meals. Joking aside, what report did you get from your doctor?

I also need some help dealing with Pepe here. While you may have to deal with the heroic vs compassionate care issue in the clinical setting, I think we are having to deal with it on a personal level here. At what point do you say enough is enough? Is that just burn out? When do we stop trying to get the next treatment when all the previous ones have been aborted or ignored due to uncaring/unloving caregivers? Her father in this case. When is it better just to let them go? Is that to minimize their or our pain?

Really troubled.

Daran Rehmeyer

http://rehmeyers.blogspot.com/

From: David H. Beyda, M.D. [dbeyda@mindspring]
Sent: Wednesday, March 28, 2007 7:08 PM
To: daran@childrenscup
Subject: Re: help

Dear Daran and Teresa,

I'm sorry that you didn't get my email that I sent you last week with an update. I retruned on Tuesday night and Wednesday morning was having several proceedures done by my urologist to figure out what is going on. Here is the take: no stones presently but I have a horeshoe kidney, meaning that the 2 kidneys are connedted to each other and that increases the risks of stones. He has started me on a medication that will hopefully help in decreasing the stone formation. Also, I have to have a CT scan of my abdomen and pelvis 1 week before I travel anywhere to make sure that there are no small stones forming. That doesn't preclude the stones from forming during flight, etc. but will help a little bit. We have decided to let me travel again, at least for now.

As for the issue of Pepe. There are 2 rules in medicine, and as an ethicist and critical care physician, I find them to be very true: rule number one is some people die, and rule number two is that you can't change rule number one. If you try, you wind up with a vegetative patient, or a patient who suffers until they die. When you look at yours versus Pepe's suffering, it needs to be about her. The greatest gift we can give others is to relieve their suffering through care and compassion, even if it means letting them die. To prolong their death becasue we are not ready to let them go, goes against the grain of human kindness. I have had many occasions where I could keep a patient alive (we do our job very well in our intensive care unit), but allowed them to die comfortably, pain free and above all with dignity. I look at it like this: there is a difference between being alive and having a life. Pepe can be kept alive by insuring that she recieve her medications, etc. But what is her life like? Is it full of suffering, pain, abandonment, helplessness, and isolation? Or is she surrounded by those who love her? The answer is not simple, but honest: she needs to be taken in by those who love her the most, cared for and prayed for, keeping her comfortable and safe as she declares her end stage illness. Prolonging what is inevitable for our own benefit, is contrary to compassion. I am not minimizing your griefor feelings. But remembering whose she is and who she belongs to, is what is important. She is His. As a phyician I used to be a "god in a white coat" believing that it was I who controlled life and death. I was very far from the truth then. I have learned through Him that He decides when, where and how. Being with her unconditionally as she dies, without remorse or concern for ourselves, is true compassion. This is a difficult decision to make, but one that is unfortunatley already made for you: she will pass on, sooner than later. Make her life the sweetest it can be for now, and allow that which will happen, happen. I hope this helps. You are wonderful people, and your love for others evident. Love the dying as you love the living.

In all things, give thanks,

David

MoM Medical

We had the pleasure of hosting Dr. Beyda, Kelly, Chris & Dave, and Libby & Phillip this past week. We held day long clinics at the Mangwaneni and Fonteyn CarePoints in Mbabane and a half day at Moneni in Manzini. We tried to do a clinic at the Nkobe Church/CarePoint in Mozambique but ran into resistance from the Ministry of Health there. We are hoping that Dr. Beyda can push that forward working directly with them so we can do a full clinic next time.


Rob Ketterling's group from River Valley Church in Minnesota did a great job helping at Nkobe and even doing eye glasses at the clinics. Rob preached the unofficial opening of the church to a packed auditorium (about 250 Mozambiquens - almost 200 of those were children!).

Makholweni Youth Outreach

The first class for the sewing project has begun. Five girls from Makholweni began class last week. The teacher is a lady from the community that operates a dress and uniform business in Manzini. The first project will be to make dresses and shirts for all the girls and boys who go to the pre-schools at our CarePoints. The last piece of equipment we are looking for is an "overlocker". Everything else is in place. We will be sponsoring a contest at the CarePoints for the logo that will be embroidered on each of the uniform.

Here is the U13 boys and "open" girls soccer team forming at Makholweni. Center, back row is Ncamiso. Ncamiso is a remarkable young man who is spearheading many of the youth projects in Makholweni. He will be the coach and manager for the two teams. Both will be registered with the Manzini Regional Soccer Office and play against other teams in and around Manzini. The teams are still in need of uniforms, shin guards, soccer boots, and other equipment. If we can arrange transport, they will play their first freindly game next weekend.

Gift From God

Today at the clinic, I saw a go-go (grandma), “60 something”, she said, when asked her age. She is taking care of 3 grand children from her daughter who died a little over a year ago. The baby was 2 months when she died. Go-Go says that the baby looked so terrible that she thought that he wasn’t going to make it. She began taking care of him and she started producing breast milk and has been breast feeding him for the past year. The baby looks fat and healthy. When I told Go-Go what a great job she was doing taking care of this one, she smiled from ear to ear. The teacher that was interpreting for me, was amazed that a woman 60 plus years could still breast feed a baby. I told her to tell Go-Go that it was a gift from God that she has been able to do this in order to keep this baby alive and healthy. Again, a huge smile broke out across her face and she responded with a very sincere thank you. Thank God for some happy stories among the many sad ones!

I also saw one of the boys that we started taking to Baylor clinic to be treated for HIV last year. He didn’t look too good today. The teacher found him fast asleep at home, in the middle of the day. He was coughing, running fever, breathing very rapidly, and his lungs sound like he may have pneumonia. He has also lost a lot of weight and has no appetite. I began to explain to him that it is very important that he eat and drink lots of water. I told him that he must take the medicine that I gave him 4 times a day, with food. I looked closer and saw tears beginning to form in his eyes and drop down his cheek. I stopped and just put my arms around him and held him. I told the teacher to tell him that I am sorry if I scared him. I told him that he was going to be ok, but that he needed to do what I told him in order to get well. I told him how much Jesus loves him and that he was going to take care of him. I asked him if we could pray and had the teacher to translate for him. Please help us pray for this boy to get well. If the antibiotic doesn’t work, we may have to consider having him tested for TB. I know that God is able to do so much more than we can possibly ask or imagine!