Caught in the turbulence

Scott brought back from his meetings a thought provoking book called The Meeting of The Waters, 7 Global Currents that will Propel the Future Church, by Fritz King. In the introductory chapter he describes two classic missionaries meeting at a guest house, two contrasting models of missions. The first is an older lady who has spent her entire life with a remote people group, rarely traveled back to America, had given up everything. We honored two couples and two single women who were just like that this past week at the AIM conference. They were retiring after 30 to 43 years of service in Africa. They had pioneered remote stations, translated books into local languages, established schools, weathered wars. They bore up under whatever life brought their way with very little outside help. They were grey-haired sturdy survivors with practical shoes, quiet and unassuming, faithful servants for the duration. One had come here as a little girl in 1946, a trip which took two months on a boat in those days. After a few years in Tanzania her parents left due to health reasons, but she returned as a young woman in 1968, was married in the RVA chapel, and the rest is history. These are the heroes that drew my heart towards Africa as a girl. They are the generation that laid down their lives and did the right thing, year after year, without fanfare. I didn't even know any of these people, but the standing ovations at their retirement brought tears to my eyes.

The second missionary in King's introductory chapter is a 30-something guy who is multitasking on his cell phone and computer, has left his family in America while he checks out a project run by local leaders that his church supports. He has a career, but is arranging to take two years to spend overseas lending his skills. This is the new generation of missionaries. The break with their formal life is less abrupt, more fluid. They set boundaries and have high expectations of personal development, exercise, protected family time, organizational support and responsibility. Travel and communication lend connectivity, educational levels are high, they are task-oriented generally, outcome-focused, and missions is an important part of their life, but not their whole life. We meet amazing people like this here too. Skilled doctors donating a month, or six, or more to boost services and education. Teachers, engineers, artists, contractors. People with the funds and vision to start and orphanage or foster micro-enterprise, who will leave it within a few years in local hands.

As I finished the introduction and started into the book (I'm only a third of the way through) I had sort of an "aha" moment. When the two rivers flow together to create the Amazon, there is a stretch where their waters flow in parallel, then a period of mixing and turbulence. And we are squarely in that turbulence. With 18 years in Africa behind us, we are a bit past the half-way mark towards the classic old-time missionary life. This is who we expected to be. And this is why over a year out from Bundibugyo, I have to keep remembering the very specific ways God led us, and convincing myself it is right to be here at Kijabe. On the other hand, we carry iphones and text our son in America, we travel, we access grant funding for projects, we connect with the national health system. We're now working at a hospital that was founded upon the classic missionary model, but is largely staffed by more modern types. When I look at the December call schedule, we are 2 of about 5 missionary doctors with more than a decade behind us, the rest of the 30-some names on there are either short-termers or young Kenyans.

So we're in an in-between generation, uncomfortable not living up to the heroes of the past generation, but not really fully able to buy into the ethos of the new generation either. I guess that's OK, to be Hebrews 11 pilgrims and strangers. Being securely settled in one group is not our goal. I hope we can be part of the melding, the settling out of the streams to honor what is best in both. Combining longevity with innovation, relationship with technology, perseverance with enabling nationals. Maybe because we're spending our first Christmas in this new place, it's a good time to reflect.

World AIDS Day, Dec 1

This morning our HIV-AIDS team at Kijabe Hospital led chapel. This year's theme, ZERO. Zero new infections by following the ABCs of Abstinence (unmarrieds), Be Faithful (marrieds), and Condoms (those who can't manage A and B). Zero stigma, because stigma hurts people, keeps them from seeking care, drives the epidemic. And Zero preventable deaths, because infected people should have access to medicine. Watch this compelling video and think about it. http://youtu.be/vKdgF7DHTG0

Complicated

It's 9 pm, and we just cleaned up from a pretty delicious dinner whose preparation was interrupted by two trips to the hospital, which makes the whole cooking scene a bit more challenging. The first call was to attend the death of a very sick preemie whom I had left only an hour before, knowing he was dying. After 48 hours of an all-out effort, his vital organs were failing and we knew we were at the end of the road. I had made the always-agonizing decision to accept that he was dying, and tell the parents. Francis was in the ICU right next to his mother, whose life he saved by being born too early. She suffered from a life-threatening complication of pregnancy called "eclampsia", which can only be cured by delivery of the baby. So this doctor had to make the difficult decision of taking the baby out of the mother way too early, or risking the mother dying and leaving behind her other two children and husband. Francis' life was only about 72 hours long. But I think this was the right decision.

