It's been a while . . .

Perhaps part of the recovery phase of a terribly crazy October through early January, short staffed, strikes, terribly sick patients, family visits, heart-wrenching goodbyes.  Perhaps the insanity of RVA meshing (or more to the point, NOT meshing) with Kijabe and World Harvest as the new term started.  Perhaps Scott being gone two weeks for meetings in America, and connecting with his parents.  Perhaps sensing God calling for silence, meditation, grounding, thoughtfulness.  But for whatever reasons, this blog has been unusually quiet.

And the pressure of resuming with something profound to make sense of the silence is too much.  So I'll just list a few happenings and praises and flow-of-consciousness information.

Patients.  Gift, whom we all prayed for throughout the last two months, went home.  He is the third survivor ever in Kijabe and probably all of Kenya of his serious bowel malformation.  He had overwhelming bacterial infections, and once completely died but was revived.  He had a persistent heart issue that slowly healed, and in the last week we thought he might have had a second life-threatening abnormality of his liver.  But he didn't, and he got better, and he went home to the coast on Friday.  Along with Daudi, who hopped a ride on an ambulance from the opposite side of the country one terrible night when I had kids coding in ICU and nursery at the same time.  He had a massively swollen belly because no one had noticed his lack of anal opening, being distracted by his obvious cleft lip and palate.  Again, thanks to partnership with our Paeds surgeons, he went home rescued and functional, with hope for more procedures soon.  It's been a pretty good month on the NICU service, lots of surviving preemies and slow improvements, lots of moms who battled discouragement and hung on, lots of victories and a bit of heartache too.  Both Gift and Daudi were majorly helped by our Needy Children's Fund as well as other funding through the surgical arm of our hospital.  It is good to work in a place where Jesus' healing power can be extended to the least of these.











RVA.  The new term is in full swing.  Which means early Saturday mornings for Senior Store coffee.  Caring communities.  Class night preparations.  Clinics.  Games.  The flurry of activity and anticipation that occurs for Banquet, the major social event of the year for Juniors and Seniors (sort of like a prom, but no dancing, so more of a dinner theatre evening).  The girls helped Jack pull off a wonderfully romantic "ask" with lots of chocolate, roses, word-smithing and atmosphere, and each of them had fun with clues and notes and surprise askers themselves.  And Friday was a parent open house day, where I got to watch Julia in her pottery class, and think about poetry and physics and Swahili.  It is a privilege I will never take for granted after two kids boarding, to be here and to participate.  I try to remember that when every night seems to be crazy busy with something scheduled.

Women's Retreat.  And in the midst of single-parenting and new terms and homework and scholarship applications and lectures to prepare and middle-of-the-night emergencies and phone calls and dinner to make and administrative scheduling and just too much of life . . the AIM mission had a women's retreat which they opened up to all of us.  Our World Harvest contingent of Ann, Bethany, and me was joined by Pat visiting from Uganda for a wonderfully refreshing weekend.

We roomed together and had a blast.  But the worship and teaching were also solid, and just to be away and quiet was priceless.  God had been drawing our attention to Psalm 1 and the tree, so when I was able to go early to the retreat and spend a day in silence and prayer, I wandered into the nearby forest and sensed the refreshment of God's presence.

Family.  Prayers would be appreciated for my mom, who underwent MAJOR back surgery two weeks ago.  She had rods put in to help with a severe kyphosis (hunching over) that would have progressed to respiratory compromise.  The recovery has been slow and painful.  She is in a rehab facility. Today she sounded brighter, and was able to get out of bed with help and take 120 steps.  But she has a long way to go.  And Caleb will have surgery on Tuesday to remove a screw from his knee that is working its way out of the bone and irritating him where his brace rubs.  He has finally, after a year, just started to run a bit.  Luke heads into February with five interviews for medical school to be completed.  That's a lot of travel, and no small amount of stress and uncertainty.  Pray that God would prepare a place for him.

