Saturday, October 24, 2015

CaringBridge

For those of you who don't know, I have a CaringBridge site, which is a site for people who are enduring illness to keep friends and family up to date (yes, much like a blog, but with a medical focus). I will still be updating this blog from time to time, especially as my attentions turn back toward Mukinge (as I hold in faith that the Lord will take me back to Mukinge). So stay tuned!

For more frequent updates in my battle against cancer, check out http://www.caringbridge.org/visit/sarahlantz

Shrinkage in Progress signs to be used during chemo
Shrinkage in Progress signs to be used during chemo

Encouraging sidewalk messages from my nephew Isaac (I can see these from my bedroom window) FYI, in this picture, Isaac is pretending to be a roadrunner.


In the meantime, please continue to pray for Mukinge Hospital, for the doctors, nurses, staff and many patients who come their way. Malaria season is coming into full swing and the rainy season is about to start, meaning harvest time is upon them. Please pray for the tumultuous economic climate and for the church and government leaders all over the country. Please pray for unity amongst the missionaries at Mukinge and in various parts of Zambia with a variety of organizations. Pray that God would raise up workers for the harvest and that many would come to know the saving love of Jesus Christ!

Team Mukinge, April 2015

SIM Zambia softball team at the annual Spiritual Life Conference, April 2015

Thank you for your support and prayers  

Wednesday, September 9, 2015

The Monster, The Princess, and Tony Stark - A Long Overdue Update

Dear friends,
Ethan & Auntie Dr. Sarah
Sorry for the long delay in posting an update, but life this past week has been very busy. For much of the week, I (the princess, obviously) have been held captive by a ferocious monster in the universe’s tallest tower. Despite being rescued on multiple occasions by Iron Man and Captain America, I somehow managed to be recaptured and imprisoned, and even once was in such peril that Superman had to join forces with the Avengers to set me free! Being continually captured and rescued is exhausting work and doesn't leave much time for writing updates!
Isaac & Auntie Dr. Sarah
As many of you know, my brother, Jason, and his family have been missionaries in South Korea for the past 7 years. Previously, I had only met my nephew Isaac (age 4 ½, a.k.a. Tony Stark/Iron Man, a.k.a. Steve Rogers/Captain America) twice and had never met my nephew Ethan (age 18 months, a.k.a. the ferocious monster). When they found out I was sick, they made a surprise trip home to see me, which was such a blessing and a joy for my entire family. Just recently, their circumstances in Korea changed, and they are now in the process of moving back to Indiana. Last week, Jason and Gail returned to South Korea to pack up their home and say their goodbyes, while their little boys stayed with us! I have loved this new degree of Auntie-hood. And even though I am sad that Jason and Gail are having to leave Korea so suddenly and unexpectedly, I am grateful that they will be close by in the coming months.

Regarding platelets: 
Thank you to the many of you who have been praying for my platelet count. Last week my count remained low, requiring a few platelet transfusions. My doctor believes I have a condition called Idiopathic Thrombocytopenia (ITP), which is where, for unknown reasons, my immune system attacks and destroys my own platelets. This condition is independent of cancer, but may have been triggered by having received chemotherapy. I have been on high-dose steroids to prevent my immune system from consuming my platelets, and slowly but surely, the platelet count is on the rise! Today my platelet count was 47,000. As a result,I did not receive chemo as originally planned, but I am on the schedule for next Tuesday (Sept 15th) as long as the platelet count is at least 100,000. Please continue to pray that the platelet count would go up and also that it would stay up following my next round of chemotherapy!

