My world, a nursery tour by phone photos

This is the Special Care Nursery, a.k.a. the NICU. 15 to 18 beds, or rather cots and incubators, mostly full of babies, about 9 monitors, two or three nurses, a handful of nursing students, an intern, a paeds resident, moms, and me. This is our tiniest baby at the moment, 790 grams. She's being assisted in her breathing with "nasal bubble CPAP", a flow of air mixed with oxygen under pressure. She's up to a whopping 3 cc of feedings every two hours. The smallest baby to survive here, so far, is about to go home. She was born at 620 grams and is now close to 2 kg. This baby came from another hospital on Monday, and almost died in the first hour. He has severe congenital heart defects. I spent a good part of today negotiating a way to get him to the national referral hospital, Kenyatta. Jaundice is very common here. This baby came with dangerously high bilirubin levels, being treated by phototherapy. The blue light emits a wavelength that isomerizes the bilirubin in the blood into an excretable form. I always think the babies under lights look like sunbathers on the beach. This little pumpkin was born today two months early, because his mom was very ill with pre-ecclampsia . Due to a lapse in communication we were not called to the c-section until the baby was out, and arrived to find the infant blue, cold, wrapped with a small scrap of cloth, with a faltering heart rate and no breathing. I made a split second decision to grab the baby and run to the nursery for a functional heating bed and oxygen . . . no one stopped me, so off I went. Once we had bagged some life into the baby he looked great, and I went back to find out who he belonged to . . Baby Pauline's mom is 23 years old, and after she delivered her preemie she did not recover normally, but lost weight and was weak. It turned out that she has extensive, incurable stomach cancer. This young woman can barely get out of her bed, but shuffles to the NICU to visit Pauline. And manages to encourage our faith on the way, reminding us that God is in control. This is the cutest baby in the nursery, born to an HIV-positive mom. In Kenya the national policy is to treat all babies as long as they are breast-feeding, so this child is on an anti-retroviral medication and has a good chance of escaping infection. Precious is aplty named. She was admitted severely dehydrated with a sodium of 200 (! really!) and in kidney failure (Cr of 9). That was several weeks ago, note her thoughtful pose as she contemplates her first day off of oxygen. This baby has a rare cleft in the sternum, meaning his heart is covered only by a thin layer of skin and jumps ominously out of his chest as it beats. He has a constellation of heart defects that is probably not survivable, but we're trying to get him to a place where he can be helped as well. Paediatric resident Dr. Allison speaks with the parents of a newly admitted baby today. I am very thankful for her, and Dr. Sheila our hard-working intern! And the nurses who are very skilled in the care of sick and tiny newborns. I'm learning a lot from all of them. The moms come to feed their babies every two hours. For most this means squeezing out their breast milk and filling a syringe to feed the baby through a nasal-gastric tube. These women don't ever get more than an hour or so of sleep. They "board" in a section of the maternity ward next door. The same place I stayed when Caleb was born. That's a brief tour. Every day we listen to these babies breathe, feel their abdomens, calculate their fluids in cc/kg/day, order labs and xrays and ponder the results, titrate antibiotics and vitamins and oxygen. Several times a day we're called to attend the birth of a high-risk new baby, which is often just a happy moment of drying off a crying newborn. . . but occasionally becomes an all-out struggle to give life a foothold.

Student Health, one of our new jobs

And a perk is, we get our picture in the yearbook! These are the people who have weathered swine flu (last year) and seasonal flu (this year) epidemics and every medical problem in between, from head injuries in falls to schistosomiasis to rashes to cerebral malaria. It's a big responsibility to care for kids whose parents live all over Africa. The health of the children is the easiest way to attack missionaries. So pray for this group!

