Our board members usually write our letters to you, but Dr. Heather Sample had an experience this summer that we felt was worth sharing.  Here are her words:

As I sit down to write this letter, to attempt to share with you what your support has accomplished, I am overwhelmed by the impossibility of the task. While PAPA is involved in many different mission endeavours, the place that has captured my heart is a small hospital compound in the bush of Zimbabwe called Karanda. I have spent five summers in this enchanted land and each trip has changed me in new ways.  However, my last trip was transforming in ways I never could have imagined.

This past summer, I found myself drawn once again to the majestic land I have come to love. Timing was not ideal.  I had been married six months and only lived in the same city as my husband, Chris, for one week when I left for Africa.  To be honest, I did not want to go.  Not only was Chris not going with me, but I felt like I was stepping onto a spiritual battlefield. I didn’t know how Satan would attack, but I knew I was walking into darkness. The night before I left, I was terrified.  I called Chris and asked him to call all of our friends and ask them pray specifically for God to protect me from this attack.  The next morning, Papa and I boarded a plane for Zimbabwe. Papa and I talked a lot on the way over about life, and Chris, and Tyler, and how things change and how we are changed by them. He told me that his faith in the power of prayer had been renewed by God’s answer to his prayer that I marry a Godly man. We landed in Harare at dusk, and went to the guesthouse with plans to leave for Karanda early the following morning.

Two days into the trip, I left our morning rounds early to help with lunch while Papa went back to the operating theatre to help Dr. Roland Stephens finish a skin graft on an AIDS patient. Papa was late for lunch. When he sat down across from me, I saw the cut on his hand. As he told me he cut himself during the surgery, a wave of nausea swept over me.  It was all I could do to sit through the remaining few minutes of lunch. Knowing that he wouldn’t want me to worry everyone else, I tried not to let my fear show.

As we walked back to the hospital, I insisted he start anti-retrovirals (ARV) to prevent HIV infection.  He was reluctant because of their serious side effects that he feared could prevent him from being as useful at the hospital.  By the time we were able find the ARVs - not an easy task at Karanda -  every second was crucial.  The three-hour window during which the first dose is to be taken was closing. I rushed to the theatre where Papa was working, and gave him his first dose, along with a considerable amount of anti-nausea medication.  By dinnertime Papa was violently ill.

Later that night, we were called to a emergency caesarean section. As Papa and I scrubbed for surgery, his breathing was labored.  He was so sick that the the simplest task - breathing - was nearly impossible.  By the time we were closing the incision Papa was flushed and sweating profusely. He kept closing his eyes; I could tell he was trying to will himself to not pass out. He leaned on the counter to keep his balance as successive waves of dizziness passed. We did three more C-sections that night and the rest of the trip was just as busy - we took call every night.  That was, after all, our purpose in going.  And Roland, having been the only physician at the hospital for the past six months, was so exhausted that even the knowledge that Papa was sick was not enough to keep him from accepting our offers of help.  I worried about Papa, but ARVs make people sick, and we were there to work in the hospital, so we continued to work, offering relief for Roland and providing care to hundreds of sick patients.

Two weeks later we left, exhausted, but as usual overwhelmed by the faith and strength of those who work at Karanda not once a year, but day in and day out.  It was Monday morning and we got up early to finish packing before heading to the hospital to help round before leaving. Roland was already busy in theatre, and though I missed Chris terribly, I still had trouble saying goodbye to Karanda, which has become an indescribable and integral part of my life.

When we had been on the road to Harare for about 45 minutes, Papa asked if he was sunburned. I had either been taking pictures of the countryside or shielding my face from the dust blowing in the open windows, but as I looked over at Papa, I could see that his face was swollen and a purple shade of red. I lifted his shirt only to find the same thing on his back and chest. It looked like hives that were so severe and raised that they had all coalesced until the hives were unrecognizable as such, and appeared to be one large burn. There was nothing I could do. If we turned around, there was hardly anything Karanda could offer other than the precious little supply of IV fluid that it used so sparingly. I tried unsuccessfully to convince Papa to let me drive as he continued to worsen.

After dropping our luggage off at the guest house, we went to the Bon Marche to eat. As the day wore on, I began to admit to myself what my real fear was.  I feared that it wasn’t just the medicine that had made Papa sick, but acute HIV. It was already noon, and I borrowed a phone to text Chris. I asked him to look up the symptoms of an acute infection and they all fit. I motioned for Mom to come to the bathroom with me… she needed to know how serious I thought this was. I told her that Papa needed to be on the next flight to the States. I could hardly breathe. My chest tightened into the same knot that had become so familiar after Tyler died.

