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Saturday, November 22, 2014

There and back and there again . . .

November somehow became a month on the move.  I (Jennifer) was asked by our Serge leadership back in August to attend a first-ever "Vision Summit" for our mission, an event designed to honor and draw in donors as we clarified our vision and described our work.  A lot of work was invested in making this a professional-quality presentation.  Serge uses three pillars to explain what we do:  Renew, Reach, Restore.  Renew encompasses the Sonship course, Gospel-Centered Life, and the plethora of resources for personal discipleship and Bible study that propel our hearts to come alongside the work of Jesus in the world.  Reach incorporates the extension of this Gospel-focused transformation from the lives of believers to neighbors and friends across cultural barriers all over the world.  And Restore embraces the full-person whole-world nature of the way Jesus is making all things new, including partnering in health care, education, rescue from slavery, job provision, agriculture, training indigenous leadership.

So last week found me on the Florida coast with dozens of supporters, board members, our executive leadership, and a few other missionaries, worshiping together and giving speeches and watching videos that represented these three pillars using examples from Serge work.  I was the "Restore" speaker, and while I loved writing the speech I was pretty nervous about giving it.  I'm told it went OK.

A huge perk for me was that my mom had been invited, so we got to spend several days together at a lovely hotel, and we decided to fly Julia down for two nights so I could catch up with her too.  Julia and I took a beach walk and a bike ride in our free time, and we all enjoyed just talking and eating together.

I left here on a Monday night after work, arrived Tuesday evening in America, conference prep and rehearsal on Weds, conference Thursday to Sunday.  I flew out of America Sunday afternoon and got back this Monday night and went back to work on Tuesday, facing a week with staffing shortage, a Tues/Thurs call sequence, and a lot to do.  It was what you might call a whirlwind.  So I have to give the testimony that God gave me grace to jump into the time zone and the work both ways.  I have never traveled so easily, and been so quickly functional.  I slept and woke on the right time zone immediately both ways.  It was amazing.  I'm not recommending this but if you have to do it, miracles can happen.

Meanwhile Scott had a birthday in which he delivered four "birthday buddy" babies by C-section then went to a dinner that was hosted by our wonderful Serge team here, held down the fort, taught Sunday School and hosted the boys' football (soccer) team end-of-season pizza-fest all on his own, while working full time.  Jack got the news that he was a National Merit Scholar which I found out when I noticed a card tucked in behind a picture on the mantle . . and continues to work on college apps here and there as the deadlines loom.

But November is not quite over, and another trip starts tonight for me.  This one is in my same time zone, but a couple countries away.  Kijabe Hospital doctors make about four trips/year into this area that is poorly served medically and difficult for outsiders to access. Most of the trips are surgical, but they asked a Pediatrician to join this one.  As this trip came together it became clear that the only one on our team who could possibly go was me.  So tonight I head towards the airport, joining two young Kenyan surgeons.  I'll be teaching all week (family medicine residents and medical students) and seeing patients in a rural hospital.  I'm not quite sure what to expect, and I have to dress extremely conservatively including head scarves, so prayers appreciated.  Renew, Reach, Restore is what we're all about here, and I'd rather do it than talk about it, but I'm nervous.  And pray for Scott and Jack, abandoned once again, with me missing Thanksgiving and the last week of the school term with exams.  Grateful for your partnership . . . Jennifer

Friday, November 07, 2014

The Inefficiency of Love

I survive on efficiency.  Multitasking, prioritizing, keeping balls spinning in multiple spheres.  Up until 4 am?  Working all day?  Dinner for 10?  Parent with a sick kid asking for help?  That's how it goes.  As in, literally, yesterday.  Which is, I suppose, a form of love.

But there is a certain inefficiency to love that interrupts, that doesn't add up, that has its own beauty.

As in, literally, the Christmas Package.

Yes, every year, our faithful friends in Cincinnati send us the Christmas Package.  There is always a puzzle and some treats.  It is not fancy.  But it has been a rare constant in a life of uncertainty and alienation and we LOVE it.  The puzzle is a family tradition in the week before Christmas, it stays on the table until it is done.

