Celebrating

Jack, first. He turned 14 this past Saturday, in the middle of Scott and I working to save other moms and babies in the very spot of his birth in 1998. By God's mercy we were able to tag team enough to pull off a pizza and games party with a handful of other 9th grade boys. Jack at 14 is: tall (reaching Caleb imminently and soon Scott), strong, smart, driven, competitive, capable, funny, loud, sincere, contemplative, voracious. He can run miles and play soccer and rugby hard; but he also loves to lounge on the couch, watch sports on TV, read long books, and cajole his sisters into serving him. He thinks deeply about things like God and infinity and why chemical reactions happen as they do. But he also has an incredible Aylestock teasing streak that reminds me of my Uncles, especially Lloyd. As the youngest he observes and he knows just how to get a reaction. He's like a tumbling, biting, overgrown puppy around his classmates, wrestling and laughing. He LOVES good food and one of his favorite relaxations is to watch an episode of Chopped (which we somehow get on our Kenyan cable). His specialty is pesto which he makes himself from our basil in the garden, for gourmet pizzas (when we have pine nuts and parmesan that is .. .). He is faithful and loyal, ready for adventure and fun, and intuitive enough to be anxious at times about the world and the future. His adolescent lengthening lean body is catching up with his already deep voice as he turns from a boy into a man, which is happening too quickly for me. He can argue. Well. And writes beyond his years. And he's the biggest Man U fan ever; his wardrobe is mostly Man U wear and he hates to miss a game. This boy started as an embryo in a hostile war-chaos-sickness environment, so I never cease to marvel at who he has become, a miraculous redemption in a hard time. If we can get him off the couch . . . he could do about anything.

Julia's team won the semifinals in their league yesterday, in a glorious afternoon of sun and wind and cheering parents and a relaxed match (it's nice to be up 4 nil). She's built good friendships and team work and been mentored by some amazing senior girls, for which I am thankful. I can't be positive enough about sports for girls. Fellowship, exercise, health, confidence, a group to belong to, values deeper than surface appearance, serving others, disciplined time management, being outside . . very thankful for this opportunity for her. And for Acacia, whose JV team had an undefeated season in league play and went to semifinals in the varsity tournament last weekend and finals in the other tournament they entered. Acacia had an equally positive experience with lots of playing time, improved skills, respect for coach and team, etc.

(here is Julia with Rachel, her "twin" for "psych" =dress up crazy to get in the mood to win)

And lastly, this is a good week to pray for Caleb's future. By mid-March the US Air Force Academy board will have made their admission decisions. By early April he'll have heard from the other universities to which he applied. His future is a big black unwritten slate and the chalk is about to become visible. I love who he is and who he's becoming and we believe he has what it takes to be an Air Force pilot . . . or anything else God has in store for him.

Exponentially Monday

Today was about as Monday as it gets.  Which is why at 9:30 pm I am debriefing through my fingers (after assaulting my children with all the gory details at dinner, something they're quite used to).  Bear in mind that tomorrow Scott will finish our 7th call night in 11 days (5 together, 2 apart).  When you take time off to go to a conference (Feb) or organize a field-wide leadership meeting (March) it's like lifting up the edges and watching all the call days fall together in the middle.  Bear in mind this stretch oh-so-conveniently dovetailed with a health worker strike in Kenya, escalating the demand for services at faithful old Kijabe.  Bear in mind these have not been the kind of calls where one wisely imparts a little experiential wisdom over the phone.  They've been more of the blood-and-guts-at-2-a.m. type.  And bear in mind that the rest of life did not stop:  2 birthdays in the last week, 2 girls in a soccer tournament, 2 10th grade events, one sick kid, you get the idea.

