A story about Hope

I have mentioned before the story of the little girl next door, abandoned at birth, enfolded into the family of our friends, missionary dentist and wife with 25 years in Africa and plenty of biological children, who simply saw a need for foster care that grew into total commitment as parents. Because of concern for child trafficking, the legal system for international adoption has become increasingly complex to navigate.  It took the Riches 2 1/2 years with Hope in their family as their child to achieve the legal Kenyan adoption, and get her a legal Kenyan passport.  Many of us prayed for that oft-delayed and difficult-to-achieve event, until the day the Kenyan judge declared Hope theirs.  Just in time for the family's planned furlough to the USA, where their fourth child will begin University studies.  However, incredibly, the American embassy in Nairobi has denied Hope a visa for the USA.  Even though the Riches were granted custody of Hope for over two years which culminated in adoption, even though they have been her only caretakers since birth, even though she is completely part of their family, she is not yet a US citizen.  And our embassy has decided she can not enter our country with her family.  Which means the Riches can not visit their elderly parents, or help their college-age kids settle in college.  They were told that they must wait a further two years AFTER her adoption.  They had sold their car and most of their possessions, finished their jobs, given away and closed up most of their life, booked airline tickets, expecting to spend the next year in America and then return to Africa to a different mission location.  Instead they now must find a place to stay with Hope and their 9th-grade daughter indefinitely, send their graduating son on to college alone.

One of their kids made this video to explain the story, generate prayer, and encourage people to appeal to their congressional representatives.  Particularly if you are in North Carolina (the Rich's home state) please consider following the links to register your support for Hope's visa to the USA.  This is not a dangerous criminal, this is a precocious healthy loving 2 year old with a family who just wants to be together.  Watch the two-minute clip here:  http://www.youtube.com/watch?v=vQMysL7-M6s

Thanks.

Happy BDay to me, a Recycling Jubilee

After a long week and a trying emotional and spiritual stretch, recovery comes from thankfulness, as demonstrated in the Psalms by David who had his share of trials but stubbornly held on to praise. Much of what I'm thankful for is recycled, renewed, restored. . which reflects what God is doing in general down here in this world. Here are few things from the last couple of days: The Year of Jubilee, my Birthday stretches on. Tonight our friends from Uganda, the Chedesters, invited our family for a delicious dinner. In this new place I forget what it's like to just relax with people we've known for so long . . and the only people around who share the most significant chunk of our life. Above, with the roses they gave me. Renewed friendships are renewing. Scott and the kids gave me a Kitengela Glass IOU for my Birthday . . . so we went into their shop this weekend after Caleb's rugby game. I thought I'd replace some of the glasses we'd bought a couple of years ago, which are made locally here in Nairobi from recycled bottles, and which we seem to break rather often. Instead I splurged on two handcrafted chairs (with chunks of recycled glass in the back) for the counter Scott put into our kitchen. It's the new breakfast spot. These are my other Birthday present, which Luke bought me in a Maasai village, made from recycled rubber tires. Luke and Thomas this morning, off to the Loita Hills, where they will camp for a week as they visit Maasai villages for their research. The house is already too quiet. Their friendship is restorative to both of them after a year in two challenging universities. I realized that my Swahili lesson today as we chatted about the current family events contained sentences like this (which are not too reassuring): Hawaogopi fisi? (don't they fear the hyenas?) Hapana, wana visu (No, they have knives) Moe, our houseguest, who has become part of the family over the last week, we will miss her when she goes back to Japan via Rwanda. And I end with my most thankful highlight of the week, Luke and Caleb with friends after leading Praise Chapel. I miss leading worship, I'm sure that David soared not just from writing Psalms but from singing and dancing them, from playing his harp. It is a great joy to see my kids have at least a chance to do that. There are so many talented musicians here, but this week Luke and Caleb were able to step in, and I'm so glad I was able to run up the hill from the hospital and worship with them.

not my plans . . .

"Tis the season for transition, closure, goodbyes and launchings. And with that comes a certain level of disquiet, unexpected since we're still in the entry phase of life, and no one is graduating in our family. I've had a hard time putting my finger on the heartache that has settled more and more heavily upon the week . . .