So when a clerk passed me in a basement hall of the hospital yesterday and said "Mrs. Doctor Scott?  You have a package slip!" I knew this must be our friends.  It is often the only package we get in a year, and for good reason.   This is the inefficiency of this system:

Over a month from mailing to receiving.
Postage is twice stated value of contents.
Hospital does not want to put package slip in our mail slot in case it is stolen, so it waits until someone happens to tell me the package is there.
I walk to the post office to retrieve it.
I pay then 75% duty on stated value of contents, meaning that if X is purchase price of goods, the actual cost is 3.75 x X , as in almost quadruple.
The Kenyan postal service has opened the box and unwrapped every item inside, then jumbled them back in with tape.  They even cut open with a knife slit the ranch dressing mix.  In case it was cocaine I guess.

But the truth is, this package makes us feel loved.  This friend was an MK herself.  She knows the value of tradition, of small pleasures, of being known and remembered.  
This is love.  Even if it costs four times what it should, and takes months, and arrives damaged.  I need prayer to be a loving person.  To waste time.  To not keep packing life until it is well-wrapped and cost-effective.  To focus on the people and things I care about even when pressure is on to be more efficient and do more.  
One night this week, I was rattled out of bed at 3 because a slightly premature but small stressed baby had been delivered by C-section and had no heart beat or signs of life. He was known before birth to have some congenital malformations.  Even though I got his heart started and he turned pink, I knew his brain was not going to recover.  But his mom had general anesthesia and was in the hospital alone.  I decided to keep giving him breaths until morning, when I could talk with the grandmother and mother, pray, and have them hold the baby.  My hand was cramping after a couple hours of bagging. I got the kind and handy biomed tech to jerry-rig some connections on an old ventilator finally. But morning came.  We took out the tube, and he died in his mom's arms.  That was not efficient.  But I think it was love.

Another night this week, it was a jaundiced baby.  I tried to bring the bilirubin down with lights and fluids.  I ran samples to lab myself, waiting and hovering, willing the news to be better.  It wasn't.  An exchange transfusion was indicated.  It was midnight.  My intern was a star.  We worked together, and got it done, and the baby is fine.  By 1:30 am I sent her home to rest, just as I was called to ICU.  
Another infant with a head injury and bleeding between his skull and brain was not breathing.  The next two hours I spent with him, putting in a tube, giving breaths. Suctioning, monitoring, watching.  It was one of those nights where nothing worked.  By the time we got an xray, the tube had slipped out.  But by that time, he was breathing again, and we had made it through the night.  He held on for a couple more hours then went to surgery to clear out the huge blood clot.  Now he's breast-feeding and crying and looking like he will live.  Some very inefficient hours fixing stuff, searching for stuff, repeating stuff.  But that, I believe, was love too.

As I walk back and forth to the hospital, trying to squeeze some efficiency into hours that might yield some sleep, I ask for grace.  Grace to be like my friend in Cincinnati, to be like Jesus.

Jesus sat by the well and asked for water.  He waited three days to show up at Lazarus' tomb.  He walked and wandered.  And I'm sure He would have sent Christmas packages, even if they were pillaged and costly.  In a way, He was the Christmas package, cut open and betrayed and yet a physical palpable inefficient love.

Tuesday, October 28, 2014

Four Happinesses

Prince Wesley.  Yes, that was the name of one of the babies I saw this morning.  I marveled at the mom's choice and wished him a good life, and that he would meet his own Princess Buttercup someday to whom he could say, "as you wish".  I filled in for the nursery doc who had to go to a meeting.  I have to say I think another of the babies really likes me. He was screaming his head off several times today, and as soon as I picked him up he was quiet and alert.  He was lonely.  Babies are a balm to the soul.

An A+ Pass.  In the afternoon I spent time teaching my interns about neonatal resuscitation using this low-cost baby model one fills with water, and it has lungs and a little heart you can make beat.  NeoNatalie.  I ran through scenario after scenario.  In some the baby cried, in others she didn't.  Sometimes there was meconium, sometimes not. Sometimes they had to do CPR.  They practiced giving breaths with the bag-valve-mask.  About six hours later on call, I had a "999" page which means "run someone is dead or dying".  By the time I got to nursery, I found my intern with a baby who was now crying.  He was on OB call when the nurse-midwife delivered a mom who had a difficult second stage.  The baby had a low heart rate, and nothing else-no tone, no color, no cry, no breathing.  But the intern was prepared.  He did everything right, and so by the time I got there what could have been a dead baby was instead pink and protesting.  I told him he had the real exam on what he'd learned, and he passed with an A+.

