COUNTING

Some blessings today.

1. My mom spent the night in the basement and Luke was under curfew confined to his dorm, but neither experienced loss or injury in the wake of Hurricane Sandy.  May the spirit of community and can-do permeate the areas most affected.  My favorite radio news story this morning was of reverse-looting in NYC--a man returning scattered items from the street to a broken shop window.  
2. ACACIA.  Enough said, but I'll expound.  We've loved her since she was an embryo.  It is a privilege to stand on the sidelines in awe of a 15 year old girl growing in grace.  I love her increasing confidence as a person, a student, a basketball player, a friend, a believer.  We celebrated her birthday with gifts, meals, friends, and a nostalgic video sent from her real family in Sudan.  
3. The young men and women who come to Kijabe to train.  Today was the final day of the year for the Clinical Officer Interns.  On "T"'s final rotation in nursery he improved tremendously in his clinical skills, but I also came to appreciate his heart for patients, and his reliability.  A good guy.  We had a formal prayer/speeches/chai/goodbye for him in the nursing staff room this morning. 
4. Moments of peace in the midst of chaos.  Monday I agonized through two deaths.  Yesterday there were three very very sick babies admitted within a short period of time, each brought desperately into the nursery with minimal life.  The first was COLD (32 degrees C) and damp and listless a few hours after birth at a small clinic, the second was HOT (41.5 degrees C) and shriveled and jaundiced and not breathing a couple of days after birth, and the third was twitchy and lethargic and malformed five days after birth having gone home instead of coming here as referred.  I had to call for backup as I organized my team to administer oxygen and push fluids and draw labs and calculate meds, checking back and forth between these babies.  There was a moment in the afternoon when all had turned the corner towards life, and I sat down to feed another stable baby whose mother has been in our ICU with serious infections after her C-section elsewhere.  There are few things more therapeutic in the midst of beeping monitors and gasping babies and needles and blood and stress than holding a baby and helping him suck milk from a syringe.
5. My kids.  I shouldn't say too much about our NHS sagas, but for reasons obscure to me my oldest was not offered admission until the last month of his senior year after he already was headed to Yale, the second showed incredible persistence in applying time after time and finally was included also later in his senior year, and the third was rejected her first application too.  So when we got an email that Julia was to be inducted today we were happy for her (though the ambivalence of the "in" and "out" remains).  She's an all-around servant-hearted hard-working faith-seeking lovely person.  Also fun to see her join with Elizabeth C, after we had watched old vidoes of these girls as 3 year olds in Uganda together.
6. Swedish meat balls.  For equally obscure reasons, perhaps hearing of one of Scott's uncle's deaths this week and remembering visiting the family, I was inspired to cook from the Scandinavian roots I don't really have genetically.  Swedish meat balls, always a staple of Scott's grandmother and mom.  Lefsa.  Only my meatballs were crumbly and my lefsa amoeba-shaped and I was about to give up on the whole enterprise but Scott kept up my spirits and it actually tasted amazingly yummy.  You can't go wrong with sauteing in butter, and dipping in ketchup.
7. Football.  Jack scored a goal in the first thirty seconds of their crucial game this week, which his team went on to win 3-2.  He's been sick and so I'm very thankful for that moment of brilliance, a boost of resilience.  The night he was sickest we watched Man U together in a thrilling controversial win over Chelsea.  This morning we talked to Caleb whose intramural soccer team lost in the finals in an equally controversial match (his goal disallowed long after it was scored for suspicious reasons).  Still that makes them 2nd in the 40-squadron competition.  
8. UGANDA:  gifts from friends, pictures and stories.  All that will have to be Scott's to tell, but his weekend was worthwhile and eventful and bonding and more fun than he expected to have going to meetings!  I'm glad we're all back together.
9. Babies, and life, which just holds on and breaks through.

Acacia is 15 today!!

Notice the birthday button!!