That's the news for tonight, thanks for hanging in there with us, and for your prayers.

A Rooted Pilgrim

Last weekend our pastor preached on Psalm 1, and the entire idea of meditating on Scripture.  So the main idea that has stood out for me in this chapter is rootedness.

Perhaps that is because the missionary life often feels so uprooted.  Right now I have a husband sitting in an airport in Qatar, a son in CT, a son in CO, my sister and mother in NC, my inlaws in CA and Norway.  Today I was on long and short phone calls with team in Uganda and boys there who were our neighbors, talking to my mom in the US, emailing with team in Burundi, and others formerly South Sudan now in limbo, and texting with team who moved from Bundibugyo to America.  While I was talking to Scott in the Doha airport, a text came in from our embassy here warning us that an IED had been exploded in the airport in Nairobi.  It sounded small, but not exactly encouraging a few hours before a loved one travels through.  My mom is preparing to have back surgery on Monday. My heart is diffused by the dispersion of those I care about and the threats they face without me, and that can lead to a sense of being disconnected from any particular place or time.

But Psalm one contrasts the people who are like chaff, blown away, with the ones who are like trees, planted and firm.

And the difference is in where a person seeks their wisdom, counsel, thoughts.  In the passing fads of our philosophies and fashion, or in the ever-flowing river of the Spirit?  It seems that it is possible to be a mobile tree, a rooted exile, a pilgrim with connections.  A centering occurs in meditating on the Word of God that gives roots strong enough to bear distant fruit.

So to start 2014, I am praying for that rootedness.  And I know it requires space, discipline, time, desire.  Which led to another epiphany this week.  I am a person who works until the job is done, not until time is up.  That is the nature of motherhood and medicine.  Task not time oriented.  No particular limits.  A baby has to be held, a meal has to be prepared, and patients have to be seen even if there are 30 instead of 15, or if they show up dying at the last minute.  But that seeps into all of life, so that if it is 10 or 11 pm and I still have a lot of administrative work to do, I plow on.  This year I would like to develop habits and limits and boundaries in the areas of life where they are possible.  Not necessarily in patient care, but definitely in computer time.  I've practiced this week turning off before the work is done.  Freeing, but unsettling too.  The requests for schedules or evaluations or plans pile up.

But to stay rooted requires day and night focus on the Word, and to do that requires ceasing from some other words.  Pray for discipline to make the space to meditate, and survive.

A Gift Update

Gift lives.  It was touch and go for weeks, but he came out of the ICU in early January and is doing his best to turn into the kind of baby you don't expect to die every minute.  His surgical wound is nearly healed.  He still needs oxygen, so we were able to get a cardiologist out to confirm the pressures in his pulmonary blood vessels are too high, and recommend a medication.  He is mostly fed through his tube still, but starting to swallow from a syringe and even attempt the breast.  His infection is gone.  But the days and weeks stretch on and his mom is getting a bit discouraged.  I try to remind her how far we've come.  Would you please pray once again that Gift could go home?  To do that he needs to be able to breathe without oxygen and feed without tubes.  God has miraculously preserved his life . . I am reminded of Romans 8 . . how shall he not also, with him, graciously give us all things (v 32).  Thanks.

All our incubators are full, and nursery is popping.  Lots of stories, some as dramatic as Gift's, some simpler.  Baby D arrived in a veritable bus-like ambulance from Western Kenya one night.  I had agreed to accept a transfer of a premature baby with meningomyelocele, since this is the best place in Kenya for such a child to receive care.  Only it turned out he was a twin, so both preemies were put in, and since they were coming, the threw in a bigger term baby with the vague diagnosis of "anomalies and distended stomach".  This baby had a cleft lip and palate, problems that paled in comparison to his tense and grossly inflated abdomen, a big jaundiced balloon laced with distended veins.  Since the original referral baby arrived dead, and we tried for some time to revive him, it was about half an hour before I could look at baby D.  One look at him and I checked for an anus.  Not there.  Well, that explains a lot.  No opening for his GI tract, so all that air and stool and secretions and food just kept blowing up.  Our surgeon rushed him to the operating theatre, and he's a thousand percent better now and nearly ready to go home.