Dinner.  About 6 pm Scott called to find out if I was OK. Always nice to be missed.  By the time I got home a lovely spaghetti dinner was on the table.  All working moms need a husband who is proactive in serving, and can cook.

Amber Vinson's Hugs.  The 7th ebola survivor (out of 8 patients treated in the USA) was declared ebola-free today, the second nurse from Texas.  We watched her press conference, and the hugs which bravely showed she is no longer infectious.  Ebola is a physically but also a mentally debilitating disease.  It is hard to imagine the toll of not only risking your life, but then being treated as a plague-bearing danger, avoided, isolated, suspected, blamed.  It was so encouraging to see her alive and well and embraced.  Slowly this disease is becoming something we can treat, and change.

Sunday, October 26, 2014

But God . . . .

So much of this weekend was filled with the sort of moments that make you stop and take a deep breath of thankfulness, that make you savor before you swallow.  Saturday evening we had ten Senior boys for gilled sausages wrapped with veggies and hot sauce, watching El Classico, ribbing each other, cheering.  We prayed for them, we played cards, we laughed.  The next morning another group of about a dozen came for Sunday School, which starts with mounds of pancakes and bacon, fruit slushies and hot coffee, animated talk.  Friday evening our Paeds consultants met for our first monthly social dinner, on the belief that investing in our friendships leads to staying power and better care for our patients.  Later we joined out Serge team for a discussion of justice, the first in an intended occasional series for individuals to challenge each other and engage in issues.  In short it was a weekend of significant thought, strengthening bonds, shared food, and joy.

Perhaps the peak of that was on Saturday, late morning.  Hot sun even at this altitude, the dormant volcanic craters in the distance, monkeys scampering into trees as we walked up to the school's football field.  Our boys were paying Strathmore in a friendly, a school of tall fast Kenyan boys.  It was a good contest, drawing out some of the best play I've seen perhaps this season.  While Scott roamed the sidelines taking pictures, I sat as usual with our friends the Battermans and Kendalls, whose kids are on the team with Jack, plus a few dorm dads who are fans.  This is our fifth year watching our sons on teams together.  We analyze and cheer, we gasp and hope.  As I sat in the sun and breeze, watching our boys struggle a bit at first then pull ahead, I had that sense that I should remember this day and savor it.  Senior Year.  Our last senior year.  Football, our favorite sport.  A perfect morning on a spectacular field with good friends.

Then suddenly, one of the boys went down with a yell, "my knee!".  Play stopped, and I sprinted down and arrived as the coach did.  RK was lying on his side, having planted and cut in defending.  No contact, no mistakes, nothing unusual, but he felt a pop and pain.  And since the same thing happened to his sister in the final game of her senior year, he had a pretty good idea what was happening.  "Not my senior year," he cried out.  But a few seconds later, he raised his hand and said "God I praise you no matter what this is with my knee".  

Well, it was his ACL.  This kid is one of the best athletes and nicest all-around godly good guys in the school.  A good friend.  He, along with Jack and one other boy, was one of the three Juniors playing varsity in all sports last year.  He would have been a star and probably a captain in basketball and an important force in rugby again this year.  In other words, an ACL tear with surgery and months of rehab is no small thing in his life.

For me, it was a PTSD-moment that took me back to Caleb.  I love this kid like a mom would, and my heart just broke for him.  I confess I cried, in a very un-objective un-doctorly manner.  Having watched Caleb say goodbye to some dreams, and struggle for almost two years to get back to health after his injury, I had some idea of the implications of that moment.

Later his sister wrote to him: God takes more pleasure in watching you play than even your mom and dad do.  So if He let this happen, it must be for important reasons, because He loves you.  RK's immediate response and this wisdom from his sister really are a testimony to faith.  When our story takes a turn we don't expect, when we lose something important and dear, when joy seems impossible, that's when real faith shines.  God loves the honest cry of the heart, "NO, please NO" and then the wrestling, grasping, tenacious hold on faith, "I trust you God."  Which brings me back to Sunday School today.  Joseph was the same age as all these boys when his brothers threw him in a pit and sold him into slavery.  Then he was unjustly accused and thrown into prison.  Yet decades later, he is able to look back on his own life story and all the pain and loss, and gain perspective by seeing God's fingerprints.  In Genesis 50:21 he acknowledges that his brothers meant evil, "but God meant it for good, to bring it about that many people should be kept alive, as they are today."

