Marfan Syndrome

My beautiful 17-year-old niece Emma was born with a rare genetic disorder called Marfan Syndrome.  This makes her tall and slender, but also prone to heart disease and eye problems.  She is a brave and confident young woman, artistic, gifted, brilliant, articulate, who takes the rudeness of strangers in stride when they feel obligated to comment on her striking 6 foot 5 inch height, which as you might imagine is a challenge socially and emotionally as a junior in high school.  God has given her compassion and cheerfulness to live with the physical limitations of her disorder.  She is on a heart medicine now, and will be for life.  This week the National Marfan Foundation is competing in a contest for grant funding, which goes into research to prolong the lives of people affected by Marfans.  People can vote for their favorite charity, and Chase Community Giving will distribute funds based on the number of votes.  The deadline is tomorrow, so please click on the following link today: http://bit.ly/jFw0Q4.

Thanks from all our family!

Initiations

Life goes on, and with each week and month we are more settled here at Kijabe.  But we learned in Bundibugyo that painful life lesson #126 is . . . there are always more painful life lessons.  Some aren't actually that painful, some are funny, some are humbling.  So here are a few firsts from the week.

First Kijabe rat--that one had to come eventually even here in Camelot I suppose.  Not as big as our average Bundi pest, lighter gray, about hand-sized, definitely more than just a mouse.  Tried and true technology, the scary spring-loaded wood and metal trap.  No more nibbles out of my tomatoes.  

First time to watch Jack play rugby--in a scrimmage on Friday, he did great.  He's been playing now for a month but we haven't been able to see him before.  The painful life lesson there is probably still to come . . . 

First BlackRock Tournament--we learned that this is actually pretty much the social highpoint of the year.  A large private Catholic Kenyan school hosts an annual Rugby tournament.  I think there were about 30 teams competing, including the Ugandan National Secondary School Champions (who looked quite impressive).  There were tents, music, mediocre food for purchase, loudspeakers, milling fans, vuvuzelas, umbrellas (first for rain and then for sun), shouts and cheers as usually 4 or 5 games were being played simultaneously.  Buses poured in, private vehicles were parked in a field.  I saw many, many families from RVA, probably more than from any other school, including lots of people without any kids playing who were just there to support and enjoy.  Kids painted their faces; dorms of girls had created matching shirts in RVA colors.  RVA varsity has a tradition of all shaving their heads the day before, which makes them suddenly quite hard to distinguish on the field of play, a lot of strong boys dressed in the same uniform with the same shiny white or black skulls.  The varsity Rugby team won both games in their first round, then advanced to quarter-finals in the "cup" tier which is the highest.  They played a well-fought and very even game, but in the last ten seconds (literally) the other team scored a try, and they were out.  Seniors pretty much crumpled on the field in grief.  JV entered too, even though they'd be playing varsity teams from other schools (talk about scary).  They won their first match and tied the second, barely losing to a very good school.  So they advanced to quarterfinals in the "plate" tier (middle), where they tried hard but lost definitively to another stronger team.  Considering that they're significantly younger and less experienced they did well.  Some moms there cover their eyes and say they can't watch their sons go into the fray.  Maybe it's being a doctor, I don't know, but I found I'm not that way.  If something happens I want to see it and be there.  I did wince when Caleb was tackled particularly hard . . but also cheered when he ran forward with the ball, or tackled others, or punted well.  

First total mix-up in communication with my new partner--to make a long story shorter, when Caleb made the rugby team we asked to be off this weekend, but the acting medical director said she couldn't manage that but would put us on call (both) with a family medicine resident so we could still go to the tournament . . .  then the call schedule changed a bunch of times, and on a later version she had stuck Mardi for the weekend instead, at a point when Mardi wasn't even going to start normal work until June . . .  Even before Mardi rescued me during my sickness last week I told her I'd still do the weekend if she could "just" back up the family medicine resident in daytime hours on Saturday while I was at the tournament . . but having never been to BlackRock, neither of us realized how many hours that would be.  But I went in at 6:30 am thinking I could tie up all the loose ends before we left.  By 8:30 a.m. my family was already in the car itching to go, calling me to find out when I was coming out of the nursery (it's about an hour's drive to the games).  By 9:30 I was still dealing unsuccessfully with intubating a baby in respiratory distress, not a small problem to leave to the resident, so I reluctantly called Mardi for help before I was disowned by the carful of people waiting to leave.  She graciously came in, but it turned out that she had thought she was just covering in the afternoon . . .  so when she ran over to the hospital HER kids were left with the houseworker . . not happy . . so I left in a very discombobulated state of regret.  God is so gracious.  The baby turned a corner, did well all day, I think there were no other crises, and I was able to get back and deal with things last night and today.  In any working relationship there will be hurdles of communication . . just sorry to have made one so early in my job-sharing effort!  Note to self next year:  plan further ahead around BlackRock.  Everyone else does.

