The Caleb Post-Op Report

Scott here.

So, early this week we were informed that the orthopedic surgeon (the "knee guy") of the Air Force's 10th Medical Group at the Academy scheduled Caleb for repair and reconstruction of his 3-ligament knee injury (ACL/PCL/MCL) for Friday (today).  My bosses at World Harvest encouraged me to leave our annual leadership meeting two days early in order to attend Caleb's surgery.  So, I forked over a bunch of money to United Airlines and flew out to Denver yesterday (Thursday) where I was generously lent a car for the week by dear friends and supporters.

Caleb's superiors released him to me Thursday night.  What a happy guy he was hobbling out of the USAFA gate.  Off we went to stay with other dear friends for the night - its sort of the theme of this entire experience, our family being cared for by an army of saints.  Caleb wouldn't admit when his last shower was, but he made up for it by taking showers both at night and the next morning (following the instructions of the surgeons to use the special chlorhexidine scrub on his knee).  "I feel so cleeeean", he said smiling ear-to-ear.

In the outpatient surgery center of the 10th MG, we had extensive briefings from the ortho doc and anesthesiologist - listing potential complications mostly.  (Interestingly, the anesthesia guy went to med school with Dr. Jason Fader, our general surgeon from the Burundi Team).

The surgery itself took a bit more than four hours - a little longer than the orthopod expected.  The biggest surprise finding in the surgery was that the ACL was found to have ripped off from the tibia bone, but the ligament itself was intact.  So, the surgeon was able to just tack Caleb's own ACL back down to the tibia.  Huge bonus.  The PCL did require replacement with a cadaverous ligament.  MCL was repaired with sutures.  By x-ray the only evidence of this surgery will be one screw and one staple.

The bottom line, though, is that the orthopedic surgeon was smiling afterwards and said "the surgery went very well."  Thank God.

Now on to rehab.  It's a long, long road. He'll be hooked up to a machine at night which passively moves the knee all night long (to keep the range of motion good).

Thanks again for praying...keep it up.

Foot Not Moved

Thank you all for encouraging comments, for pointing us to the truth, for having more faith than we do, for praying.

Tomorrow, Friday, 6:30 am Caleb's surgery begins.  It will be a several-hour procedure under general anesthesia to repair all three ligaments at once.  Pray for Dr. Allred to have skill and success in this difficult surgery.  Pray for God to heal Caleb's knee more completely than anyone anticipates.  Pray for Caleb to come through with hope and strength and minimal pain (especially since we found out after the accident that's he's allergic to codeine and/or morphine).

A few praises:  Scott was given the grace to leave the WHM meetings he was attending in Philadelphia today and fly to Colorado. He will be with Caleb for the next five days.  Our friends the Grahams are opening their home, and Caleb's sponsor family has been super, and other friends leant a car.  We are very grateful.  Another praise is that the Squadron Cadet Review Board meted out a not-too-terrible punishment.  But we're waiting on confirmation from the Air Officer Commanding (AOC) of his squadron, who has the final word on what his consequence will be.

Caleb's future in the USAFA is still uncertain.  Though the discipline committee does not seem to be pushing him out, the medical review board still could if he does not recover sufficiently to perform the demanding physical duties of the Air Force.

My dad's favorite Psalm, 121, has been on my heart as Caleb heads into surgery and I am almost ten thousand miles away, looking up at the hills of Kijabe.  My help comes from the LORD, who made heaven and earth.  He will not let your foot be moved. . . The LORD will keep you from all evil; he will keep your life.  Surely the one who made heaven and earth can make a few ligaments, and keep that foot from being moved.  He can keep evil at bay, and lead Caleb in paths of life.

Thanks for standing with us.