Welcome to the Pearl

Scott left at 4:30 this morning to get to the airport in Nairobi in time for a flight to Uganda, to meet MAF and then hopefully in the next hour land in Bundibugyo.  This trip was thrown together at the last minute:  he had better hospital coverage here in November, but the team in Bundi had set aside tomorrow for major meetings about CSB, so thanks to gracious pitching in by Drs. Letchford and Claud, off he went.  Meaning I stayed up past midnight writing 26 cards/letters to send some greetings, and we filled up a bag of Nakumatt goodies.  I apologize in advance for the hundred letters I DIDN'T write.

SO PLEASE PRAY this weekend for:

• The airstrip to be dry enough for Scott to fly in today (Friday) and out Monday.  Hard to do a quick turn-around without MAF!  And they've already had at least one plane-stuck-in-the-mud day lately.
• Jesus to be present in every interaction, the greetings, the requests, the encouragements, the reunions, the challenges.  Pray Scott would be a river of living water, overflowing to others.
• Wisdom (another name for Jesus) as the team meets tomorrow to consider what directions God is leading CSB.  This school has blessed all our kids (biological and foster) and is the foundation for lasting Kingdom change.  It is also the epicenter of attack.  Pray for Isingoma and the entire leadership team as they meet with Michael, Travis, and Scott.
• And for us here.  I left Scott for two months.  Within two hours of him leaving me there was homework crisis over a malfunctioning computer, an adult missionary with medical issues who needed him, missing puppy (she's back), and of all days, Jack's team chose to wear ties to school . . . leading to a slow-loading too-long YouTube how-to video within seconds of him running out the door late.  I don't take lone survival for granted.  Pray also for Baby Lopez to whom I have been quite committed.  She turns 2 weeks today, much of that in the ICU, and her prognosis is uncertain.  I'd love to see her prayed to life.

Thanks for partnering with us.

Happy World Spina Bifida and Hydrocephalus Day

Here from the world epicenter . . .

Our hospital has attracted top neurosurgical services, which is a good thing, because the incidence of these two problems is something like 100 times higher in East Africa than in places like America where most neurosurgeons like to live.  Yesterday in chapel our very own Dr. Okechi spoke about the causes and treatment of spina bifida (an opening of the spine exposing the nerves in the back, which happens early in fetal development and requires surgical closure shortly after birth before infection sets in, and even with good care leaves a child with some paralysis of the legs, difficulty with bladder and bowel function) and hydrocephalus (collections of fluid in and around the brain, found in about 80% of the kids with spina bifida, as well as occurring due to scar tissue after meningitis, and requiring a tube to shunt the fluid off into the abdomen).

But the real highlight of the morning was the panel of former patients.  Three had been operated on by Dr. Dick Bransford the pioneering surgeon with a heart for special-needs kids here at Kijabe back in the early 90's (making them about Luke's age or a few years older).  One now writes computer programs and works in IT, the second is in nursing school here at Kijabe, and the third has a bachelor's degree and a good job.  A fourth woman spoke who did not get surgery until later in childhood, but is now a Paralympic basketball star from Kenya.

They are pioneers themselves, showing their families and the world that they could overcome such severe challenges to reach places in life that few of their "able" bodied contemporaries manage.  Courage, vision, and a sense of grace and gratefulness permeated their speeches.

I confess I sometimes feel discouraged by the nearly daily appearance of another baby with a big spongy head, an infected brain, atrophied legs.  It was good for me to see the 20-years-later picture of hope.  And to remember that Jesus cares so much about the kind of kids that the rest of the world would hide away (or abort) that he's uprooted people like Dr. Leland and Susan Albright to come all this way to care for them, and trained people like Dr. Humphrey Okechi and Dr. Njiru and Dr. Nunthasiri and nurses like Janet and chaplains like Mercy and dozens of others to pour their lives into making a way for these children to live and grow and thrive.