I love working in this nursery. Yes, it's HOT and crowded, and there are hourly ethical dilemmas, who to move when the next preemie arrives unannounced and all our incubators are full, how to share 7 monitors among 20 or 30 babies.  Yes, it can be heartbreaking when we lose one.  Last week we spent several days almost constantly at the bedside of a baby with very very very sick lungs, and then she died.  But these are balanced by the preponderance of infants for whom we can offer life-saving assistance.  Wednesday I stood by and watched and coached and cheered for six babies being born, all doing well, even the 3 pound one.

So pray for Gift and his mom Dorcas to have a happy ending too!

Motherhood, the battle

A month or so ago I witnessed the mother ibis, who had built a nest in a tree in our yard, successfully defend her eggs from an onslaught of monkeys.  She raised a racket, extended her wings, hissed and jabbed with her beak, and the dozens of monkeys who were scampering through the branches finally gave up and went on to scavenge easier prey.  It was impressive, this glossy squawky ungainly bird holding off much larger and more agile mammals.  I've been rooting for her ever since.  Three eggs hatched, and one of the small birds died when he fell out of the nest early on (or after he fell out, not sure, but found the carcass).  The other two have been making noise, venturing out a bit, over the past weeks.  Saturday morning I was awakened by a ruckus of the dogs going crazy.  That can mean that our neighbors are on a walk, or the world is ending, hard to tell.  By the time I walked out I found that the monkey troupe was chasing through the trees and over the roof, and another baby ibis was injured but alive in the yard, and the mama ibis was flapping and screaming and berserk.  I let the dogs off to chase the monkeys, and kept an eye on the young bird.  Our dogs obediently left it alone.  The mother circled for a while.  But the hours went by and it didn't get up.  Mid day I moved it into the tree, but it couldn't hold on.  So I placed it carefully in the flowerbed beneath its nest, and brought water which I poured gently into its beak.  It swallowed, rapidly, gulping.  I could feel the fluttering heart, the warmth under the feathers.  It opened its eyes, then closed them, wearily.

Just before we piled in the car to go the the airport, I checked it again.  It was dead.  This morning the parent ibis pair perched on a branch above the body of the infant bird, crying out.  I later moved the carcass to the compost pit.  

And if all that drama had not occurred the day I was putting Luke on the airplane back to the US, I might not have been so emotionally involved.

Last day bitter lemons after a picki ride

But the truth is that motherhood requires a spirit of battle.  No matter how strong and great these kids get, there is always a troupe of evil ready to swoop down and wreak havoc.  Applications rejected, ligaments torn, fevers escalating, hearts bruised, homes lost.  One got back to school last week and spent this weekend in bed with a fever and sore throat, coughing, and alone.  Vacation days are times of sweet vulnerability and connection, which makes the partings harder.  The future is blatantly uncertain.  

Yes, mothering is not for the faint of heart.  I identify with the ungainly ibis, relatively powerless, but ready to squawk.  Mourning loss.  I went for the first long walk I've had in ages on Friday, and I was not ten steps down the path before I started sobbing.  Scott is in America for WHM meetings, gone two weeks.  Son 2 had left and son 1 was about to, and South Sudan is falling apart and changes are ahead.  Sometimes it is just all too much.

Yet when I feel the pain of another goodbye, I also feel the thanks that I'm here to say those goodbyes.  This month we're helping host two different families where the missionary mom died of breast cancer.  One is a fantastic young mom herself now, with her mother's poise and practicality.  I'm hoping she and her husband come back long term.

Betty and Denise were courageous women, who struggled for their kids and for the Kingdom.  It is a holy honor to see their families thriving in the midst of grief.  

So I will battle for my kids, and battle my own heart's self-pity, with a dose of thankfulness.