For one thing, Mardi was gone, which made me realize just how much of our survival rests on the space she creates in my life at least, which of course spills over into the rest of the family in details like actually having enough food cooked . . After a month of job-sharing, going back to solo full-time-plus was harder than I thought. All the interns did their quarterly transition to new services this week too, which makes the medical care temporarily more challenging as people orient and adjust from 75 kg waling-talking patients to 1 kg fragile mysteries. At 2 am on my call night I was summoned to break the news to a mother that her baby was dead, and since it was a baby who had not previously been thought to be sick and was found cold and lifeless, it took hours of investigating just what went wrong, as well as explanation and comfort for the oddly stoic mother. Out of that sorrow came some good meetings and ideas about documentation and responsibility, so that if this was at all preventable we'll have a better shot at doing so the next time. And another afternoon just when everything seemed quite calm in nursery, a nurse came running in with something in a sheet, which turned out to be a 750 gram 26-week girl who had been delivered in the grass outside. That led to immediate action, resuscitating, warming, breathing, testing, getting her into an incubator and on support. And the whole process was complicated by a sullen quietly distressed non-communicative mother who it turned out had hidden her pregnancy from her parents, and "happened" to be hanging around the hospital because another child in the family was being seen in a clinic for another problem. Between the social complications of negotiating disclosure to the mother's father, and trying to keep the baby breathing, it was a long afternoon, and the tiny baby never really had much drive for life. So after some hours I was left with the excruciating task of deciding that we had done all we could do, gathering the medical team to discuss options, getting the mother and her father in to see the baby once, and then allowing her to die. That is the awful responsibility that I find very very draining.

There were some highlights in the nursery too, though, a much-valued only baby Shunetra who has hovered on the brink of death for two weeks with meningitis, sepsis, prematurity, feeding issues, respiratory distress, a heart lesion, you name it, gradually improved. A baby whose heroic mother did every-one-hour-feedings for weeks came back a week after discharge having gained great weight and looking so cute and normal. A malnourished baby whose intestinal obstruction was surgically corrected went home miraculously well. I had some time for teaching, both bedside and in a weekly lecture, which I enjoy. But I missed sharing the weight of responsibility.

Then there is the social craziness of this week. One day I came home and found we had four college kids from four countries for lunch--fun to hear them compare Korea, Japan, Scotland, and the USA. We have one girl from Luke's class staying with us for "alumnae weekend" and others drift in and out for movies and meals. Though we're not nearly as involved as many families here, the Netherlands and Australia have also been represented at meals this week, not to mention everyone's African countries (Rwanda, South Sudan, Kenya, Uganda). There are concerts and games and special events. The three younger kids were in exams, so that added a level of stress and a variation to the schedule too. Luke is slowly recovering from a couple of motorcycle mishaps, which have left him bruised and scraped, and rather uncomfortable and discouraged. Rugby semi-finals were yesterday too, a well-fought match against the same school that beat us badly a week ago, we came close to a tie, but disappointingly it did not happen. In the midst of band and choir and teams and returning alumnae and conversations, some of the disquiet comes from hearing kids process the school, the tension between exclusion and inclusion, the lines between who is in and who is out.

Somewhere in the middle of exams and visitors and work and patients, I totally forgot a staff meeting, and slipped even further behind in any progress on a list of things to be addressed in the newly delineated department of pediatrics (which I am supposed to be clinical director of, by virtue of being a decade older than everyone else I think). Every day I think i'll get time to make progress on details for our Africa field retreat only a month away, but another day goes by.

Besides the sapping of energy from hard decisions and lots going on . . . a large part of the crushing heart-level weariness I realize comes from a couple of specific prayers unanswered. Or at least not the answers I wanted. One prayer was for our neighbors to receive a US visa to bring their legally-adopted-Kenyan 2 1/2 year old to the States as the family completes their service in Kijabe after over 25 years, and accompanies one of their older children back to university. The US Embassy denied the visa, in spite of many appeals and letters and a reasonable legal interpretation of the statutes, and I feel their pain as they must split their family. Of all the dangers our embassy must protect American from, allowing a brilliant healthy darling loved daughter to travel with her parents does not seem to be one of them to me. Then I had prayed a couple of specific things for one of our kids, and yet watched them experience rejection, which really hurt at a deep level.