The Birthday Girl

Patience.  All two months and 1400 grams of her.  See post below.

How Cake Saved a Life

Literal cake.  And metaphorical bread-of-life type stuff too, but read on.

It is Sunday morning, and the misting clouds have lifted from the ridge leaving a day washed in intense sunshine.  Not that I've sen much of this weekend.  From 7:30 am to 11:30 pm yesterday (except for 2-3 hours mid day) and today has also involved quite a number of hours in the halls of Kijabe already.

In those 2-3 non-hospital hours mid-day yesterday, however, I got to go to an RVA party.  A creative missionary-women's afternoon tea for the FOUR pregnant RVA staff members.  There were funny stories, a "Parent Rap" music video (http://www.youtube.com/watch?v=N_NspDWssIY), fruit and cakes, a fashion show of various atrocities from the shared maternity closet modeled hysterically by belly-padded hams, including a finale inspired by a story from SEW about the practical African response to the speaker's father's great idea in T-shirt provision.  LAUGHTER.  There was also a great devotion by Darilyn B about going to Jesus in prayer in every situation, identifying the real enemy (world, flesh, devil not your sibling), and imitating God.  I only got called about four times during all this (!) but managed to stay til the end, and really enjoyed meeting a couple of new women and praying for the moms.

As those who provided refreshments packed up, I asked for some of the left-overs because baby Patience reached her 2-month birthday Saturday (I have to use her name, because it is perfect for a child whose mother has spent 2 full months in the nursery feeding her infant encased in an incubator through a tube passing from the baby's nose into her stomach, with milk she the mother squeezes from her own breasts EVERY TWO HOURS around the clock).  I had planned to make cupcakes or something, but didn't manage due to long hours of work in the hospital that morning.  A few of the RVA women shared miniature scones and chunks of banana bread and snacks, which I wrapped in plastic then stopped and arranged on a plate from the hospital cafeteria on my way in.  

As soon as I walked in, however, I saw that Baby L who had been born 8 days ago, whose swollen body seemed incompatible with life but who had pulled through an ICU stay and seemed to be healing, was struggling to breath.   I quickly set the cake down (Mama Patience was later delighted, sharing her goodies with the other mothers, a true signpost of the hope that perseverance pays off) and started evaluating baby L, who was blue.  The nurses were surprised as she had been (relatively) fine up to that minute.  She was NOT fine now, and we awkwardly extracted her with her tangle of tubes and monitors out onto the resuscitation table and went to work.  A chest xray confirmed my suspicion of a popped lung, a "pneumothorax", a known complication of the high-flow air and oxygen blended help she was getting called CPAP.  For the next 4-5 hours I kept bagging her, as the paeds surgeons adjusted her chest tube, we waited for xrays, we pulled off air and fluid.  At one point the labor-and-delivery nurses rushed in another non-breathing newborn who was big and blue and I ended up running back and forth between the two, talking my MO intern through an intubation and more help for that baby.  Both were revived, and lived.  Both could have easily been dead.  If it weren't for the cake I wouldn't have happened to be in the nursery, and the delay in recognizing these problems and calling for help might have claimed one of their lives, or both.

It wasn't just the cake that carried me through that long day, it was also Darilyn's meditation on going to Jesus in prayer with EVERYTHING.  I do pray for my patients in one opening-of-the-day public prayer, in many silent and desperate "help me God" ongoing prayers since I am in over my head more than half the time, and then with parents if a baby dies.  But yesterday evening I was reminded to pray in every situation.  With the staff, as we worked.  Before I tried procedures.  When I was making decisions.  It was an evening that called for hard reckoning, smacking up against my own limits and those of this health care system and this broken world.  Going to Jesus in prayer with all of the mess transformed it.