First Java House Expresso Shake--I've heard of them before . . but now I have tasted.  There was a half-hour lull between scheduled RVA matches, not enough time to go eat.  I had had nothing all day, since I went into the hospital for those early rounds and never left until I was picked up on the way to the tournament, and arrived as the first game had already started.  Scott had the good idea (when I kept saying how hungry I was) that we would run to the shopping center a couple miles away and just do take-out milk shakes. Well, with traffic and lunch crowds that still took some time . . but it was so worth it.  I'm a believer.

First Summer Job for our kids--Luke worked as a tech advisor in the library last term, but then he got a short-term well-paying job moving furniture for Yale for a couple weeks after school ended.  We are proud of him for doing what he can to earn some money.  Ironically in that place of brains, this is a pure brawn job but was highly competitive.  He's surviving on cereal, orange juice, and take-out since the cafeteria is closed.  Only one more week from today until he lands in Africa!

First major health screening clinic day--We roped in six other doctors and in a couple of hours the eight of us examined all 70-some seniors for their pre-collge physicals, and the five nurses did 70-some PPD's and 70-some meningococcal vaccines.  It was actually pretty fun to have a little time one on one with a number of seniors, talking about their future plans as well as important adolescent health topics like risk-taking behaviors, alcohol and driving, sex and abstinence, body image and eating disorders.  I really like teenagers.  

Every week in a new place brings many firsts.  Glad to be mostly done with "first major febrile illness"  . . and "first xray" as Caleb hurt his hand in a game last week but it wasn't broken.

New Life, Day One

When we moved to Kijabe Scott and I were theoretically sharing a full-time position, meaning each of us would work half time, though in different areas of the hospital.  This was to allow Scott to invest the needed hours in being a WHM Field Director, and I had dreams of being a more available mom, of processing the last couple of decades by writing, of living at a healthier pace.  Everyone was very supportive at Kijabe, also in theory, but we were each assigned full solo consultant responsibilities for busy services and normal call schedules.  Except for the two weeks off to go to Uganda, and a couple of days for Burundi, we've been fully present.  At first I tried to get my hospital work done in half a day but soon realized that was impossible.  I do love the work, and many days I would not have chosen to miss any of it, but I also see the shrinking time left with my teens, and know I've been pushing too hard.  When I got sick last week it was a pretty major forced slow-down.   But in God's amazing timing, that illness came exactly as my new best friend Dr. Mardi was getting settled at Kijabe.  We had planned a slow transition into work for her in May with real job-sharing beginning in June.  But she jumped into the gap and found she was needed and appreciated and able to manage.  So this week we are, for the first time, giving the job-share a go.  

I'll work Monday, Tuesday, and Wednesday up to mid-afternoon, then hand over to Mardi.  She'll finish Wednesdays (nice because sports events are often WEds afternoons) and then take over Thursday and Friday.  We'll take turns doing Saturdays, so some weeks she'll hand back over to me on Friday afternoons, and other weeks we'll touch base on Sundays before I start back on Monday again.  This allows her to do preschool/playgroup things with her small children (ages 2 and 4), and have focused Swahili time as well.  