Pi(e) Day

The joys of being a parent include . . . having to respond, even if you've been on call for the whole weekend, even if you're in sleep deficit, even if it's a gorgeous evening outside and you wish you were there, even if you are juggling cooking dinner and preparing a presentation and answering phone calls from the nursery, when your 13-year-old announces that tomorrow he needs a pie for pi day. March 14th, of course, preferably served at 1:59 and 26 seconds or something like that. In my weary stupor I actually missed the whole date significance of the assignment until after-the-fact (and thanks to Alie Benson's facebook post I now get it . . . ). However, being a lover of math and puns, and the author of a book for my kids based on this very topic, and finding it important to recognize the beauty of a universe in which the ratio of the circumference to the diameter of any circle is constant, and being a lover of pies and baking, and recognizing that math and food are two of Jack's highest priorities, well, how could I say "no" ? The geometry students were all assigned to come up with a creative representation of pi. Here is Jack's creation, based on Joanna Stewart's grandmother's Kentucky Derby Pie recipe which I have tried to replicate over the years (we still miss Joanna's cooking) plus a Joy of Cooking dark chocolate frosting. I suspect it tasted wonderful, but that's only a guess, because in spite of Jack's best efforts to save a little for the fam, it was consumed in class. My last year to have a kid in geometry, it's a good thing I finally heard about pi day before it was over forever!

For all the saints . . .

. . who from their labor are not resting.

Two couples in WHM who have mentored and loved us from a decade or so further down the road. And who are now in the epicenters of March 2011 history. One, feeding refugees fleeing from civil war in a very tricky situation north of here. Serving thousands of people, because he was asked, because he was willing. And the other couple, flying to Japan for a conference to teach about marriage and the Gospel, landing into a country devastated by earthquake and tsunami, surely no coincidence. People with the skills to counsel, to listen, to point others to hope, in a time of fear and loss.

From three decades further down the road, undaunted, Rose Marie led us last year in a meditation on the end of Hebrews 12, where the earth is shaken that the things which remain may be strengthened. Let us pray for mercy for North Africa, and for Japan, civil and natural disaster, shaking and destruction, that only a redeeming God can turn to good.

And lastly, our not-resting neighbors, peers age-wise, but in the process of adopting the Kenyan child they have cared for since birth. Just because they ended up fostering an abandoned baby when the nursery was packed full, to help the nursing staff. Then because the Kenyan family they tried to get to adopt her didn't, because month followed month and year followed year and now at age 2 she only knows their family and love, because she's an amazing little girl who has thrived in their care. Because it is right to make legal what is already true in reality. Because, like the two examples above, they found themselves at the point of need, and did not turn away. In the current climate of awareness of the abuse of children, international adoptions in East Africa have become very difficult. Their final hearing was Friday, the verdict will be rendered mid-April. Yesterday I read about Mordecai and Esther, and it reminded me so much of this situation, a chosen and precious girl, adopted by her uncle, who goes to great lengths and risk to protect and raise her. Pray our neighbors would be legally granted this smallest already-member of their family.

These are all saints-over-50, taking risks, laboring, not resting. Pray for God to strengthen and bless them, so that they stand firm as the world around them shakes.

Limping for Lent

Lent came upon us last week, and like everything else in this new job/country/language/life, it hit me unprepared.  The church calendar is not a big part of the kind of protestant evangelicalism in which I was raised, with the suspicion of all things too-high-churchy.  But I appreciate the yearly structures of celebration and remembrance, which seem to be part of how we're created, to need communal rhythm (as in all those Old Testament feasts).  Lent is a time of preparation, borrowing from the 40-day examples of Moses and Isaiah and Jesus, a withdrawal, a fast, a challenge, an approach to God.  Fasting serves to declare, experientially, that the things which seem to bring us life (food, drink, sleep, pleasures) are expendable because they are not real life.  Real life comes from God alone, and sometimes when we leave behind the props and are forced to fall upon Him, we become more aware of that reality.

So Ash Wednesday came, and went.  I found a booklet I bought at Wheaton during our Chicago visit:  A Clean Heart Create In Me, Daily Lenten Reflections from C.S. Lewis.  A verse, a thought, a prayer.  And that's about all I did, while I read about friends embarking on vegan diets, or writing challenging blog posts about sacrificial service.  Lent light.  Lent for the weak, the just-coping. Lent while still eating chocolate, and it seems pretty wimpy. Surely I could do more to generate a sense of dependence upon God.

Then I got to the third reading:

Fasting is a different experience from missing your dinner by accident or through poverty . Fasting asserts the will against the appetite--the reward being self-mastery and the danger pride . .  

