Weekend Highlights

Friday 5 pm: The weekend begins with a downpour so violent and drenching that I decide to get sign-out for call from my house instead of going into the hospital (the picture above Mardi took, it is symbolic of our new life of sharing the nursery job . . ). Start to cook dinner, and call comes about a 4.8 kg two-year-old being admitted post-op to ICU. Thankfully I'd planned ahead on this meal so it's almost good-to-go, but it turns out the child does not need a ventilator and I'm not needed. Another call about a newborn with a slow adjustment to life-outside-the womb. Both stable. So back to family, spaghetti, one of the kids' friends comes for a home-cooked meal, I realize that with 5 teens I should have made more, so Julia helps me get a batch of cookies into the oven, while the boys clear and begin to watch a rugby game on TV.

9 pm: I've dozed while reading when the phone rings, there is concern about the labor of a woman in maternity, who happens to be the wife of one of the doctors. I hurry over to the hospital to find the baby already born, a lovely full-sized vigorous girl. One of those pleasant paediatrician moments, just hold the baby and congratulate the parents. Check in on the two other kids, both doing well, which bodes well for the night. I love the quiet corridors after dark, the slumbering hospital with its continuing pulse of life. Back home by 10.

3 am: calls from hospital about post-op 8 day old with tachycardia (fast heart rate), hemoglobin drop by half, discuss plans for transfusion. Intern says baby is breast feeding and alert. Baby also has rising creatinine indicative of renal failure, but weight constant, so not dehydrated or overloaded. Complicated child who has had meningomyelocele (opening in back exposing spinal cord) repair, colostomy (because born with no opening of rectum in anus), ureterostomy (because born with only one kidney which is cystic and malformed, and obstructed outflow). There are so many babies like this at Kijabe, it is a magnet for rolling back the Genesis 3 curse about bringing forth children in sorrow.

6 am: up for early rounds, go direct to neurosurgical area to see the baby above who now is in the middle of a blood transfusion, with a dangerously high heart rate and murmur, and wonder if cardiac anomalies are part of her complicated anatomy. The baby is wide-eyed, but her mom is fast asleep in bed with her, and I don't wake her, certain that she's had an exhausting night. Write a note about her critical condition and marginal prognosis and go to make arrangements to transfer her to NICU. Which requires moving another baby out, because we're full. Scott is meanwhile starting OB rounds at 7 and finds a mother who needs an immediate C-section. He goes to theatre with one intern while I start rounds in Nursery with another, a competent and efficient young woman who has already done most of the morning's work.

8 am: Ready to transfer baby, go back to ward to inform nurses and primary surgical team . . .only to find out baby has just died. Mercy, or too little too late. Short discussion with medical staff. Back to finish rounds in Nursery.

9 am: home, kids getting up, time to make biscuits, cut up golden dripping sweet mangoes and an orange, set table . . but by the time I'm done it's almost 10, so I leave Luke, Caleb, and Julia to eat breakfast, Scott still not back from his morning rounds, and hurry up the hill to be on time for . .

10 am: Under-13 Rugby 10's mini-tournament, RVA and two other Kenyan/British Nairobi schools. Jack it turns out is captain of his team! I am just on time, and join the handful of other parents as swooping darting swallows comb the field for insects after the night's rain, and the sun warms the earthen bleachers cut into the hill on the sideline. Jack scores the first try, and kicks the conversion. By the middle of the game the whole family has joined to cheer. Jack is sometimes put in the U15 games, but here he is playing with his actual age-mates (though I think that "Under 13" is defined as having turned 13 after the previous July, and since he's a March birthday he's on the young side, but he's still among the tallest and fastest). RVA wins both of its games by huge margins, they dominate the other two teams. Jack scores about a third of the total points, and has many good tackles and runs. THIS IS A HIGHLIGHT DAY: whole family here, sunshine, Jack running about 60 yards through many opponents, tough, clutching the ball, scoring a try and touching it down over the end line. All of us standing and yelling as he makes this play. It is a joy as a parent to see your child affirmed in who he is and how he's made. I remember my Dad, my Uncle Harold, and Paul Leary always telling us that Jack should play American Football--this is probably as close as he'll ever come. A mental snapshot of that moment is filed in my heart.

1 pm: As we walk down the hill after the tournament, the joy of the day is tinged only by the sad ache that I wish my Dad had lived to see this, as a football fan, he'd have loved watching Jack run with that ball in his hands. And the realization that every kid should get that thrill, should have at least a few moments in life like that, cheering crowds, admiring parents, fun in doing something they love.