I knew the morning would be difficult, because we had agreed to withdraw baby Malt from the ventilator because she showed no signs of brain activity.  Her dad, from a religion and culture that is supposed to be stoic, held onto my hand and wept.  (Crying men really get to me, two dads in one week, two decisions to stop aggressive care, is almost too much).  Malt had brainstem reflex gasps that kept her heart beating for a full hour and a half after I pulled her tube, which was cruelly agonizing, making me second-guess my decision and giving the family a false glimmer of hope that was dashed.  Two beds over we waited for the death of another child, 4 years old, a long and complicated story of malnutrition and a mysterious mass on his back that took weeks to diagnose as a mycobacterial infection.  After two months at Kijabe he was discharged back to a refugee camp on the Somali border where he got none of his ongoing care, developed an obstructed bowel that diverted out through the skin on his back, then lost his kidney function, and finally came back to Kijabe past the point of no return. Both these families are from remote areas to the northeast where they would almost certainly never encounter tangible witness to Jesus.  If I were planning it, I would have had both their children improbably and miraculously healed.  Instead their children slipped away to death.  I do think both families could see the extreme effort poured out on their child by strangers; the odd intimacy of being swept into the most crucial hours of someone's life may have more Jesus-witness in the long run than a proud victory.  I don't know, and I'm clearly not in control here.

That would have been enough for one day.  But the strike goes on, and we're packed.  In another one of those timing flukes ... in spite of my fantasies of perhaps a gentler post-weekend-call day, perhaps departing early . . . it turned out one person after another on the Paeds team had some sort of illness or family crisis or tiredness or whatever that took them out of reach for parts of the day.  So it was a non-stop day, except for running home to check on Acacia who had had a fever last night and missed school (she does feel better now, but pray for her).  At 3:30 I admitted a post-operative neurosurgical patient to the ICU (where I'm not really working but seem to spend a lot of my time).  I wonder if Kijabe is the only place in Africa a kid could have two world-leading neuro and craniofacial surgeons work on their skull and brain.  By 4 I was starting to think of the evening and rest, and deemed it wise to call the two new family medicine residents who will take call and give them a little sign-over and orientation.  We all introduced ourselves, washed hands, and I opened my mouth to tell them about the cozy humid little nursery where everyone was doing fairly well.  

Then all hell broke loose.  At that moment, a desperate call back up to ICU.  The xray I ordered ended with the little post-op patient's breathing tube being dislodged.  Only when I walked in I saw it was more than that--the little boy was pulseless and pretty much gone.  Mostly dead, but not all dead.  Another opportunity to use the PALS course skills from last month, running a full-scale code to get him back.  Which we did.  And just as that finished, a desperate call back from nursery.  Where there was another new admission of a mostly dead baby.  He had lost 1/3 of his body weight in his short 5 days of life, was blazing with fever, convulsing, and dry as a prune.  For you medical types: Na 180, K 6.4, Cr 3.1.  These are very bad numbers.  I pushed some fluids in an intra-osseous (in the bone) line until the Paeds surgery fellow who happened to walk in was recruited to get a real IV line.  It was one of those admissions where everything was harder than it should have been, no gloves, no lines, no nurses, just that time of day I guess.  Another distraught mom.  By 6 he was stabilized (though far from OK, he still may die) and I literally had my hand on the door latch to nursery when a nurse burst in with a 1 kg 29 week (very premature) baby in a cloth, just-delivered, dusky and wet and mewing slightly, heart rate falling.  Really?  This was the baby whose mom was, as per the last hour's report, no where near delivering tonight.  Yet here he was.  Thankful for Bob our clinical officer who stayed and helped me, we had to scoot one baby over to reach oxygen for this one, intubate and give the magical soapy surfactant mixture for his lungs.  It was dark, after 7, when we finally walked out the door.

Monday, to the max.  Time for some sleep.

Strike two you're out

This is Malt. She arrived at Kijabe hospital at 11 pm last night, after a seven-hour ambulance ride from Isiolo, a rather remote Kenyan town far to our northeast. In those seven hours, as her post-c-section mom held on for life, they called EIGHT hospitals and were refused admission until they finally made it all the way to Kijabe.