Ahh, pride.  That is the reason I feel uncomfortable not doing something bigger for lent.  And then I realized, I am fasting from something this lent.  I'm fasting from feeling on top of the game; I'm giving up competence for lent.  Because these two months at Kijabe have been ones of NOT doing a lot of things well.  Friday the resident in the ICU asked me to help her get an IV in a child, and I failed, and had to call in one of my more experienced peers.  On rounds I suggested a change in therapy that someone else questioned, and then I saw they were right, my idea would have been harmful.  At about midnight last night I was called in for a blue, floppy, not-even-really-gasping baby slimy with meconium, and when I took too long trying to intubate, the anesthesia nurse jumped in and took over, and did a great job.  It seems like every day, every few hours, I'm confronted with something I should know but don't, someone expecting me to be competent in something that I've long forgotten.  I mean to study my Swahili, but there never seems to be the right time, while Scott organizes his notes and comes out with great phrases I just listen.  I barely get meals together, and I have lapsed in lots of communication.

After we were here a few weeks, climbing up and down these steep hillside paths, I got a pulled/strained muscle in my hip which made me limp, and prevented exercise for a couple of weeks.  It is now resolving, but at the time it was rather painful and inconvenient.  It did remind me, however, of Jacob's wrestle.  He had a similar injury, and walked with a limp ever after.  

Encounters with God are like that, sometimes.  Damaging to competence and strength, leaving us wounded, reduced.  This year I guess I don't need to buckle down and find a nearly-impossible challenge to generate a sense of unworthiness, the reality of that is close at hand.  

For this lent I'm limping, towards grace.  Towards Good Friday, good news for the poor in spirit.  Towards Easter Sunday, resurrection making new strained hip muscles and marginal medical abilities, resurrection reviving smeary choking babies and damaged relationships.  Lent, a valley in the shadow, approaching the light of the table, even if the gait is a limp.

sports-woman-ship

Today, beautiful sunny day, late afternoon, loading up the car, following two vans and a big bus, to the International School League Sports Finals in Nairobi. The biggest school, Rosslyn, hosts the final matches, the top two teams in each category, narrowed down after a 3-month term of play and a series of semi-finals. Boys and girls, varsity and JV, basketball (boys), football (soccer) (girls), field hockey (both), and swimming (a more limited number of schools with pools, not RVA). RVA made it to the finals in boys' basketball, JV and Varsity, and girls' football, JV and Varsity. A traffic jam of schools and parents streaming into the school grounds, teams swarming, kids from Africa, Asia, Europe, America. Coaches, balls, whistles, screams, cheers, friends, claps, laughter, dust flying, colors.

We locate the JV girls' football field, and mill about with parents, waiting. Shouts erupt from the gym and we hurry over to catch the opening five minutes of the boys' varsity basketball, but then Julia's game starts and we hurry loyally back. We play Peponi, definitely the best team we played in the regular season, and the winner of their group as we won ours. The RVA girls come out strong, a more confident and active team than the tired girls we saw at the end of the last match. Their coach has done a great job, the growth in the team is clear, and they are ready for the final push. Twice we apparently score, but it is called off, a questionable off-sides and a hard-to-see other call. Undaunted they play on. Julia takes every corner, goal kick, and free kick, always running back to her defensive position as sweeper. She lobs corner after corner into great positions, and the team does a much better job of being in the goal box and playing it in. Late in the first half there is a penalty not too far outside the 18 yard box. We know Julia can score from there. And sure enough, she does, a strong solid on-target kick, the keeper gets her hands on it but can't stop it. We're ahead 1 to 0. The second half is a well-fought battle. Julia twice saved goals by kicking the ball out of the goal at the last minute after her keeper had been beat. All the girls are playing hard, sprinting, reaching, pushing themselves. When the final whistle blows, they are elated. They have won the season.

RVA won three of the four events they entered, as well as sportsmanship awards in all the teams that came, plus the overall school sportsmanship award (voted on by all the players and coaches). We only lost the boys' varsity basketball, and that was by one basket, down to the wire, an impossibly close and exciting game.

Rejoicing that our kids can participate in sports. And not just in sports, but in sportsmanship, in applauding their opponents, respecting the referees, honoring the coaches, supporting their classmates. And watching our daughter score the winning goal of the season was a pretty sweet gift, too.

