Slow-Motion Miracle

This is Bedan, who was born with a large sac of brain membranes and fluid protruding from the middle of his face (wish I'd thought to take that photo).  He went home from his seventh surgery yesterday (bottom picture), having been admitted many times in this last year.  His mom thanks those who helped and those who prayed.  And we all thank her for believing in this baby, even at the cost of her marriage and security.  And we thank Dr. Nthumba, the plastic surgeon.  He's part of the heart of Kijabe.  The young Kenyan doctor with a passion for surgery who serves at Kijabe, is sent for further training, forgoes lucrative positions, and returns to establish services here that smooth contractures, reconstruct damaged bodies, heal burns, save lives.  When he's not sewing people back together he also manages all the interns and medical education.  Bedan's story is one that illustrates well the essence of Kijabe:  rescuing from the ash heap those that most of the world would abandon.  Mobilizing resources to help the marginalized.  Pioneering services that are not available on many places on this continent.  Investing in the next generation of Kenyan doctor-leaders.  And doing it all in the name of the love of Jesus.

Show the path

Read Psalm 16 this morning.  "I have set the LORD always before me, because He is at my right hand I shall not be moved. . . You will show me the path of life."  Praying today for Scott and Caleb.  In about 45 minutes they'll be at the clinic for follow-up.  In the next few hours they need to decide if Caleb is ready to return to the rather harsh life of the dorm, and go back to classes.  Because of the bone fracture and extensive surgery it is no small thing to crutch around a large campus in the snow where 3/4 of the inhabitants are bent upon abusing you anyway to make you tough.  But missing classes is also no small barrier to overcome in survival.  And Scott has a plane ticket to fly out of Denver this afternoon, out of Dulles on Thursday, and land in Nairobi Friday night.

Meanwhile the US embassy just issued all sorts of dire Kenya advice, totaling up all the random bombs and deaths and kidnappings in the last year, so that we're properly sober about the potential for chaos in light of the primary elections due to take place tomorrow.

We are grateful for so many prayers and know they carry us along as the world shakes with torn ligaments and uncertain futures and corruption and riots.  I guess I'm just feeling it today.  Ask the One in whom we put our trust to heal Caleb, to show him and Scott the right path.  To not let him be moved from his USAFA path, nor us from our work here in Kenya.  To give us counsel, to let us rest in hope (v. 9).

The rest of life: 2013 year in review

In between phone calls to Colorado, life still goes on.  And 2013 feels long enough already for a year-in-review post.  Perhaps the first one in the blogosphere for this particular year . . . Here goes the 2013 year in review.






Research, education, goals, and public health:  Last week a group from Kijabe hospital joined other paediatric and obstetric doctors and nurses at the University of Nairobi and Kenyatta National Hospital to discuss our progress, or lack thereof, in reducing neonatal mortality.  60% if infant mortality occurs in the immediate post-birth period.  While overall under-five child mortality in Kenya has halved in recent decades, neontal mortality stays stubbornly high at 31 deaths/1000 live births.
We listened to presentations on the top killers:  sepsis, prematurity, and asphyxia, and discussed ways that better communication and team work, appropriate hygiene, basic warmth and feeding, could avert up to 75% of those deaths.  Inspiring stuff.

And particularly relevant at Kijabe where the new year started with the delivery of quadruplets.

Patient Care:  On Jan 1, on the way back from taking Caleb to the airport, I got a phone call from the medical director and thankfully we could mobilize four docs to receive them on short notice.  They are all girls, perhaps identical, perhaps two sets of twins.  
Here are Erika, Immaculate, and OB Martin speaking to the media.  The safe delivery and so-far survival of these 900-1100 gram girls was quite an event.  I was standing behind them looking useless and official.  The next day a random guy stopped me and said "I saw you on TV!"  That was fun.