Because though two lives were clearly saved, two others were lost.  One twin baby had severe congenital malformations of his jaw, ears, eyes, head.  Thanks to a heroic effort by our excellent anesthesia nurse we passed a breathing tube into his invisible airway.  But his degree of anomaly was not compatible with life, and after I prayed with the team (after a good number of advice phone calls) and made the agonizing decision that we could not solve his issues, he started bleeding profusely in his tube, and the answer was clear.  I pulled it out, and held his limp little body as his heart wound down to beat its last.  His mother was fully focused on the living twin, and protected herself by refusing to see him.  So he had only me, and I felt he should die in someone's arms not left on a table.  The second death was even more agonizing.  A baby born of an acquaintance-rape situation, delivered in secrecy and with no hygiene, arrived cold and ill a few days ago. On Saturday morning it became clear that her bowels were infected with a life-threatening process called "necrotizing enterocolitis" .  We put on aggressive antibiotics and fluids and oxygen and hoped for the best.  But the worst soon followed, mottled skin, gasping breaths, cold shock, swelling, acidosis.  I thought maybe the infected intestine had burst and called for my surgery colleagues as I intubated the baby.  They opened her abdomen with a small drain hole for the cloudy bloody fluid right there in nursery but after two hours of ventilating, fluids, medicines, the surgical procedure, and even CPR, and a call to a more experienced surgical colleague confirming that even a survival of the night would not mean a long-term survival with such extensive death of the gut . .  I had to admit we were losing this battle too.  She no longer had a pulse.  I pulled out her tube and she died in less than a minute, as I stroked her arms and we prayed over her too.  Her mother was distraught, wailing, undone.  As she poured out her lament, she sounded just like many Psalms.  It was a raw moment of faith clinging to a God who has allowed the nightmare, for her in the baby's conception, birth, and death, all horrific.  

Today saw Baby L back in ICU, back on a ventilator, though I still believe God can and might fully heal her. She's next to a one-year-old with AIDS.  These days that does not mean automatic instant death, if we can bring him through his life-threatening other infections he could live for many, many years with treatment.  

So cake was lifesaving, and prayer pulled us through some sorrows, and there is hope that tomorrow will be better.

Multicultural Celebration

(First, a thanks to the respondents regarding the blog below.  We have been pledged more than $2000 for the Needy Children's Fund, which should be very adequate for Baby A and Baby E.  Both are still quite sick, but we see some good and hopeful progress.  THANKS.)

On a different note, today is my one fully non-medical day in the week, and so I was able to attend RVA's annual Multicultural Day celebrating the diversity of countries and cultures represented in this amazing cross-roads.  Or perhaps it's not a different note at all, since Americans and other distant people are joining with a Kenyan hospital staff to assist babies in need.

I (mostly) love Multicultural Day.  Flags, costumes, music, fun.  The morning program culminates in the flags of each country represented in the student body being carried in by the kid with a passport from that place who has been at RVA the longest.  I should have counted as the alphabet of countries marched by, there must have been nearly 30, Australia, Brazil, Burundi . . . all the way to Zambia.  South Korea, USA, and Kenya have the biggest followings.  Though New Zealand and Rwanda made some spirited noise.  It's good to be reminded that a kid might sound American because of attending this school for many years, but actually be from Malaysia or Lesotho or the Netherlands or Canada.  Our team mates the Maras are an Irish/American couple, but as the first RVA students from the Republic of Ireland no flag had previously been purchased, a situation Ann will rectify by next year!

Following the ceremony and tea time (we are still quite Kenyan after all) there was a 5K One World Fun Run to raise money for AIDS orphans.  This year was professionally organized.  We had numbers.  There was a real start and finish line.  A crowd of cheerers.  Corporate sponsors that donated bottles of water.  Julia and Acacia took off on their own this year, and finished well.  They stuck together while I hung back gasping.  I appealed to the organizers for a category of "over-50 female who gave blood last week" but instead all over-18's were grouped as "adults".  Needless to say I didn't win any prizes.  A good number of people would have to go on furlough or sustain serious injuries for me to come close.  My goal was to survive, and at least I can say I did that, though I wasn't sure at some points I would.  I think I felt every inch of the 7200 foot altitude and the rocky 5 kilometer distance.