Laikipia

In the beautiful season of having my entire family together for the space of 12 days of Christmas (literally), I have neglected this space.  7 of those were work days but 5 were not, and we packed up the Landrover and headed to Laikipia.  Laikipia is the general area of a high plateau west of Mt. Kenya rich in wildlife where European ranchers established vast tracts in the last century.  Several have turned those into private game reserves, and the towns carry a wild-west quirky colonial flavor amidst the African dukas and pickis.  Laikipia is also, it turns out, a ridiculously over-priced vacation destination.  When I started planning our five-night safari over a month ago, I first had dreams of reaching Lake Turkana and the real North.  I soon realized we would be on the move every day, camping or scrambling for accommodation at a new place every night.  That did not seem like a good use of our non-work relational time with our kids (though car trips can be pretty memorable).  So I opted to halt our northward trek in the Laikipia region. (note the pictures below are nearly all Luke's, who is an excellent photographer in a family of creative photographers).

For the first two nights we camped in Ol Pejeta (http://www.olpejetaconservancy.org/) which, while pricy (the campsite booking fee we paid ahead was about $80, for six people for two nights that was fine . . but it turned out we had to pay additional daily camping and park fees on entry), does give value.  It is a 90,000 acre ranch that is now managed in a way to showcase the combination of cattle ranching, tourism, and wildlife preservation.  We booked a private campsite, Murera Donga, which is our family tradition after years of campsite 2 at QENP in Uganda.  Just us, tents, a campfire, and the savannah.  We could watch waterbuck and impala and baboons and birds from our tentflaps, and a few of us caught a glimpse of lions retreating as we pulled up.  No people, only stars and smoke.  Lovely.  In the morning there was a spectacularly clear view of Mt. Kenya to our east.  We went on game drives which were also practice-driving-drives for teens.  We cooked good meals, read books, and rested.  We saw rhinos and visited the chimp sanctuary, watched the sunset and talked. It was glorious.

Night three we drove to Timau, after lunch at Dorman's in Nanyuki.  Timau is less than an hour north.  I had booked the Timau River Lodge (http://timauriverlodge.com/) as one of the few affordable places we could stay in a bed and get a hot shower between two two-night camping stretches. This place was, shall we say, unique.  I loved the eccentricity of the scattering of cabins, wandering geese and peacocks, a zip line, dogs, rabbits, secluded waterfall, short hiking paths, and a tiny plank bench located up the hill with another stunning Mt. Kenya view.  The management is Indian and we had decent but not spectacular Indian food for dinner.  The cabins are rustic-unfinished logs, sort of dusty and musty and tacky decor.  But good space for a fair price, and for younger kids the playground/animal aspect would be even more fun.  We were all so tired after two nights on the ground that we slept well.


Nights four and five we drove another hour or two north and slightly west into the Mukogodo forest, which is managed by four Maasai communities.  I found the contacts via the Laikipia tourism web site here:  http://laikipiatourism.com/camp-sites.  The directions were a bit vague, drive past this police post, go through this gate, etc.  We sent Luke out to chat with Maasai herders a couple of times and they kept pointing us onward.  Which turned out well, for though we did not find the campsite we had booked, we found a spectacular one run by the same group.  When we drove through the forest and piled out of the car, Luke explored a path and came running back to say he'd found the best view in all of Kenya.  We set up our tents in a clearing of thick soft grass at the foot of a rock kopje. But we spent most of the day sitting on the rock cliff under a fig tree, reading and picnicking with a hundred-km 180-degree view to the north.  The forest dropped away to dusty plains, distant mountains (the Matthews range) and a winding river. A constant wind updraft worked like air conditioning.  One day we also took a hike through the forest to another ridge-top viewpoint.  The campsite was truly spectacular. It also happened to be the home of a leopard who was none to pleased with our presence and spent the night prowling the perimeter with his low menacing coughing growl.  The Maasai group insisted on sending us an man armed with a large gun to guard us at night.  I think I was more worried about his gun than the leopard.