After a couple months of ICU, Dr. Sarah and I have switched to the general paediatric floor, also covering the maternal-and-child-health clinic.  High volume, lots of malnutrition and seizures and sadness, and a sprinkling of the truly puzzling.  Last week we figured out (with tons of help) that the 11 year old girl we thought had TB because of the fluid in her lung linings actually had a quivering  floppy failing heart because her kidneys were being damaged by obstruction to their blood flow.  And that the toddler with diarrhea actually had an unusual sequelae called hemolytic-uremic-syndrome.  And the teen with a massive liver had been infected with Hepatitis B at birth and developed liver cancer.  And on and on.   Some stories I find particularly heart-breaking.  Like P, who is cradling his little cup of porridge as we try to extract his story.  Ten years old, with AIDS, abandoned by an abusive alcoholic father that ended up in jail after his mother ran away, shuttled through four orphanages already in the last year or two, stunted and infected and quiet.  We tried to find any person in his life to connect him to his family or past; he could only remember one lady who owned a salon where he used to live who was kind to him.  In the end my colleague connected him with an excellent ngo which serves HIV-infected orphans.
Or baby N, from Sudan, a refugee in the vast border Kakuma camp, born with hydrocephalus and twitching for weeks until the agencies in charge managed to transport her and her mother to Kijabe.  Where they can't communicate with anyone.  We plug through rounds day by day, hearing the stories, prodding and probing, thinking and tweaking.
Many get better, thankfully, like this bundle of cuteness.  There are satisfying moments such as popping a heavy needle through the tibia (leg bone) of a 10 month old who is probably less than an hour away from dying of diarrhea, pushing syringe after syringe of fluid, and watching him wake up, his eyes flutter open, his arms start to push us away, his face looking for his mom.

Training:  We are a teaching hospital, continuously raising up the next generation.  This past week I led daily devotions for the next class of nurses Dr. Erika is training in neonatology, to improve our NICU.  And I taught the weekly mid-day paediatric conference, this time looking at the Lancet's publication in December about the Global Burden of Disease.  But because I'd been to a teaching-training at RVA last month, I used some of my newly-learned techniques.

Here are the interns sitting in groups of four, each a committee from the WHO who must decide how to spend a hundred million dollars on health.  Targeting the most prevalent diseases?  The most lethal?  The ones which rob younger people of life?  At least no one fell asleep.  Later Luke interestingly said he'd put it all into poverty-reduction measures, because before anything was known about bacteria and viruses it was empirically evident that disease targets the poor.  Fascinating.  And true.



RVA life:  School is back in session.  We passed our two-year anniversary in Kijabe, and the kids started term 2.  I zip back and forth for Student Health clinics and Junior Class meetings, and field phone calls from the nurses about everything from sore throats to insomnia to broken bones to depression.  Here are Julia and Acacia in USAFA-shirts from Caleb, a reminder to pray for him in his trials:

Much of our best RVA moments come in watching our kids play sports, which for me is the sacrament of the present moment.   Looks like we'll get plenty of opportunities if we can juggle the hospital duties with the above schedule.  I love sitting with my community of fellow parents, cheering, soaking up some sun, not trying to multitask any other productivity into those moments, rejoicing in who these kids are.

Julia and Acacia are playing football-this is Julia getting the ball at a scrimmage.

 Jack is playing JV basketball, which is not his strongest sport but since he's 14 and passed the 6 foot mark and is generally athletic we think he has great potential.

Community and friendships:  I'll end this post with shots of friends and visits.  The Christmas season spills over into January.  Luke was with us until early yesterday morning as he flew back to school, and with Luke our home becomes more social, more adventurous, more fun.  

 He and the Congdons (Stephen from his class at RVA, Robert from a few years earlier) rode to a lake on the Kenya/TZ border which is the breeding ground for all the Lesser Flamingos in East Africa.  His pictures are beautiful of spectacular landscape and challenging terrain.  I only got the moment of departure.  Oh, and the laundry and dishes afterwards.

 We hosted families passing through, such as our friends the Wrights bringing their daughter Anna back to school, or   teachers from RVA whom we wanted to get to know . . .