This evening there will be games (for boys, lamentably no girls) and then fireworks for all.  This day is placed to celebrate Kenya's independence, and has blossomed to include a celebration of all the nationalities at RVA.  It is the only school-day of the year that is fully a community event with activities and groups of chatting staff and food and sunshine.  It feels like a real summer-day holiday.

But for TCK-MK's, the day does have some angst.  Half my kids were born in Kenya and have lived more time here than America, but they are subtly reminded that they can not embrace a nationality that differs from their passport.  Julia wore an American cow-girl outfit for the morning and then changed into a Ugandan shirt for the afternoon.  Acacia wore Air Force garb (like me!) since Caleb is our main connection to full-fledged American patriotism . . but painted a South Sudan flag on her face. African kids at an American school need to hold onto their roots to preserve them, but that can be hard on the kids who FEEL African but LOOK American and end up on the outside of that.  

The good news is that the day ultimately celebrates the Kingdom of God, where all nations can be distinct yet united.  That paradox of belonging yet remaining individual is an essential truth of creation, of our relationship to God and each other, and one that we too often get wrong.

Lifting from the ash heap

Jesus specializes in the poor and needy.  Psalm 113 talks about lifting them from the ash heap, or basically the garbage dump.  I have two patients right now who would be essentially cast off as useless rubbish were it not for this hospital, and grace.

 Baby A has been with us for about six weeks.  He arrived severely malnourished, with a diagnosis of a cleft palate, and we thought we just had to help his mom figure out how to feed him.  But the cleft turned out to be an almost imperceptible problem, and paled in comparison to the fact that his mother has a fatal infection, plus TB. And has most likely, in spite of her best efforts to protect him, given both to him.  And has been abandoned by her husband.  And though she turned to her brothers, they aren't too excited about being responsible for her or her very sick baby.  Baby A. has a heart problem in addition to his infections and cleft palate and fatherless state.  We can't get him of oxygen, and he just coughs and coughs.  Many people, including most of Baby A's family, would not consider this a life worth struggling for.  But Jesus specializes in the impossible, and invites the discarded, the gasping, the infected and scabby, the lethargic and slow, to the feast.

Baby E was delivered at another hospital, after a way-too-long labor and a too-slow rescue.  They got her heart going, but her brain had been starved for oxygen too long, and as her body convulsed for a day they decided to transfer her to us.  Her mom has hung on for the last three weeks hoping that she's about to turn a corner.  We've seen a tiny improvement in her lung function, but we've barely been able to get her to keep down feedings.  A couple nights ago her mom was sobbing, because she's financially dependent upon her own parents, and they refused to pay bills for this hopeless baby.  Baby E's mother is hopeful, loyal, dedicated, to this child of hers who does not do anything for her.

Both Baby A and Baby E will not be able to pay their hospital bills.  They have no safety net, no one at all in this world who cares, except their single mothers.  Niether has a particularly promising prognosis.  Yet both would qualify as "the least of these" to whom Jesus points us to love.

Our Kijabe "Need Children's Fund" has been depleted by patient after patient, usually by matching funds with families who can't quite cover the total cost of care, averaging fifty or a hundred dollars.  But these two babies will have hospital bills on the order of several hundred to a thousand dollars.  Less than a few hours' worth of western care, but even the bargain of Kijabe Hospital adds up over weeks and months.  Both mothers gave permission for their pictures and stories to be shared with you.  They're desperate, desperately in love with babies that no one else cares about, and desperately without any resource of their own.

