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COME WALK WITH ME
By Melvin L. Cheatham Mark Cutshall
THOMAS NELSONCopyright © 1993 Melvin L. Cheatham
All right reserved.
Chapter OneThe smell of sickness hung in the air at Tenwek Hospital. It greeted me like a familiar companion on a day that has never faded from my memory. In fact what happened that morning changed my life forever, both as a physician and as a follower of the Great Physician.
Come back with me and you will begin to understand.
Returning in my memory to the small operating room of the 250-bed hospital in western Kenya is like looking through a mental scrapbook and finding a favorite photograph. The images are still sharp and clear—the heavy overhead surgical lights, the tired, ancient operating table, the gracious Kenyan nurses. A single, sparsely filled cabinet stands against the wall, and the anesthesia machine looks old enough to be an antique. I reach to pick up the photograph and my memories come to life, again.
My translucent rubber gloves touched his black skin. Preparation for the surgery was almost complete. Anesthesia would soon bring a complete loss of feeling from his lower rib cage to his toes. A gray wool Kenyan blanket elevated his hips, freeing his abdomen so he could breathe more easily.
The anticipation that always precedes surgery began to build inside me like a slow fire. The mounting emotion was no different from the feelings that had preceded the thousands of other surgeries I had performed back home in California. The difference was that I was in Kenya, more than 10,000 miles from home. I was in a mission hospital, a facility that provided the only medical care available in a large area that was home to 300,000 Kenyan natives. I was a medical mission volunteer.
Less than forty-eight hours before, my plane had touched down on the grassy earth of East Africa. Now I was looking down at a twenty-six-year-old Kipsigis tribesman named Stanley and preparing to operate on his spine. And I was as unaware as he was of what the next few hours would bring.
I held the surgical knife firmly in my right hand and placed the blade against the skin over his lower spine. Then I drew the edge downward. The incision created a small chasm. After a moment the bleeding began.
Short bursts of electric fire from the electrocautery sealed each small blood vessel as it erupted, and I progressively deepened the incision until I could feel his spine. Then I stripped and separated the muscles from their attachments to the bone. Below this lay the cause of Stanley's pain.
I needed to see the problem, for the facilities of Tenwek Hospital were unable to provide the kind of information I was accustomed to having before surgery. I had a hunch or two, but I really didn't know what I would find.
Biting away the bone, I exposed the spinal cord sac. Through its bluish-gray transparency I could see the spinal nerves floating in the fluid. For a moment I saw the intersection of a doctor's career and a young man's life, and I wondered why Africa? And why Mel Cheatham?
Back home in Ventura, California, I used an operating microscope for neurosurgery. This morning, in the first neuro-surgery I performed at Tenwek, I had to rely on surgical magnifying glasses. They fit snugly around my head, and I could see things two and one-half times as large as they were in real life. Without this improved vision, successful surgery would be impossible. At least now, there was some hope.
I was in my fiftieth year when Tenwek Hospital became a significant part of my world. I thought I could see life clearly, but this young Kipsigis tribesman helped me see with new eyes. His name was Stanley Cheborge, and Til never forget him.
I looked down at him and thought of the pain he would feel waking up. I thought of the night before when I first met him. Dr. Bob Wesche, a missionary surgeon from Michigan, and I had worked all afternoon performing general surgeries, one right after the other. In the middle of an operation, Dr. Marty Graber, a visiting physician from Indiana, came into the room and said, "Stanley's here, and he's waiting to see you." Bob and I finished the operation, and within minutes I was standing in the doorway of a small cubicle bathed in dim light. I could see a tall, thin black man lying on a bed. He was supporting his upper torso on one elbow. And a broad grin was spread across his face. "Welcome, my name is Stanley! You must be Dr. Cheatham. I'm sure you are very weary from your long journey. Please, come in and sit down."
Stanley Cheborge was not like other patients. Whatever the problem, most people naturally begin to talk about their condition–how they feel, how they slept the night before, how they want to go home from the hospital. But with Stanley there was no self-pity, no longing for attention, and no mention of his illness. Instead, he wanted to know what I was feeling. His interest was genuine and deep. His words resonated warmth. His voice was alive. Within a few moments I observed a depth of character I've seen in only a few other people in my life.
After Stanley had greeted me, he greeted Bob Wesche. For the next several minutes they talked effortlessly. I stood on the fringe of their conversation, listening in without trying.
"Yes, this is Dr. Cheatham," Bob said. "He is the neurosurgeon who will be able to explain the pain that keeps throbbing in your lower back and keeps radiating down your lower leg."
"I know God has brought Dr. Cheatham to take away my pain and restore me to health," Stanley said. There was total confidence in his voice. Would I, the surgeon, speak with as much confidence after I cut to the core of his pain and saw a fragile, human condition staring back?
I looked over this young man and wondered what it would be like to lose a leg. Had I known him better, I could have asked Stanley. What I had already learned about him only whetted my desire to know more.