Today was the first day of the rest of my life. After morning Swahili lessons when I would normally be rushing to start rounds and answering pages . . . I instead said goodbye to everyone else and stayed home.  I spent about two hours sitting at Scott's desk reading and pondering and editing something he's writing and had asked my input on.  I worked on some administrative details for the Africa Field retreat we're planning in August for all our WHM missionaries in Africa.  I went through the top ten or fifteen flagged emails and crafted some answers. ( This is the kind of thing that I otherwise only do from about 9 to 10 at night, which is not a great time for clear thinking. )  After that productive time I BAKED COOKIES, which seemed like what you might hope your mom would do if you were a teen and she was having her first morning "off".  Molasses, a favorite of Jack's.  I helped Abigail make rice and beans for lunch, and had the food on the table when the kids came in from school (they come home for lunch about half the time, and eat at school the other days).  Thursday afternoons I'm still on duty as the RVA doctor, so I headed up the hill after lunch to the weekly clinic for students.  But when that was over at 4, I WENT FOR A RUN with Star, plodding slowly along a narrow descending path through the woods, and then heaving even more slowly up a rough steep twisting road back home.  Then I made TACO SOUP for dinner.  Writing, baking, doctoring, exercising, cooking.  And mostly just the relief of  not having the tenuous fates of 20 tiny babies on my shoulders, not rushing to push through rounds and track their care while still worrying about the hundreds of RVA students and the needs of my family.  This, perhaps, is how normal people live their normal days.  It's nice.

Tomorrow beckons.  Prayer out among the flowers in our yard is my first hope, to listen to how I should use the gift of this time.  By Saturday we'll be back to the pressure and rush, early rounds, and on-call all weekend.  So looking for sabbath tomorrow, and hoping that I'll be able to keep the boundaries of sanity in this life.  Thank God for Mardi, an in-the-flesh testament to the God who hears and sees and knows our weaknesses.  If He plopped her here all the way from Australia, surely He will along with her freely give us all we need.

Gateway to Eternity

Today was non-stop, before I even made it to the hospital I was called about a new baby admitted during the night with complicated kidney disease and worrisome blood chemistries, but he soon proved to be one of the more stable patients of the day, which at this point 14 hours later sort of blurs into a continuous mix of babies with minimal gaspy sort of breaths, babies with failing hearts, babies with inexplicably low sodiums, babies with heartrending anomalies. And two babies who simply could not make it. Two deaths in one day makes for a very very draining time. The first was an infant only three days old, we got the call from casualty and my colleague wisely advised them to just send the baby on to nursery. Stanley came in, as most do, heavily bundled in multiple layers of clothing and thick blankets, which I peeled back as I started to get the story from the mom. But on peeling off his obscuring clothes I found a very yellow little 3-day-old, with short intermittent ineffective shallow breaths, and a quick listen confirmed his heart was dangerously slowed down. So began a several-hour saga of attempting to save his life, unsuccessfully it turns out. Anand intubated him, but the ICU could not help us, so we just kept squeezing the bag of oxygen to expand his lungs manually. Mom later told us that he had been febrile even when he was discharged from another hospital post-delivery, which is scandalous, ignoring a fever in a 1-day-old. So he'd spent 48 hours at home fighting off infection and losing the battle, until he was too weak to even feed. Looking at his scary-yellow glow we knew an exchange transfusion was inevitable, so we asked Paeds surgery to put in a line right away. Stanley had fluids and antibiotics and tests sent off, but just when I had finagled a ventilator on loan from the ICU and ordered the blood for exchange, Anand noted that in spite of pretty decent numbers on the monitor Stanley was no longer moving. He had no heart rate. So we gave CPR and 4 rounds of cardiac-stimulating medication with zero response. He was gone. His dad took the news harder than his mom, who had probably concluded in her heart since his day-of-life 1 fever that this child would not survive.

An hour or so later we were in xray with our kidney patient when we got the dreaded "999" pages to the nursery. Anand and I ran through the halls to find Nelly blue and limp. Nelly has been our patient since her birth more than six weeks ago. She was petite and fragile, with disfiguring clefts in her upper lip/nose on both sides, and some minor anomalies of her spine and fingers and toes. But her biggest problem was her heart, a hidden and serious malformation. We have walked a tightrope with her for the last month, titrating doses of cardiac meds, almost losing her numerous times, trying to get her to cardiac surgery experts (she's the one who came back after attempted transfer because the money demanded was impossibly high and the care less personal in Nairobi). Her beautiful mother and "do everything you can" caring father were constantly at her side. Usually when she became agitated and hypoxic her mother could calm her down and we would see improvement. But not today. Her heart just gave out, basically, becoming more and more tired, less and less functional, until it stopped. Her dad stood by us for the last hour or so of her life as we tried all we could do, and understood. Her mom simply cried her eyes out when it was all over, which is exactly what I would do. I love seeing how parents can wrap their hearts around a baby like this who is so tenuous and abnormal-looking, so precious and loved.

