LONGONOT!!

There is something about mountain-climbing as a family that we just love. This is the kids' long weekend mid-term school break, but my dreams of exciting and memorable camping trips had to bow to the reality of Caleb's intense school-work load of things due in the next couple of weeks, our post-call weariness, some unpromising weather, and general lack of planning and skill to know where to go in Kenya. So . . . we decided instead to drive to Mt. Longonot, which we can see from our yard, less than an hour's trip away, for a day-hike. The extinct volcano rises from the floor of the Rift Valley to over 9 thousand feet, and the hike from the base and around the rim and back down is about 20 km. The soggy misty cold of the last few days lifted, and we had a gloriously sunny morning. It took us about four hours (which is a pretty typically Myhre-intense pace) to do the circuit, pausing to look at the distant tree-tops below us in the crater, or to scan the dry acacia-strewn slopes for wildlife (saw one giraffe and one probable leopard at a distance). Steep rocky climbs, a narrow ledge of rim, dozens of species and colors of small wildflowers, a diving eagle, swooping swallows, sun, passing clouds, inches of billowing dust with every step, adrenaline moments of running down and peering out, a snack at the peak, conversation, long draughts of water, memories.

Jesus always took his friends up the mountain to get away, and we find it refreshing too. A heavenly dimension of sorts, quieter, different atmosphere, the extreme effort and thin air. Thankful for today. And it's probably a very good thing we're back home and not camping, because as soon as we returned Scott and the boys started working on our long-awaited new pizza oven. Yes, the Bundi tradition shall live on at Kijabe, eventually. It's a big project, but they're off to a good start.

Paeds Team

The problem with hellos, is that they carry within them the seeds of goodbyes.

Departure is the dark side of team. Missions has an inherent instability, throwing people together who are all outsiders and have some degree of temporariness. Add to that the fact that Bundibugyo pretty much chews people up and spits them out, and it often felt like we were always saying goodbye to our colleagues there. Here in Kijabe, we're part of a much larger community, the very size of which blunts some of the impact of the losses. But both of our nearest neighbors are due to leave in July, families with 20-30 years of service here. As is the former medical director who gave us our jobs, and his wife with whom we've worked closely in the RVA clinic and just enjoyed as a person. And the superintendent of the school, who has been here most of his life. Every year has turnover, but many are saying this year will be a record one.

The first goodbye of the season, though, hit very close to home. Anand M and his wife Sophia came here as missionaries from India last Fall. Both were from southern Christian families and grew up as third-culture-mission-kids in the North. Both have a great heart for missions and a connection to Africa. Anand finished his medical internship, and Sophia qualified in paediatric dentistry. And by God's grace they found themselves here at Kijabe. I have worked more closely with Anand than anyone else since I arrived, rounding and pondering and resuscitating and reviewing our patients together nearly every day for the last five months. He's one of those cheerful, competent, can-do sorts of doctors that are a joy to have on staff. And as a couple they invested in Bible studies for the interns. We spent some fun evenings together. In the course of his time at Kijabe he was accepted to a Paediatrics Residency program in the USA, in Cleveland, a wonderful opportunity to further his training. So on Monday we gathered as a Paeds Team at our house for dinner, prayer, and goodbye.

I'm thankful for Dr. Mardi and her family here via SIM for at least 2 years, for Dr. Dan E. and his family volunteering for two months as they transition from a long career in Africa probably back to the States for at least a year or more, and Bob and Lillian the married clinical officer couple who provide continuity and good clinical judgement as the rest of us come and go. I'm thankful for Dr. Immaculate M, who is on a two-month leave so missed the party. But I will miss Anand and Sophia very much. I've had a heavy irritable heart much of the week and finally realized why. Losing a colleague who has become a friend hurts, even for a good cause.

This goes out to . . .

All our teams in Africa, but in a special way to the Massos, getting on the plane today to return to Sudan, and Scott Will, living in Mundri team-less but embraced by the people.  John C, taking his ophthalmology boards today, and his family whom he left in Kenya. Kimberly T, who plugs away in an under-equipped clinic serving refugees.  Martha and George M, taking on interns and a church team and kids-home-for-summer and leading all of those into pioneering ministry situations.  Jessica, figuring out how to live in Bundi, and Anna pitching in to cover for unexpected personnel lost to sickness.  And most of all the Johnsons, who have now reached the 1-year mark of team leadership in a very tough place and are realizing what a toll it has taken.  