Why? Because yesterday the public sector nurses, clinical officers, mortuary attendants, lab and pharmacy personnel, all went on strike, for a "hardship allowance" to be added to their salaries. The entire government health system was paralyzed, leaving only private and Christian hospitals like Kijabe to suddenly fill in the gap. This was much worse than the previous doctor strike. Proving we can limp along without doctors, but we can't manage without nurses!! There are many issues of injustice tied up in who controls health funds, and how they are distributed. However I suspect that Malt's parents live on less than the INCREMENT the Kenyan nurses are demanding in their monthly salary. And there are the people who suffer and die when the strikes begin.

Malt's mom had two children, then lost two who inexplicably died just before delivery. Finally someone in her remote village sent her for antenatal care on her 5th pregnancy. She was found to have the blood type A NEG. Malt is O positive like her dad. So her mom's body began sending antibodies to destroy Malt's "foreign" blood. Sensing impending disaster Malt's mom asked for a C-section. And sure enough, by 24 hours of life Malt was turning yellow from severe jaundice and dangerously anemic.

And so we began the delicate process of putting a line in through her umbilicus and gently removing her blood and replacing it with compatible blood. Two teaspoons at a time. Over and over until we had exchanged her entire blood volume twice over. I finished at 3:30 a.m..

Malt still has a long way to go. She may live, or she may succumb. She was a bit premature, and her jaundice was severe enough to cause brain damage. The delay in her care certainly makes her survival less certain. Malt's story of a seven-hour ambulance ride to reach the 9th hospital for help is only topped by Lucy. I have to tell you that in this picture Lucy looks peaceful. She had just died. Lucy''s mom only lived about 15 minutes from Kijabe. But she labored all day at a small cottage hospital in the small town she's from. When she broke her water and started pushing and was going nowhere for some HOURS (maybe five . . . ) she was put in a taxi with some sort of nurse and they drove FOUR HOURS (12:3o to 4:30 am) to THREE HOSPITALS trying to get a C-section. At 4:30 they finally came back near home to Kijabe, where the mom proceeded to deliver a dead baby.

Well, mostly dead. There was a slight slow heart rate, with nothing else. No breathing, no crying, no moving, no eye opening, no nothing. I was called and even though I intubated the baby right away, gave resuscitation drugs and CPR and revived a heart rate for a while, Lucy's brain was gone. She didn't more a millimeter, ever. Her pupils were fixed, her reflexes gone.

Because the whole hospital was getting inundated with transfers and desperate people (did I mention the 29 weeks pregnant seizing woman? Or the two kids with meningitis?) we had no ICU space to even consider pushing Lucy along in her brain-dead state, hoping for a miracle. So I had the agonizing responsibility of calling it quits. Pulling out the tube, which was filled with excrement from this baby's stressed pre-delivery deterioration, and waiting as the heart rate fell to zero. And then sitting with the mom to explain and console. Who said through her tears, "God is faithful."

Lucy's life was not important enough for several hospitals full of people to take note and take action. We must stand against injustice for nurses, but not at the cost of the lives of the innocent. I am profoundly weary this morning. Nothing is more wearing than acknowledging defeat and waiting for death. Particularly the death of a baby who, if managed properly a few hours earlier, would have been alive, well, normal.

Not much else to say other than pray for Kenya, for justice and mercy to flow down. Because they seem pretty dammed up right now. I am falling asleep typing (we happen to hit this strike in a bad stretch where we are each on call 5 of 9 days . . two weekends in a row and two non-matching days in between, so that means 6/9 nights with interrupted or very little sleep), so I leave the last picture one of my other anchors. A morning jog with my dog, clearing the weight of that night of terrible decisions and sorrowful outcomes.

Anchors

This week has had some difficult moments.