Burritos and Baldness 
In the meantime, I have had a noticeable physical response to chemo, with palpable tumors and lymph nodes smaller than they once were. My bone pain had nearly disappeared for a while, although it has been on the increase in the past few days. Even still, I praise the Lord that He is shrinking this cancer! Every day, my appetite and physical strength improve, and I am now able to walk through public places without the use of a wheelchair or shopping cart for support. Today I ate an entire Chipotle burrito, which was a satisfying accomplishment! As you may have seen, I had my hair cut short a few weeks ago in anticipation of losing it because of chemo. One morning last week, my hair started hurting, like it had been pulled tightly in a ponytail for a long time. Later in the day, it started coming out in large quantities. Not unexpected, but still a bit disheartening. So my friend who is a hair stylist came over and shaved it off. The practical side of me knows that this was a good choice to help with the soreness and to keep me from waking up in a pile of my own hair. But it is a difficult thing to look at myself in the mirror and accept that I have no hair because I have cancer. I have all sorts of cute hats and scarves that I’ll now get to wear, but they all still highlight my baldness. It is very weird, although it does feel pretty nice to have a constant breeze to my head while it is so hot and humid here! My good friend Karen lives in a place where women traditionally wear head coverings and will be giving me a tutorial on how to fashionably apply a scarf to my head. I’ve never been good at hair or accessorizing, but I suppose now is a good time to learn!  

Black Jack & Zoe
The Princess Zoe
And in non-clinical news, this past week also brought the excitement of adding two little kittens to the Lantz family.  Black Jack (Jack) and Zoe are 3 ½ months old and are as sweet as can be. When I first opened the cage at the shelter, Jack jumped straight into my arms and nestled in as if to say, “I’m choosing you!” He immediately made himself at home and was even somehow ok with allowing little Ethan to pick him up and carry him around.  Zoe was a snuggler from the start, but also has a feisty personality. She spends her days attacking strings and bugs and unseen enemies throughout the house.  She loves to play and pounce almost as much as she loves to eat and snuggle! 
Black Jack
Jack’s original name at the shelter was Aldous (like Aldous Huxley), which means“old.” Zoe was originally called Swiss Miss (and had siblings with equally terrible names such as Kool-Aid, Ovaltene, and Yahoo) Isaac is the one who picked “Black Jack.” The name Jack is a derivative of John, which means “God is gracious.” Zoe is one of my favorite girls’ names, from the Greek meaning “abundant life” (John 10:10 - I have come that they may have Zoe…”). I am grateful for both of these little ones whose names are a prophetic representation of what God has done and what I am continuing to ask Him for in my own life. My dear Zambian cat, Lloyd was such a faithful and loving companion. I miss him terribly, and these little ones in no way will ever replace him. But I am excited to have some companionship and an outlet for my cat-lady tendencies through the road ahead!

And now you’re up to date! Thank you for your continuous prayers and support. Thank you to the many who have sent encouraging notes and emails, brought meals, and stopped by to visit. God has been so good to me. He has somehow given me a heart full of gratitude at a time when I feel I should be angry, scared, sad, confused and hurting. Even the other night I couldn’t fall asleep as I recounted the blessings that came just that day. This is supernatural. Not at all of myself, and not because I am someone who has great faith or is in denial about what is happening to me. I can say with confidence that God is in control even though I don’t understand this at all
I feel very much like Shadrach, Meshach and Abednego as they faced the fiery furnace, trusting that God can do what He says He will do and that He is who He says He is, but that even if He doesn’t do what I’ve asked Him to do, He is still good and still God. (Daniel 3:17-18). I have no idea why this has to be happening to me. I don’t understand why I have to experience physical weakness and pain (which at times is quite intense because of the cancer in my bones) or why God chose now - just 19 months into my career as a missionary doctor - for all this to unfold. And I don’t have any idea what He plans to do with it all. But for all of my life, God has been preparing me to trust Him in the unknown. So even though I never thought I would have to trust Him in this way, I know that the Lord is trustworthy.  It is hard to know just what to ask God for in circumstances like these - whether I can be bold enough to ask for everything that I want (complete and miraculous healing, to return to the field as a missionary doctor, to someday be 40, to have my life’s dreams and goals still satisfied) or if I have faith enough to ask for the even bigger and scarier thing of whatever it is the Lord wants, even if His plans don’t line up with mine. As God himself says, "Behold, I am the Lord, the God of all flesh. Is anything too difficult for me?” (Jeremiah 32:27). Of course not.  And “Shall not the Judge of all the earth do right?” (Genesis 18:25). Absolutely. What I want most is to be faithful with whatever He has planned for this.  More thoughts on this to come later…

Sunday, August 9, 2015

The "C" Word

I have had plans to blog for months and months. First there was going to be the blog about the night I was called in for a woman pregnant with twins where the first twin delivered normally, but the second twin was stuck sideways, and in order to save both mom and baby, I had to reach up into her uterus to turn the baby around to get him to come out the right way. I would have told you how terrified I was and how, in the end, by God's grace, mom and both babies did fine.