And sometimes it seems like most of the people we have gotten to know in the last six months . . are leaving within two weeks.

So today the message of Jesus in all of this unexpected unease, came through seniors giving testimony, and through the choir's excellent drama on the book of Job, the reminder once again that God's plan can not be thwarted by apparent rejection or loss. This week did not, in many seemingly important respects, go the way I hoped it would. Which is usually the context for God's work. Jesus was despised by men and acquainted with grief; He did not live a life of peace or success. He allows disappointment and injuries and goodbyes and failures for His own mysterious purposes, which we declare by faith are good, even if painful. Amen.

The 9th of July

Happy Birthday to South Sudan!  We join with our team there in rejoicing over the end of decades of civil war, and the palpable sense of hope for the future.  We also grieve that some ethnic groups continue to be targeted by violent aggression, particularly on the North/South border.  Please pray that the launch of this new country would usher in a peace that allows children to survive, families to unite, villages to thrive, and a whole nation to taste a glimpse of the righteous rule of Jesus.  And remember our team, on the ground in Mundri as witnesses to this birth.

Stories

Sitting in the front yard, wrapped in Julia's purple Maasai blanket as clouds pass over, Star at my feet the perfect company. Caleb's guitar strums from the house, it is Sunday afternoon and I hear an occasional voice as everyone putters around for a while doing their own things. Ibis squawk, poinsettias flame, a breeze moves leaves in the muted cool daylight of the southern hemisphere "winter" (60-70 degree days feel positively arctic after acclimatizing to a Bundibugyo life, and when it rains and dips to the 50's we shiver). We're back from an outdoor service at RVA where 18 young people were baptized, most of them missionary kids who have been challenged to own their own faith as teenagers apart from their parents. Eighteen stories, each a unique variation. Someone found her life was not her own but God's while she was held hostage after a carjacking. Another sensed God's love when peers sought him and pulled him out of a protective isolation. Another had to confront her emptiness when her family's move to Africa landed her at RVA without access to drugs and alcohol. Another realized even "nice" kids can be obnoxious. Another confronted his cruelty in the way his peers were damaged by his abuse. They mentioned loneliness, neglect, bitterness, bulimia, cutting, deaths of friends, feeling ugly, feeling on the outside. They also mentioned peace, scripture, caring friends, involved adults, and the compelling presence of the Lord. All took the opportunity to make public their commitment to Jesus and their desire to follow Him. And all were pulled up out of that water with spontaneous smiles.

It's good, it's faith-pushing, to remember that we're in the middle of the story. Even inside the RVA fence, protected from much that is evil, kids are in process, and many are facing life-pivotal-moments. Depression stalks, pressures abound, and yet love breaks through. When Scott and I see these kids in clinic, we want to honor their journey, remember that they will reach graduation more fully themselves than they were in the years before. When I see obnoxious attention-getting behaviour, I don't want to label that kid, but see through it to the person who might be giving next year's testimony. I am convicted today of how easily I label and box, and how crucial it is to see beyond to the glory that will be revealed.

And reminded that the current US Ambassador to Kenya attended RVA, as did his wife.

Several calls from "kids" in Uganda this week, people we care about . . . who have their own stories. Parents separating, destructive effects of alcoholism, gossip, jealousy, anxiety, and the struggle for getting needs met. Frustrating to be powerless, for them and for me. I am convicted again of the importance of believing, taking the longer view of glory.

So, how to pour into these stories in a way that peels away the crust of the Fall and reveals the wonder? Sometimes just by being present, and bearing witness.