On Monday, I met with the parents of baby J. He was born two weeks prior and came to us with jaundice and cataracts, and we later diagnosed severe hearing loss. His liver, eyes, brain, and lungs were damaged by a viral infection (CMV= cytomegalovirus) his mother contracted probably early in pregnancy. A negligible disease unless you are an unborn baby or immune compromised, and then it can be catastrophic. Baby J seemed to rebound early in his second week of life, and for a couple of days I hoped he'd just be a hearing-impaired but possibly relatively normal kid post-cataract surgery some day. But then he developed progressive respiratory distress. By Thursday night last week he was teetering on the brink of death, and was rescued by the ICU. I kept him all weekend on the ventilator, once doing CPR for a couple of minutes when his heart was faltering down to zero, once re-intubating him, and often adjusting and evaluating. We had started a new antiviral medication and hoped that 24 to 48 hours would make a difference. By Monday I could not see much improvement, and had already turned away another child who needed an ICU admission because we had no beds. So I had a long, gut-twisting, heart-wrenching conference with baby J's parents. I told them that I thought we were not helping him, and were possibly causing him more pain and more problems with this tube that was in his airway, for no real benefit, and I wanted to bring up the possibility of taking him off the breathing machine. In a country with extremely limited resources, this is a conversation we sometimes have to have.

I wanted to give them a day to adjust and think and pray. But an hour or so later they called me in to say they were ready. They stood by his incubator and put their hands on him and said goodbye. They cried. I cried.

I pulled out the breathing tube and suctioned and put him on nasal CPAP, a less invasive delivery of oxygen and air under pressure through the nose. I didn't know if he would even try to breathe. But he did. Fairly well. After an hour it was clear that he was going to fight on. He was actively moving, whimpering a bit, and pulling hard but keeping his blood oxygenated. I was cautious but slightly optimistic again. We moved him down to the nursery.

Tuesday morning I was nervous walking in, but there he was, yellow skin and bruised IV sites, fluttering eyelids, breathing away. Not great, but alive.

I still didn't think his long term prognosis was very hopeful, I'd seen him too close to the edge too many times. But these parents really got to my heart. I think English-speaking parents, without the barrier of translation, are more difficult to protect one's heart from. This mom was so completely dedicated, attentive, anxious, invested. And the dad was amazing. So caring. He came in his suit from work, and listened, and put his arms around her. I was really pulling for them.

Tuesday afternoon, I was teaching a group of a half-dozen nursing students how to resuscitate a newborn using the materials (model baby) we got at our conference. They were taking turns, putting breaths into the baby with the bag and mask. When I noticed the nurse carrying a REAL baby to the other resuscitation table, and Bob walking towards them. I left my students to check what was happening. It was baby J, with no pulse, no breathing, milk spilling out over his face. The nurse had been moving him from one bed to another, after a feeding through his nasal-gastric tube, and he vomited. He had absolutely no reserve. All those periods of marginal oxygen, all that infection in his brain, it was the final straw. So I moved from pretend CPR to the real deal, for about ten minutes we tried to revive him, with no success.

His parents came in at the very end. When they realized what had happened, they broke down. We got them into chair in a side room, where we talked and comforted and prayed again. They held his body. They said thank you. I said what I could, probably not very profound, but I hope they knew I cared.

And from there, I walked out to cook a birthday dinner.

Which brings us to the title topic, anchors. Sometimes I can't bring myself to think of another meal to prepare. Keeping the house stocked with limited time and resources, keeping kids fed, keeping laundry moving. All that lillies-of-the-field stuff we aren't supposed to worry about feels like a challenge. But this week as I took a couple of hours in the middle of a long weekend of call to make funnel cakes and play UNO with my "caring community" of 10th graders, or spent hours on Caleb's birthday cake, I realized these concrete wholesome tasks are anchors.

Stirring and kneading, measuring and washing, sorting and straightening. These daily solid tasks of life hold me. When I think about another dying infant, or the sadness of the parents, or the vast things I can't do and don't know how to help, I can despair. So I'm thankful for the necessity that anchors me to earth, that gives me a wholesome alternative to the world of the hospital. As much as I stress over coming up with another dinner, that incarnate reality steadies me

God put our souls into these bodies for many reasons. One is sanity.