2 pm: Somehow the entire house took a spiral into chaos since Friday . . time to attack counters full of dishes, put clothes on the line for a few hours of drying, sweep several meals worth of crumbs, while Scott and Luke mix mortar to add the first layer of bricks to the pizza oven foundation, Julia goes to play soccer with her former JV team, Caleb works on never-ending homework, and Jack recovers from a morning of effort. Finish the last sweep just in time for . .

3pm: Two sequential visits from friends, one needs me to review all her daughter's immunizations and see what is lacking for their upcoming trip back to America; the other needs prescriptions for inhalers refilled. Both are women whose company I appreciate, and I'm glad that medicine gives the excuse for them to have come by, the setting for talking about kids and life. From walking into the delivery room to pre-college physicals, I like the longitudinal family-centered depth of paediatrics as a background to the day-to-day challenges of extremely ill inpatients. And having left intensely close community in Bundibugyo, I value highly such friend-time, when it happens (not often enough really).

4pm: I'm technically covering call during Saturday too, for one of the other doctors who wanted to go into Nairobi to see his senior son play on a rugby all-star team. Which is very important. It's been a quiet day call-wise, but just before he comes back another neurosurgical baby starts to have breathing difficulties, so I'm back to the hospital to meet the intern, examine, ponder, plan, draw blood, transfer to nursery again. We're just about done when the real on-call doctor returns, so I'm free to . .

5pm: go on a short run with Star just to stretch our legs and get fresh air, Scott and Luke are still finishing the brick-laying, one layer takes a lot longer than they thought (doesn't everything). Try to hurry everyone along because Saturday night is a special event at RVA. Our water pressure is limited, so showers have to be staggered, I jump in at a quarter-to-six. This is a dress-up evening, and my hair has been even worse than usual with frizz. What to do? Options limited, so at five-to-six I decide to give myself a haircut, an inch or two off all over, since it's been many months since my last visit to a salon in America. With springy hair like mine an inch cut translates into about 3 or 4 inches shorter when it dries. Put on my one fancy outfit, my Christmas skirt and shirt, call a friend with good taste like my sister's to borrow jewelry, in time for . . .

6:15: Sophomore Restaurant. An RVA event that is part fund-raiser for the 10th grade class, and part social event of the term. The sophomores sell tickets, and the adults an upperclassman buy them to come to the cafeteria which has been decorated in a theme (China this year) and be served a special meal. We had been invited to sit with two other couples, both are doctor-nurse pairs. It is a rare evening of going out, being served food I didn't have to cook, adult conversation. I enjoy learning about their pre-Kijabe lives, and hearing about their adventures and plans. The food is probably what you expect when American missionaries are cooking mass-production Chinese, but the atmosphere is very fun. The only sad moment, realizing both of these couples are finishing their terms in July. Sigh. More goodbyes loom.

9 pm: back home in another drenching rain, dripping wet, time to warm up. Jack and Julia are watching Ratatouille and we all watch the end. Chat about the evening, the week, consider watching a post-younger-kids-in-bed movie but the sound doesn't work on this disc, and we take it as a sign to get to bed by 11 anyway to recover from call and be rested for . . .

SUNDAY: family breakfast with coffee-cakes which stick to the pan but are so buttery that everyone declares them the best ever even if they are eaten in crumbles, iced juice, bacon and eggs, coffee. Our Sunday morning tradition has been more difficult to keep up here at Kijabe, but this morning it works. Kids off to Sunday school as I clean up, then we meet again for church, great worship.

1 pm: after church our houseworker Abigail has invited us up to her house for lunch, a rare chance to get off the insular world of Kijabe/RVA and into a real Kenyan home. Abigail lives with her son, her sister, and their elderly mother, surrounded by the homesteads of her brothers, with their kids. And their gardens, a polka-dot of cabbage and spinach, bordered by corn and pumpkins. Their village Maingi is on the top of the escarpment, about 9000 feet, chilly, in the clouds, which part for stunning views. Abigail's sister was our houseworker when Jack was born here, and we've stayed in touch ever since. ( There are pictures of our kids at various ages on the walls of their greeting room). We are escorted in to sit on plush red-velvet-floral covered couches, with low tables draped with lace in front of us, and two stuffed antelope heads leaning out of the split-log-painted-blue walls. This time we can at least exchange a few sentences in Swhalii with the non-English-speaking family members (small progress?). We pray together, and eat a mashed mixture of potatoes, beans, corn, and pumpkin leaves, accompanied by a stew of diced carrots and tiny pieces of meat, and chapati. When we insist "nimeshida" (I'm full) she clears the plates and all three women sit with us to drink chai and talk. This family has truly blessed us, and we pray for God to care for and bless them too.

