Operating in the Gray (By: Matt)

“For now we see only a reflection as in a mirror; then we shall see face to face. Now I know in part; then I shall know fully, even as I am fully known.”

Though I hesitate to admit it, some patients are more likeable, and it didn’t take long to know that Jim was one of those. At that first encounter, Jim was a robust New Guinea highlander, mid-20’s, a large man with an even larger personality and a smile to complete the portrait. He came to me because of a cough, but his exam wasn’t worrisome and his chest x-ray was normal. I reassured him, that with a little medicine and time, he would recover. Jim responded with his patented “thumbs up.” A friendship had begun; neither of us aware of the approaching storm.

Jim is the son of a well-respected man in the Jimi Valley, an extremely rural and inaccessible area just to the north of Kudjip. Better off than most, he was able to complete secondary school with plans to further his studies in the near future. It was evident when we met that his passion for rugby, his community, and his family were only outshone by his faith in Jesus Christ.

Several weeks after our first meeting, I was surprised to see Jim hospitalized for anemia. We see anemia frequently, but Jim’s diet was better than average and I was surprised to see him requiring a blood transfusion. This is when the other doctors and I started an aggressive plan to diagnose Jim’s underlying problem and to save his life.

Frequently at Kudjip (much more than in the U.S.), we cannot make a clear diagnosis. With our limited diagnostic capabilities such as blood work and imaging tests, we go with our best educated guess. Many times, in missionary medicine, we operate in the gray. As an emergency medicine physician, I am fairly comfortable with functioning in the gray, with minimal patient information available at first. Despite my focus in the emergency department in the States, I also liked to look up my patients a couple days later to discover the final diagnosis and outcome. However, here at Kudjip, and most places in the world, a definitive final diagnosis is not the case. A large percentage of patients will not follow a routine script and there is no black and white test or consultation to ensure our diagnosis and subsequent treatment.

We initially thought Jim could have Leukemia. We took a small sample of bone marrow from his pelvis and sent it to an American pathologist hoping that this would provide our answer and make things a little clearer. While waiting for a response, Jim’s condition continued to worsen. Jim and I became close as our physician-patient relationship and friendship grew. We talked about Christ and prayed frequently. I was honest with him that we did not know why he was so sick. I followed him as an outpatient in my office, in the emergency department, and during the times when he was admitted to the hospital.

Jim Hydronephrosis
Ultrasound of Jim’s kidney with hydronephrosis.

Slowly, over the course of several months, things kept getting worse for Jim as one organ system after another started to fail. He developed a large pericardial effusion (fluid around his heart – cover photo), Bell’s Palsy (paralysis of his facial muscles), Pancytopenia (low blood counts), hydronephrosis (extra fluid in his kidneys) and a large cystic lesion in his liver. The bone marrow sample fortunately (and unfortunately) did not show Leukemia. I frequently discussed his symptoms with other more experienced doctors, particularly Dr. Bill, one of the smartest doctors I have known. We sent his list of ailments along with pictures to doctors at the Mayo clinic. His list of problems kept on growing and we did not have any answers. We tried what we could—TB medicine, antibiotics, steroids, cardiac meds—but nothing helped.

Jim Steve pic
Jim still smiling with half of his face paralyzed from Bell’s Palsy. A poor representation of the healthy male I saw on my first visit.

Every day I asked Jim how he felt. Just one of his many afflictions would have made me miserable, but Jim never complained. In fact, he was always ready to go home. One morning during rounds, Jim’s whole family was there. He was developing worsening renal failure and our hope was running low. Dr. Bill and I prayed for him and we told Jim of his deteriorating prognosis. His response, with both sides of his face now paralyzed, was his typical, composed thumbs up. We continued on our rounds and as we finished, we noticed Jim and his family had left. Two days later, Jim died.

Dr. Bill and I still discuss what could have been the common denominator, the disease that would explain all of Jim’s diagnoses. The truth, is that we will never have an answer; it will never be black and white. However, the ultimate answer for Jim was that Christ loved him and gave His life for Jim so that he could spend eternity with Him. While we were uncertain of why Jim was dying, Jim was certain of his place in heaven with Christ. Jim was grounded in a solid hope for this life and the next life. At the end, this brave, faithful young man with so much potential left in this world was ready to be with Jesus. I think he realized death was just the beginning. The words in Romans 8 come alive to me as I think about Jim in heaven with Jesus.

“For I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither height nor depth, nor anything else in all creation, will be able to separate us from the love of God that is in Christ Jesus our Lord.”

~Romans 8:38-39


4 thoughts on “Operating in the Gray (By: Matt)

  1. You can see God’s hands at work through you & others. He has given you experiences that most of us will never have. I continue to pray for all and all the works you are doing. God bless all.


  2. Matt,

    I just got off the phone with Peter. He explained to me that he will be reconnecting with you on his trip to PNG! Can’t wait for you two to renew your friendship after all these years. I am praying for you and your family as you serve Christ at Kudjip Hospital. I’m so thankful that you have chosen to spend these years of your life there with people like Bill!

    Praying for you,
    barb Holmberg


    1. Barb (Mrs. Holmberg),
      I am very excited and amazed that we will be reconnecting next week. It is quite a ways from Minnesota! Thanks for your prayers. I hope Peter loves it as much as we do here, it is a great place to serve the Lord.
      – Matt


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