International Women's Day

On this day, we recall that it is more likely a girl in South Sudan will die giving birth than graduate from high school.

On this day, we reaffirm the Gospel that calls out good news for the women of Sudan and Uganda and Kenya and Burundi and beyond, the hope of dried tears and justice, the comfort of real love.

On this day, we honor women like Melen Musoki, wife of the late Dr. Jonah, who three years ago this day gave birth to their only son, months after he husband had died of ebola. She labors on with her nursery and primary school which provides a head start education to many of our friends and colleagues in Nyahuka, with her five daughters all in various boarding schools, with her management of the family farm, with her tenacity to protect her children from the greed of relatives who would cash in on Dr. Jonah's compensation.

On this day, we stand humbly beside the moms in the hospital, those that hover in this grey realm of having brought life into the world but unsure how long it will last, those sleepless patient women, who gather courage in the midst of foreign beeps and screens and monitors and tubes, to touch their babies. The lady with AIDS whose rocky post-partum course dried up her breast milk, whose husband abandoned her and her older children, who labors to feed her precious baby D. The lady with what looks like metastatic ovarian cancer who is too weak to get out of bed, but requested that the staff slip her feisty little preemie P out of her incubator and wrapped in warm blankets for a glimpse today. The eighteen-year-old with cute braids and a simple smile who cares for her devastated toddler, his brain severely damaged, his face half-eaten by infection, on morphine and fluids for comfort, death inevitable but slow. The mom of Baby N who spent her 95th day in the NICU today, plugging along with feeding and growing, up to 1700 grams (3 3/4 pounds). The new mother of twins, delivered too-early, one pink and calm and perfect, the other fighting hard for her life, ribs pulling against non-compliant lungs, tiny fists batting against her oxygen tubing. All these women, every two hours, day and night, around the clock, coming in to sit by their babies' incubators and cots, to squeeze out life-sustaining breast milk and drip it through naso-gastric tubes, or to hold the larger babies and breast feed them.

On this day I remember the international team of women who have been friends and mentors and prayer warriors and encouragers. Who cooked food for our family, who planned school or taught it for my kids, who read our blog and cared as if it really matters, who planted flowers to welcome us back from furlough or sorted umpteen ages and sizes of baby clothes when I was overwhelmed, who stepped in to care for our team and kids in crisis, who listened and prayed and biked and walked with me, who showed up to work in chaos so I wasn't alone. Women from Uganda and America, and a few places in between. Nurses, teachers, counselors, missionaries, neighbors, friends. And most especially, my mother and Scott's.

On this day we ponder the wholeness of the nature of our God, expressed in the paradox of male and female, a celebratory dichotomy and an essential equality.

And lastly, on this day, we cook breakfast and sort clothes, we examine patients and xrays, we chop vegetables and sweep floors, we answer homework questions and wash dishes, because it is, after all, women's day.

In Praise of a Home

I am wary of feeling at home.

Which is probably only to be expected, seven thousand miles from where I grew up, and a country away from where I spent the most significant portion of my life since. And after leaving our only home as a family. And after being on the road and in transition for the better part of a year. And ascribing to a theology summed up in the antique cross stitch over my Virginia bed: Heaven is my Home.

But it is creeping into my heart anyway, in spite of my guard. I must confess, I love this little house at Kijabe. As I write now I've just cleaned up from a Sunday post-church chocolate-chip-pecan waffle brunch with neighbor's kids whose parents are traveling, a lovely hour of family and fullness. Fragrant, exuberant lilies and bright yellow zenias explode from a beautiful blue vase that Pat gave us: a perk of living near the massive flower farms that supply Europe from Africa, one can buy spectacular flowers cheaply, year-round. My dining table and chairs match, an island of harmony. There are wide bright windows that overlook a yard with a poinsettia tree, sparse dry-season blooms and grass. We have two comfortable couches that turned out twice as nice as I expected. The floors are a wooden parquet or tile, no exposed rough cement. All three kids are quietly reading or studying or playing guitar, in three separate bedrooms, instead of piled on top of each other. We have hot water for washing, electricity most of the time, and the most awesome washing machine for clothes, with a sturdy line out back for drying. We have two bathrooms for the first time ever, a perk when we're all trying to get out the door by 7:30. Not a single rat spotting since we moved, nothing worse than the occasional roach or harmless small spider or fly. I'm told there are no snakes at this elevation, either. Books and pottery on the shelves, and photos of Uganda and family on the walls. I really like it.