And to me, too, at the end of a pretty stressful week.  Almost had a baby die in my hands because in the hour it took to get an xray I didn't think of a tension pneumothorax as he turned bluer and bluer and his pulses faded (I had called in the chaplain and told the mom he was dying from his congenital heart disease, which may still happen, but when I finally got the xray and threw it up on the light box I was so glad to be wrong).  Looking back on our life in Bundi more this week too, and feeling the inadequacies of all we did and didn't do.  Evaluated a child for potential sexual abuse, which is always a heavy weight, and heard of another case in the hospital.  

So here is a meditation from the highly recommended Jesus Lives by Sarah Young.  She writes as if Jesus is talking to you.

My power flows most freely into weak ones aware of their need for Me.  So take heart:  Though the journey you're on is one of faltering steps, such steps of dependence are links to My Presence.

Today you feel the journey more than usual.  It's a challenge to take the net step--and all too easy to be aware of you neediness.  Sometimes you get discouraged bout your ongoing weaknesses.  You know that dependence on Me brings spiritual blessings, yet at times you feel trapped by your limitations.  Only the knowledge that I am with you keeps you out of the pit of despair.  

Awareness of your need for Me is what creates a strong connection to My Presence.  My Power flows into you continually:  It gives you strength to take the next step, strength to ressit discouragement and despair, strength to know Me in intimate dependence.  Only My Power can enable you to live abundantly in the midst of your limitations.  Your day-to-day perseverance, in dependence on Me, is every bit as supernatural as an outright miracle.  So don't think that your difficulties signify lack of faith or lack of blessing.  They are means to help you stay on the path I have chosen for you.

Because you are My beloved child, I choose to bless you, but I bless you in ways that are unique to your needs and My design for you.  Though the way before you may be steep and rocky, it is nonetheless the path of Life.  It is where you encounter My luminous Presence--radiating Peace that transcends all understanding.

May we all be people who find the inexplicable, miraculous peace of persevering when when we have nothing left to give.

More Luke Returns Home Photos

In the course of coming to RVA we have tried hard to blend into the Letchford family, neighbors, friends, mentors. So it we convinced Hannah, who was walking by with Caleb after working on Chem lab together, to pose for this Myhre-kids-together-at-last photo. WHM educational consultant Debbie H sent goodie bags for all the kids, and even STAR got a fun throw/chew toy. It's great to be able to let her tag along as the kids play pick-up soccer games, or we go for walks or runs. Here they are on "upper field", quiet on a Sunday late afternoon. After two days on the plane, Luke's feet had to get back on the ball . . . Caleb with rugby ball, the new sport in our family. Jack (we forgot the camera!) played 90% of the U15 match on Saturday, which was an honor for him because he's actually on the U13 team. RVA beat Strathmore 12 to 5. And for the first time, we actually arrived ON TIME and watched the WHOLE GAME. Luke ferried a number of internet-ordered items for us, mostly some shoes, sports equipment, a sun hat, and an electric fence set-up for the dog. Guess which shoe I bought last Fall and have used for 9 months, and which just came today? Now you can picture the same aging process occurring in our bodies . . .

LUKE IS HOME!!!!

NYC, airport, Turkish Air, stopover in Istanbul, then Africa, landing, visas and customs, picked up by the Mayfield Guesthouse van and delivered to the guesthouse in Nairobi at 2 am. We told him to just SLEEP and we'd wake him when we arrived between 9:30 and 10 am. But when we pulled into the Mayfield parking area, there he was, bright and alert and looking at his watch, first words "What took you so long?" Ahh, our impatient restless Luke, still the same. He'd already settled his own bill and checked out, independent. 18. His fresh haircut courtesy of an RVA friend he visited a week ago who had clippers, his old favorite brown travel shirt, and a new pair of jeans he trash-picked. Full of stories, about America and life, Yale and soccer, professors and paper-writing, grades and competition, craziness and cliquishness, the lines of race which have thrown him, the opportunities and choices. Working for two weeks with the janitorial department not only proved financially helpful, it turned out to be a fascinating insight into American culture for this kid, as he went into dorms and cleaned up and picked up all the stuff people threw out, shocked at the waste, and as he hung out with non-students, older men. He unpacked some of his finds, nice button-down shirts, and told us about the fridge and the futon he got for his suite next year. He is so happy to be back in Africa, and we are so happy to have him. The whole family dynamic shifts as he blasts into our life again, energy and opinion, demand and delight.