And while we were working on Nelly, an intern who was hovering nearby finally said "you're probably wondering why I'm here" (I wasn't, but that's OK) and told us the sad condition of a one-day-old who had also just come to casualty. I knew the nurses were at their limit (we had 20 on the service at that point) but asked if we could admit just one more . . and we cleared the body of the first baby away just in time to repeat the same story, newborn, high fever, not feeding, unwrap and find a baby convulsing and desperately ill. This one though was still breathing well, and still with a stressed rapid heart rate rather than a declining one. So our day ended with another all-out push to investigate and treat, to give fluids and antibiotics, to stop convulsions and modulate temperature. When I left about six this baby was still alive, so I'm hoping she can pull through. I thanked the bustling charge nurse for taking on yet one more admission, and we agreed that if we had declared the nursery full and transferred the baby from the emergency department to another hospital, she would have been dead before arrival. Still a very hard decision to make when we can barely manage the ones we already had. Not even mentioning the baby delivered in our own hospital this morning who would have died without resuscitation, or the one from yesterday with a similar story of rescue.

The nursery is an interesting place, in many ways a sort of intermediate station or gateway between heaven and earth, a territory where little bodies and souls seem to be only partly inhabiting one sphere or the other. A place where we watch in awe as the improbable healings occur, but also choke on our prayers with grieving parents as the reality of loss sweeps over them, where we clean up and move on to the next needy person.

Africa United

A few weeks ago our WHM colleagues in London sent us a DVD called Africa United. Chris and Josephine, thank you, and happy birthday to Chris today! In honor of the day I am posting a plug for the movie you sent!

The movie weaves the lives of a handful of African teens who are thrown together as they attempt to get from Rwanda to South Africa for the opening of the World Cup Football games. The main character is a plucky, conniving orphan, self-appointed "manager" of his very talented football-playing friend, who has been invited to try out for a youth team called Africa United to be featured in the opening ceremonies. It's more fun to watch than for me to tell why they end up on an odyssey of every form of transportation from foot to boat to ox-cart to truck. But it's a great movie for several reasons. First, it's shot completely on location in eastern and southern Africa, and feels very authentic. The actors are African, a couple were growing up in England but the rest were found by talent searches in Rwanda. At one point the kids start singing a gospel tune as they ride on a truck, and all my kids just brightened up, it was a Swahili song they know from church (seeing something close to their daily life in a movie is not a common experience for MK's). You see a good cross-section of Africa as you watch. Secondly though, this movie fulfills my key requirement: redemption. The characters actually develop as they go along, and there is a powerful scene where one faces the evil he has done in the past as a child soldier, but is still welcomed into the group. Eventually their acceptance heals his scarred heart, which is the Gospel message. Thirdly there is a healthy theme of friendship, of working together, willingness to lay aside individual glory for the good of the community. There is one scene that promotes a not-so-great "listen to your heart not your parents" message, but if you can get past that, it's a movie full of courage, love, perseverance, loyalty. And lastly, there is a repeating creative parable sequence that breaks into the live-action with cartoon.

(Because the themes include AIDS, prostitution, war, and loss, it is appropriate for teens or pre-teens who are aware of the world, but not for younger kids.) Hope this movie gets a wide audience.

sick time=internet time

Finally an afebrile day, which is a huge plus, even if the stomach rumbles and cramps have yet to subside, there is progress.  And the drop in temperature coincided with a functioning internet access (no small thing) so I actually answered some emails, and replenished my Kindle (THANK YOU friend who made that possible) with lots of free classics and a few new reads.  And here is a link to check out, courtesy of our WHM renewal department:

Acts 29 Pastor Daniel Montgomery Talks About How God Used Sonship in His Marriage and Ministry:  http://bit.ly/jHNduq // check it out!

Meanwhile just resurfacing enough to realize how un-Job-like I am in even this minor illness, I'm more like the friends, wondering what went wrong, how to avoid even this level of suffering. And even as I type this the chills are coming back.  Sigh.  Praying that the rest of the family continues in health.  Praying that everyone doing my work (Scott at home and Mardi at Kijabe) will not get too tired of it, even as I grasp the hard way that the world goes on quite well without me.  Wishing I had something a bit more profound to have realized in 3 days of inactive silence, but hoping to at least remember even in a febrile fog that God is God, the main message of Job.