A year ago we had made blanket tarps and bought everyone cool collapsable little camp chairs (http://shop.alitedesigns.com/monarch-chair.html) for Christmas, but our camp-out became a sit-in-vigil watching over a severely injured Caleb post-motorcycle-accident.  So this year was a sweet redemption, to pull out the tents and chairs and to set up camp in two beautiful spots, a wild-life rich savannah and a cool forest mountain ledge.  This year for Christmas we gave our kids money to give away, and a kindle a piece.  After many years of all of us sharing two kindles, we decided to buy four more "paperwhite" devices.  I know it sounds a bit extravagant, but I have no regrets.  We all share the same amazon account so everyone could read the best of the books I had bought us over the last few months.  As a family we went through twenty books in those five days.  Reading, hiking, resting, viewing, appreciating.  Music and campfires and stories and time.

I HIGHLY recommend the Mukogodo Forest.  If you hate heights (and as a mom I admit to some anxiety) there are several other sites without death drop-offs.  And if you go, please mention us. If you can afford Ol Pejeta I also recommend the bush campsite do-it-yourself, or the Pelican House if you can share with another family. I probably corresponded with twenty tented camps and lodges looking for something we could afford.  There are many options that charge $250-$800 PER PERSON PER NIGHT, meaning thousands of dollars for our family.  I am not kidding.  Besides the camping, I found four lodges that were on the $30-$60 per person per night range.  They may have been nicer than Timau, but Timau was conveniently on the way between our two campouts.  The others were http://naromoruriverlodge.com/, http://www.castleforestlodge.com/, and http://www.rhinowatchlodge.com/.  The Rhino Watch looked perhaps the classiest.

Very thankful for this taste of the timelessness and beauty and togetherness of Heaven.

Christmas in Disguise

Christmas Eve at 6:30 am I was awakened by a 999 stat code page to ICU, where Gift had stopped breathing.  When I arrived he still had a thready rapid pulse, but that soon stopped.  He was essentially dead, and I wanted to cry, but instead did CPR and called for help.  We got him back, and he spent the day intubated on a machine for life support.  In retrospect he probably had respiratory depression from his post-op pain meds and is so marginal and slightly dehydrated that he went down fast.  He improved through the day, and Christmas morning I happily pulled out his tube.


This child is a miracle baby, and Christmas is a fight, and I am battle weary. I thought we had lost him, but over Christmas and Boxing day he opened his eyes, moved, cried.  We started feeding him.  I rejoiced.

Then this morning he had respiratory distress and got intubated by Erik again.

Here is a CS Lewis quote shared by George Mixon:

“The universe is at war, but not between two independent powers.  It was all created good by God, and went wrong.  It is a CIVIL war, a rebellion. We are living in a part of the universe occupied by the rebel. . . Enemy-occupied territory – that is what this world is. Christianity is the story of how the rightful king has landed, you might say landed in disguise, and is calling us all to take part in a great campaign of sabotage. . . Why is God landing in this enemy-occupied world in disguise and starting a sort of secret society to undermine the devil? Why is He not landing in force, invading it?  Is it that He is not strong enough?  Well, Christians think He is going to land in force; we do not know when. But we can guess why He is delaying. He wants to give us the chance of joining His side freely. . . [before He comes] without disguise. . . . It will be too late then to choose your side."

Christmas:  victory in disguise, the King lands as a vulnerable infant, and that is why Gift can be healed and live.  But not without a struggle.  So please keep praying for him.  After a very intense week of nonstop work and entertaining . . we are walking out the door in a few minutes to do a 5-day family camping trip.  But my heart is in the ICU and I really hope that prayers for Gift continue, and I find him turning the corner to life when I get back.

Meanwhile check the post below for our annual prayer/Christmas letter, and here are a few photos of the day until Scott has time to post his good ones. We had church and carols and a cinnamon pastry and a few presents and all the interns and a "motherless" family (because of travel) over for dinner, and lots of joy together.