The second call was much more fun: the Kenyan lady who runs the "Supa Duka", the one-room everything-you-really-need small store in our village, had just delivered a strapping healthy baby boy. We are always called for C-sections, but this time there was nothing to do other than admire the lovely boy.

And while I was in the nursery, I checked on Dancun, the little boy whom I agonized about a couple of weeks ago, an HIV-exposed 28-week preemie who nearly died that night. He's now a "feeder and grower", a seemingly healthy little speck of a baby, who in spite of starting out similarly to Francis has miraculously lived. And I ran into Scott in the operating theatre, who had just finished his fourth or fifth surgery for the day, a woman whose ectopic pregnancy had ruptured her fallopian tube spilling two litres of blood into her abdomen. Thankfully her life was saved.

Which was a nice end to three solid days of nonstop work. Well, not exactly end, but at least it's in sight tomorrow morning.

Let's see, the last couple of days included a little boy with an rare congenital syndrome called Pierre-Robin, the usual parade of malnourished marginal toddlers and their desperate mothers, another boy with meningitis, preemies, two kids with severe heart lesions, a girl with damaged kidneys after an infection, the amazingly improved and nearly-healed baby born with part of his intestines missing as well as the one who had hemorrhages in both lungs, quick consults for rashes including chicken pox and fungal infections. And most distressingly, an 8 year old deeply jaundiced with a liver mass that turns out to be lymphoma, a cancer that could potentially be treatable. Only we need to get him to a hospital with an oncologist and chemotherapy. Which requires a lot of money. Which his Maasai father thinks he can manage by selling off his cows. Meanwhile we are starting chemotherapy at Kijabe and hoping we can keep him alive long enough for the cow market to come through.

The sheer breadth of pathology on this service always surprises me. One can spend all day, non-stop, from bed to bed, to ICU, to nursery, to the clinic or the emergency room, conferences and meetings, and then back around to all those places again, without a moment of down time. Yet the doctors in Kenya have threatened to strike on Monday, Dec 5. Meaning a barely-survivable day could get lots worse. Kijabe hospital without any functioning Kenyan doctors is unimaginable.

When a patient dies, the nurses use their own creative verb, saying "he complicated". It's an interesting take on death, as a complication of life, or of their disease. Or does it mean that the patient has made our life or our job more complicated? Difficult, confusing, complex, interrelated, entangled. Not the ending we all planned. Life as a doctor here is just that, complicated. The clues to a disease are often obscure, the labs unreliable, the history vague. Understanding the thoughts of the parents who come looking for an easy fix adds another layer of complication. And sorting through all of those layers with the pressure of time and people waiting complicates things further.

Hoping that no more patients complicate tonight.

Light shines in darkness

Here is one more Advent site, thanks to counselor Susan S here at RVA.  A daily devotion is posted, including scripture, prayers and a meditation.  The site is:

http://www.d365.org/followingthestar/

Below the short thought on Mark 13:24-27

Many of us carry the false assumption that the goal in life is to be happy. That is why so many people around us mask their struggles and claim a false sense of happiness. Doesn't God want us to be happy? God cannot intend for us to be in darkness, depression, despair.  

Mark tells this story so we would not forget that darkness cannot stop God. Mark calls us to be honest. Yes, there is darkness. It hurts when someone close to us dies. Our hearts break when a friend abandons us. The pressure to succeed smothers us at times and we don't know if we will ever see the light of day. The one who comes may come right in the midst of that darkness. Darkness does not stop him from making all things new. True, the one who comes may not bring simple happiness. The one who comes will bring meaning.