Praying this summer turns out to be fun and formative, as he interacts with the Ma'asai doing research on traditional medicines. And very thankful for God's provision to bring him back into our home, his home, that he saw for the first time today.

A day's work

Walking into Kijabe Hospital, the Special Care Nursery (aka NICU, aka SBCU for special care baby unit) lies behind the windows you see to the right. Patients congregate in this grassy area to rest, get some sunshine, or pray. This door is the barrier between cold, high-elevation-escarpment Kijabe, and the tropical rainforest of the Nursery. I'm not sure I'd make it here without spending many hours of my day in the incubator temperatures! The current team, Ann the intern, Bob the clinical officer who knows more than the rest of us combined, and Limo the family medicine resident. They are writing notes on their babies and preparing to round with me. Overview of the nursery, from a back corner. Note the charge nurse Seraphine in dark blud in the middle, whose angelic name is appropriate, she's one of those people who knows how to get things done. Nurse Miriam holding Mary-baby-of-Jane. Mary was one of our tiniest preemies a couple months ago, and her survival looked uncertain. He mom suffered from post-partum depression, and one day just disappeared. It seems she was already grieving the death she thought was inevitable, and worried that her husband would resent the rising hospital bill. So she wrote a letter that basically said "I hereby give my baby to Kijabe Hospital." The nursing staff has fully cared for Mary and done a fantastic job. She's now 2.3 kg and ready to go home, only we aren't sure where "home" is. Our social worker and Kenya's Child Protection Officer found out the mom WANTS Mary, but is ashamed because she told everyone in the village that the baby died, and rather than face a change of story, she ran away. So they are evaluating a paternal uncle who wants to keep the baby. We're hoping that she can be reunited with her mother eventually, that the ties of love will be enough to redeem the poor decisions that Jane made in her grief and panic. This is Bedan, who was born with a large balloon of brain tissue and fluid protruding from the middle of his face, after he survived the removal of his encephalocele and a very serious against-all-odds-to-clear meningitis (acinetobacter for your medical types, 3 weeks of meropenem). He was still left with a gaping hole in his face, which we slowly reduced with scotch tape. Highly technical. This is the day he had plastic surgery to pull his face together. He'll need more, but this procedure allowed him to actually start to breast feed! And this is Bedan today (sorry I don't know how to rotate pictures, so just cock your head or lift your computer) on DAY 50 of life, about to leave Kijabe hospital for the first time. Yes, he was discharged. I will miss him and his sweet mom. Ruth, our current tiniest, at 940 grams. I love that warning behind her, as if she could suddenly jump out of her box. Shantal, whom I find beautiful, a bit more alert after several days of fever, convulsions, and lethargy, due to overwhelming infection. Almost healed. Luke, whose mom finds it very amusing that I have a Luke too, only mine is 18 years old and 6 foot 2 and coming in four days! But I digress, this Luke has an abnormal connection of his ureters to his bladder, which led to a serious blockage in his plumbing so to speak, damaging his kidneys before he was even born. For a few days it was touch and go with potentially lethal levels of potassium . . but now he's much improved. Still searching for the exact surgical solution. Mark very happy to be Kangaroo-Cared with his mom. Another content Mark (in addition to two Marks and a Luke, we have a John, and a doctor named Matthew, so the full Gospel is represented). These moms hand-express breast milk and tube feed their babies EVERY TWO HOURS around the clock. They are saints. Main entrance as I'm leaving this afternoon. Turn 90 degrees right and look down the road, our house is the faint yellow one in the trees ahead. Home at last.

Death Watch

We watched Waithera die today.