Which brings us up to now. A weekend with friendship, community, work, worship, family, sports, food, home, projects, rest, all the essential ingredients of full life. At dinner last night someone asked us if we feel at home here yet, and today I would have to say yes. Which is no small thing.

comfort from Psalm 9

For the needy shall not alwasy be forgotten;

The expectations of the poor shall not perish forever. (v 18)

This verse leaped out of my Bible this morning, in the context of our Bundibugyo Team's mourning.  The four-year-old son of one of our CSB teachers died on Monday, after a very long dwindling illness characterized by pancytopenia (no red blood cells, white blood cells, or platelets to carry oxygen, fight disease, and clot blood) and massive hepatosplenomegaly (big liver and spleen) that was possibly leukemia or some other form of childhood cancer.  Jason's father K.F. was a WHM-kid in many ways, one of those little boys who hung around the mission looking for friendship and help and role models.  He found that in the Fillyaw family and then others, and after finishing his education came back to teach at CSB.  Unlike many parents of sick kids in Bundi, K.F. and his wife were able to take Jason to the nation's central hospital.  They exhausted every avenue of possible care in Uganda, and had the huge advantage of personal attention from Dr. Travis and Dr. Jessica. Travis consulted many people about his care, spent hours getting him transfusions and antibiotics, and even provided the last few days of care via personal visits to the family's village home where they had taken him to die.  An illness like cancer is rarely survivable in Uganda.  It's a terrible and threatening disease, but the underlying issue is poverty.  In Africa the medical system lacks the resource and expertise to rescue a kid like this.  We mourn with the psalmist and cry out for this promise to be fulfilled, that the poor shall not perish forever.

Please pray for our team.  Jason was Patton's age. The CSB staff are like extended family to each other, and to our team.  No doubt there is an element of Job-like spiritual attack here, a taking away of that which is precious from someone like K.F. who has seemed to benefit from mission attention and care.  The Johnsons in particular invested a huge amount of heart and sweat in just helping Jason survive this long, and going through the grieving will be exhausting for them as well.  (One of my babies died last night, a preemie with an anomaly of her bowels, whom we had struggled to keep alive for a week . . . and one of Scott's did too, a post-partum mom of twins who seemed to have a sudden bleed in her brain, both tragic, but both relative strangers to us, it's not the same as walking through the intensity of community in Bundibugyo . . )  PRAY that Jason's dad would miraculously continue to testify, as he already did at the burial, to God's goodness and love in spite of personal tragedy.  This is where the real test of faith comes.  We who have healthy children can only marvel from the sidelines and pray as those who suffer cling to Jesus.

Surgery and Construction

Today there were three Myhres in the operating theatre for a few moments: Scott performing a C-section, me waiting to receive the baby for paediatrics, and Luke there to observe. Scott has been on a grueling schedule for OB for the last couple of weeks, but it is paying off as he's had a solid number of opportunities to refine his surgical skills. He can write more about his experiences with the scalpel. It feels a bit awkward to take photos as women have their abdomens sliced open . . . so I've documented the other side of his job, that of construction engineer. The original surgeons were also barbers, so I guess it makes sense to be a person who saves lives by cutting and sewing and also creates new buildings. In this case, the long-awaited pizza oven. Scott and the boys started on Saturday, after the Longonot hike. Above they are digging out the site for the foundation. Making concrete from cement, sand, and stone on our driveway. Caleb ferried uncountable loads to the foundation site. After the first layer of concrete, a wire mesh, and then more. Smoothing the layers, adding more. Meanwhile Julia was inside, washing and paring 2 kilos of strawberries bought from a local farmer.When the foundation was full, they smoothed the surface with this board. Final touches. If you can see the stack of local stones in the background, quarried from a site very nearby. Unfortunately when we tried to stack them the next day to prepare for the walls that support the oven, we found them to be rough, uneven, and unsuitable. So . . .Scott spent his only day off driving into Nairobi to purchase bricks. He contracted a lorry to drive them out to Kijabe, rushing to get home first, which was rather pointless as it took the lorry 8 hours to get there. Meaning the massive load arrived in the dark . . Here we are at 8:30 pm unloading 1,400 bricks. With Thomas L. It took the seven of us plus two lorry drivers about half an hour to carry them four at a time off the truck and onto our porch. Calebtopia . . . Scott and Caleb constructed piles. The proverbial ton of bricks was actually 4.2 tons. Dreaming of pizza . . . which is still a couple months away.

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.