If you are prompted by the Spirit to lift these two children "out of the ash heap" or provide a cushion for others like them, you could:
1. Get together some friends, make a donation to your church (for your own accountability and tax deductibility).  Then your church could write a check to us, email us drs.myhre@gmail.com and tell us, we have it deposited into our bank account in the USA (we'll give you details) and withdraw the same amount from an ATM in Kenya, take the cash and deposit it in the hospital's Needy Children's Fund (#70351) where it will 100% help Baby A and Baby E and if there's any money left after that, others like them.  We can scan the deposit slip from the hospital and email it back to you for full-circle accountability.
2.  Donate through Africa Inland Mission, to Kijabe Hospital, using this link:  Donations for KIJABE.  YOU MUST DESIGNATE "Needy Children's Fund 70351" in the comments or it will be lost in the sea of this large hospital with many projects and needs.  Still send an email (drs.myhre@gmail.com) so we can track it.  It takes about a month to be processed by AIM, and another month to be processed by Kijabe Hospital, and there is a 15% deduction for overhead.  But this is the best way to give if you need a tax deduction and don't have a church to go through.

Over the two years I've been here at Kijabe the generosity of strangers has blessed the lives of dozens and dozens of babies and children.  I'm grateful to work on a team that cares for the least of these even if they can't pay, and aware that the hospital runs on a tight margin that will crumble if hundreds and thousands of dollars of bills go unpaid.  Thanks for anything you can do.

What I Love about Medicine

Rain on the roof, a steady off-beat ticking in the darkness. Another challenging sermon from John 12, on dying, both literally, to self in community, to the familiar, to busy-ness. Another week of work, draining, but in a good way. In spite of working to make up for the time off at midterm, covering both ICU and Nursery at once, dealing with a switch in interns and the absence of both our CO's and most colleagues, as I walked away from Saturday morning rounds, I felt a sense of completeness or satisfaction or whatever it is one perceives when in a spot where the way we're created fits the job we're given.

Which led to some thoughts about just what that is. As a child I learned the catechism, and for some reason the attributes of Jesus as Prophet, Priest, and King came to my mind. Because Jesus was the epitome of what it means to be fully human, those are roles that reflect the image of God in human flesh. Mind, Heart, Will. Prophet, Priest, King. The prophet perceives, analyzes the present and looks towards the future, teaches, calls for action, warns, weighs, moves ahead guided by the Spirit. The Priest listens, prays, represents, advocates to God, sacrifices, bears the burden. The King makes decisions, directs, takes responsibility, leads, moves others. And medicine affords abundant opportunities for all of that, the environment in which one can plumb depths of being fully human, and therefore more like Christ.

On Friday for instance, as a doctor-prophet, I started the day teaching on rounds. Organizing the data in the present, anticipating what might happen, asking my team to think through it, challenging them to take action. Sometimes chastising. But continuously exhorting. Why is this baby jaundiced? How should this sodium level impact our fluid management? What tests should be done in response to this fever? What plans should we make for the next few days? I like this kind of teaching, and my team grows on my heart day by day, as I see them grasp the concepts, make the effort. As a doctor-priest, I spent a large portion of Friday listening to parental concerns. Praying for them. Sacrificing lunch or rest or seeing my kids or a breath of fresh air to be available. Advocating. Making a phone call, begging a mother to consent for a certain study, holding out hope. And as a doctor-king, there was a pretty intense sequence of decisions and action in the middle of that day.

We had been warned for a couple of days that the OB team planned to deliver baby L by cesarean section, the mother had complications and the baby on ultrasound had what was described as "trivial pleural effusions" (fluid in the lung cavity) and "possible ascites" (fluid in the abdomen). Though we hoped it was much ado about nothing, I made a list of what I wanted the nursing staff to be ready with, equipment and people. I texted the paeds surgeons in case I needed them, to be on standby. I went to the operating theatre and read the mom's file while she was being prepared for surgery. And when the intern on OB pulled a lifeless slippery purple body out, with much difficulty, my heart sank. The intern kept patting the baby's back. Just cut the cord and hand her over, I told her, and whisked the baby off for care.