Down and Out

Haven't been feeling so well for a few days, and then at 2 am the fever just shook me right out of bed.  I can't remember the last time I spent 24 hours straight in bed.  And it's not over yet.  Not malaria (test negative), just some random virus I guess.  Meaning that Scott has had to work and then provide the meals and clean-up and homework help alone, including a little Bday party for a neighbor whose parents are on furlough.  And meaning that my paeds team friends graciously covered the work of the day and my call tonight.  

AND meaning that we missed Jack's first rugby game, and Caleb's second.  We're 0 for 3 now in attendance, which is rather painful, as it was supposed to be one of the major perks of being here, and makes me wonder what God is telling us . . . The teams are however 3 for 0 on wins.  Caleb scored 7 on conversions and a penalty kick in his team's 22-0 victory.  Jack scored 3 tries and 3 conversions which should add up to 21 of his team's 45 points (he's a little vague on the details).  All those people who told us all our lives "that boy should play American football" . . well, this is the closest he'll get, and he's loving it.  

So, as the fever starts to climb again, retreating under the covers for yet more sleep, and hoping to emerge for Julia's volleyball game tomorrow (oh, and clinic, though I probably won't expose the nursery babies even if this thing resolves by morning).  Pray for Scott to be miraculously protected from this bug, and the rest of the family.  

Angels in Charge

In a second, our life almost changed.

We were heading into Nairobi for Caleb's first rugby match. Caleb had gone on ahead on the team bus, and Scott, Julia, Jack, Joop (friend of Caleb's) and I were in our vehicle driving to the International School of Kenya, on the outskirts of the city. We had come back from our overnight about noon, quickly done some prep for the dinner for our caring community that was to happen tonight (family time for boarding students, we have a group of 9 who spend an evening with us now about once a month or so), and then jumped in the car and headed out again. Driving in Kenya is not for the faint of heart, and in spite of rugby's violence I had said this week that the most dangerous part of the game was getting to it on the road. This was Scott's 5th trip into Nairobi this week, which is exhausting. We had almost reached ISK when Scott slowed down and turned on his signal light to turn right (remember we drive on the left, the driver's side is the right, and turning right means crossing the lane of oncoming traffic). The cars behind us also slowed, no one was coming, and he was about to turn into the intersection, when I heard an ominous, impending whoosh and saw something out of the corner of my eye, swooping forward in the same direction as us, but at high speed. I yelled, Scott jerked the wheel back, just as we impacted a racing lorry full of sukumu wiki (the cheap popular Kenyan spinach-like green). The driver, who it later became clear was slightly under the influence and not overly-bright, must have seen the cars slowing and decided to pass all of us. He of course didn't notice our signal light, or think to himself that it would be illegal or at least unwise to pass in an intersection. There was a loud bang and a jolt, but we were all fine. The truck, having passed us now, pulled off the road and so did we, and we both got out to inspect the damage.

The massive "bull bar" metal grill on the front of our vehicle was bent in half and sticking out at a 90 degree angle, ready to snap and fall off. And we had a dent and some scraped paint on the front right corner. The truck had matching streaks of white paint from their front left corner back towards the passenger door. The truck driver immediately began blaming us. We told him he was at fault, but we didn't want any money from him . . however if he intended to blame us we would call the police to settle it. Calling the police in Kenya is never simple. For one thing we had no idea how to reach them. For another they could have decided anything, so it was no guarantee that they would help us. But we didn't want to risk this driver or the truck owner later trying to sue us, their golden chance to get rich. It took about an hour and a half. . . meanwhile we were missing Caleb's game. We actually had a lady in a shop call us a taxi, and put Julia, Jack, and Joop in it (Joop is adult-ish) to go on to the game, sensing that the mess would take long to untangle. It was pretty wrenching to get messages from Joop at the game and find out that Caleb scored the first "try" (touchdown for those in America) of the season, and of his career (this being his first real game) and then kicked two conversions (field goals). And we were missing it, stuck on the side of the road, with a damaged car, hot sun, the inevitable drunk and mentally ill bystander who hassled us continuously, a stubbornly unreasonable driver, and his very kind pastor passenger who just kept trying to mediate some peace between us, dreading the involvement of the police. I texted about five friends to pray.