CALEB, Numbers 13

The boys get bigger, the toys more complex, but Caleb's birthday gift reminded me of all those years when a new lego was the ultimate fun. Be on the lookout for some awesome gopro videos. On a more serious note, this child has worked 17-plus years of faith challenge into our hearts, as we held him with open hands even before he was born. Perhaps the decision to stay in Bundibugyo with a strong history of preterm labor and loss (and realizing that faith did not equal an outcome of my choosing) was the hardest, but only the beginning, of a process that will leap forward as he leaves home this year. In my chronological Bible-reading plan for the year, February 28 takes one to Numbers 13. Yes, on Caleb's birthday, the story of Caleb. Really.

And so once again the reminder that this young man is very much like his namesake. Tough. Quiet leader. Can-do. Brave. The type that would go into enemy territory if asked. And mostly the type that would not be influenced by the majority opinion. Caleb stands on his own, and has no qualms to make his own way apart from the crowd. Tonight was a small gift, a fire, good food, a fun gift, time together. In the light of impending graduation and continental separation, we all pause to soak in the goodness of a birthday, and the wonder of a great young man.

Caleb 17th Birthday Surprise Pizza Party

Late, tired, and slow internet, so here is an unfiltered bunch of pictures. Kids, flour, music, laughter, teasing, blue silly string, a guitar cake, balloons, pizza, more pizza, fire, sodas, stories, memories, pictures, candles, singing, the torrential downpour of the afternoon stopping just in time, mud. Caleb turns 17 tomorrow, but we surprised him tonight. No small feat. And all the dorm kids got back for mandatory study hall at 7. Yeahh.

I am going to call her Little Miss Red Shoes, because she reminded me so much of the young girl Heidi dubbed Little Miss Polkadots. I'm sure I'll get some flak because I am posting her picture here, and I do so soberly and with thought. I could black out her eyes or distort her face in some way. But I want her to be seen as she is: a diminutive nine year old, looking alone on a stool in the casualty department, brave, patient. Not something other, something veiled. A real little girl who bravely told her story today. It is not a happy story, and so feel free to stop reading here. Many lives are not rated G. Little Miss Red Shoes goes to school with her friends. She's in second grade. She lives with her mother and an aunt. Her father left the family years ago, though she thinks she saw him sometime in the last year. Her mom is HIV positive on treatment, sells little bits of beans and corn for a living, and often turns to the local church for assistance. Little Miss Red Shoes lives about a kilometer from me, in a community full of hospital workers and dedicated Christians. But that did not protect her, or at least five friends she could name including one girl in nursery school, from being raped three times in the last year by two teenage neighbor boys.

One of whom was her cousin. She's been lured into a home to run an errand, locked in a room when her mom was away, grabbed and forced. The boys gave her 20 shillings once, and 5 shillings another time (a few pennies), which probably made her feel even more violated. She sits kicking her red shoes back and forth, fingering a muffin into crumbs, quietly telling her story, restlessly, slowly. She and her friends have all been beaten by parents for reporting such stories. Last night, though, when she told her mom again, her mother saw the soiled clothes and heard her sobbing, and believed her, and stormed out to confront her sister's teenage son. Who did not deny it. And shorty afterward the mom's sister, the perpetrator's mother, the victim's aunt . . . showed up at Little Miss Red Shoe's house and beat her again. To keep her quiet.

But this time she was not quiet. She and her mother reported to the police, and then the hospital. The MO, who is a gentle, careful young woman, and I coaxed enough of the story out to be outraged, and then got a pastoral counselor, a community pillar, a respected grandmotherly type from the church to come and listen. Just the person we needed, who will mobilize reaction even if the police do not. We sent off tests and filled out reports. We listed the names and classes of the other girls, so they can all be drawn in by this lady for counseling.

The raping 15-year-old boy is in custody, but his family is well off, and likely to sway the police in their favor. They followed Little Miss Red Shoes and her mother to the hospital and tried to convince the senior nurse not to pursue the case. Instead he helped me arrange for a security escort to bring the report safely back to the police.