Faint slow pulse. No cry. No breath. Grossly swollen baby, an almost frightening froggish look to her edematous face and distended belly. Not a normal baby. I put the bag over her face to force in some air. Not much movement of the chest. So in less than 30 seconds I just decide to intubate her. Even with a tube, little air seems to move in and out, though now her heart rate picks up towards life. She moves a little. Coughs. We warm and dry, we push the air in and out, she is still dusky. We run to nursery. And there the prep pays off, I have an xray within minutes and paeds surgeons immediately after. The xray does not show any lungs. Solid or liquid, but no air. Yet I can hear some breaths as I bag. We have the portable ultrasound. Seems to be fluid, both in lungs and abdomen. Both kidneys are there. The heart is beating. There is a moment when I wonder, should I be trying to save this baby, or is she beyond hope? Her terrible swelling dehumanizes her. I can sense the hesitation from the rest of the team. She's still pretty blue. The list of conditions that can result in this picture is LONG, maybe 50 conditions, and at least 40 of them are devastating diagnoses.

But I know we have a chance, and we have to keep going until we understand the real issues, or until we fail. Our helpful paeds surgeons put tubes in her chest on both sides, the fluid compressing her lungs begins to drain, and her lungs expand more. Breathing for her becomes easier. We draw blood, do more detailed scans, I replace her tracheal tube with a slightly larger one. I push hard for an ICU bed, and in between other crises manage to get her there on a ventilator. And over the evening and then the night she improves. The teamwork of surgery and pediatrics, doctors and nurses, radiographer and lab, nursery and ICU, all has been pulled together for this one goal. I know I"m out of my depth, not an expert, just plunging ahead with courage and doing my best. I ask my partner Erika to come have a look, give me a little reassurance. That kingly responsibility can be lonely.

Teaching and thinking. Listening and loving. Directing and organizing. All these roles flowing together, and in the process a resurrection from death to life. This is what I love about medicine, the fully human-imagio-deo aspect that any day can bring. And while there are many jobs that require focused thinking, tender empathy, and decisive leadership . . .it is good to find one that combines all three, and all for a purpose beyond self or profit or dominance, instead a pouring out of one life to give life to another.

As a mom, and working at a school, I would encourage kids to look at the future through this lens of Jesus-like humanity.  Isolated mind can lead to harsh, cold, amoral, distancing intellect.  Isolated heart might lead to paralyzing sorrow.  Isolated will to bossiness and self-promotion.  But a braiding of the three carves out a tiny territory of Heavenly Kingdom for the true King, be it a thriving home, a few interns and rooms of patients in an African country, or on to more glorious responsibilities of classrooms, businesses, armies, countries.  

Snapshots of the week

Jolting along a rutted track at over 10,000 feet in the Aberdare Mountains, testing each mud-hole with a stick lest we become stuck out of the range of cell phones, having not seen another human all day. Bamboo gives way to heather, bogs, grasses, sky and more sky. Acacia spots wild dogs, rare carnivores which hunt in packs, their variegated ears round and large and effective, pointing up through the tall grass. Then we come around a curve and a large feline crosses the road, jumps up on the embankment, and turns to watch us, crouched, poised. It is a leopard, sleek, powerful, perfect. Time suspended, we ease down the windows, watch, awed. Then it saunters away.

Rain sweeps over the plateau, at ten thousand feet, chilling dampness. We decide to leave our remote tent site and drive to a simple shelter built for group camps, to be dry as we cook dinner. The setting sun dips below the clouds and sparkles back a vivid rainbow, a full arch across the sky as we light our charcoal. I roll out simple naan flatbread cooking each round over the coals while Scott grills the chicken, and we all eat huddled around the fires, with our fingers, ravenous and thankful.

The Norwegian blood rises to the surface as always, and everyone decides to go for a swim in the icy mountain stream, where a 100-foot waterfall pours into shady pools. Breathtaking. Painful. Alive.