Well, to make a long story slightly shorter, the owner of the truck finally arrived bringing the police, and they were all respectful, thoughtful, calm people. They took statements, inspected the damage, looked at the marks and paint on the road, and found the lorry-driver at fault. No roadside breath tests, but I'm sure they could smell the alcohol involved too. The police wrote up all the details on plain white paper and told us we would have to come to the police station if we wanted an official report, they kept asking us if we were planning to file one with our Kenyan insurance, and Scott said no, our coverage was for third-party damage when we were at fault, but for this dent and front end work we would cover it ourselves. They dismissed us at last, possibly in order to then press the truck-owner for money in lieu of issuing fines and citations. Who knows. I felt bad for the truck-owner, since we weren't trying to get him in trouble with the police . . but I am consoled that perhaps this driver would have killed someone soon, careless and slightly drunk, so it was best to involve officials to get him off the road.

We arrived for the last minute or so of the rugby game. RVA was winning so dramatically by half, and the other team had an inadequate number of players, so the coach asked for volunteers to switch sides, and we found Caleb in an ISK uniform. As he climbed into the car, with raw skinned knees, limping, happy, having played very well in his debut, he gave the quote of the day: " the thing I love about rugby, you look down at your arms after a game, and you have no idea if that's your blood or somebody else's . . . " Yikes.

At first I confess I was bitterly disappointed to be spending the afternoon on the roadside, missing the game. Scott noted the pattern in our lives: whenever we would go to Semliki Safari Lodge for our once-a-year birthday/anniversary get-away, we would have drastic car trouble on the way home that erased all our rest and turned the journey into a survival challenge. Here we were again, a few hours from peace and cottages and fireplaces and flowers and delicious food and friendly conversation, thrown again into the hassle and danger and uncertainty. We were frustrated with the aggressive driver of the truck, unsure of how to proceed, at the mercy of the police. Vulnerable and shaken. But by the time we drove away, though, we were just thankful. Thankful to be alive. A few more degrees into the intersection and the full-speed impact of the heavy lorry would have hit Scott and Jack' side head on. They could have died. We could have spun around and lost control, or involved other vehicles. We could have had a car that we were unable to drive away. We could have been unjustly blamed, taken to jail, fined, who knows what else. Yes, we missed the glory of the rugby game. But we were alive, intact, innocent, and free to go home, no small thing.

The words from Psalm 91, that Patrick gave us during ebola, echo in my heart tonight, "He will give His angels charge concerning you . . " Once again we were so close to disaster, but walked away unharmed. We don't deserve such rescue, but we are thankful that the angels in charge of us pushed us from devastation to inconvenience today. Sobering.

and made them cry

Tired of making moms cry.  Post-partum women are emotional, so am I, but it isn't fun.  Last afternoon it was the mom of a baby delivered breech at another hospital, only they couldn't get the baby's head out for about half an hour after the body was delivered.  Half an hour of no oxygenated blood to the brain is pretty devastating.  Babies are resilient, but I don't think this one can make it.  It is so hard to find the balance between leaving room for miracles, and not giving false hope.  When the silent tears start to drip down their face, as they lie in their beds, in pain and alone, I know they understand the gravity of the situation.  Today it was a frustrated mom who just wanted to go home and couldn't grasp that her febrile baby could die if she left.  I am rarely so adamant, but I could see she was irrational, and she would someday be glad someone pushed her to a little more patience.  

One last call from the hospital and I'm out the door.  Scott and I have our 24th anniversary Monday, and Dan and Gini who are visiting had their tenth yesterday, so we're all four going to a nearby inexpensive cottage/garden/dinner sort of club where we can have an evening of friendship and an overnight away.  Three teens home alone.  Caleb with SAT's tomorrow, then his first rugby game, then we have a dozen teens for dinner tomorrow.  So praying to find an intake of breath, of spirit, of grace in the next 12 hours.  Prayers appreciated.