Michelle Thomas-Bush

Advent

Today begins Advent, a season of preparation, repentance, anticipation, and party. I've been looking for some resources to celebrate with our family, and here are a few I've found.

1. Advent Conspiracy: Worship fully, Spend less, Give more, Love all. http://ac.wcrossing.org/default.aspx?page=3684

And here is their 2011 short video on youtube: http://youtu.be/9IN0W3gjnNE

2. Daily Scripture readings from the Anglican Book of Church Order: http://www.crivoice.org/advent2.html

3. A booklet of Advent readings and meditations from my friend Bethany's church: http://fairmount.liberti.org/advent/

If these don't come up as links, then copy and paste into the browser (sorry!!).

Unexpected Cost

6:30 a.m., a light rain in the chill of the early morning, and a dozen bleary-eyed students balancing stuffed duffels into the back of a van, heading home.  Yesterday they did the traditional end-of-term countdown, and were released to clean up and pack.  By this morning the bustling boarding school was nearly empty, eerily quiet and damp.  I help Acacia load her suitcase, checked her passport, her money, her phone.  Then a big hug, and I'm standing back by my car holding in tears that rise and surprise me.  

When we agreed to bring our friends' daughter into our home, I thought about a lot of things.  Whether she would be too homesick.  How she would find the volume and pace of our family in comparison to hers.  Whether she would find friends, or regret not living in the dorm.  Whether we would thrive together.  How the sibling relationships would work out.  It is an awesome responsibility to parent someone else's child, and I expected some sense of relief if we made it through our first three months relatively intact.

Instead, I felt only grief.  Another precious person to hold and release.  Another important relationship that has huge gaps of space and time.  Another piece of my heart sent away.  Four kids were going to leave our home eventually, and now we have to survive five.  

Be careful whom you love, or just let the cost sink in and hurt?  

stuffed-animal-love

As Thanksgiving turns to Christmas Consumption, and we read of people flocking to Walmart and the Malls .. . here's an idea for de-cluttering. Would you like to pass on some of your small stuffed animals, beanie babies or about that size? The sophomore class at RVA (which we help sponsor) does an annual Valentine sale to raise money for the class. We're in charge of creating gift baskets which parents can purchase for their children as a reminder of their love while separated far away at boarding school. I know my kids have been very attached to stuffed animals, particularly in stressful times of life. So along with candy, we thought it would be fun to include a little stuffed animal in the baskets.

If you want to donate some of your slightly used but still lovable animals for this cause, mail them by Dec 10 to Luke who will fill his luggage with as many as he can to transport them here:

Luke Myhre

PO Box 201510

New Haven, CT 06520-1510

If we get more than 50, we will pass them on to the children at the hospital. Thanks so much. No doubt the suite of guys at Yale will get a kick out of this influx into their dorm too.

Thanking Whoever . .

. . out there sent up some specific, directed, effectual prayers between late-Monday and mid-Tuesday.

Because we were enveloped in a cloud of grace. I picture this like the glory-cloud that fills the temple, the palpable presence of God. Monday night, I was on call, only I didn't get called. At all. This just does not happen. When my alarm went off at 6 I sort of panicked, the way you do when you're a young mom and your baby never cried all night. I had left two babies intubated in the ICU and the ICU ALWAYS CALLS. I got out of bed and re-checked the call schedule, and only then did I realize that the ICU doctor on call was one of the few who handles paeds cases (much better than I do I might add). And the intern I was on call with is extremely competent, so she just messaged me in the morning about what she'd done overnight. Wow. Then I went to work and discharged 6 more patients, in addition to the 9 from the day before, with only 1 admission, bringing our service down from 24 to 10. When we have 24 patients, you really can't even eat lunch or go to the bathroom, it is nonstop. When we got down to 10, I actually took my medical students to the cafeteria for chai and had personal discussions about paediatric medicine and their lives. An idealistic consultant moment. Then I went to the office to check on next month's call schedule and found out I was NOT ON CALL for Christmas, and it looked great. One of my patients whom I've cared for his whole life, Bedan with major malformations, smiled at me. He is much better and ready to go home, and sat in his bed beaming from his little yoda-like face. This was not my typical day at the hospital.