I contacted Terah to have her start working on changing our flights, then found a book to look up the medication Papa was on.  As I began reading possible drug reactions, the usual ones were expected, but then the list continued – Lipodistrophy syndrome, which he most certainly had, Stevens Johnsons syndrome, rhabdomyolysis, acute liver failure – all life threatening. I felt the inevitability of every terrible side effect, and while 20 minutes before I had convinced myself it was acute HIV, I now convinced myself it was a drug reaction. I felt completely inadequate and impotent. The weight of responsibility settle on my shoulders; I was the doctor who would make decisions in the next 48 hours that would determine whether Papa lived or died. Though I had so many times before made these decisions for someone else with confidence and clarity, I was too close to be objective and I knew it. This is why doctors don’t treat family members.

We arrived back at the guest house and settled in to wait. Papa had perked up a little, but his skin still looked terrible and I knew it was simply a matter of time before the pendulum swung and he started to deteriorate again. Terah called and said she could change two tickets and that one of our friends in Dallas knew an Infectious Disease doctor, at Baylor Medical Center, who would see Papa as soon as we landed. I gave her a list of the individual medications he had been taking and asked her to call the ID doctor and ask him if we should continue the ARVs.

Mom told me that I should go with Papa as that was his best chance if anything happened. I’m not sure Mom and I ever really discussed the gravity of the situation, but it was understood. She knew how sick Papa was and yet, selfless as always, she chose to send one daughter to care for her husband so that she could stay in Africa with the other. I cannot grasp the fear that must have accompanied this decision. Dreading what the next 40 hours of waiting might bring, I crawled into Cori’s twin bed with her and tried to sleep.

It was still dark outside only a few hours later when Mom came in to say that Terah had texted back and the recommendation was to stop one of the combination pills and keep taking the other. The driver was ready for us and I looked on as Papa hugged Cori, and then Mom – all of them aware that it might be the last time.

Papa didn’t want to continue any of the ARVs, and I felt the same way to a great extent, but we both knew the dangers of self-treating – of thinking that since I’m a doctor I know better than the expert in this field who is giving me advice. So against our better judgment, I gave Papa another dose as we left the guest house. He got worse after that. By the time we reached the airport he was violently ill again. We settled into our seats on the airplane and I tucked the blanket I carried with me around him as he began to shake with fever. By the time we landed in South Africa, he didn’t argue with me when I insisted he let me get him a wheel chair. I had prepared myself for a battle on this issue, and when none came, it only increased my concern. We found a little cafe with a tiny love seat and settled in for the 12-hour lay over. It was 17 degrees outside the airport, and inside the air conditioner was on. I have no idea what the temperature was, but the airport staff-members had their heavy winter coats on indoors. I scoured the airport shops until I found a fleece for Papa and a power adapter (so I could use the computer in case he passed out or became unresponsive).

Despite my efforts at keeping Papa warm, he still shook uncontrollably. By the time I got a thermometer, his temperature was already over 104.5 F. (Papa took it out and refused to let me continue taking it at that number.) All I could do was pray. I paced the floor trying to stay warm. I alternated looking up symptoms online and holding Papa’s wrist to count the number of PVC’s/min and the increase in his respiratory rate as his pulmonary edema worsened. By this time he was impressively encephalopathic – further confirmation that his liver was failing. He was still himself at the core. He told me that he felt like he was dying. I told him I thought he was right. Somehow I think that the thought of seeing Tyler in heaven made it easier to think about dying. He told me to send all the kids a message that he loved them. But most of his sentences were disjointed and hardly made sense. By the time we boarded our 17-hour flight to Atlanta, I was at my breaking point. I had never felt more helpless, and had never doubted myself as a physician as much as I did at this moment. I had already told people to pray, but I sent one final plea to Chris - to tell him to call Kendall and Amy and Geoff and Candy, and anyone else he knew to be prayer warriors and have them on their knees.  You may have been among those who prayed.

It’s ironic looking back on it... we are always at the mercy of God, but at times like these, it is so undeniably apparent that we are helpless. I sensed as we boarded the plane that the coming hours would be the most difficult of my life. As we took our seats, the flight attendant motioned for me to come to the back. She asked what was wrong with Papa, as it was overly apparent at this point that he was not well. I tried to hold back the flood of tears that threatened to burst forth and told her as little as possible. A few moments later I was told that the pilots wanted to speak to me and was taken to the cockpit. I was desperate to make them understand that he had to be on this flight. I told them that I was a doctor, and that he was in acute liver failure, and that his only chance for survival if his liver didn’t recover from the insult was a transplant in the next few days. He had to get to Atlanta. I told him that I was aware that he might die on the flight, but that if he did worsen, his only chance of living was to be in the States. Regardless of what happened, they were not to turn the plane around - even if he died. They seemed satisfied with this and told me they would cut as much time off the trip as they could. I returned to my seat and wedged myself in between Papa and the 600 pound man that sat to my right. Armed with my stethescope and a vial of epinephrine I had with me in case of an anaphylactic reaction, I tried to plan out how I could drag Papa the six feet to the cabin area so that I would have room to do chest compressions if he coded.