I grieve deeply that any nine-year-old girl should live in fear of her own relatives and neighbors. Should have her tiny innocent body violated. She wanted us to give her medicine that she could take so the boys would leave her alone. Her world is not safe. Her mother is thinking of sending her away to live with another relative, so she won't have to see this boy at school.

It is easy to think that such stories are rare, or exaggerated, or distant. But this one was real, and matter-of-fact, and right in our neighborhood.

So tonight please pray for JUSTICE, for Little Miss Red Shoes and the countless little African girls (and others all over the world) who are raped, beaten, blamed, sold. Lord have mercy on them.

BACK TO THE NURSERY

Introducing . . . After two weeks of the CMDA conference and a field trip to Naivasha's maternity and neonatal programs . . it was time to return "home" to the Special Care Nursery. Here are a few of the babies. Naomi is well on the way to becoming the SECOND gastroschisis survivor. Hannah Wangari went home at the end of last week, and Naomi has had a miraculously straightforward course, her protruding intestines quickly fit back into her tiny abdomen. Little Samuel has a spinal cord open-to-the-air defect on his back and no opening to his anus, not to mention a very very small head and un-find-able testicles. I find him cute in his own unique way. Can't seem to find a clear syndrome that combines all his problems, so maybe he really is unique. Amazingly Kijabe has some of the best surgeons in the world for these malformations. This baby's mother was infected with a virus called CMV, relatively benign for her but devastating for the baby. He has cataracts, and severe hearing loss, jaundice from a liver that doesn't work normally, and he needs oxygen to breathe. However he's much better over the course of the week with supportive care, and he'll get good audiologic follow-up from our neighbor and eye care from the nearby Kikuyu eye hospital. I had little hope when I was pitching in two weekends ago to help a visiting doctor cover that baby Paul would live. His mom died in the ICU that weekend, and I was second-guessing my decision to intubate Paul. But he's a champ, and it looks like he might make it, all three pounds of him. This baby, sadly, died this morning, after I had snapped this photo yesterday. He was born in an ambulance on his way here to a mother who had no prenatal care, at 27 weeks (out of 40) gestation and weighed 830 grams yesterday. That's small. He had a rough night, and when our team tried to help him all morning we just kept losing ground. Finally we gathered around him, holding his tearful mom's hand, and prayed. But God did not do the miracle we asked for. An hour later he died in his mother's arms. Satan always attacks the weakest. So sorry for Lucy, the mom. This little pumpkin is my vote for the cutest baby in the nursery. He's close to being big enough to go home. Lastly, our newest baby, NEONATALIE. She is a very realistic baby model made for teaching. After our excellent conference I was able to go through a "Helping Babies Breathe" curriculum with the staff, and have them practice ventilating and caring for little NeoNatalie. The instructor can make the baby breathe, cry, and have a pulse. Or not. So that the student has to really react and take action.

I loved sitting in class, absorbing. But it is also nice to be back in the real world with Paul and Naomi and Samuel and the others, fighting for life instead of just talking about it. Even though we don't always win.

Thoughts on rainbows, sacrifice, transition, and hope

Early morning darkness, a faint smattering of rain staccatos on our plastic mbati roof then peters out. After two weeks of daily all-day commutes to our continuing medical education conference at Brackenhurst, there is finally time to squeeze in a short run with Star before the day begins. The dust of a nearly two-month drought has been dampened by the scattered drops. By the time I reach turn across the escarpment the clouds are breaking and glowing pink with a new sun. I'm thinking about Leviticus, my current waypoint in the year's chronological Bible read, about the difference between burnt offerings and peace offerings, waves and heaves. And remembering the clear message in late Exodus: the point of the sacrifices was presence.