We may not live to see the good that is wrested from evil in every aspect of our lives, but we live on the promise that all things are being redeemed.  That God is at work for good, even in what is intended as evil. That busted knees which change life-path-directions do so in a way that will mean life to others, even if it takes years or decades to look back and see.  I would gladly give Caleb my knee, as would RK's parents (well, our old knees may not be that useful, but you get the point).  We hate to see our children injured.  We hate to see doors close on them.

But then they lead us in faith, and respond with grace, and hold onto God, and we follow them down this hard road of living.  We pray over them from  Rom 8, and wait for the all-things-made-new of redemption in their lives and knees, and ours.

Saturday, October 25, 2014

Ebola...a paradoxical parody

Sometimes you just have to take a step back, take a deep breath...and smile...

Friday, October 24, 2014

On labor and love

Sometimes one can wonder why babies come into this world at such a cost. There's a lot of loss, as untold numbers of conceptions end in miscarriage (some think 30% or more). There's grief, disappointment, dashed hope, tenuous chances.  Then when things go well, it is still far from simple.  There's what is euphemistically referred to as discomfort.  There's blood and pain and the absolute terror that the contractions will never end and one's body will split apart. There's indignity and soreness and inconvenience and bone-weary-blury-tiredness and dependence.  There's all those days of seeing one's mistakes with retrospective clarity.

It's been a few years since I last gave birth (16, actually) but I regularly stand at the very bed where I delivered a son, and hold the hands of moms doing the very same thing.  Tuesday night was a meconium fest.  Stressed babies, stressed moms, stressed staff.  One mom tried to bite me.  I know she didn't mean it.  It's just that hard.  I often stand there trying to fill their minds with encouragement and truth, trying to be a human presence in a rough spot.  Her baby was cone-headed and limp, breathless and blue.  I intubated his trachea and sucked out the green fluids, gave him breaths and dried him vigorously.  We took him to nursery to be sure he was OK.  He was.  Two hours later he was dressed up in his nice warm little outfit and hanging out with his mom, who was already probably forgetting the way she had been screaming.

It was a long night, followed by normal work the next day, and the usual flow of the week.  Things like praying with our department, fielding phone calls about transfer patients, examining labs, running rounds, researching protocols, organizing job charts and reviews, responding to anxious parents, looking at rashes.  So when I walked through the gates again at 8 Thursday morning, I was probably still a little tired.  I was barely in the door when my phone rang, nurses asking me to come to the neurosurgery ward for a resuscitation.  I briefly tried to think if this was someone else's job, but no, it was mine. So I excused myself from the patient I had started to see and hustled over to help.

Baby A had been discharged the day before, after repair of his meningomyelocele (spina bifida). We are a world epicenter for spina bifida care.  Our ward is packed with little bodies with big heads.  Babies who have spindly limbs and too many infections.  The excellent neurosurgical clinical officer had already taken several appropriate steps of evaluation and treatment.  We had a line, gave fluids, bagged breaths, checked blood, listened and examined.  His breathing was shallow and erratic.  I admit my first thought was:  does this baby really have a prognosis that justifies intensive care?  I confess some compassion fatigue, but it's a legitimate question in a place with very limited resources.  The surgeons who were his primary team popped their heads in the resus room.  Yes, they said.  So be it.  We moved him to the HDU until ICU could be prepared, gathered our resources, and I put a tube through his mouth and into his airway, and took over his breathing.  We got antibiotics, stat.  We got warm bags of IV fluid to pack around his cold little body.  We got a cot-warmer on wheels, portable oxygen, and headed to ICU. Xrays, tests, ventilator, monitors.

Later as I was signing him out to my colleague, I implored for all-out care.  Baby A had responded to our interventions.  I was hopeful.

And I was invested. Because he was no longer just another spina bifida baby.  Those hours of intensely working on him created a bond.

Which is why I think babies are so much work.  They need a bonded, invested human being, and we are wired such that the more we pour in, the more we care.  Where your treasure is, there your heart will be also.