Desperation and Deliverance

PLEASE pray for Caleb this week.  The knee accident has been worse than we realized.  The orthopedic surgeon who saw him yesterday was able to talk to us on the phone, and was not at all encouraging about the prospect for full healing.  I realize some of that is cautionary medical don't-get-your-hopes-up attitude, but it felt like a physical stab to hear it.  I'm so thankful for Mike Mara our orthopedic colleague here, who has been a voice of hope and reason, and for other medical friends calling their medical friends and offering opinions.  The end result is that surgery has been scheduled for Friday.  Scott is in the USA for WHM leadership meetings; he will hopefully be able to get to CO to be with Caleb in the post-op period.  Friends we really need a miracle here.  Medicine and science can only go so far.  The procedure timing is controversial.  We're not talking about a few weeks or even months to recover, but years.  This is a kid who was the fastest in his squadron in basic training, whose intramural soccer team was in the finals, who worked super hard to achieve one of the top academic scores in the first term.  This is also a kid who has had a life-long pattern of being knocked down, and getting back up.  Pray for his heart. Pray for his knee.  Pray for God to take a desperate situation and turn it to deliverance for His own glory.  Our hospital chaplain read from Exodus as Moses faced the trek through the desert and the battles for the land, he said, if you don't go up from here with us, then don't send us.  As we go into 2013 we're passing through a desert and into a battle and we desperately need God to go with us.  Great leaders have a pattern of early loss and struggle, and I know God can use this for good.  Remember Joseph in prison.

Secondly pray for TODAY's SCRB ie Squadron Cadet Review Board meeting.  This is the group who will decide Caleb's punishment for riding a motorcycle.  I'm glad I looked into his eyes and discussed this before the kids went out to the valley,  and know without a doubt that he went out with a clear conscience.  But it doesn't matter to the Academy if he understood this rule or not. I suspect that illegal drugs or alcohol or visiting prostitutes would be less of a scandal than taking what is normal transportation in Africa.

Thanks for supporting Caleb and us in prayer.  We truly can not do a thing to pull him through, only God can.  Through you.  

Traveling Mercies

Saying goodbye reaches new depths of sorrow when you say goodbye to a child in a wheelchair.  Who is 17.  Who is traveling alone, injured, back to one of the hardest years of life one can choose.  Who has just spent an hour waiting for Kenya Airways to ineffectively find him said wheelchair and regret to inform us that they can not find any bulkhead seating.  When you know the flight is already delayed to the point of making the connecting flight in Amsterdam unlikely, probably beyond the point of possible.  I came out of the airport and called KLM in Kenya, in America, and in the Netherlands, but no one could really manage to make the computer give Caleb a seat where he could manage his leg.  Leg room is now a money-making opportunity, and not for the injured.  Watching him pushed through immigration felt very helpless.  

He was in God's hands, not ours.  Where he was upgraded to a better seat.  And where his connecting flight was also delayed 2 hours.  So as far as we know he is now over the Atlantic en route to Atlanta.  This child has been on God's hard altar since he was a fetus, and it doesn't get any easier, even if the ram rustles the thicket with encouraging flight news.  Your prayers are appreciated.

Staycation

This term comes from Karen Masso, who at times just did NOT want to move again on a break.  Missionary life involves just too many transitions, too many rough roads and expensive flights and buggy beds, that the idea of staying HOME on a vacation appealed to her.  I personally like to be in motion, exploring, away from the accessibility of needs and calls, and finding new adventures.  However at Kijabe we live in the nicest house we ever have.  We have a fireplace, a Christmas tree with lights, a pizza oven and a grill, and beds for all.  We have access to woods and views.  We have half our kids coming specifically to BE HOME.  And we had, this year, a kid with an injury on crutches and in pain who needed recovery time rather than the planned wilderness camping.  So we canceled our four-day three-night game park outing with other families, and stayed home.  A STAYcation.

Which would have been lovely most Decembers, but this year Kenya is experiencing record rains.  Daily.  Nightly.  The sun has been a rarely sighted memory.  Thick clouds weigh down on us.  Occasionally there would be enough light to cast a shadow, but soon the rain would pound in again.  Dozens of people have actually died in flooding, and hundreds have been displaced, so this deluge is more than an inconvenience.