Yesterday, I was walking back from early morning Saturday rounds at the hospital. . . .I had just spent a couple of hours in the NICU, making the difficult decision to pursue comfort measures and time for her parents to hold her rather than aggressive intervention for an infant born with such severe hydrocephalus at another hospital that the OB's had to literally pop the balloon of her head to get her out and save her mom. This sweet baby had minimal and abnormal brain tissue on CT, and after a week of care was only getting worse, with periods where she stopped breathing and had to be resuscitated. We have one of the premier pediatric neurosurgeons in the WORLD here, but even he could not recommend any surgical help. I had also just gone over plans for another infant with another experienced pediatric surgeon, this one born with no anus and a confusing perineum, unclear male or female. On another baby we were increasing our oxygen and pressure to maximum levels, her lungs and body damaged after being born at home with a difficult labor, choking and aspirating, limp and uncrying, and five hours later landing in our care with a temperature of 33 degrees (that's very cold) but alive. We have darling preterm twins whose mother was just released from the adult ICU herself, narrowly surviving and ecclamptic pregnancy. We're filled pretty much to our capacity with 17 babies in a small space. Scott ended up managing the adult ICU for part of the weekend too, when it turned out that all the docs who usually cover (the most experienced handful here) had an unusual intersection of travel and he was the last man standing. . . . Anyway, as I walked back home about 9 am, the sun was warming the air. I had handed over to the on-call doctor for the day. I looked up and saw our little cream-colored house, waiting.

I was glad at that moment to have been a small part of the care of all these little lives, and glad to be back out in the sunshine, and glad to have a home to return to. My heart was filled with thanks because we had just talked to Luke on the phone, and his Global Health Fellowship for the summer was approved by Yale. He worked hard with his friend Thomas at Princeton to design a research study, to be interviewing Maasai in two areas of Kenya about their traditional medicines, so that medical personnel can be aware of possible effects of these herbal treatments when the Massai come to the hospital. It is a good, solid project, but my heart was particularly relieved because he is now funded to return to Africa! It is odd to be living in a home that 1/6 of our family has yet to even see. So the news that he gets to come back here, even gets his costs covered to do so, was sweet.

Which then made me wonder, why should I be surprised that God gives me a home, and brings my family to it? Why do I keep wondering when it will all fall apart, again? How do I revel in this place of beauty and significance, and yet not hold on to it too tightly? Another missionary mom rode to the girls' football game with me this week (I drove to Nairobi, thanks to Scott's prompting, another milestone of actually beginning to LIVE here, but I digress). In the car she expressed the same thing, having moved here from a very harsh and hostile environment in northern Kenya, from a place where the local kids threw stones at hers to a place with a good school and kind people and useful work and kids on sports teams that we can cheer, she asked God, is this OK? Are we allowed? Yes, I thought, i am asking the same thing. Are we?

As I said, I'm wary. I believe in the all-out lay-down-your-life mode of going through this world. I believe in eternity, and the perspective it lends to daily life in hard places. But I also believe in a Father who does not give a stone when we're hungry for an egg. For this season, He seems to be allowing us to take a deep breath, to learn from others, to have friends, to sit around a table with our kids, to have curtains that match fresh sheets and cozy beds. He seems to be giving us a taste of the eternity we long for, allowing for our finite, concrete, in-body experience.

To be at home.