This is precious, being discharged yesterday.  I spent countless hours on her survival, which makes me care a lot that she was prayed for by so many people, though nothing compared to her mom's happiness.  She still has a long road of brain recovery, but we are hopeful and grateful.  Keep praying.

I've been reading a book by our very own Serge missionary and friend, Barbara Bancroft.

The exhausting nature of ministry drags us down and steals our faith. Just one phone call, email, or Facebook posting can ruin our day.  Serving people means that we are invested in them; we have intertwined our lives with theirs.  Thus, we are vulnerable.  Paul's prayer for the Ephesians points us to a source of joy and power that is not connected to our ministry.  Rather, it is connected to the character of our Father and the love of our Savior. . . . 

Thus the mystery of the labor of love.  Need calls to our hearts.  We are intertwined with fragile babies, not to mention distant kids who sometimes have a bad day, a failing grade, a broken relationship, a sore throat, a busted knee, a dashed dream.  Thus, we are vulnerable, as Barbara says.  Our hearts are in places where outcomes are sometimes tragic.  So our very survival depends on being re-filled with God's spirit, being renewed with the assurance of His love.  The answer isn't to stop caring about spina bifida or college applications.  The answer is to keep allowing our lives to intertwine with the very things that can break our hearts, while depending on the unstoppable and inexhaustible resources of Heaven.   Sometimes these precious ones will revive, survive, be glorious.  Sometimes they will not.  But either way I want to care, all-out.  And I want to believe God is present.

Open Letter: Post-Care for Ebola-Zone workers

Dear New York-
We are deeply grieved with all of you that Dr. Spencer, an Emergency Medicine Fellow in training in NYC who volunteered to work with ebola patients in Guinea, has fallen ill.  We pray that he will fully recover, and that no secondary cases will arise.

Some thoughts:
1.  Dr. Spencer is unlikely to have infected anyone.  NO ONE became ill from Mr. Duncan's initial visit to the hospital in TX, when he had mild symptoms. Ebola becomes contagious after the patient is symptomatic.  Decontaminating cruise ships and planes because they were touched by exposed people, in some cases prior to illness and in other cases without any illness at all ever, may not be an effective use of resources.  Following up random subway and bowling alley strangers may not be either.

2.  Post-ebola-care workers need a place to go, because of the climate of hysteria.  In spite of calm pronouncements that people are not infectious until they are sick, panic ensues. Then politically someone has to take action which is justified by the phrase "out of an abundance of caution".  It would be much less expensive to provide a designated 21-day incubation camp near an excellent hospital prepared to care for any post-service cases that arise.  Note that SIM quietly set up an RV camp for potentially exposed people returning from Liberia, kept them quarantined for 21 days, no one got sick, and all was well.   The ebola czar would spend less money designating a place for medical workers to recuperate/isolate/incubate and be well cared-for, than in spending money reacting to the panic that arises with any new infection.  Even though they are not putting people in danger going to the grocery store while well, it is true that human beings facing potentially fatal diseases have such strong denial mechanisms they may block out their initial symptoms.  So if we're going to pour resources into "an abundance of caution", let's put them in making life better for the brave souls who volunteer rather than persecuting and second-guessing them after they return. Perhaps the "sluggishness" reported by the press that preceded Dr. Spencer's emergency trip with a 103-degree fever should have been recognized as a prodrome, but anyone who is recovering from a stressful stint of work, jet lag, and culture shock, can feel sluggish.

3.  Not everyone who returns from West Africa is in the same risk category.  Ebola is transmitted by close contact with sick people.  That means family members, health care workers, and burial teams.  Those are the people who need to be followed up, and need sympathy and care.

4.  Remember the numbers.  Liberia, Guinea, and Sierra Leone are home to about 21 million people.  Ten thousand have been infected with ebola this year.  That is 0.05% or 1 in 2000 people. Horrible, tragic, and way too many, absolutely devastating to any country to lose that many people.  However, not all Africans, or West Africans, or even Liberians, etc. are potentially a danger to anyone.   There are 1,999 safely uninfected people living in those countries for every ONE person who is infected.  Amongst international travelers, only one random guy has become ill.  If 150 people a day travel from those three countries to the USA, that means in the 8 months of the epidemic 36,000 have come to the USA, with one sick.  Just keep that in in mind when setting budgets.