We are safely perched in a sturdy house, so for us the enforced inactivity of a nearly ligament-free knee and the dreary confinement of rain has meant nearly constant fires crackling. LOTS of cooking.  Lots of dishes.  A day spent on motorcycle maintenance while the non-mechinca's sipped chai on the porch.  A day playing a massive game of risk, table pulled up to the fireplace, snacks and chance and strategy and protest and laughter.  Kindle books.  The Batman series of movies.  Premier League football matches.  More food.  A day driving out to Malewa (our only few hours out of the house this week) to visit the Congdons in their impressive new home.  Good coffee, actually really excellent coffee.  Our spastic tree aways blinking in the background.  Occasional visitors.  A few work-related phone calls.  Watching an URBANA talk on youtube.  Phone calls to grandparents.

I'm not sure how often we'll ever do a staycation.  Kijabe makes it much easier than Bundibugyo, but I still miss the motion aspect.  I do think this has been a restful stretch; the sheer exhaustion of Caleb's injury drained us emotionally in unexpected ways.  In all the sorrow I AM thankful for hours spent together, unrushed, still, a rarity in our life.  

And so 2012 drew to a close with silly hats and blowing horns and toasts and a party-popper, all four kids here, basking.  For that I am thankful.

Not the Christmas We Expected

We should have known better when the Sunday sermon emphasized interruption.  God interrupting plans.  Mary's, Joseph's, the Magi's, the Shepherd's, pretty much everyone in the story.  But especially Mary's, because everything she must have dreamed of before the angelic interruption (a happy marriage, a peaceful life) and even after the angelic interruption (victorious overthrow of the rich and proud in her lifetime by her son) was turned upside down.  Her heart was pierced when her son came into the world suffering, and a few decades later left it the same way, in blood and cries, seemingly at the mercy of cruel and indifferent authority and injustice.

We welcomed Caleb home on Friday.  Together at last, after six months.  Stories slowly eeking out about his first term at the USAFA and Luke's at Yale, good food, Christmas movies, too much rain, decorating cookies, puzzles, pizza, visitors, church.  

This is our second Christmas at Kijabe.  Last year we were both on call, and we missed out on most things, somehow on the outside of the season.  Yet this is my favorite time of year, steeped in patterns and traditions over two decades in Africa, welcoming Jesus anew.  So last year was a hard transition. I missed our home in Uganda, our team, our neighbors, the rhythms and patterns of community.  The predictable cow slaughter.  Visiting our neighbors.  Knowing the songs, the expectations.  The pace.  The hot dry wind blowing in, the cocoa drying.  Our own dairy cows, an every-ready real manger in our own yard.  This year I really wanted to anchor our family in the continuity of some of our old habits and grasp onto the Kijabe versions of some new ones.  We did advent Sundays, inviting different groups over, both missionaries and Kenyans.  And I tried really hard to sync the hospital needs where we're still working, the RVA we're-all-on-holiday cascade of events, the Myhre family traditions, our new WHM team mates, figuring out Kenyan culture, and the new realities of kids home from college who need space and rest.  Tried too hard, probably.  Planned, dropped, added, negotiated, re-evaluated.  Chose which services and events we'd do with the community, with RVA, with the hospital, with friends and neighbors.  Planned a big camping trip for four families of people who know each other well and often do things together, but with whom we've never been able to spend that time.

And almost none of it came to be.  We see pictures of our old team in Uganda and our sister team in Sudan doing the kinds of things we loved; we hear about all the great things people around us here managed (gift baskets to needy families, visiting rural churches, candlelight services, caroling).  But our Christmas was quite different.

On Christmas Eve morning I was in the hospital, catching up on the details of ICU patients from the weekend, checking in with our ward and nursery teams, examining patients.  There were contract issues for our new CO, and payment issues for some TB meds, notes to write, phone calls, prayer.  