Then I got home and found out the best news of all: Caleb was nominated by one of our VA Senators for the Air Force Academy. This senator received 740 applications, offered about 30 interviews (Caleb's was by phone last week), and then selected 10 for nominations. Only one of those ten will be appointed by the academy, so he still has some odds to beat. But this was a huge relief, to know he still has the chance. (He has not heard from the other Senator, or our Congressional Representative, or the Vice President, so if any of those also nominate him his chances go up). About 4000 kids are nominated and 1000 admitted in a given year. He's such a great kid, I see deep things happening, and I hope for the best for him, wherever that is.

And did I mention that my Kindle, which had been in a deep unresponsive coma which I feared would be fatal, revived after my neighbor advised me to hold the on switch over for a full 15 seconds? And this happened later, but still counts in the tally of super-thankful: Julia was chosen for the Varsity Girls Football (soccer) team, and Acacia for JV. This is huge.

By Tuesday evening, going up the hill to the jazz band concert with Caleb after having actually managed a creative and nutritious dinner ON TIME for the whole family, I thought, someone is praying, and why do I ever worry?

Which was, of course, a short-lived triumph. Because that grace-cloud did not last very long. In the last 24 hours, life settled back a little towards normal. That beautiful call schedule, it turns out, had to be totally changed when other doctors objected to being on call Christmas, so now Scott and I are (though we're working out a way to share so others take Christmas Eve and Boxing Day). Internet issues slowed me down, went to watch soccer scrimmage and ended up with a student with a broken arm, fighting general single-parent tiredness, one kid forgot to turn in homework, another bombed a test, finals-week edginess as everyone struggles to get things finished.

Yes, my thankfulness is very fickle. Just like the Israelites. God might part the Red Sea one day, but the next I'm ready to complain about food. A 24 hour stretch of an amazing series of things-going-right is quickly forgotten when I get back to a normal day. You'd think I would be on a faith high over that senatorial nomination for weeks, instead of worrying about the next nomination or application.

I suppose I'm learning that thankfulness is a daily discipline. Like manna, one day's does not spill over to the next. I think that a "series of fortunate events" will inspire me towards perpetual thanks, but it doesn't. I have to be thankful again the next day, and the next, even when (especially when) the circumstances are less ideal. Perhaps if days of triumph worked thankfulness in us, God would give us more, but He knows that we haven't changed in several thousand years, and no matter how richly He blesses us we still have to be prodded towards thankfulness.

But I'm still grateful for whoever prayed, and would welcome you to do so again.

Worth

A week goes by, and the baby who barely lived through the night and upon whom I gambled the $200 surfactant treatment, thrives. (see http://paradoxuganda.blogspot.com/2011/11/who-is-worth-it.html) Here he is with a morning yawn as his smiling mother gets ready to feed him through the tube. He's gaining weight, off of oxygen completely, and behaving like a reasonable preemie. I admit I did not expect him to make it this far. But God thought otherwise. He still has a tough life ahead, even if he escapes infection he will have twice the normal chance of dying here, and he will lose his mother before he grows up. But for the present moment, they are a happy pair. This is Tume, the severely malnourished 9-year-old girl who was transferred from NE Kenya with TB, a dislocated hip, sores where her fragile skin had broken down as she lay immobilized in bed, and allergic reaction to her drugs. Two weeks ago she was not moving or talking, let alone smiling. Now she's up with a walker, coloring pictures, and chatting. Progress. But something about the poignancy of her "Prom Queen" shirt tugged at my heart. Her mother is also HIV-positive. This girl's challenges include eventually being orphaned, and possibly being lame. A bit far removed from some other distant little girl whose cast-off shirt seems shallow and vain in this context. Yet I hope Tume feels beautiful too, and loved and admired in the same way the prom queens do. And guess who is going home today? The little girl who stopped breathing in casualty just when the power cut off (http://paradoxuganda.blogspot.com/2011/11/high-and-low.html). It was a rocky course in the ICU but she's no longer convulsing, perkily alert, and possibly healed. On a long Monday it is good to be thankful for those who DO get better. And to be thankful for prayerful blog readers.

