Evisceration and Revelation
Last night, around 1 a.m., our team began emergency surgery on HayMooPaw, a five-year-old girl severely injured in a Burma Army airstrike. As our team operated, I prayed.
Often, my prayers struggle to compete with the echo chamber of my own thoughts, but last night, it was easy. Jesus felt near—in the OR. Kind of off to the right.
Around 5 p.m. yesterday afternoon, HayMooPaw and her family sat down to their simple supper. They are a Catholic family, scratching out an existence in the jungles of war-torn Burma, on the east side of the Yunsalin River. For the most part, their village, Pwar Day Mu, had little to do with the war. They were far from any battle lines or active fighting. No soldiers from any side visited their village. Life as a subsistence farmer was hard enough. The villagers of Pwar Day Mu couldn’t fathom any reason the Burma Army would see them as a threat.
Suddenly, during supper, out of nowhere—“SSCHHWWAAAA,” as the girl’s mother described the sound of the jet. And then her house blew up. At first, they didn’t even know what had happened. In the confusion, no one could say how many bombs were dropped. They didn’t have time to collect anything from their homes—they just ran. And as they ran, the village burned. One villager had the presence of mind to realize: the jet came back for a second, intentional bombing run.
Sound travels far in these jungle hills. We can sometimes hear the noise of an airstrike from a distance that would take us three or four hours to reach by road. Raykaw (RTC Site Director) actually heard this village being bombed from his first aid station on the front line of the active fighting. So when the village called through the Karen civil radio system, saying they had an injured person, he sent our Physician Associate (PA) graduate, HlaWin, to help.
Meanwhile, HayMooPaw’s uncle cradled his little niece in his arms for one-and-a-half-hours on the back of a motorcycle to get her to the banks of the big Yunsalin River. A boat ferried them across. On the far side, another sympathetic villager took them to where PA HlaWin was waiting.
When HayMooPaw arrived, PA HlaWin could see her intestines spilling out from under her shirt. Shrapnel from the airstrike had torn open the five-year-old’s abdomen. Up to this point, she had received no medical care. PA HlaWin gently covered her intestines with saline-moistened gauze and plastic to prevent evaporation. He started an IV in a large leg vein and pushed an appropriate dose of antibiotics and Tramadol, a low-level painkiller. Bundling her in blankets in the back of the open pickup truck, he sent her directly to our mobile surgery team. Several others, injured in the same airstrike, would make a similar journey and show up later, many in blood-soaked clothes. Later we would find out that most of the village burned to the ground. This whole community lost almost everything in a few sudden terrifying seconds.
These roads are by far the roughest I have ever traveled. Average speed is only around 8 or 9 miles/hour. The driver grins when he can occasionally find a smooth stretch and shift into third gear. I usually get to sit inside the cab on a seat and even that is like a rodeo ride on a mad bull inside a steel box. My biggest concern is not bashing my head against the window or the dashboard as the vehicle bucks and lurches down the road. But that is nothing compared to riding in the back of the pickup. While it was probably better than the motorcycle ride, I can’t imagine the pain of having an open evisceration, bouncing over these roads in the back . Each bump would have caused excruciating pain.
Four long, long hours later, HayMooPaw arrived at our mobile surgical outpost. It was 1 a.m.
The sound of the pickup roaring into camp woke Dr. Augustine. We all shook sleep from our brains and bodies. But Dr. Augustine and Dr. Zu, however, were burdened with more than sleep. I watched as Dr. Augustine slowly woke up and shouldered the yoke of responsibility for a little life. It was subtle. He was still kind to the core of his being, just perhaps a little less talkative than normal. No jokes. Having been with him on many deployments to the front line, I knew.
I also watched as his wife, Dr. Zu, shouldered that same responsibility from the anesthesia side. Dr. Zu normally laughs at everything. At RTC, I can usually locate her anywhere on campus by the sound of her laugh. Doing patient rounds in the hospital? I hear her laughing at the crazy questions and answers students come up with. Eating supper? Laughing. Playing badminton? Laughing. I’ve seen her laughing while we were running for the trenches with the sound of helicopters strafing nearby.
But she wasn’t laughing now. She was concentrating, calculating the doses for all the anesthesia drugs she would be using on the child. Anesthesia for kids can be tricky.
Still wrapped in blankets, HayMooPaw lay on the steel stretcher in our outdoor triage area, alert but quiet. She had suffered past crying. We did a quick history and physical exam without opening her abdominal packing. That would wait for the OR.
Our PA, Aung, checked her blood type—type B. TahHayMoo, one of the Community Health Workers standing there with us, was also type B. We all knew that because she had donated a few months back. Most of the team, in fact, had donated blood over their months on the front line.
Because most of our patients are adults, we don’t carry many pediatric-sized supplies. Thankfully, we had some small feeding tubes. We dropped one down her esophagus to empty her stomach and used another for her bladder to monitor urine output.
The real revelation, however, came when we got HayMooPaw to the OR. As we peeled back the blankets, her clothes, sprinkled with bits of straw and dirt from the pickup, looked little more than rags. The blast had shredded them further, her injuries staining them with blood. As we cut away those shredded strips of cloths, it hit me. I felt it more than I could articulate at the time. It wasn’t just the sight of intestines sprouting from the little abdomen. It was the pale little body underneath the bloody rags, a severely injured frightened child with her heart fluttering at 130 beats per minute — this carried the soul of one of God’s most beloved.
“The least, most vulnerable, skinny, pale of these… that is Me.”
Evil had tried to stamp her out, to snuff out the precious light within her. I shouldn’t have been surprised to feel my prayers so easily connected to God. Jesus really was near.
“Master, what are you talking about? When did we ever see you hungry and feed you, thirsty and give you a drink? And when did we ever see you sick or in prison and come to you?
Then the King will say, “I’m telling the solemn truth: Whenever you did one of these things to someone overlooked or ignored, that was Me—you did it to Me.””
Three hours later, the surgery team successfully finished HayMooPaw’s operation. As they walked out of the OR tent, weary and looking forward to warm beds, another pickup truck roared into camp. By the light of my flashlight I could see two IVs tied to the frame of the truck and a bundle of blankets and people in the back. A child was crying.
God, give us eyes to see You in everything, in every distressing disguise. Help us to see Your love and grace through our own brokenness. That is enough for me.
Follow up: about 3 weeks later our little patient is ready to go home.