The new 3-bed HDU (High Dependency Unit, a room with monitors and oxygen and a more intensive nurse-patient ratio than the general wards, but a step down from ICU) had finally been finished, so we gathered our surgical and nursing and chaplaincy colleagues in to dedicate it in prayer.  I was trying hard to be efficient so I could sign out early at 2 pm and take my kids to join the maternity and nursery nurses as we took gifts of food and clothes and crafts up to a children's home a couple miles away, something the Kenyan staff had arranged themselves.  Then we planned to do our traditional Norwegian Christmas Eve white dinner, and join the hospital staff once again for caroling in the hospital, concluding with an 11 pm candlelight service at RVA.

Instead, an interruption.  

"Mom, there's been an accident, it's Caleb, he's OK but his knee is swollen".  

After this it was hard to concentrate, but Scott was able to quickly leave in the car and go get him.  All the kids had gone down into the Rift Valley on pikis (motorcycles) for a picnic breakfast and just visiting time with friends.  They were on a road, but the road had been washed out, which they didn't know.  The first riders went right but Caleb was on the left side and suddenly the road emptied into a crater.  He swerved, the bike nosed into the hole, and stopped, throwing him.  It took Scott an hour to get there and another to get back, with Caleb's leg splinted using the car jack, in excruciating pain.  I met them in the casualty (ER), where Caleb's knee was terribly swollen, but his attitude was as usual calm and stoic and selfless.  An IV, morphine, exams, xrays, discussion.  Looks like 3 of the 4 ligaments which hold the lower leg on to the upper were torn:  ACL, PCL, and MCL.  Bad news.

In that first hour, all I wanted was a rewind.  We had discussed him not going.  Yes, it's part of this culture, it's the way to get around on these roads.  But the consequences of an accident for Caleb are potentially more than for most of us.  His life involves physical training.  LOTS of it.  His dreams involve things like jumping out of airplanes.  His days are full of stress and abuse that will only be worse on crutches.  Scott and I felt sick with sorrow.  He had to face calling into his commanding officers.  The Air Force doesn't always take kindly to disability, and will hold him responsible for taking this unnecessary risk on his vacation time.  He's looking at surgery, or several surgeries.  Months of crutches.  A year of rehab before he can do the things he loves, like run and play soccer and go for the parachute training and flight training he is pursuing.  If we had seen this unwanted, extremely interrupting moment, we would have done almost anything to change his path.

But we didn't see, didn't prevent.  And now a new hard road opens up before him.  We have a lot of decisions to make about travel and medical care, and I'm sure many things we haven't thought of.  But with 48 hours' perspective here are the lessons I've been tossing around again.

1.  We live by community.  When Caleb was wheeled into casualty our neighbors flocked to help.  One couple had accompanied Scott and held Caleb's head on the bumpy road back, providing comfort and advice.  The paeds surgeon did his head to toe trauma exam, the ortho surgeon evaluated his knee, the casualty doc checked in, the PT person came up with a brace and crutches, someone led us in prayer.  My paeds colleague covered the rest of the day for me, and Scott was relieved of call that night.  We were even given ice.  When you are in need, then you find out that great friends support us.

2.  It could have been worse.  This was one of the first things our friends said.  He could have injured his head or broken his neck.  He could be dead or paralyzed.  A knee can heal.  In our grief for all the suffering this interruption involves, it helps to remember that this is NOT the worst case scenario, no matter how sad it seems to us.  In the same 24 hours two women we know died in Uganda, one the wife of our pastor and translator from complications of pregnancy, the other a woman who suffered from HIV from complications of chicken pox.  A destroyed knee impacts life, but does not end it.

3.  Parents make mistakes.  Kids make mistakes.  Accidents which might have been prevented, aren't.  This is where GRACE is needed.  To save us from ourselves, even when we fail.  A washed out road can still be redeemed by God's purposes.  I don't feel that way right now, but I do know it is true.  I would not write the script this way.  Caleb has already had plenty of pain, already had three previous surgeries, already broken bones two other times.  He worked very very hard the last six months.  And now the next six, the next twelve, will be even harder.  I don't know why he has to face this, and how exactly our bad choice (to let him ride the piki) and God's providence work together.  But grace trumps.  Worse outcomes were prevented, and the hard one he got will be matched in some way by mercy.