Wandering the hospital with my IPhone, and pondering

This is my first full-Swahili patient visit. Our MCH (Maternal and Child Health) clinic bursts with charts, especially on Mondays. While I would like to stay free to consult on the patients already screened by the interns, clinical officers, or medical students, they sometimes get bogged down and I reluctantly pick up a chart on my own and at least try to get started before calling for translation help. I'm embarrassed by my stumbling slow progress. But for many reasons, not all of them noble, I just haven't invested the time and effort I should in Swahili. I do work with an excellent language helper two or three times a week, but I must be one of his more disappointing students. So this week I really celebrated when I called this baby back to an exam room, had a conversation about her condition with her mom, and finished the whole visit with no English and no help. I have to admit it was the simplest patient of the day. She was healthy. Her mom was returning for a check up after an admission to the hospital, and answered "no" to all my limited "Is she vomiting" type questions. I have far to go, but I'm still thankful for this baby step. Charity narrowly survived severe dehydration this week. I found her on Monday morning, having arrived in the middle of the night. When her sodium came back as 191 (almost the limits of the machine) I transferred her to the ICU for management of her fluids. She was also in kidney failure. But a few days later she is greatly improved. Her mom lost her previous baby to the same problem exactly a year ago. Pray for her. In today's political climate, I'm not sure just why a parent would choose to name their child Gadaffi, but this diminutive twin enters life with the burden of a very low birth weight, a need for a skin graft to heal a terrible IV extravasation burn from another hospital, and an ominous name. This darling little girl, Karen, was my patient months ago when she was transferred to our NICU for the expert care of our surgery team after being born with a developmental defect in her perineum-no rectal outlet. I remember how hard it was to get her to gain weight post-op, and when I last saw her she was scrappy and scrawny. In spite of a dangerous gastroenteritis and bacteremia with high fever a few days ago, she's healed and perky and almost ready for her next surgical step in creating a functional perineum. This is Bedan, who I posted pictures of months ago. He was born with a front0-nasal encephalocele and mid-facial cleft (his face was split open from between his eyes down to his lip, with a balloon of brain-lining-tissue and fluid bulging out). After a month or more in the NICU our surgeons were able to piece his face back together, and he returned this week for the next step in his reconstruction. He's about tripled in size as his mom feeds him well! Unfortunately he came with a bronchiolitis, a temporary lung infection that would have made his next surgery too dangerous, so it had to be delayed. His mom was abandoned by her husband after she delivered such a deformed child, so she struggles to get help to pay for his medical expenses. But she's a brave and dedicated lady doing a great job.

These are all kids who remind me that what looks like a disaster often turns out to be an amazing story of healing, or love, or something else intangible and important. Our moms' prayer group guide this week included this paragraph, even more poignant in light of the top news story out of Penn State football: " Where they (our children) have been the victim of evil, I pray that You would heal, restore, and lift them up above it. Bring good out of it. Just as You raised up Joseph to save a nation after evil plots on his life were carried out, I pray You would raise up our children to great things in spite of the evil perpetuated on their lives. In the meantime, enable them to navigate through this time and find “grace in the wilderness” Jer 31:2." What a powerful reminder that God is at work even when the hard realities of a fallen world impact our children. Whether it is having an application denied, or being born with brains bulging from one's face, or being abused by supposedly responsible adults, our kids suffer and our hearts ache, but we cling by faith the the story of Joseph, that evil can be transformed to bring good.