Then I was going to write a sensational story about the night I was doing an emergency C-section for fetal distress, and in the middle of sewing up the uterus and resuscitating the baby, the power in the operating room went out, making it pitch black and turning off the oxygen and the baby warmer, and we had to carry on under the guidance of flashlight until the generator was turned on. And again, God's hand was on all of us, and mom and baby were fine.

There might have been a blog about when we finally started doing thyroidectomies, or about when the architect came to visit and we made real-life plans for a brand new operating theatre + ICU. And there probably would have been something in there about my sweet cat Lloyd.



But life at Mukinge has been busy. And then I was traveling a lot. And then life got even busier with many in the missionary community going on furlough, having babies, and getting married, and many visitors coming and going from Mukinge. And then I started feeling unwell. And then things got worse...

In a regular day at my surgical clinic at Mukinge, I will see patients who come with a variety of chief complaints – hernias, hearing loss, broken bones, a bean stuck in the ear, weird lumps and bumps they want removed, tumors large and small.  In the Western World, “cancer” is a word that automatically evokes fear as it is largely understood to be something bad, something serious, something associated with long and painful treatment, something associated with dying. In rural Zambia, the word “cancer” often has little or no meaning. In Kikaonde, there isn’t even a word for cancer. Many of my patients have not heard it in English before, they don’t understand its seriousness, and are therefore not scared by it. I will frequently have to explain what a cancer is, what it does, and what we can (or often, cannot) do to treat it. Even then, to my patients receiving a new diagnosis of cancer, the word itself holds little meaning.

As a surgeon, I have spoken the word “cancer” countless times. To my patients, to their loved ones, in academic discussions with my colleagues, and in hearing the sad news of others. I have learned to speak about cancer without emotion and without fear because, after all, like a broken arm or a bean in the ear, it is a clinical problem that I am working to solve. Even when it involves sharing difficult news with a patient or hearing of the tragic diagnosis of a friend, it does not consume me, and rarely does it change me.

This week, however, I have heard and spoken the word “cancer” more times than I can recall. And all of them in regard to me.

When I left Mukinge just last week, I left with a host of non-specific symptoms, all of which I had attributed to a lingering viral illness, as well as with a lump where a lump shouldn’t be. I made the long journey home to Indiana to see some doctors and undergo testing. As feared, the lump turned out to be malignant. If that weren’t enough, there’s cancer on the other side too. And it’s in the lymph nodes. And all the other symptoms – the fatigue, the aches and pains in my legs and hips, the coughing and shortness of breath, the weight loss over the past few weeks – those are likely to be from a cancer that is making itself at home throughout my body.  

One week ago, I was a missionary surgeon in Northwest Zambia. Today I am a 34-year old woman with advanced breast cancer. The word “cancer” has become very personal. 

Life forever changed.


I don’t know what else to say to you at this point other than that despite this devastating news and the myriad of emotions I’m feeling as a result, I wholeheartedly believe that God is still in control, that He loves me, and that He has a plan and a purpose for me that is for my good and His glory. I have a lot of questions for the Lord that start with “WHY?!?” I am grieving the loss (at least for now) of the life I loved and have spent most of my life preparing for with great passion and purpose. Along with my family, I am preparing for some difficult days ahead as I get ready for chemotherapy and all its glamorous side effects.

"Though he slay me, yet will I hope in him..."  ~Job 13:15

I am thankful for each of you, for your prayers, your friendship, and your support. Thank you to the many of you who have been praying for me and have sent encouraging emails in the last week. I’m sorry that I haven’t replied to most of your emails. Know that I have read each one and have been so blessed by your love and concern for me. Please keep sending them – even if I don’t reply right away.