4.  Parental love never rests.  With every milestone survived, new dangers open up, and our kids are always at risk.  A sword shall pierce through your own soul also.  Repeatedly.

5.  Our kids are amazing and resilient. Patient in suffering.  Remarkable in hope. 

Tomorrow instead of a camping trip we're heading into Nairobi to get an MRI (we hope) and begin to make more concrete plans.  Prayers appreciated for miraculous healing.  For sustaining courage to face all the implications.  For wisdom as we figure out how to support Caleb.  For our family to roll with the unexpected.

To accept interruptions in the spirit of Mary:  behold the servants of the Lord, let it be to us according to Your will.

On Christmas and Redemption (part 2)

I am going to tell a good story.  With a happy ending.  But you can't get to resurrection without death. The Christmas story itself drips in the slaughter of innocent children (see post below, part 1).  The context of Christmas is death. And you have to live in darkness to see the great light.

Three times this week I've seen children die.  That's the context.  But twice in the last 48 hours I've seen a miracle.

The first was on Tuesday evening.  It was a long day, and I was passing by my ICU patients about 6 pm thinking I would soon head home.  A 6-year-old girl (a theme this week it seems) lay in one bed, still groggy and on a ventilator after our neurosurgeons had removed a brain tumor the day before.  As I stood there, she became hypoxic, her monitors starting to flash red.  I moved in to examine her as her heart rate slowed dangerously.  Her skin turned to a deathly pallor.  She did not respond to deep pain, at all. The nurse and I began to increase her oxygen, sample her blood, call over her surgeons, push IV fluids.  The senior surgeon shook his head, acknowledging that there was not a lot we could do if she was bleeding into her brain as we suspected.  Niether of us expected her to live.  But an hour later she was back to her baseline, and I spent the night watching with bated breath.  By the next morning we were able to remove her from the ventilator.  Her eyes were open, she responded to us and was breathing on her own.  I can't explain what made her deteriorate, and then revive completely.  But I'm glad.

About 24 hours later I was finally home, and had put on my Christmas pajamas and settled in after a great dinner to watch the Princess Bride with the family.  When I got a desperate phone call from the nursery, the baby with whom I had spent the prior night slowly exchanging his blood, had been getting a second exchange transfusion with the on-call staff, and arrested.  Could I come?  I threw on clothes and tennis shoes and ran.  This was a cute and loved little newborn boy who had been very sick but was crying and active only hours before.  Now he was lifeless.  The doctor on call, Sarah, had intubated him and I confirmed her efforts were moving oxygen in and out of his lungs, which usually brings a newborn back if he's save-able, but not this one.  A nurse was doing CPR and another had drawn up medicine.  We gave adrenaline once.  Twice.  More CPR.  Blood glucose normal.  Three times.  No response at all.  His pupils didn't constrict to light, he didn't move, his heart was completely flat.  Sarah and I switched back and forth, giving breaths and pumping on his tiny chest.  I could see his mother over my shoulder, sitting in tears.  He'd been down for 10-15 minutes by now, and I would have given up, but we tried one more thing.  I had asked for calcium gluconate, but they were having to order it from pharmacy (!) and it was taking long, so finally I just looked at one trusted nurse and asked her to RUN not walk to ICU and bring back a vial. She returned and drew it up to push slowly as per protocol.  He's dead, I said, just shoot it in there now.  We followed it with a big push of IV fluid, not expecting it to really do anything, but wanting to give him one last chance.

It was the most amazing thing I've almost ever seen.  This dead baby opened his eyes. He looked up at us, and started to squirm.  His heart started beating.  He started fighting our breaths, and looked like he wanted to cry, only he couldn't with a tube down his airway.  His color returned.  He blinked under the bright lights of the nursery.  After a few disbelieving minutes, we pulled his tube out and he cried like any normal baby, as his teary-eyed family and doctors and nurses looked on.  We held a thanksgiving prayer.