Yesterday the rugby teams, Varsity and JV, traveled to a school near Thika, to play a match that had been delayed and rescheduled and confused all term, and so it felt like a last-minute addition. It was the last game of the season, coming just before exam week, and against the number one school in the league, a large well-known Kenyan institution that emphasizes rugby and trains year round, with a professionally qualified coach who works internationally. It was a school that beats us, and pretty much everyone else, decisively and repeatedly. Some of the varsity seniors chose to quit the team rather than play that last game. Plus it was over two hours away, in road-contruction-mass-confusion Nairobi outskirts traffic, to a dusty acacia-studded field, where about 500 opposing students chanted and massed on the sidelines, laughing loudly at our mistakes, taunting. At that distance, on second-to-last weekend of the school year, the supportive crowd was thin. Me and three other parents and two young siblings, to be precise. It wasn't our teams' best games, by far. JV lost 36-10, and Varsity something like 26-0. I did get to see Caleb kick a penalty for 3 points, which was a significant percentage of the total points RVA scored, but he also was frustrated with himself for a few errors, not his most heroic game. But the boys walked away satisfied, declaring that they had had fun, they had supported each other as teams, they had stuck it out to the end. The lone parent-car that went had errands to do on the way back, so I ended up on the bus packed with sweaty, scraped, dusty, thirsty kids. And I didn't hear one word of complaint. They recalled plays and tackles, they joked. (There was one kid that gave me a scare on that ride by falling into a deep sleep and slumping onto the floor, which made me worry that he'd had a head injury in the game and was now progressing to coma, but when I pried his eyes open he answered questions appropriately, and in spite of my nerves walked off the bus smiling when we got back, saying he's a solid car-sleeper . . ). They demonstrated sportsmanship and resilience.

The stories that will be told of these kids, including my own, will be long and often harrowing and intermittently hysterical, and involved scattered hard-to-reach-hard-to-love spots all over this world. Perhaps if we could see where they are heading, we'd be more willing to invest in them now.

Jubilee

A week ago, I entered my year of Jubilee.  Most likely my only one, unless I live to be 99, which is not very likely.  7 x 7.  I think it's supposed to be about rest, which is ironic, because I haven't even had a moment to think about it until now.  Last weekend's call blended into one of those Mondays that ran into another call on Tuesday that spilled over into a Wednesday morning when the other paediatricians all had extenuating circumstances and so I found myself with the terrible responsibility of stopping unsuccessful CPR on a 1 1/2 year old boy and then turning around and taking his soon-to-follow 1 1/2 year old room mate to the ICU where I intubated her.  I had to tell two families within 12 hours that their child had died, which is as always a holy but wrenching moment.  I also spent solid portions of both Sunday's and Tuesday's call on a punky preemie, one of those babies who just keeps teetering on the edge of existence, including sitting several hours by her bedside and ventilating her until I was about to give up and she miraculously started breathing.   Thankfully Mardi stepped into the picture on Wednesday afternoon.  Since then, RVA clinic, a long morning hospital meeting, a couple of hours tracking down xrays and an ortho consult for Luke post-accident (persistent shoulder pain and limited motion, but seems to be all muscular, which he was certain of but at least I fell better about it now), some admin work, clothes-patching, and major cooking--two dinners for young people--one night two of Luke's returning classmates, and last night two young Kijabe doctors, all delightful people.

Which brings us to Friday at last.  To quiet and journaling and reflection and prayer, to the inhale that has to be deep enough to last for through the craziness.  To the beginning of Jubilee, a week late.  To Leviticus 25.  To more thoughts to follow, but here are some initial ones.  Jubilee is good news in the middle of life.  Jubilee is course-correction.  After 49 years of divergence from perfection, Jubilee is the time when God restores the broken, recovers the lost.  Inequalities are undone.  Resources are redistributed.  Grace is real.  Jubilee calls forth faith, the faith to live on God's provision only, the faith to refrain from striving, the faith to let go of what seemed like gain, to accept what seems undeserved.  Yes, there is some rest, for the land mostly, which reminds us that it belongs to God and not to us.  But liberty is the clarion call of Jubilee.  It is an act of proclamation, which culminates in Jesus as the incarnated Jubilee, proclaiming the year of the Lord's favor, good news for the poor, healing for the brokenhearted, liberty for the captives, open prisons for the bound, comfort for those who mourn, beauty for ashes, the garment of praise for the spirit of heaviness (Is 61 fulfilled in Luke 4).  