Bottom line:  Spend money and emotional energy and logistical support where it counts.  Send help to the affected countries, and take care of the family members, health care workers, and burial teams.  Prioritize creating safe places for those who volunteer needed care, so they are not hounded and stigmatized and blamed when they return.

A pair of docs

Thursday, October 23, 2014

A Clear Night

Not on-call or post-call.  No moon.  No clouds.
So, I went down to the Kijabe airstrip for some night photography of the Great Rift Valley with a photographer friend.

"The heavens declare the glory of God,
and the sky above proclaims his handiwork..."
Psalm 19:1

Sunday, October 19, 2014

Ebola, Incarnation, and Cost

Thanks for reading the ebola post, and thinking about it.  We are given the blessing of being part of the way God blesses the world.  I hear a lot of fear, and I want to hear that with compassion.  But being a blessing is a costly pursuit.  Just ask Jesus.  He said "take up your cross".  So if American soldiers and doctors and epidemiologists and pilots all do that, Amen.  A few may get sick.  Most won't, and in the process will have the opportunity to be part of a story of redemption that is thousands of years in the telling.  Some of the comments on the post are supportive, some are hostile.  We have left them all up to respect the diversity of opinion.  One sticks in my mind, and I think will become my new description of the incarnation:  "skinny-dipping in ebola juice".  That was meant to chastise us (even though we're currently thousands of miles away in Kenya).  But it is a vivid image of Jesus, safe in eternity, entering this world of muck and danger, for us.  

Beautiful Dust

Walking into brokeness means a lot of brain tumors.  I didn't think I could handle another brain-dead child on a ventilator, another entry to the ICU to find a new patient, to examine, to slowly realize the very peaceful looking little body with its stillness and steady heartbeat belies the truth inside his skull, which looks like this:

The agonizing conversation, the weeping mother whose lament is translated for me "I would gladly cut off both my arms here and here to save my child".  The bewildered father, holding his wife, sniffing his tears.  The stoic aunt watching with me as we remove the tubes and his heart beat slows to a dwindle, then nothing.  He is gone.  The prayers.  The ache.  These last ten days have held four similar scenarios for me, and I am losing my resilience.

They have also held a series of sermons and worship at RVA.  Once a year the school has an invited outside speaker, and nightly meetings.  This year we heard from Eugene Cho, who pastors a church in Seattle and started an organization for justice called One Day's Wages.  This has been a draught of grace, an infusion of the Gospel, a picture of God's loving purposes in our messy lives and His invitation to step into the world alongside His work.  Eugene is a TCK, born in Korea and raised in America, with the kind of life experience and pain and redemption that speaks to the kids here.  And to me.

One of the songs I have loved in the worship time has a line "You make beautiful things out of the dust".  Last night, Eugene talked again about how God is with us in the low times when we can't see His purpose.  About how He invites us to respond.  He asked kids to raise their hands as we sang.  I was on call, and sitting in a back corner.  A girl in the row ahead raised her hand, tentatively.  I watched her friend on one side go forward to pray with a teacher, and her friend on the other side jump up to hug the first friend.  But she sat quietly in her chair.  As we ended, I put my arm around her shoulder, and asked her name so I could pray for her.  She said she didn't know any of the teachers up front well, and wasn't comfortable going ahead.  I promised to pray, respecting the private holiness of her moment.  But my phone was buzzing.

Scott had decided to take a 31-weeks-pregnant mom into the operating theatre.  Her life was in danger from severe pre-eccplampsia.  They were about to pull out this very premature baby, and I ran down the hill in the rain to be there.  The theatre lights at night, the bustle, the scramble to get our equipment prepared, and then the little guy was out, limp, whimpering.  But with a bit of vigorous drying he was crying.  A beautiful little boy, tiny and complete.  Here he is 30 minutes later, having pushed his oxygen up onto his forehead.  He didn't really need it.
Beautiful things, out of dust.  A shy young woman, making a spiritual commitment.  A tiny baby, all 1380 grams of him (2+ pounds), kicking and complete.  New life, of the soul and the body.  

Redemption comes, slowly, in unlikely places.  A shy student and a preterm baby.  And redemption comes with cost.  Late nights and missed events.  Weary bodies.  But it comes.  Beautiful things formed out of dust.  Broken places healed.