Mercy, mercy

Mercy, mercy.

Jennifer writes about lots of tiny babies, but today let me share the story of a 57 year old woman I'm caring for on Kijabe Hospital's Womens' ward.  Mercy's her name.  

She came in with some diffuse respiratory symptoms: cough and shortness of breath for several months.  Let's call it a chronic cough.  Should she have come earlier?  Perhaps.

She underwent the standard work-up for her problem: complete blood count, chest X-ray, sputum examination - as well as a test which every patient get who is admitted to any hospital in Kenya: an HIV test.  Bang - positive.  Life-changer.  I have not gone into the details of her lifetime partners with her, but in most of the cases we see at Kijabe, women are married and faithful to their husbands - while men are out and about and inadvertently bring the virus home to their wives.  Don't mean to man-bash here, but those are the facts.

So, Mercy is very sick.  She has several signs suggestive of tuberculosis.  And she's dealing with a new diagnosis of HIV infection.  That's a lot to deal with.  She's got to be worried about the possibility that she might not live as long as she once expected to live.  She is dealing with denial, anger, or fear - or all of the above.  

So on Friday we were rounding and began to speak with her at the bedside.  As if things couldn't get any worse…she told us that she received news that her two sons who are in their late 20s got into a serious fight the night before…and killed each other.  My jaw dropped.  This is beginning to sound a lot like the Book of Job.  Debilitating and potentially terminal illness.  Estrangement from her husband.  Death of her children.  Not much left except for her house to burn down.

I stood at her bedside with my two medical trainees - silent.  What to say?  I tried to think of what to say.  I tried to express some words of consolation and encouragement.  Everything I could think to say just seemed so trite.  I really can't imagine being in her shoes.  Try it.  You have just been told you have AIDS and that your two sons killed each other last night.  Unfathomable.  

Well, I made an effort to console her in her sorrow.  Then she looked up and said, "If you put God first, then everything else will be OK."  No sobbing, fist-shaking, screaming.  Only quiet confident words of faith.  Very inspiring.  

That's my prayer when I face disaster.  No cowering, groveling, cringing.  Lament yes.  But hopefully, that howl melts with disturbing clarity into worship.

'Tis the Season of Beautiful Sorrow

Six years ago today Scott, Scott Will, and I were sitting at our table in Bundibugyo. The rest of the team had evacuated to Kampala a few days earlier, after the Ebola epidemic broke out, but we three stayed having already been exposed, to work.  It was night, and my phone rang.  I went out under the bougainvillea on the side porch to get better reception because I couldn't believe the message.  Dr. Jonah had died.  A tragic and sorrowful day in the history of Bundibugyo, and in our lives.  Today I was sitting in the NICU at Kijabe when my phone rang.  Melen and her daughter Biira were visiting Jonah's grave at Bundibugyo Hospital, and called me from there.  The years have softened the deep ache of that night, the disbelief, the shock, the heart-rending numbing wonder of what God was doing.  The years have shown us some redemption as a half dozen young people are following in Dr. Jonah's footsteps, the seed in the ground is now beginning to bear fruit.  But we still miss him, and no amount of redemption in this life completely erases the truth of that loss.  So for us, the season of Advent always begins with that beautiful sorrow, the mourning of a life laid down for the Kingdom, the longing for the no-more-tears of a New Heavens and a New Earth.

December is also a season of goodbyes and transitions.  Once again many of our colleagues are taking their annual leaves, migrating back to families upcountry or overseas.  School is out for the next month; Acacia baked her last batch of cookies (our first batch of Christmas baking) before her departure yesterday to spend Christmas with her family.  No decorations up in our house yet, though.  Just trying to survive.

With all the goodbyes, I am particularly thankful for the visitors who have come to fill the gaps.  Tonight we celebrated their kindness with some pizza. Drs. Keith and Lesley (left) are helping on Paeds, Dr. Sagar (left) in ortho, and Drs. Bruce and Rick (right) in medicine.  

'Tis a season of beauty in all the sorrows, and a hospital is a privileged place to spend Advent.  One of the devotions this week pointed to the God of the IMPOSSIBLE who brought a baby into a virgin womb, who redeems the world through suffering and glory.  Here is a tribute to some impossibles.  First, Pauline and her twin girls Malin and Erin.  They were 27-week twins, and it seemed to take forever for them to get off oxygen and be big enough for discharge.  But here they are today after a half a week at home, with mom transformed by civilian clothes and a huge smile:

Or dear Patrick, now improving with increments of strength and tone nearly every day, sweet and hopeful.  I remember his tears when he couldn't breathe or move, and so I delight in his smile now:

The aptly named Emmanuel is still battling those odds of impossibility, waiting for his miracle.  Pray for him.  He arrived last week jaundiced and vomiting with a severe hepatitis and failing liver.  While getting a CT in Nairobi he "complicated" and was rushed to nearby Kenyatta National Hospital in coma.  Overnight his parents watched other children die, and by morning they decided to escape by taxi, trailing his disconnected oxygen and holding his IV bag.  I moved him up to our ICU today with a heavy heart.  A few hours later, I was examining him and called his name, and his eyelids fluttered open.  His pregnant mother burst into tears at this little sign of hope.  Emmanuel, God with Us, needs God to show up tangibly and heal him.