She was 1.7 kg (about 3 3/4 pounds), born almost two months early, with at least two major malformations in her tiny body. Her open spinal cord with its fleshy ballooning mass of flesh and nerve on her lower back was the most obvious one, and related to that her bizarrely hyper-extended knees with her ankles resting up by her ears. The on-call team scooped her up from the delivery room and settled her in an incubator in the nursery with CPAP, a high-flow bubbling oxygen tubing in the nose that helps babies breathe. By the time I saw her Monday morning she looked relatively comfortable, but I ordered a routine chest xray since she was on oxygen. We had a lot of other sicker babies (or so we thought) so her film was the last one I reviewed a couple hours later. I flipped it up on the light box expecting the usual tiny preemie chest and glazed appearance of immature lungs. Instead I did a double take. What was that? Her heart was pushed far to the right side of her chest, because her stomach and intestines had crept up into her left chest, filling the space. There was very little to be seen of lungs. This is an internal hole between abdomen and chest, called congenital diaphragmatic hernia. A condition that has no more than a 50% survival rate in the most technical of NICU's with heart-lung machine type therapy, let alone Africa, let alone in a premature baby with an open meningomyelocele.

However, most of Monday, she seemed to be defying the odds. One thing about Kijabe, you never know when you're looking at the baby that could be the first survivor of some difficult surgical problem, because we have great surgeons. And one thing about Jesus, you never know if you're looking at the most unlikely specimen of grace and miraculous healing. So we consulted the neurosurgeons (for her back) and pediatric surgeons (for her intestines-in-the-lungs problem), read up in some texts, and decided to give her as much of a chance as we could. Which would mean intubation (tube for breathing) and ventilation (putting her on a machine). Which would mean ICU. It took until about 6 last night to get that set up, but she did remarkably well. Amazingly the little bit of lung she had seemed to be working well. We gave her tenuous prognosis to mom and dad, and made plans for the first surgery to begin this morning.

But that was not to be. The poor visiting anesthesia fellow from TN who got stuck covering the call in ICU struggled with her much of the night, and by morning he was convinced she was not going to make it. He had "coded" her twice, giving strong drugs for a falling heart rate, re-intubating, taking her off the machine to manually push the air in faster and harder. I got another xray, spent an hour trying this and that, but she was failing fast. She was nowhere near stable, and surgery would have to be canceled for today. And if she was getting worse rather than better on maximum intervention, it was not likely that surgery would be possible later. It is so hard to make the change from "let's do all we can to give this baby a chance" to "we are prolonging the inevitable, giving her pain for no reason". After talking to the surgeons and nurses and ICU fellow, everyone was waiting for me to make the decision about what to do.

So I did, one of the hardest type I have to make. I called in the chaplain and family. Dad had disappeared and turned off his phone, sensing the disaster no doubt. So I went over the whole picture with Waithera's mother and two aunts, by the bedside. They listened soberly, with some quiet tears, but were very understanding. We prayed together, then I removed all the monitors, IV's, blood pressure cuff, and endotracheal tube. I wrapped her up in a blanket like any other baby, and handed her to her aunt. Waithera opened her eyes briefly and had one of those reflexive smiles, very sweet. Then we all sat for half an hour as her mother held her in her lap, watching her turn from pink to grey, with shallow gasps of breaths. Her little heart stumbled along at a very low, non-sustainable rate. She blinked and spasmed a few times. We waited. I read aloud from John 11 and talked about the truth that Jesus IS the RESURRECTION AND LIFE, that He will make Waithera a new and whole and perfect body to go with her sweet soul some day. But Jesus, knowing that, still wept over his friend Lazarus, so even as we held Waithera and affirmed the truth of her resurrection healing, it was appropriate to weep, to mourn her loss. Finally her little heart just gave out, and I pronounced her dead. The aunts both took another turn to hold her body in goodbye.

As death-watches go, I was thankful for the process. I'm glad we tried everything for a while, but I'm also glad we didn't keep coding her and injecting her and refusing to give up. It's a very hard line to establish, the line between giving our best effort for any child regardless of birth "defects" and a stubborn refusal to admit defeat. It is a holy privilege, a weighty one, to sit with a dying infant, to witness the last moments, the passage from this world to the next. I hope I don't have to watch another death soon, but if I do, I pray for the right mix of hope in the truth and mourning for the loss.

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.