Which is a good thing to remember this moment. Because the whole two-week conference was another milestone of closure and grieving and moving on. For the first time, we were FROM Kijbabe not Bundibugyo. Our kids were in school, and living at home, rather than missing school in Uganda. We were listening to lectures and pursuing workshops to improve health care in Kenya, not Uganda. Heidi and Jessica graciously came for an overnight to connect with the kids and our life here and talk about Bundibugyo, which is good and home-sick-inducing all at once. And though it never worked out to have the Johnsons connect with us and our new colleagues the Steeres (we figured they'd become great friends so we really did try) we did get to at least have a lunch with Travis and Amy, and take them to a soccer game, and visit the kids and grandparents at their lovely nearby tea-estate location. So once again our present reality intersected with our past, which can be both good and unsettling.

Ruth VanReken reminded us of the hidden losses, the discordance between how you think you SHOULD feel and how you DO. Ahh, so familiar. In the two weeks I can't count how many times people asked us "how do you like Kijabe" or "what made you leave Uganda" or "are you glad to be with your kids" or some such evaluation of the last year. These are the same brave souls we hug and chat with and compare notes with every two or four years. And every time I am asked I summon up cheer and confidence and repeat the list of ways God opened this door and told us to walk through it, and the list of ways that we are thankful He did. Only every time I still feel like I'm convincing myself. Repeatedly hoping that God really DID lead us. Guilty for not being completely ecstatic that I'm here in this great hospital with a home full of kids and pleasant weather. So it was helpful to hear Ruth say that this is normal. Many losses are hidden. They don't make sense to others, particularly not those who are feeling the weight of their own loss to BE in the place that I miss.

Then there was the medical education workshop I mainly went to in order to support the speaker who was covering for me in the hospital these two weeks. And by the end I was floored with the realization that the Spirit was speaking. He talked about leaving a program he had set up, and seeing it discontinued and changed. But then seeing that what mattered were the people whom he invested in over the years. Education as discipleship. The programs may come and go but the individuals and the community persist. And that is still true for us, as we read the notes sent our way from Bundi, as we get the texts and emails.

Back to the rainbow. Sacrifice is cost. But not destruction. The rainbow symbolizes that what is lost (the whole world) is, in God's mystery, redeemed. Genesis and Leviticus are telling one story. This is a messed-up world, and we are called to sacrifice if we would approach the One who is Holy and Other. But the sacrifices are ways of inviting, of cleansing, of preparing, of approaching. They are not wanton wipe-outs.

So this morning I was reminded that it is OK to feel the loss, and in some mysterious way it is perhaps necessary to clear the space for the cloud of glory that comes and fills and guides. That what goes on God's altar is transformed and redeemed to bring relationship. That it's not just about counting the cost, but seeing the hope of what it brings. For most people that probably means leaving their kids, and going to a hard, hard place. For me that has meant leaving the hard, hard place and coming to my kids.

And I did see that, in some concrete ways these weeks. The heart ache was there, of not being in harmony with our old life in the same way. But then the gradual permission blossoms, to become rooted in this new life. In the middle of the conference two of our interns came over one late evening for dinner to bring us a thank you gift for being part of their lives this past year. We brought our old friends to the soccer game, and were reminded of all the new friendships that are deepening here. Perhaps it is the magic milestone of passing one year and entering the cycle for the second time, but as I hug and chat and cheer, I am with some women who have shared deep pains in prayer this year, I am with some kids who have been in and out of our house, I'm with people who are walking our same path. I'm with people whom I am growing to care about and feel part of. And best of all the evening that one set of friends needed to spend on an alone date, we ended up with new friends having a real time of fellowship and celebration.

This transition started exactly two years ago, when our replacements arrived in Africa at this very conference. It took a major step a year ago when we moved to Kijabe. And I think I feel more at peace now, in February 2012, about actually living here, not just temporarily serving, but living, than I have since we arrived.

The rainbow painted that truth, that our God does not delight in destruction. That if He wounds He also binds. That the tears have meaning and water the new harvest.

As the colors disappeared this morning, ephemeral in the mist, I'm sure this sense of moving through a milestone will also evaporate. Reminders will be necessary. But for today I am embracing this new life.