And I may be in trouble for posting this photo, but this dear patient is closer to my heart than all the others combined and caused a fair amount of tears and angst this week.  My nephew Micah was admitted to the ICU in NC with a severe asthma exacerbation and respiratory infection.  We had all hoped he had outgrown this after some scary episodes as a baby.  I think for many missionaries, it is very very hard to miss supporting family in crisis because we are many thousands of miles away.  I'm thankful for cell phones.  But it's just not quite the same.  Micah has a precious gift of loving others, spontaneity, joy, a mean basketball shot and a passion for bacon and videos.  I'm so relieved he is well enough to be discharged today.  A season of cough and danger, and of healing.

OK a few more signs of the season.  Inexplicably, the maternity ward had EMPTY beds this week.  This does not usually happen.  My only explanation is that 9 months ago Kenya was in the throes of election anxiety, anticipating chaos, people traveling back to home areas, and, who would have thought, taking a pause on baby-making??

 And the season of college apps draws to a close as Julia submitted her final one tonight.  Prayers appreciated for her on Saturday as she takes the SAT one more time, quite late due to a clerical error which invalidated her registration earlier this Fall.

Advent at RVA means AP study.  RVA runs on a year round schedule which goes from early September to mid-July.  So when AP's roll around in May, RVA students have had two months of vacation that most schools have not.  Hence the habit of teachers to assign large loads of independent work over those two holidays.  Here are the station kids in BC Calc working on their problem sets together at our house.





This is our December of beautiful sorrows, mourning, hope, remembering, working, hosting, studying.  Waiting.  Trusting that love will break through.  And I truly do hope that we will get out Christmas decorations soon!

Thanksgiving

Thankful that my two oldest are at their grandmother's being stuffed with carrot cake and turkey and steak and love.  Thankful my mom and sister will be together in the snowy mountains of West Virginia.  Thankful that our Paeds team gathered 40-plus-strong with visitors and kids to feast together, a taste of the Kingdom, shared struggle against suffering, shared victories, shared love.  Thankful that Patrick's sister got him up into a chair and spent the day reading through Genesis aloud. They were on chapter 9 last time I saw them.  Thankful that my patients made it through today and I have a weekend off. Thankful that the home-front-kids finished exams for the term and we can celebrate with them and Miss Bethany this weekend.  Thankful for almost 50 pounds of turkey on the grill, and more mashed potatoes than a human army could eat.  Thankful for colleagues, particularly the young Kenyans pictured above, and even my colleague with preterm labor who is calmly emerging from the danger zone.  Thankful for this reminder on the true nature of Thanksgiving:

"One act of Thanksgiving made when things go wrong is worth a thousand when things go well."  St. John of the Cross

Sometimes Silver Linings

Shimmering, beneath the surface of a dull, scratched world.

Some are trivial. My swollen not-broken toe is annoying. But, it slows me down to walk Kenyan-paced.  I'm no longer zipping past people in the halls.  I have more time between places to think.  I have more time in general because I'm not exercising at all.  Which is not so mentally or physically healthy, but I think I needed that margin this week.

Or the fact that half my family is in a time zone 11 hours off.  So when I was wiped out post-call and the three kids here were all in late evening study groups and Scott was also occupied, I could call them.  Nice.  Sometimes 11 hours is easier than 7 or 8.

A big one this week is that Scott is finally getting administrative time.  So even though I feel even more behind on many things and tempted towards jealousy, it is HUGE to have a functional parent.  He is making phone calls to teams, working on our legal/immigration issues in Kenya, going to meetings, and even wrote our December prayer letter which is shockingly the only one this year.  It's been one of those years.  And a nice perk is that he made dinner the last two nights.

I had been in the hospital this morning for over an hour with a visiting cardiologist seeing patients when I was called emergently to the Annex.  A neurosurgical patient on whom we had consulted for the last week had been found pulseless, milk vomited all over his face.  He was not just temporarily arrested.  He was dead for at least 10 or 15 minutes, which his mother had not recognized, getting an extra blanket in response to his coldness.  I intubated him and gave him drugs while we did CPR as a team, but no response.  Bagging air in and out, needles, syringes, suggestions, checking anxiously, more drugs, more chest pumping, more time.  It wasn't working.  Finally the reluctant halt, the lifelss reality.  A prayer. Not sure where the silver lining is here.  His mother was hysterical, disbelieving, shaking.  His dad was sober, then weeping.  I am sad, and feel defeated, or perhaps cheated.  He was getting better.  We had not expected this sudden death.  I am going over the scenario this evening in my heart, over and over, looking for answers.