While in Johannesburg, we decided that even if it was an acute HIV infection, it was too late for the ARV’s to help much. And given his violent reaction to the medication, and how much he had deteriorated after his morning dose, we both knew he probably wouldn’t survive another dose. All we could do was wait. I woke Papa up every thirty minutes as I had since leaving Zimbabwe to drink water. I had reached a new low, checking the magnesium content on the mineral water and calculating how much water he would have to drink to consume the equivalent to a treatment dose for torsades – another life threatening side effect of his medication.

He finally drifted off to sleep, and I crawled over him and made it to the bathroom just in time to vomit the water I had forced myself to drink. I slumped over on the floor of the tiny stall, not caring how disgusting it was that I was curled up in a fetal position on the floor of an airplane bathroom. I wept. Through my sobs, I told God that I would never understand why he didn’t save Tyler, and that I knew Papa wouldn’t live forever. But Cori was only 14, and she and Ben and Shelley needed him. And selfishly, I begged that if he did die from this...just let it be “not on this flight.” I’m not sure how long I stayed there and prayed. When someone finally knocked, I realized that I should go check on Papa. I left the bathroom and saw him still sleeping. I stood, trying to clean my face before returning to my seat, when one of the four men standing in the galley started trying to ask if I was sick and offered me Tylox. I refused and he began trying to explain in broken English what Tylox was. Trying to blow him off, I assured him that I was ok and knew what it was, and told him, “I am a doctor.” His face brightened, and he explained that he and his three friends were doctors too, as were 96 other passengers. They were the top physicians from the University Hospital in Monterrey, Mexico. I began to tell them the real reason I was sick and they quickly brought their friend who is one of the top Infectious Disease doctors in Mexico to meet me. They all agreed that Papa’s symptoms were most likely a drug reaction and that there was nothing else to do.  I had lost all sense of pride, and asked them, as I had almost every person on the airplane, to pray. They did. They told me they would watch him while I slept. I squished back into my seat, placed my fingers on Papa’s wrist so I could feel his pulse, and closed my eyes for the first time since leaving Karanda.

It was as if God was laughing at me, asking how I could be so lacking in faith to think that just because we were on an airplane over the middle of the Atlantic ocean, that the situation was beyond His control. When I awoke Papa was standing a few feet away talking to one of the Mexican doctors. I was shocked. He still looked terrible, but the fact that he was able to stand and complete a sentence was a huge improvement. He was still sick enough to be in an ICU by any standards, even without knowing lab values.  But his liver had obviously started to metabolize the drug, which meant he hadn’t reached the point of no return. His skin was still swollen and purple, but his breathing had slowed and he was experiencing fewer premature ventricular contraction, a sign of impeding heart failure. And though he was still not himself, I knew that he was going to make it to Atlanta. By the time we landed he had improved enough that I felt safe flying to Dallas where doctors would see him immediately. When we met with the doctors, they were amazed at Papa’s miraculous recovery. Not only did Papa come back from the drug reaction in record time, there was not a trace of HIV in his blood work.

The strangest thing is this: when confronted by death itself, my thought was not, “why did we come to Africa?” but, “why didn’t we come more often?”  For all the difficulties that a trip to Karanda poses, it exemplifies the very thing that gives life meaning. I never once considered that this event was caused by Africa. In fact, there is a much higher chance that I could die on my way to work tomorrow than from an HIV exposure such as this.

In this season during which we remember Jesus’ birth, I am humbled by the privilege of sharing His love for others by loving the people of Africa.  And I am awestruck that in the process, I witnessed a miracle. I witnessed first hand the power of prayer.  If you have ever felt like me, that your contribution is too small, your prayers too inarticulate, your sacrifice not weighty enough to matter, I hope this story inspires you. Your prayers do not fall on deaf ears, and they are not to a God who is distant and uninvolved.  I cannot explain why God doesn’t always answer in the ways we expect, but I can tell you that He is alive and well, He loves us deeply, and He saved Papa. And in this season, when we remember the “Christmas Miracle,” I want to personally thank you for your prayers and remind you that miracles still happen.

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