I also ask that you join me in praying for many things:

For my doctors as they make decisions about treatment and for all those who will be involved in my medical care along the way.

For my family as they walk through this with me. Pray for courage and endurance, and pray that they will draw near to the Lord. Pray that we would grow closer to one another through this.

For my friends and missionary family at Mukinge as they carry on minus one surgeon and as they also grieve alongside me

For me in the days ahead – scans and surgery this week, then chemo for the next few months. Please join me in praying for complete and total healing. Pray for my heart, that I will lean on God and trust in His sovereign plan, that He will soothe the fear and sadness and, let’s face it, the anger that I feel, and that He will give me the courage and the grace to move forward. Pray that in all things, I will bring glory to God.




Thursday, February 19, 2015

新年快樂 (Happy Chinese New Year!)

Greetings from Chiang Mai, Thailand! My fellow Mukinge doc, Missy, and I arrived here yesterday and have been having a great time! Today is Chinese New Year, and we had a great evening celebrating (and eating) in Chinatown with my family and with all of Chiangmai!
Good morning from Chiang Mai!

Uncle Chuck, Me, Nai Nai, and Aunty Mary
Stopping to smell the flowers (yes, they're fake)



Grilled crawdads
Fried caterpillers
Roasted quail 
Fried crickets








Fried cricket up close
Down it goes!





Best bumper sticker ever.

Happy Chinese New Year!

Sunday, February 15, 2015

A Year in Review: Ned & Lloyd

I do not consider myself a “cat person.” I don’t dislike cats, but I’ve never really taken an interest in other people’s cats or in having cats of my own. Even after I arrived in Zambia, I watched the cat of a fellow missionary for a few weeks while she was away, and that experience did not change my feelings toward cats. Some friends here had a cat who had kittens that needed homes, and for reasons that I still do not quite understand, I agreed to take not one, but two. Ned and Lloyd were named after a container on the airstrip where we play Frisbee (and where the occasional plane will land as well). In no time at all, these little ones worked their way deep into my heart and have somehow become so precious to me. I’m still not a cat person. But I am so grateful for my two “littles” and for how they have become a beloved part of my family. This year they even got Christmas presents from Grammy!

Ned loves climbing everything and can often be found at the tops of tall trees, on windowsills, or dangling precariously from my clothes-drying rack. She is an expert hunter and specializes in grasshoppers and lizards. She loves having her face rubbed, exploring outside and playing in the rain. Every morning as I head to work, she walks down the driveway and halfway down the road with me before returning home to start the day’s pursuits in my yard.

 
Lloyd enjoys eating avocados, popcorn and pretty much anything I happen to be eating or cooking at the time, and for this reason is a full kilogram and a half (3.3 pounds) heavier than Ned! He is passionately committed to snuggling and loves having his belly rubbed. He was a clumsy hunter and climber at first, but is becoming stealthier and steadier. He recently caught his first rat and proudly carried his kill around the yard until hunger won over and the rat was eaten.  I was so proud.



At 9 months old, Ned and Lloyd remain good friends and companions for each other. In the cold winter months, they both enjoy cozying up in front of the fireplace; in rainy season, they will sometimes sit on the porch with me and watch the rain. Rain or shine, they spend most of their days outside, hunting, climbing, exploring, wrestling and napping. About twice a week, I cook Nshima (corn meal-based staple of the Zambian diet) with Kapenta (small dried fish) that serves as their daily fare. I never knew making cat food could be so easy or inexpensive (ingredients for a month’s worth of cat food costs around $6). One of my favorite moments of each day is when they come running through the yard to meet me when they hear me coming home from work. Like I said, I am not a cat person. But I can’t imagine how antic-free and snuggle-less my life might be without these two precious little cats of mine!

Ned hunting egrets in the yard
Lloyd investigating a praying mantis




Post-Script:
I originally wrote this blog post about a month ago, but I wasn't able to post it until today due to slow internet (or no internet).