When Stanley was only six, he began herding his family's sheep, cattle, and goats. Every day he faced the threat of hungry, wild animals and raiding Maasai tribesmen. In the teeth of these hazards, Stanley learned to survive. Avoiding danger on a daily basis was not so much a matter of courage as it was a necessity of life.
This young man dreamed of becoming a great runner. By the time he was fourteen, Stanley stood six feet tall. He was blessed with long, muscular legs, and he loved to race across the vast open grasslands of western Kenya. He could outrun almost every opponent.
One day while running, Stanley thought he had pulled a muscle. At first, he had a dull ache in his left knee. Gradually, the pain grew.
"Perhaps exercise will help," he thought. He tried racing across the savannah through the short new grass brought to life by early summer rains. He dodged zebra, giraffe, and impala, running in a wide circle to stay out of the territorial hunt of lions.
The soles of his feet, hardened by years of going barefoot, were as thick as leather. Unlike his left knee, they were numb to pain. Over the next month, the pain in his knee grew worse until almost every stride was agonizing. Then, on the soccer field at school, the leg snapped, and the fall twisted Stanley to the ground. His hands clenched tightly into an angry ball. And he screamed.
There were tears. For a young, confident athlete, the injury was an embarrassing admission of weakness, even failure. His own body had broken his pride. He was carried to his family's hut, and there he braced himself for the future. The uncertainty lasted three days. When tribal medicine didn't relieve his pain, Stanley's family carried him twenty miles to Tenwek Hospital. There Dr. Ernie Steury, a missionary doctor from Berne, Indiana, told Stanley and his family there was evidence of a tumor that had been slowly eating away at the bone below the knee. The stress of running had caused the diseased bone to break. To save Stanley's life, Dr. Steury amputated Stanley's left leg.
I could stop here and explain how this single event altered Stanley's life. But you will find out soon enough. For now you need only to imagine this proud Kipsigis tribesman returning home to his village as a cripple, unable to stand or walk without help, and being watched intensely by forty or so well-wishers.
What silent doubts he must have carried inside himself. "Will I be accepted by my friends?" "Will I be an outcast now?" "Will people be able to take their eyes off this amputation stump and see me?"
Stanley was forced to face being totally dependent on his family and friends. Someone had fashioned a sturdy tree limb into a pole about six feet long and two inches thick. Using it for support, Stanley was able to stand on his right leg and propel himself along in a swinging motion by placing the pole ahead, then hopping forward on his right foot. Imagine the world champion in the 100 meter dash reduced to hobbling with a stick. This is the picture of Stanley Cheborge standing alone with his fractured pride.
He began to venture out of the family compound and visit friends and acquaintances. No longer swift of foot, he trudged along in an awkward dance, lunging then halting–steadied by one pole and then one leg.
It took about six weeks for the amputation stump to heal. Then Dr. Steury located a crudely made crutch. But the hope of walking proved artificial. Stanley found the crutch painful and awkward. The whole tragedy might not have touched me so powerfully, except for one thing. Stanley had started a Sunday school class for some small children at Aisaik Primary School. In spite of his pain, he was already reaching out to others.
After one year of secondary school at Kabungut, he was accepted at Tenwek School where he could get around more easily. But that presented a new problem: Without money for a bus ride, how would he get from Tenwek to Aisaik to teach the Sunday school class? Stanley solved that problem by walking seven miles both ways once each week the entire school year so he could continue teaching the class. It meant waking up at five o'clock every Sunday morning. This gave him enough time to hobble the seven dusty, sometimes muddy, miles to Aisaik and back, all on one leg and a bent stick. He did that for a group of students who meant more to him than the inconvenience of walking for six hours.
Once I heard this story I began to understand how unusual he was.
I looked down at him on the operating table and saw the look of total calm on his face. I thought to myself, "Mel Cheatham, you have been given so much in life and yet you do so little with it. This young man has so little, and he has already done so much with his life. What can you learn from him?"
Moments before the operation began, Stanley had looked at me and said, "Dr. Cheatham, I prayed to God last night and again this morning and thanked Him for bringing you here to operate on my spine. I know that He is going to use you in healing my body. I have placed my entire trust in the Lord and I know He loves me and He will not fail me. He is always faithful. Because of this I slept well last night, and even now I am at peace."
"Stanley, it's a privilege to be here at Tenwek and to have this opportunity to try to help you," I responded. "Is there anything I can do to put your mind at ease?" As I looked at him, I realized the humor of my words. Stanley was already at ease. Before the words were out of my mouth, his face broke into a wide grin, revealing the gap between the slightly mottled teeth in the center of his smile.
In fact it struck me that he might have been more relaxed than I was! And it didn't make sense. Stanley was the one who would spend the morning under the scalpel, not me. Suddenly the thought of doing neurosurgery in a strange place with such limited equipment made my doubts more reasonable and my prayers more ardent.