So perhaps the first week of my Jubilee isn't so far from a true celebration.  Breath for the flagging, fluids for the parched, encouragement for the youth.  A change from the past many years, a relocation, a letting go of most of my former work and responsibility and satisfaction.  The challenge will be to live on God's provision while still living out Jesus' mission, to live in rest in the midst of a restless world.  To return to what God has given, to be without a push to do.  To celebrate Jubilee personally without letting down a community that expects so much.  To balance the rest for my soul with the proclamation of liberty for others.  I'll get it wrong, most of the time, but that's the whole point here:  God steps into the 50th year and makes it all right again.  

on blogging: rich human compost

Frederich Buechner (Telling Secrets), on encountering God in the concrete details of our actual lives:

We believe in God--such as it is, we have faith--because certain things happened to us once and go on happening.  We work and goof off, we love and dream, we have wonderful times and awful times, are cruelly hurt and hurt others cruelly, get mad and bored and scared stiff and ache with desire, do all such human things as these, and if our faith is not mainly just window dressing or a rabbit's foot of fire insurance, it is because it grows out of precisely this kind of rich human compost.  The God of biblical faith is the God who meets us at those moments in which for better or worse we are being most human, most ourselves, and if we lose touch with those moments, if we don't stop from time to time to notice what is happening to us and around us and inside us, we run the tragic risk of losing touch with God too.  

Precious

Precious in the sight of the Lord is the death of His saints.  (Ps 116:15)

A precious child died today, the extremely premature baby boy of dear friends of ours in Nyahuka, a couple with whom we have a parental relationship.  His mother's life is still on the edge as she lost a lot of blood.  All weekend as her saga unfolded we have carried the burden of caring about her and her young husband, worrying about them, and sadly being far away.  We're thankful for Isingoma and Christine, and Travis and Amy, who stepped in with wise counsel and timely medical care.  Please pray for the Isingomas and the Johnsons, who are stretched in so many ways, to have spiritual refreshment and stamina, and to keep investing in the lives of younger people.  And pray for our friends in their grief to turn to God and find new depths of faith in Him, and trust and comfort in each other.  It's been a rough few months for them, and they desperately need a fresh hope.

At the same time in Kenya, I was caring for another precious child, this one a 1 1/2 year old girl NAMED Precious.  When the intern and I decided to admit her to the hospital, it was largely because her mother had brought her to the clinic about four times in that same week, and so even though she did not look as ill as most (she had a normal temperature, breathing, heart rate, no history of vomiting or diarrhea) I felt like her mom was sensing something more was wrong, and it would be prudent to figure it out as in inpatient.  Precious had rickets, a common form of malnutrition here, and was slow in her development.  However when I was called to the hospital that evening for a code, she was about the last patient of the MANY on the paediatric ward whom I expected to find being resuscitated.  She had spiked a burning fever, and possibly aspirated (choked) as she weakly attempted to breast feed.  By the time I arrived she was completely flaccid, with no effort to take a breath, though her heart beat had returned after CPR and adrenaline, and we treated her with fluids and strong antibiotics for presumed septic shock.  Then I had an excruciating decision.  Our ICU resources are very limited, and if she had been pulseless for more than 5 minutes she would be unlikely to ever recover fully.  Her motionless body and unreactive pupils were did not give me much hope.  Yet it is hard to stop breathing for a patient that still has a strongly beating heart.  A wise ICU doctor came to my aid when called, and suggested we ask her mother what her wishes were.  And she said "This is my only child, please do everything."  Ah, the name now made sense, Precious, the only baby.  We intubated her.  And before we could take her upstairs, she started to breath a little on her own.  This morning she opened her eyes.  She has a long way to go, and she may or may not recover.  But I came so close to stopping what looked like futile therapy.  Because though I care about my patients, they are not as precious to me as they are to their own mothers.  

Then I got my turn this morning to move from doctor to mom.  Luke had a pretty serious motorcycle accident riding on a rough road down in the Rift Valley on the way to interview Maasai traditional healers for his research project.  He lost control after a bump, skidded to the side of the road, where his bike stopped abruptly into a boulder and he flew off and hit his head against a rock.  Thankfully his borrowed helmet saved him. He ripped his clothes and had a bloody scraped side, but no serious injury.  When he messaged us on rounds I was eager to run home and just be sure he was intact.  He's precious to me.