Both of these children will die again some day, whether this week or in one year or seventy.  But for this moment death was defeated.

Because Christmas ushered in a new reality, a deeper truth than the existence of evil.  Christmas began a redemption that is still pushing out through the world, rescuing and reviving, renewing and resuscitating.  Babies and water systems and economies and families and minds and bodies.  After the Matthew 2 slaughter, read the Isaiah 35 blossoming.  Fear not, God saves.  Springs arise in the desert and life returns to children and the recompense of God arrives.  Evil undone.  In the world, and even in me.

On Christmas and Slaughter (part 1)

Having spent 17 of the last 20 Christmases in Africa, the wind which blows in a drier hotter season now feels familiar, and the flashing spastic lights we bought in our capital a couple years back (our first electrified season) feel appropriately chaotic.  Last year was our first in Kijabe, and I remember the church Christmas pageant which included a band of skinny little camouflage-clad Kenyan boys as Herod's soldiers marching in like a rebel resistance army, and Jesus' parents fleeing before them like any other refugees. I don't recall much focus on this part of the story in America as I grew up.  Our plays ended half-way through Matthew 2, with the gifs of the magi, while the scene was still serenely beautiful and triumphant.  The slaughter of innocent children gives the story a jarring, uncomfortable ending, dangling, unresolved, and terrible.  Rachel weeping for her children, because they are no more.

Five years ago on this day I had just flown from Bundibugyo to Kampala to see my own children for whom I had wept, thinking that Scott and I might be no more, after surviving a 3-week ebola-exposure incubation.  Many innocents had died all around us.  That Christmas was awash in grief, much like Christmas in Connecticut this year.  The 20 first-graders who died, and their six heroic teachers and administrators, are a modern-day slaughter of the innocents.  Angry evil lashing out at those who are defenseless.

We should not have dropped this part of the Christmas story all these years.  Because slaughter is the context of Christmas.  The whole story hinges on the presence of rampant evil.  When masses of children are violently killed, it becomes hard to deny the reality of injustice and suffering, the horrible brokeness of our world.  And in Revelation 12, we see the evil pictured as a great serpent, seeking to devour God's holy child.

Christianity is not about a moral standard, who is right and who is wrong, winning arguments or elections.  It's not about the right songs or the right politics, or power or influence.  It's not about an intangible inward assurance of a distantly future eternal location.

Christmas and Christianity are about redemption of a real evil in our real world.  This is a serious business.  People get hurt.  The evil that made Adam Lanza mentally ill, that tortured his life, that deprived him of treatment or cure, that deceived him into believing this last act of horror was something he needed to do.  The evil that split up his family, that lured his mother into buying assault weapons capable of firing hundreds of rounds of deadly ammunition in a matter of minutes, the evil that insinuates that limiting this sort of weapon to the military is an infringement of human rights.  The evil that kills twenty African children every three minutes of every hour of every day of every year, over and over.  The evil manifest in viruses that turn love and motherhood into death, in greedy dictators who steal from their own people and ruthless terrorists who throw grenades into neighborhoods, in failed crops, hunger, ill-equipped hospitals, careless drivers, floods and droughts.

On this continent it would be absurd to deny the horror and heartache of evil, just as absurd as it would be to do so in Newtown.  Or in Bethlehem, when the bloodied bodies of baby boys were being buried.

The birth of the child who is God ushers in a turning point in the story.  A foe capable of meeting evil, and defeating it.  Disguised and humbled in human flesh.  The incarnation sets in motion a complete reversal of all that is wrong, all that is sorrowful, all that is painful, and in the course of this battle, a lot of people die.  The baby survives and becomes the man who will refuse to ride against Roman powers as a King, that is a victory too small, a territory too temporary.  This King will choose a path of suffering, voluntarily taking on all that evil could throw at him, in his own body, nailed to a tree.  Like the teachers at Sandy Hook who put their bodies in the path of bullets, trying to protect the children.  This King will defeat evil.  He will walk out of a tomb, so that every 6 and 7 year old gunned down, every starving baby, and even the Adam Lanzas of the world, can be redeemed.

