Yogurt, granola, coffee, tea, making sandwiches for lunches, checking email, thinking through the day, greeting workers and making sure they are set, gathering a few supplies to restock at the hospital, getting on bikes to head off to school and work . . ..
Wednesdays are usually pretty full, with rounds on the over-crowded ward and then mid-day in the HIV clinic. Today was no exception. Sometimes the nurse coming off of night shift tells us whom she thinks is the most critically ill, so Heidi and I begin there, then proceed slowly, bed by bed. Checking labs, counting out pills, examining, touching, talking, thinking, searching for clues, trying not to miss any important danger signs, patient after patient. Sometimes the sheer effort of listening in another language fatigues. I try to think about teaching staff as we go on rounds together, too, though the extra energy for that can be hard to find. And with two interns (one pre-med and the other in med school) who are bright and questioning, I come to the end of what I know pretty quickly! I remember why parents like to justify action with "because I said so . . ". Sigh. Mid-rounds I excuse myself briefly to call the District Police Chief and complain that the rapist still has not been arrested, a moment of advocacy in the midst of science. With all the beds full a dozen or more patients are on mats on the floor, so I have to kneel or squat to examine them. One of the last kids looks pretty comatose, but responds to pressure on his hand, opens his eyes, but does not talk. I see him trying to focus on me, on his mom. So I pull out a sweet, and ask if he'd like it, and he raises his eyebrows . . and I'm reminded of Kevin coming out of his coma, and smile. This kid has severe malaria, but he'll be OK.
Then over to the clinic for AIDS patients, which is usually bustling. I see patients in a little side room, calling out "onje?" (is there another?) through the curtain as I finish with each one. As I'm tracking down a lab result, I notice one of the interns looks bored having finished weighing all the patients, and pull him in to see patients with me, more time here to discuss the complicated issues surrounding HIV-care in a resource-limited setting, something close to my heart. We tell a mother that her baby's HIV test was negative, a joy I get to repeat twice today. I notice that Barak Obama, who was named after our American president after being born in our truck on the way to the hospital, is also negative. Fun. I review the 5-years-of-growth-chart data on Mumbere, who has the ID number 4 (out of a thousand or so), one of our first HIV patients. This is where he came starving and malnourished, this is where he got TB, this is where his mom died, this is where he began anti-retrovirals, this is where his grandmother took over his care. Later I notice a baby whose mother coughs, a lot, and I send her for TB testing, no use to just treat the baby when his greatest risk is probably his mom's untreated infection. In and out of the exam room, connecting some patients with peer counselors, making sure that CD4 counts are being collected, that medicines are being dispensed.
Back to the ward, malnourished twins have arrived, a rather complicated (and in duplicate) ending to a five-hour morning . . then notice that three of our best nurses are struggling to get an IV in a very anemic child, who is going into shock. While they keep trying, I walk the medical student (who has EMT experience) through an intra-osseous line. He gets it in, but we are not getting good flow, and by that time the nurses get an intra-venous line.
Brief stop at CSB to discuss some team issues, then back home for an hour, firing off a few emails and counting out funds to send 30 blood samples for CD4 testing (has to be done in Fort Portal), with the bonus of returning with blood for transfusions from the blood bank. Back to CSB for chapel, very optional, but an opportunity to greet a few staff and students, touch base with Jack and Julia, pray while the chaplain preaches, for heart transformation and spiritual growth and cultural change and peace at the school.
Then cooking dinner, Jack and Julia stay for football (soccer) pick-up games with kids at school, and I'm alone for the first time since 6 a.m. Liz from the WHM office has sent me a fantastic sermon series, so instead of the radio, I put one on as I cook, knowing I need my frazzled focus to be re-directed to Jesus. The story is of Mary Magdalene, of looking beyond the voices in our lives which tell us who we are, to the unseen reality of what God says is true. Again, looking clearly for that which can not be seen. I've seen a lot of grief and anxiety and conflict and instability over the course of the day, and I realize how strongly I want to blame my stress on the situation, want to have the problems fixed my way, instead of waiting on God.
Wednesday nights are family night. Right now that's just three of us, but we set out our best plates and glasses and light our candles and eat our spaghetti with freshly made sauce. I'm so thankful for this protected evening, setting ministry and other relationships aside, to listen to my kids tell about their friends, about what a teacher said or how a soccer play went. Their lives are not always easy. Today Jack was blatantly fouled from behind while dribbling the soccer ball, then had lots of kids jeer at him as he rode his bike alone up the road, and came home to chores and the news that he has an unexpected chemistry test at 8 in the morning. That's a lot for an 11 year old to take. So we talk, and call Luke, and listen to music, wash dishes, read out loud, until Wednesday fades into sleep.