Last Sunday I went in as usual to make rounds. When I returned home, I found the body of my sweet Ned lying in the grass just outside my back door. I don't know what happened, although I suspect she was bitten by a snake. My patients will often describe their chief complaint as "my head is paining" or "my leg is paining." My heart is paining over losing Ned. I never understood the loss that people feel when they lose a beloved pet. I don't think this is crazy. While the pain is nothing like that of those who experience the loss of a loved one, this pain is still real. Lloyd has had a hard week as well. Ned has been by his side since the day they were born. He can smell her around the house and in the yard, and is distressed that he can't find her.  A dear friend encouraged me with these words: "The Lord took the time to create each animal and thought it worthy of Adam's time to name each one. Not even one sparrow falls to the ground without His notice. I know He understands your loss. Mourn so you can be comforted. That is His promise." Each day, Lloyd and I get a little better at life after Ned. I am so thankful for this sweet little one who might have actually turned me into more of a "cat person" than I care to admit. 



Sunday, February 1, 2015

A Year in Review: Excellent Care


Chronic Osteomyelitis
From a clinical standpoint, this first year as a missionary surgeon has felt, in many ways, like being an intern all over again. In those first few months especially, I constantly felt in over my head as I tried to learn general medicine, tropical medicine, and the vast breadth of the surgical subspecialties that made up only a brief part of my residency training. The “normal” day-to-day work on surgical ward and in the operating room (“operating theatre” as it is known here) has been busy and full of many learning opportunities. In the past year, I have performed nearly 1000 operations. Only 2/3 of these cases are what would be considered within the scope of a general surgeon in the United States, hence, only 2/3 of the cases I have done have been procedures I was trained to do in my residency. The rest fall into the categories of OB-GYN, orthopedics, and urology. In fact, the most common operation I do is bilateral tubal ligation (“tying the tubes”) for women who have decided that they’re done having babies (usually after they’ve already had an average of 8-10 children), which is traditionally done by an obstetrician. The vast majority of operations I do emergently in the middle of the night are C-sections with the occasional laparotomy for sigmoid volvulus (twisting of the colon, which causes a blockage and cuts off the blood supply to the colon). I have learned procedures such as prostatectomy, hysterectomy, and how to set a variety of fractures. In addition to learning the surgical subspecialties, I am learning a great deal about HIV, tuberculosis, sickle cell disease, malaria, and typhoid and how they relate to surgical pathology.

It has been a challenge to learn to care for patients in a setting of significantly limited resources compared to what I have known in the States. Just a few examples:
*Patients come from great distances, and most do not have a car or access to reliable transportation. Many have to make a hard decision to leave fields and crops unattended or large families at home uncared for in order to come to the hospital. As a result, by the time most patients come to us, they have been living with their condition for weeks, months, and often years! 

*We often experience inadequate supply of medications and blood. When we have more patients who need blood than we do units of blood to give, we have to make difficult decisions about who will receive the precious blood available. 

*We do not have any oral narcotic pain medicines, meaning that patients going home after major surgery, with broken bones, or with inoperable cancers are given only Tylenol and/or ibuprofen for pain. 

*We lack advanced medical technology in the way of CT scanners, ventilators, intensive care monitoring, advanced lab tests (i.e. electrolytes, bacterial cultures), laparoscopy, endoscopy, on-site pathology, and the ability to provide advanced cancer care through chemotherapy and radiation.  Our ability to make diagnosis is dependent on a good history, physical exam, and occasionally an x-ray, ultrasound, a basic lab test, or even exploratory surgery.

Melanoma of the foot
*With the exception of Burkitt’s lymphoma, Kaposi’s sarcoma, and Wilms tumor, we do not have the ability to administer cancer chemotherapy here.  Many of our patients do not have the means to go to the capital city for advanced cancer care. Most with a diagnosis or suspected diagnosis of cancer will not be able to receive the appropriate medical treatment that will provide a cure or prolong their survival. Cancers often are not diagnosed until they are very advanced and after they have spread throughout the body, meaning that surgical resection is not a reasonable option. Our main focus in advanced cancer care is helping our patients be reconciled to God through Jesus Christ and in making them as comfortable as possible for however long they have left to live.