Or the lovely Dr. Emily whom we met by email correspondence years ago when she decided to make her birthday party a Matiti project goat fundraiser, then visited us in Bundibugyo, then we visited her in Indianapolis and met her Kenyan friend Dr. Evans, and they both stopped by to say hello on their way from Eldoret to Nairobi. 

 We are grateful for some friends returning from HMA, like Rich K.

 And sad that others, like Luke, have to return to the US to progress in their schooling, like Rachel and Hannah, the core of the Caleb fan club and wonderful young women who are friends and role models for Julia and all of us.

And so life goes on.  We pray for Caleb, mourn his pain, and wait for each day's unfolding progress.

 We mourn Luke's leaving back to America, miss those moments of kicking a ball around, making a meal, building a fire, watching a movie.  We correspond and do homework and update databases and go to meetings and take call and do dishes, and pray for Jesus to make 2013 a year to remember for healing and deliverance and love.

Early Lent

Lent officially opens exactly one month from today, Feb 13.  But this 2013 year is already so out of control that an extended season seems in order.  If anyone else has that same impulse, feel free to join. I had the idea (hopefully from the Spirit) of fasting from 3 normal, beautiful, pleasurable  life-giving things to remind me that all life really comes from Jesus alone.  One for each ligament in Caleb's knee that's healing.  Alternatively one could add 3 spiritual disciplines that one does not already normally practice.  There will be no public accolades or heavenly brownie-points.  But there will be this:

1.  A daily reminder that in our weakness (when we really WANT that thing given up; when we FORGET to pray) Jesus is strong.  We lean on him to do what we can't.  In fact as we struggle, and even when we fail, the power of Christ comes upon us, and is completed. (1 Cor 12:9).  This is Lent by Grace, not a contest for the super-strong, but a life-source for the weak.

2.  A daily reminder that the things which promise life (a certain food or drink, a certain show or hobby, a certain place or luxury) are mere reflections of true life.  (John 1:4)

3.  A daily sense of participation in what God is doing.  In our flesh.  In continuity with the sufferings of Jesus.  (Col 1:24)

4.  A daily conviction that the Kingdom comes, with a cost.  That that which doing in this world is not easily done.  That the battle matters, is real.  (1 Pet 4:12-13).  This is the normal way that redemption marches forward, that darkness is fought back.

5. A daily, incremental, barely perceptible growth in core faith, as testing results in patience, endurance, molding of character into that of Jesus (James 1:3-4).

You will undoubtedly think of more, those are just what comes to mind this afternoon.

Perhaps a healing knee seems peripheral to the work of God, to the suffusion of the earth with glory and truth.  But the Bible is full of small healings.  This is where real life is lived, in the agony of a child's pain, in the loss, in the overcoming of discouragement to struggle on, in the actual restoration of a limb or a heart.  When Isaiah announced the coming of the Messiah, he described the filling in of valleys and smoothing of roads (Is 40:1-5), the rough places made smooth. The abysmal state of the desert path was part of the curse upon the world; anyone who has lived in Africa can relate to that.  The sudden drop-off of the road into a gully was a literally broken piece of this world that caused Caleb such grief.  And when Jesus announced his Kingdom coming (Luke 7:22) he referenced the poetic picture of Isaiah 35:
     Then the eyes of the blind shall be opened,
     And the ears of the deaf shall be unstopped. 
     Then the lame shall leap like a deer,
     And the tongue of the dumb sing,
     For waters shall burst forth in the wilderness,
     And streams in the desert . . . 
     A highway shall be there, and a road . . . 

Sometimes we over-spiritualize everything to the point of forgetting that my child is lame, Jesus can heal him, and so let's just ask for that.  Literal knitting of ligaments, literal strengthening of feeble knees (Heb 12:12-13).  That alone is a goodness and redemption.  My suspicion is that it's part of something bigger, too, of what God wants to do with this boy's life in this world.

I think it will be our privilege, then, to look back and remember the community of saints which drew together to pray and strain through this time of healing.

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.