+ and -

+ Kangaroo Care--this is how we had moms incubate preemies in Bundibugyo, and it is a well-proven boost for small infants. However at Kijabe with its big plastic warming boxes, monitors and alarms, few moms seem to take our suggestion. So I was very happy today to see that after I had put one preemie skin-to-skin under his mom's gown, I found two moms holding their babies that way. Samuel and Precious are both feeder/grower types, out of the worst part of the dangerous woods, but still vulnerable. Both babies gained an ounce since yesterday.

+ Noreen, came back for a check-up, now quadruple her 620-gram birth weight. And no longer jaundiced. And with beaming parents.

+ I asked Julia to bake cookies with our part-time houseworker during the school break hoping she could teach her how. Now the kids are back in school. And I'm not exactly relaxing at home baking cookies either. So I asked Abigail if she could try. Abigail is wonderful, a dose of mopped floors and wiped shelves and folded clothes that helps us survive. But she is extremely reluctant to COOK. So I was quite delighted (as was everyone else) to come home and find three racks of perfectly shaped and baked colossal cookies waiting.

+ Taught the lunch conference today, and felt very ill-prepared. Just as the intern who was to present the case stood up, he was paged to the delivery room, leaving me on my own. However there are several new residents rotating from the USA, and one in particular kept nodding, answering questions, and appearing generally interested and encouraging. Perhaps this person AWLAYS looks that way, but it was very helpful when standing in front of a few dozen medical students, interns, residents, and even a couple of consultants, to TEACH, to find someone tracking with me in such a positive way.

+ Star, our dear old dog, who loves us. Nice to have a living creature so excited to see me every morning. Nice to see her revel in her new environment, runs and space and exploration.

+ Half-way through the first week of rugby practice. Major abrasions needing bandaged, concern about a banged nose (not fractured), one lost toenail, one jammed finger. But all that is pretty minor. No broken bones or concussions or major blood loss. Yet. This sport is a bit of a medical-mother's nightmare. I try to remember how much they love it (the camaraderie, the teamwork, the exercise, the proving oneself) and try not to focus on the injury potential.

+ First JV girls' volleyball game. Julia did quite reasonably well. We were the only fans for JV, so we cheered a lot. The girls won 2 games to 1. Varsity plays best of 5, and boys and girls both won there too.

+ Caleb finished AP chem and calc. He's exhausted. Me too.

+ Went to the first delivery of the morning--full term twins, babies being born to a 40 year old mom with no previous successful pregnancies and a lot of loss. One boy and one girl, pink and squalling, very alive. Nice.

- Chapel ended this morning with a security announcement, which went something along the lines of, "the one who was killed has many brothers who come to our hospital, so keep a careful eye on them." It felt a little creepy, a little racial-profile-prone. I tried to imagine the thin mother of our baby with severe bladder and bowel anomalies as part of a plot against Kijabe. Couldn't see it. Yes, we have a significant patient population from an unstable m.sl.m country. But they come because they have sensed love and care, not because they want to overthrow or destroy. And most of the convicted Al Qaeda after the embassy bombings in Kenya, or other bombings in Kampala, do not appear middle eastern or north african. They look like everyone else around them, which is how terrorism works.

-Reading blogs and fb and talking to Kenyans about Osama's death. Felt guiltily unpatriotic day one when I didn't want to rejoice. Now feeling relieved by people like Grant Walsh who are introspectively trying to apply some of the tough Jesus sayings (pray for your enemies and those who persecute you) to the current world situation. Justice, it seems, but who really wants justice for themselves? Finding that there are Christians who are soberly cautiously grieved, which seems most appropriate.

- Falling asleep waiting for the slow crisping of granola. Barely keeping up with the food consumption.

-Telling parents of a week-old baby with severe hydrocephalus and total-body infection that their daughter will not survive. Praying Psalm 23 with them. Resisting the urge to soften the truth too much, to hold our the false hope that somehow we can fix all this, the one thing they really want me to say. Exhausting.

-Nelly, below in her traveling duds, a baby with cleft lip and severe heart disease, on day 40 of life and at her parents' request we transferred to a private hospital in Nairobi for expert cardiology management. A 36 hour nightmare later (they asked for a several THOUSAND dollar deposit pre-admission, transferred her to the public hospital, where the impatient dad wouldn't wait for the cardiologist) she came back, weight down a little but miraculously not much the worse for wear. This is a hard medical system to navigate for parents of special-needs kids.

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