Shivering into the delicious warmth of a down sleeping bag, dry and protected from the night's downpour, as a hyena barks and whines in the darkness not too far away. And awakening to a cloudless alpine vista, the night washed clean.

Sitting by the window in our Treetops hotel room, where the current Queen Elizabeth stayed on a Kenyan tour in 1952 the night her father died and she was transformed from Princess to Queen 60 years ago. Scott reads aloud from our friend Josh Trott's excellent adventure/fantasy/allegory book while I watch bushbuck, eland, buffalo, warthogs, and later and elephant all come and go from the waterhole below.

We get texts on the way back to Kijabe that a sweet couple who came to have their baby at Kijabe have indeed delivered during the night. We're sorry we missed the event, and hurry over to see them as soon as we pull in. Having had two babies here, and for other indefinable reasons, I feel a real connection with this family. So it's an honor to be asked to pose for a photo with baby Ashton.

Plunge back into the hospital: complicated patients, anxious parents. Scuffling through the corridor in a sterile gown and cap, cradling the newly delivered infant of a mother who has not one but two serious potentially (and eventually) fatal diseases herself, and has just produced a baby with hydrocephalus, a fluid-ballooned brain. The baby is not breathing, but a minute of expanding her lungs with air from the ambu bag and drying her blue wet skin and positioning her huge head, and she begins to whimper, then cry. Death to life. Never gets old.

Sitting with another couple, gently explaining that their baby's brain injury confirmed by CT scan is catastrophic. Leaving room for miracle, room for hope, but pointing to Heaven as well. Life to death, never gets comfortable.

Up to RVA for Spiritual Emphasis Week, hand-raising drum-rolling guitar-vibrating worship with complicated riffs and energetic passion, then a powerful prophetic no-hold-barred preacher who was once a Kenyan MK and RVA student himself. Messages full of Scripture and truth and challenge, radical stuff. Sitting in the back and praying, knowing that the harsh words about holiness and glory suffering and death will be hard for many to hear, the wrathful picture of God may be frightening, but also that many will be stirred and changed.

Chatting with my expat patients whom I love to see, with colds and motorcycle scrapes, then back to the ICU with a child whose intractable seizures after surgery for a brain tumor require massive intervention, then back to the premature twins huffing along with perhaps too much expenditure of energy, watching, wondering if they will turn the corner soon, and which way.

And it's only Thursday.

Sweet Sixteen

"My name is Julia Kathleen Myhre and God wants me to push that button!"  This is the girl whose confidence and spiritual awareness continue to propel her through life.  At sixteen she is friendly. Gracious.  Fun.  Unpretentious.  Seeking.  Hard-working.  Sensitive.  Sure.  More concerned about others than herself, about having fun that looking a certain way.  She's practical.  She grabs hold of a dream and sticks with it, until we all agree, hence the puppy this year.  She is careful with her homework, and spends way too many late evenings and early mornings.  For her Bday she requested coffee cake, for an early family breakfast party.  Her new Netherlands football jersey commemorates the year she first went to the Uganda National secondary schools girls' soccer tournament, and as the only white person and taller than most, the rumor went around that this 12 year old was a secret member of the Dutch National Team.  She still loves football passionately, and this year decided to take up tennis, as seen in her cake above.  She loves people and the outdoors.  After school she went on a long hike with the Koinonia team, the group of students with whom she leads a weekly fellowship.  She arrived home breathless and dirty only a few minutes before her all-girl party, escorted by a group of guys.  Then it was all silliness and laughter and pizza and cake. She received simple gifts with joy and gratitude.   Later she was the speaker for the 100-120 kids who came to the fellowship, and we saw a new side of her, Julia the preacher, capturing attention and testifying from the heart.  Julia is one of the greatest gifts of our life, someone we don't deserve and didn't earn, someone that amazes us more each year.