Our Medical Director reminded us this morning that God our Father waits for a glimpse of us, delights in us just because of who we are, His children.  This is how my friends feel about their tiny, unviable fetus.  This is how Precious' mother feels about her with her ventilator and tubes and fever and listlessness.  And how we feel about Luke, accentuated by the risk of near-disaster.  A parental love does not flow because the baby has done anything, it exists because the baby IS.  I know I have a hard time believing this is God's passion for me.  

Weekend DIY

'Tis the season of goodbyes. Last Sunday afternoon there was a tea for the Bransfords and the Riches, with a combined years of service something like 60. Jacqui and Sue created a spread fit for a magazine from local fabrics and flowers, and everyone contributed homemade cookies and fruit. Yesterday Jack's 8th grade class had their celebration, a rite of passage to high school. No catering, no restaurants, so here you see many parents and students in the RVA school cafeteria kitchen (an impressive facility, pretty new, my first time behind the scenes) doing food prep. We served salads, breads, a main course of grilled beef fillet, linguine alfredo, and parmesean tomato. Then for dessert . . I did mousse duty with Jacqui, creating 50 mousses from local chocolate bars, cream, and eggs. I had never made it before but by the time we worked our way through four double recipes I got the hang of it. Jack at his table, wearing Scott's tux jacket from college over his best shirt (we didn't really get the formal aspect until the last minute). The kids did a drama and Jack was the star of act 3, a talent I suspect we'll see more of in the future. After kitchen duty in the afternoon, I worked as a server in the evening. I did leave a little early to get home by 8 for the birthday dinner Scott and Luke had cooked me! DIY celebrations. Caleb was on choir tour all weekend--here is a preview shot from church last week. He is not yet back from the third straight day of going to schools, churches, slums. They are presenting a drama based on Job, with music. DIY entertainment and enrichment. Caleb's class party: all the girls got to choose (somewhat athletically, like a major capture-the-flag week-long contest where the girls trap boys and tie a scarf on them) a boy to be their costume partner. Caleb's was pretty fun and benign, as Mr. and Mrs. Santa, pictured here with Peter Pan and Tinkerbell. DIY costumes. The latest on the pizza oven, Scott with the kids, enjoying the project and the time together. DIY pizza, someday. Tomorrow we have another goodbye party . . . and everyone is supposed to bring lasagna. So here is DIY lasagna in process. Ricotta made two nights in a row from two days' worth of fresh milk, tomato sauce made from scratch this afternoon, pasta made by hand, and local sausage and cheese. Rolling out the pasta. The pictures are from my phone, which explains the low quality . . . and I do not include the approximately 16 hours spent in the hospital Sat and Sun (so far) . . including middle of the night last night . . . DIY doctoring. One of the challenges of missions is that if you want it, you have to make it. It's also one of the joys.

Life is Iterative

Luke just buzzed out of our drive on a motorcycle, with notebooks in his back-pack, heading down into the roadless Rift Valley to interview Maasai people about their use of traditional herbal medicines. He and his good friend Thomas developed a research project based on the observations of some Kijabe doctors that patients were coming in with difficult-to-explain symptoms that might be caused by unintended effects of these plants. He had hoped to be much further along in the project by now. But the original Maasai questionnaire confused people, the motorcycle transport was not ready, the local partners serving as guides and translators have at times had their own agendas, the randomization by overlaying a grid on a Google Map projection of the valley and selecting quadrants by random number table can make some of their target areas fairly inaccessible . . . it's a daily process of adapting in order to move forward. Qualitative research is supposed to be iterative: you take what you learn on day 1, and follow that lead on day 2. Most people are not comfortable with that. We'd like a plan that is laid out in advance, tested and true, and then the task is simply to get it done. But life is not that way.

Last weekend I was covering for another doctor and got called to see a lovely little baby girl who had been born with a meningomyelocele (defect in the lower spine/spinal cord) and was not breathing as well as she should have been. We admitted her to the ICU nursery, in an incubator, with CPAP to assist her breathing, and a full court press of medicines and monitoring. But she continued to deteriorate, and by 48 hours later it was clear that her brain lacked the capacity to regulate her breathing. Her somewhat fix-able spinal cord problem was only the visible side of a deeper and fatal nervous system deficit. We consulted the neurosurgeons, the chaplains, the parents, meanwhile reviving her multiple times in order to keep her alive. In the end the baby was discharged to go home to die. Her parents lived many hours away, and the intensive care had been expensive for them. But it would cost more to transport a body than a live baby-in-arms on the bus, so they were eager to get started on their journey before she died. Should we have let her go at the very beginning? Perhaps. It might have saved grief, time, effort, resources if we'd had a clear prognosis and plan to act on from day 1, instead of a several-day process of groping through a dim perception of her survival chances only to have to give up. But life is obscure at times, a process of trial and error and correction and change.