We saw the Hobbit movie a few days ago.  The filmakers inserted a scene at Rivendell in which Gandalf muses that it is not so much the power of armies that keeps evil at bay, but the ordinary acts of courage and kindness that preserve our world.  The community outpouring of love which will heal hearts in Newtown.  The tenacious pushing of a teenage girl who gave birth to a baby, and the steady painful walk he took towards death.  The daily self-sacrifice of his followers who sweep streets and teach children and suture wounds and defend the fatherless.

Evil is real.  Innocents suffer.  But the story does not end there.

DOGS

Some things I love about my dogs:
They'll try new paths on wandering jogs
They wait for me when my pace slogs
They never complain about my blogs.

Some things I love about my kids:
EVERYTHING.

Luke's HOME! Day One

I'm typing this as I eat dinner at midnight, which is also lunch, which gives some overview of the wonderful chaos and energy that has always seemed to swirl around this boy.  If Day One of his Christmas Vacation Visit is any predictor, we may not survive.

The above picture was taken about 9 am at Jomo Kenyatta Airport.  If we all look a little weary, realize Luke had been on the plane two straight nights, and the rest of us had arisen early to arrive at 6:30 ahead of the traffic, for his 7 am flight.  Only KLM seemed to have stashed his bags so deeply in the bowels of the aircraft it took them two hours to locate and unload.  Nevertheless we were all thrilled to hug him.  We stopped for coffee on the way back through driving rain and traffic and didn't reach Kijabe until almost noon.  At which point Scott and I guiltily ran into the hospital to relieve our friends who had held down the ship all morning; and the kids were enveloped by a happy noisy Letchford/Rabenold/Kinzer crowd.  I didn't know it would be the last time I saw them all day.

While I was catching up on dying patients, putting my 10 month old malnourished baby B on not just dopamine but epinphrine AND dobutamine drips, panicking over my 6 year old post-brain-tumor surgery girl, and helping a colleague find referral numbers for another 6 year old with leukemia and matching hemoglobin and platelet counts (2), plus working on policies for newborn resuscitation . . . Luke and Jack decided to go on a piki ride.  First day home, first priority.  They were joined by several other boys and headed for the highest point around, Kijabe Hill.  When I finally finished work at 7 and walked in, I was surprised to find out I hadn't missed any time with them.  They were still gone.

In fact I found our neighbors, ever kind and patient, coming for tools to take to Luke and Jack who were stranded by a flat tire.  Luke had gallantly stayed with his little brother when the puncture occurred, in spite of the cold and rain.  Tyler K rode back to the rescue in the dark while I finished cooking dinner, though as it turned out they had to seek help from a random mechanic who fixed the tube with what looked to me like a bolt through a patch of rubber . . .  Only before any of that could actually get finished, Scott was called back to admit and ICU patient and I was called back to nursery. Rachel S happened to be stopping by at that moment, so she gamely followed along.  And spent the next three bloody (literally) hours with me putting an umbilical venous line into a 2 1/2-day old baby with a bilirubin of 28 and then pulling his blood out and putting fresh blood in, 10 cc at a time (2 teaspoons), 44 times, to completely exchange is blood volume twice.  Rachel is in a nursing program at Calvin so she claimed to be happy to monitor and record the baby's vital signs every minute or two, while I carefully did the exchange.  This baby would have been severely brain damaged if we did nothing, and hopefully now he can recover and possibly be OK.  We prayed with his anxious mom.

Thankfully Luke and Jack survived darkness, rain, and a detour on a dangerous highway, to make it home. with only one low-speed sand-induced spill that resulted in seven stitches, but a mere flesh wound.

So dinner at midnight, while the Christmas lights sparkle, thankful for all these fun college kids and their enthusiasm for Africa and each other, thankful for survival, thankful for getting a line in the baby and making it through the procedure, thankful Caleb is packing right now having finished chemistry exam, and hoping for a bit less eventful of a day tomorrow.