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Wednesday, June 18, 2014

Dangerous Orange, sailing over love, and other tales of the day

In light of the Netherlands' victory, dangerous orange could easily refer to Dutch National Football.  Though Australia gave them a solid run, and we enjoyed watching with the loyal Steere family.

But a more dangerous orange was the one a 10-month-old previously well baby was munching on this morning.  He coughed and began to turn blue.  Within thirty minutes his parents had reached Kijabe hospital and our alert team had deduced from his wheezy breath sounds, dusky color, and collapsed lung on xray that some part of the orange had lodged in his respiratory system.  I had the privilege of watching over visiting Paeds surgeon Drew's (former MK from Nigeria I might add) shoulder as he guided a bronchoscope down this toddler's trachea and into the left bronchus.  Sure enough, there was an orange seed, which he then used remote-controlled forceps to pull out.  Pretty satisfying, and definitely not something that can happen that quickly and expertly and life-savingly in many places on this continent.

In that same vein, I had the joy yesterday of introducing a miracle mother to her miracle twin girls.  Mama W had come into our maternal-and-child health clinic on Friday nearing the last month of her difficult and miraculously precious pregnancy.  But everything had gone wrong.  She was barely conscious, with severe hypertension.  By the time Scott rushed her into the operating room it was not clear if anyone, she or her babies, could be saved.  He began the surgery as another missionary anesthetist struggled expertly to revive her.  As Scott cut, he saw that she was hardly bleeding at all.  Which was because her heart had stopped beating and the team was doing CPR.  Scott said he had never done surgery during CPR before, but he got those baby girls out fast.  Our team revived them, and though they needed a big of oxygen and care they are both healthy, just a bit small.  Meanwhile the mother's heart restarted, and she went to the ICU with little hope of recovery.  We took care of the twin girls in the nursery, snuggled into our twin cot, crying and being fed by nurses.  The family was too focused on the potential loss of their mother to help much.  But by Tuesday she had moved into the High Dependency Unit, sitting up, talking, and looking 100% better.  After rounds that day Scott mentioned that she had not yet even seen the babies she nearly died for, so a nurse and I carried them up to her bed.  She named them Blessing and Favor, and together we prayed a thanksgiving prayer.  Again, this is one of the only places in Africa, let alone Kenya, where the threesome could have emerged alive.  And the effort took dozens of people doing their jobs, from the clinic to the theatre staff, anesthesia, medicine and OB, paediatrics, nursing, call coverage, biomed for equipment, and on and on.  

Which is why this place is a magnet for last-chance-efforts.  This morning I walked around maternity to check on the moms in various stages of labor:  A woman in her 4th pregnancy (all 3 previous ending in 2nd trimester deaths) who arrived threatening to lose the 4th at 29 (out of a normal 40) weeks, a woman at 26 weeks fully dilated with a baby that could pop out any second lying on strict bed rest and hoping, another at 25 weeks who seems to be quiet now, two at 34-ish weeks who were being induced to deliver after premature rupture of membranes, and a woman at 33 weeks whose baby was barely growing, stressed and small and lacking amniotic fluid.  We kept tabs on them all as we worked to care for the 20-some babies already under our care.  Each a story of potential loss, of a close shave with disaster, of coming almost-too-late, of serious malformations and infections and danger. Each hanging on by drops of fluids and carefully measured shots of medicine, by effort and prayer.

One of the 34-ish week babies emerged mid-afternoon pink and lovely, a perfect petite little girl.  And then at the very end of a long post-call day, a difficult C-section for the lady with no amniotic fluid.  Scott stepped in again to help the OB trainee who was struggling, and they pulled out a tiny little boy.  One kilogram exactly, about a month-delayed in size.  So he was improbably wailing and flailing like a more mature baby in a miniature body.  This mom had also lost 1 of her other 2 babies.  I held him up for her to kiss, and then whisked him to nursery.

A day of work and miracles and joy and risk, so let me end with this passage quoted by Eugene Peterson in Tell it Slant (chapter 17, reference to Hans Urs von Balthasar, Prayer, 1963):

 We "let ourselves be gripped by this primary truth, namely, that the whole compact mass of created being and essence and the everyday world we are so familiar with sails like a ship over the fathomless depths of a wholly different element, the only one that is absolute and determining, the boundless love of the Father."

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