A similar story on Tuesday, though with a shorter course. I was sitting in nursery marveling at how calm and quiet the afternoon had been when nurses from the women's ward next door rushed in the door with a bloody little bundle of cloths and said a preemie had just been born, as it turns out in the mother's bed, from a precipitous labor (she had not even been in labor on admission for a urinary tract infection, so no one was prepared for the baby). As we unwrapped the cloths we found a blueish limp ball of baby, low heart rate, and went into gear for bagging breaths into his lungs, turning up oxygen, warming and drying. But a quick look at this baby showed he had many severe birth defects. Legs scissored up over his head, no openings for his urethra or anus, only a rudimentary tag of a penis, no hip joints, another meningomyelocele of soft fleshy cauliflower of skin on his back, a contracture of his arm, peculiar little clovers of split thumbs. His lungs were hard to expand, and we suspected that all his lower-body defects might be associated with absent kidneys, which would mean little amniotic fluid, which would man poorly developed lungs in utero, which would explain his blueness. But like the baby above, at that moment we didn't know if he could live or not live, and on the principal that God values every life equally whether it is contained in a perfect body or a crippled one, whether it lasts 30 minutes or a hundred years, we kept working to keep him alive until we could more clearly outline his anatomy. As it turned out our radiologist was able to come do an ultrasound which confirmed that he had not developed any kidneys. No one can live without kidneys. I went to get his mother, who almost broke my hands squeezing in pain as she was still dealing with bleeding and clots and stitches post-delivery. She didn't want to see him, to have a picture in her mind forever of a less than "perfect" infant, but her sister-in-law came with us to the nursery briefly to see him alive before we stopped resuscitating him. Then he died, quietly, winding down. Later I was the one to break the news to his father, which is always a holy and terrible moment, telling a parent that his child has died, trying to testify to God's love at a very bleak moment in someone's life. Again, this was not an outcome that was anticipated or smoothly planned for. We had to react to what we found, try therapies, adjust, make decisions. It would have been kinder all around to have realized the need for an antenatal ultrasound, to have known ahead of time and made a plan, but life did not work that way.

So this week I'm thinking a lot about this reality: life is iterative. The veil over glory, over reality, over the future, is thick. We walk out a few steps, then look around and adjust our course. Every day brings mistakes, from which we learn, and redirect. This is true on the scale of individual tiny lives of hours to days, as well as on the scale of two-month survey projects, or programs that represent the investment of years and lives. We gave a lot of responsibility to a head teacher once, thinking this was the best thing, who later turned out to be unable to lead the school in the direction we hoped. We started programs in nutrition that blessed many lives for many years, but later had to be suspended due to lack of personnel. A new team built very communal housing for survival, and later grew to value a bit more independence. So many times in life we cannot see far enough ahead to anticipate the outcomes of our actions, we attempt a rescue, invest in what looks good and right, only to find out by living a few more months and years into the process that we have to change course. New surveys, intensive care, hours of agony, closing programs, funding buildings, all these course corrections are costly to someone, on some level. It is natural to then assign blame somewhere, perhaps to God in particular, for not preventing our mistakes, for not protecting others from our painful learning process.

But somehow in the sovereign order of the universe, we walk by faith not by sight. We are called to hand over our two fish and be stripped of all our resources, without knowing if the multitude will be fed. We set out for a land unknown, without a road map. We pour into others' lives, without knowing which of the young people will break our hearts and which will become pillars of the Kingdom. We fiercely apply a face mask and squeeze the bag of oxygen, sometimes only to regret prolonging the inevitable. We get it wrong, and all too often the very people we meant to help are the ones to pay the price. The human condition seems to require this learning-by-living process. Life is iterative, but grace fills in the gaps and wrests some good out of every iteration.