*Patients who need long-term nursing care in the way of home health or inpatient nursing facilities do not have access to such services. This means that those with significant disability (spinal cord injury, stroke, debilitation from chronic illness, major trauma) do not have the option of rehabilitation. They must rely on their families to care for them in places where there are no wheelchairs, ramps, or handicap accessibility.

Despite our many limitations, it really is incredible how much we are able to do here.  It’s amazing to see God at work when we feel like we have little to offer.  Just last week, I operated on a woman who developed multiple large enterocutaneous fistulas (small intestine forms a connection with the skin and drains its contents onto the abdominal wall) after complications from previous operations. Operating on her right away would have been dangerous because of the inflammation and scar tissue inside her abdomen, so we were forced to wait. The injuries to the small intestine were high enough in the GI tract that whole pills would come out of her wound rather than being absorbed by her intestines. Her condition put her at significant risk of dehydration, malnutrition, and skin breakdown as well as a good chance she would not survive. She has been admitted here for the last 4 months as we have worked hard to keep her alive, healthy and strong, allowing time for her skin to heal and the scar tissue inside her abdomen to become less dense to prepare her for an operation. In the States, this woman would have had multiple CT scans and a vast diagnostic work-up. She would have had home health nursing care to help her manage her fistula output. She may have even received IV nutrition (TPN) or tube feedings to maintain her nutrition and electrolyte balance. We have none of that here. Instead, she was given a bed with a hole cut into the foam mattress to allow stool to drain from her abdomen into a pan on the floor. We kept her in a steady supply of Vaseline and cotton wool to help protect her skin from the caustic intestinal contents that spilled onto her skin. Each week, we bought her a tray of eggs and a jar of peanut butter to provide her with enough protein to help her body heal and to keep her from losing weight (in 4 months, she actually gained 1 kilogram!) We spent much time in prayer, asking God to heal this young lady and to help us make the right decisions regarding her care. Her operation this week to remove the injured intestine and reconnect the healthy ends went so smoothly, and she is recovering well on the ward. Hallelujah! 

Every day, people come to our hospital with a variety of illnesses and injuries, and every day, people go home healed or on the mend, having received treatment, medication, surgery, physical therapy, and spiritual counseling.  Like most mission hospitals, we operate under the knowledge that “We Treat, but Jesus Heals.” We believe this wholeheartedly here, and we see it every day as patients are healed despite lack of resources or limitations in our knowledge and ability.

Mukinge is not on the main road. It’s not on the way to anywhere, really. It’s at the end of the paved road, about a 2 ½ hour drive from the nearest city. And yet, patients come from far outside our district, making the long journey here because they have heard that if they come to Mukinge, they will be cared for. They have heard that there’s something different about Mukinge Hospital. They come all this way because they have heard that God is at work here, and they come believing that they will get better.


Over the course of medical school and residency, as I would talk with people about medical missions and about becoming a surgeon in the developing world, a number of medical professionals made comments to me about how they didn’t think they could practice medicine overseas because they couldn’t stand the thought of not being able to provide “excellent care.” I’ve thought about this a lot over the years.  What does it mean to provide excellent care in the developing world?  In Africa?  In Zambia?  At Mukinge Hospital or elsewhere?  Can a commitment to excellent practice be made in a place where the conditions seem less than ideal?

I appeal to you that it is possible to deliver quality medical and surgical care in the developing world, that it is possible to provide excellent care even when the conditions are less-than-excellent. I think we do this every day at Mukinge Hospital. I don’t think that Excellent Care means that we have the ability to provide stereotactic radiation, robotic surgery, or state of the art diagnostic imaging.  I believe that Excellent Care is providing the best care possible with the resources available in a compassionate and caring manner. It means treating patients and their families with love and integrity.  Sometimes it means knowing helping a patient to die well without inflicting unnecessary suffering through prolonged hospitalization or surgery that will not improve their quality or length of life. Here at Mukinge, we strive to provide excellent care for each of our patients. As we work under the guidance of the Great Physician, we trust that God will provide for our needs and those of our patients. He does excellent work, and it is a privilege to work in a place like Mukinge Hospital where “We Treat, and Jesus Heals.”