Thirteen

Today is Jack's day . . . and it seems to be a popular one with Kijabe babies, there were so many being born this morning that the nurses were scrambling to get the ID bracelets attached to their ankles as we stacked them up two to a bed where they lay blinking and waving, waiting for their mothers to revive and hold them. We began our celebrations this morning by breaking out the final tiny 4-ounce jar of apple butter that our kids smuggled through security in their backpacks, to have with our biscuits. By 7:30 the kids were heading up the hill to school and Scott and I to a staff meeting. As I tried to engage in the discussion of appropriate triage of patients, and the structural implications of the nursing school upgrading from a diploma to a degree program under Scott University, I was thinking of how to get my NICU work done in time to finish party prep, and looked around the room. There are three other women consultant-level doctors here on a staff of about 25 to 30, but none come to meetings, and none are really in my position (two are young Kenyans who are married and mothers-of-one, and one is a single American surgeon). It hits me: I'm a mother of four teenagers, as of today. And it's as demanding in its own way as being a mother of four toddlers.

Jack decided to invite his whole basketball team to lunch. There are ten boys on the Jr Hi "A" team, and they finished their last regular game of the season undefeated this week. I am so thankful for this natural grouping for Jack, a healthy way to spend almost every afternoon with a core of classmates. I never dreamed he'd spend his 13th birthday with a basketball team, since he just learned to play a few months ago! They came down the hill shouting and teasing, very comfortable with one another, and thanks to help from my trusty houseworker Abigail and an hour-off from my trusty paeds team, I was ready. We turned ice cream, and ate chili and corn bread, then celebrated with a chocolate cake. Noisemakers, balloons, sodas, laughter, stories. It turns out that Jack was by far the youngest, 2 boys have been 13 for a while and the rest are 14 and even 15, even though they're all a similar size, there is a wide range on the puberty issue (sometimes I try to remember why we let him be an 8th grader, but it's complicated. Should have thought harder about sports). An hour later they all bounced off the walls and into each other and back up the hill to school. It was a fun party, and the first time Jack's had such a large group of peers to celebrate with. This evening we had a family gourmet dinner (Jack does love his food), much quieter than the wildness of the junior high boys. Phone calls from Grammy, the Bundi team, and Acacia. Emails from a CSB classmate (may you live to blow a thousand candles), and absent brother Luke.

Jack at 13: still growing into his body, reckless abandon in all pursuits, intensity, messy, curling up with a book, avid fan of premier league football, affectionate, teaser, handsome, attention-seeking, anxious at times, friendly, popular, loud, sprawling, adventurous, emotional, spiritually sincere, still mostly kid with hints of the young man shining through, sharp and creative with unanswerable questions because he sees things in his own unique way, smart and artistic, unsure of himself, low frustration tolerance, a drive to win. A remarkable person, who surprises and enriches us every day. I am thankful for that day 13 years ago when I walked into Kijabe hospital with Scott as my doctor and delivered him on the very bed where my patients today were born.

Sixteen

Caleb, sixteen, and sometimes sweet (are boys allowed?). Thoughtful, affectionate, affirming. Quiet, needing down time to play guitar, to listen to music. Never quite enough sleep. Aggressive on the field, coordinated, strong, wiry, endurance. Aware. Thankful. Sometimes a loner, not one to bend to the crowd. Keeps his thoughts to himself mostly. More likely to just shut the door and do the work than to complain or ask for help. Quick wit. Sharply funny, in the right mood could be a stand-up comedian, the eye for the incongruous. Still silly.

Today Caleb turned 16, right here where he was born. All three meals a celebration, punctuating the normal work of the day. Culminating in five friends joining us for tacos, chocolate cake, and home-made ice cream (inaugurating the hand-crank freezer that took up the better part of a trunk, 10% of our luggage allowance!). Crazy noise-making horns and bubbles so the HS Juniors could revert to their true 5-year-old souls.

Birthdays wipe me out, carrying the weight of expectation through the day, to push to make it special because I want to honor the person I love. But the rest of the world turns on, punky babies are born and forget to breathe properly, children vomit, mothers are anxious, labs come back abnormal, xrays need reviewed. So the day becomes a struggle to be two things at once, creative at-home cake-baking mom and responsible in-the-NICU doctor, all accentuated by the rigid time-keeping of a boarding school where the friends who come for dinner have to be at dorm study halls at 7, though mercy was reluctantly granted for a 15 minute lateness. Add in a basketball home game for Jack, Scott and I tag-teaming on cooking and cheering and hospital calls (alone I NEVER would have made it). I suppose that tension between the worlds of work and home started back with the first giving-birth and will continue until they are all grown and launched, and beyond.