Stanley remained still. His body numbed by the anesthesia, he was unaware of what might be found inside him. I moved the spinal fluid sac slightly and then I saw it—the abnormality I had discovered in the X-rays taken before the operation.
They had revealed that Stanley had a serious problem; a portion of his spine seemed to have been eaten away. An earlier examination showed some weakness and numbness in his leg, which confirmed an earlier suspicion of a pinched nerve. But the numbness extended further than I would expect from a pinched nerve or even a ruptured disc.
After seeing the X-ray, I had decided to perform a myelogram. This procedure involves injecting material into the lower spinal fluid sac that will outline the spine. Another X-ray would reveal if there were an abnormality. The Kenyan X-ray technician handed me several sheets of smoky film taken with Tenwek's old X-ray machine. One by one I held them up to the light, then let out a deep sigh. I saw what Stanley had been carrying for weeks, maybe months. The X-rays hinted that Stanley had cancer of the bone.
Now, only minutes into surgery, my suspicions were confirmed. A large tumor extended from the bone and displaced the spinal fluid sac. It was grayish-purple and it bled easily when I touched it with my surgical forceps. Bob Wesche was assisting me and he saw it too. I glanced across the table at Bob and his eyes spoke the disappointment we both felt. I looked over the sterile drapes that hid Stanley's face from the unkind reality at my fingertips. He was dozing, feeling nothing because of the spinal anesthesia, and unaware that his body had betrayed him again.
Sorrow swept over me. It welled up deep inside and found the corners of my eyes. Sadness such as this had struck my heart many times before when I found cancer in other patients. Except this time the emotion was more intense. Perhaps it was because after coming nearly halfway around the world to help patients at Tenwek, my efforts were being defeated with this first neurosurgery case. Or maybe it was the realization that back home, cancer patients at least received pain medication and good medical care. I knew that once Stanley returned to his village, he would have neither to rely on. Now all I could seem to do was stand by his side and feel a sense of helplessness.
"Why this man?" I wondered. And why now? How could this cancer, which had already robbed Stanley of his left leg, have remained dormant in his body for twelve years? Like facing an intruder too strong to be evicted, I wondered if anything could stop this tumor from spreading and robbing Stanley of life.
I worked quickly to remove as much of the cancerous growth as possible. I clutched a biopsy forceps and bit into the tumor to confirm the malignancy. There was heavy bleeding. I kept biting into the tumor, and as I removed more, I found more.
I glanced over at Marty Graber, who was monitoring the vital signs. He and his wife, Ann, were Stanley's special friends. Wordlessly, Marty started a blood transfusion to keep up with the blood Stanley was losing every minute. When our eyes met he looked down and slowly shook his head.
The bleeding from the tumor intensified. Without some gelfoam and thrombin, aids to help promote clotting I always had when I operated at home, it was very difficult to control the bleeding. I was beginning to be uneasy about getting it stopped, when the antiquated suction machine suddenly failed. Blood welled up in the wound and began to pour down the sterile drapes and onto the floor. I could feel my heart pounding against my ribcage and hear its urgent pulse in my head. Bob Wesche and I worked urgently in silence.
Thirty minutes must have passed. Gradually and mercifully, the bleeding slowed. Time and surgical instruments brought it under control. My muscles were tiring. Sweat was running down my face behind the lenses of my surgical glasses, but I could see enough. Portions of the tumor still remained lodged in Stanley's spine and extended deep into his body. The cancer had resisted.
I stared down at the pieces of death that remained unbudging, unfeeling, threatening to erupt into uncontrollable hemorrhage. It was obvious to Bob and me that complete removal of this widespread cancer was impossible. Reluctantly we began to close the deep, gaping wound.
As we worked we said very little. Extended pain would greet Stanley when the anesthesia wore off. He would feel intense pain, not just that afternoon, but for days and weeks to come.
How would Stanley react to the news of this discovery? Would he be able to accept the fact that his body was harboring a malignant tumor? And, I wondered, will the surgeon be able to accept these results?
Closing the wound took twenty minutes. Still lying face down, Stanley began waking up before the gurney cart arrived. A few minutes passed before he was alert enough to talk. "Dr. Cheatham," he said, his voice slurred with sleep, "were you successful in removing the tumor?"
"Some of it, my friend, but not all." My eyes found his, and a hundred silent conversations passed between us.
The entire surgical team helped wheel the cart carrying Stanley back to his room. As we neared the door, I could see his family waiting. Ann Graber, Marty's wife and a nurse, greeted us. She put her hand on Stanley's shoulder, and with this one touch took responsibility for his post-operative care. Immediately she began to monitor Stanley's vital signs and try to make him more comfortable. He seemed to be completely awake.
Excerpted from COME WALK WITH ME by Melvin L. Cheatham Mark Cutshall Copyright © 1993 by Melvin L. Cheatham. Excerpted by permission of THOMAS NELSON. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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