We'll be off-line this week.  Merry Christmas.

Myhre Merry Christmas letter

Merry Christmas from the Myhres!
Click HERE to download our annual Christmas missive...

Gift's surgery, lefsa, and the jumble of medicine and Christmas

The 23rd of December, Christmas Eve Eve . . . Caleb home last night, immediately bringing the ease and laughter of a completed family back to us after too many months of aching gap.  So thankful for these hardworking kids, and the way they value relationship, and the way they can keep perspective, can avoid buying in too far for things that don't last, can stay true to who they were made to be.  I can't remember why, but at one point in the car on the way back from the airport I was laughing like I haven't laughed in a long time.  This is their time, to connect with each other, to sleep, to eat Christmas cookies, to play the guitar, to cut out snowflakes and visit with friends.

And a lot of my heart wishes it was my time to do those things, too.  The strike has officially ended, but maternity and nursery are still bursting at the seams. Today was pretty nonstop.  A 30 week preemie, two severely jaundiced babies, rounding on our Paeds ward where there are no visitors to fill the gap anymore and trying to figure out the diagnoses and plans and who can go home for Christmas.

But the good news is, Gift was able to go for surgery, and seems quite stable so far post-op.  Due to a low platelet count he needed fresh blood in the theatre, and I just happened to match his type. That needle is big and blunt but it may be the most concrete way I can help my patients.  The real skills today came from Dr. Erik who was finally able to do the repair.

 And then after a day of labs and resuscitations and orders and calculations, home to make a steaming pile of lefsa and celebrate a traditional Norwegian white dinner and Advent reading with friends here.

Scott read the prayer his Grandfather used to say in Norwegian, and we ate cod and rice and coconut shrimp and vegetables in a cream sauce, polished off by both Australian and American cookies and one of my favorite Christmas books:  Papa Panov's Special Day.  Which reminds us that we meet Jesus now in those who are marginalized, needy, different, difficult, poor. In those who draw out compassion, in those whose gift is their weakness.  

A Christmas Gift

For Christmas, I asked for hope.  Because it is hard to keep pushing 110% effort into small things that die.  And that's when Gift was admitted. He was born on the Kenyan coast with his intestines protruding from his abdominal wall.  This is a condition called gastroschisis, and as far as we know there have been only two survivors in Kenya.  One at Kenyatta and one here.  The exposed bowel gets infected, and something that should be fixable isn't.

Gift was taken to two other hospitals before being transported to Kijabe, where he arrived severely dehydrated on his 4th day of life, his bowel matted to a dirty dry guaze.  Our surgeons inserted a "silo", a sterile plastic bag with a coiled ring that slips under the skin and contains the bowel until it can be gently pushed back into an abdomen that did not grow big enough in utero.  We admitted him to the ICU for fluids and antibiotics and resuscitation and close monitoring.

And that's where he's been for ten days, fighting for his life. His little body has been overwhelmed by a serious bacterial infection in his blood, causing him to go into shock and bleed.  We've transfused and added the strongest combinations of antibiotics.  We've followed his blood pressure and his sodium level, measured his urine output, worried over his chest x-ray.  

And we've prayed, which I'm asking others to do now too.  He should have died, but he has held on.  At one point another doctor wrote in his file that it was time to call in the chaplains to comfort the parents as he was going to die.  But he didn't die, yet.  And with each day he's hung on that stubborn hope just takes hold.

He's his parents first child.  They journeyed a full day and hundreds of miles to get him to our care.  If he lives he would be only the third survivor of this condition in Kenya.  I know God can be glorified by life and by death.  But this time I'm asking for life.  It is my job; that's what I do, and though it breaks my heart too many times, I do believe Gift can be healed.

Please pray that tomorrow, Monday, his blood infection would be cleared enough for him to go into the theatre for surgery to close his abdomen, that he would survive that and be able to breath with his intestines back inside, and Gift would be God's gift to his parents and his medical/surgical team this Christmas.