And that is legitimate too.  Lament is lament.  The silver lining is too subtle, too tarnished, for me to see with this child.  I was reminded in reading a friend's blog about Jonah that lament is an expression of faith.  The world is not as it should be.  Sometimes we can see a glimpse of redemption in the suffering, a silver lining.  But sometimes we can not, but we hold on in faith to the evidence of unseen sparkle.

The most efficient health care ever, and a 2nd happy moment

A couple of nights ago I dropped my computer, corner down, directly onto my foot as I was trying to balance several things and get under the mosquito net and plug it in on my bedside table at night.  I'm pretty uncoordinated, it was the end of a hard day, and in spite of the word "air" in the name, when dropped from a height onto the unsuspecting toe, it can do damage.  It hurt.  BADLY.  I cried like I haven't in some time.  The next day my toe was purple, and the day after about a tangerine-sized bruise was fanning out on my foot.  It hurt to walk.  I wondered if it could be broken, but at least the computer worked fine, and frankly it is easier to heal a toe than replace a computer here.  So I hobbled all weekend, on my feet doing Senior Store and walking back and forth and cooking.  Today back at work, I kept looking for a few minutes between too many colliding responsibilities to get my own health care.

So let me sing the praises of being at Kijabe Hospital.  It was 12:38.  I had a meeting at 1:00 and labs to check and phone calls to make and perhaps one more patient to see.  I checked in with nursery where I was waiting for a 25 week preemie to be born.  Not yet.  As I walked down the hall I decided to just get an xray because there was miracle-of-miracles NO LINE.  I had a form in my pocket, and filled it out as I stood at the cashier's window and made pleasant conversation, writing in my own diagnosis.  Before I could look up my medical record # he had it on his computer.  Price:  30 bob please.  That's less than 50 cents.  I guess my toe is small.  I took my receipt across the hall where the xray techs were having tea.  I chatted with them and one jumped up to take my xray.  They were quite entertained.  She warned me not to walk barefoot where the last patient had been bleeding . . . an awkward position, a charge and a beep and I was out.  While they processed the film I went back over to lab to follow up on some results for my patients.  Back across the hall and the techs declared I had not fracture, but I carried the film a few steps away and showed it to a visiting radiologist.  Normal, just soft tissue swelling.

Total time:  15 minutes.  Total cost:  less than a dollar.  Total cure:  none.  That's the only down side, my foot still aches and I'm still limping.  But my computer works and hopefully each day will get a little better.

In a day which included:  calling my boys in California, rounding on my service, seeing a missionary baby and connecting the family with specialist care, getting another missionary kid discharged post-surgery, being called to the delivery of a 25-week baby whose fused eyes and transparent skin made her look even younger, and deciding to stop the resuscitation because she was not viable (weighty and sad), waiting for ANOTHER 25 week baby who is still not born, running up to RVA to applaud Acacia's induction into the National Honor Society (!),  
 evaluating admissions, going to an early staff prayer meeting and a lunch-time Moms prayer meeting and having an evening WHM conference call and just generally surviving  . . . This little pocket of efficiency was very encouraging.

And the other happy moment:  About 4 pm I was comforting the mom of the too-early-to-survive preemie and got an emergency call to ICU.  Patrick, the 11 year old with Guillan-Barre induced paralysis, had extubated.  Since he's pretty inactive it couldn't be blamed on him, but somehow in the process of suctioning and turning him the tube was gone.  I had seen in the morning that he was moving his legs a bit as he tried to talk around the tube to me.  So as I ran up I thought we would give him a chance to see if he could breathe.  It had been a week on the ventilator.  I had expected longer before he began to improve, but so many were praying, maybe he would be OK.  I examined him and talked to others and asked him if he felt he could try to breathe, and he nodded.  Then he was trying to talk and we all leaned in to hear what he was saying.  "Jennifer".  He was talking to me.  I guess he had read my nametag and heard me introduce myself.  You have to realize most of my patients are less than a year old and don't speak English.  Having an 11 year old say my name as the first words out of his mouth in the ICU was sort of sweet and sort of chilling.  It is now 10:30 pm and he's holding his own for now.

A cheap quick xray with no fracture and an unexpected turn for the better.  Against a background of struggle, two bright spots (plus Acacia and friends to pray with) for today.

Angel Parties

Julia decided she wanted to be baptized at RVA, to publicly declare her faith in the context of this quite Baptist culture.  Even though all our kids were baptized as infants in the Presbyterian church, we have maintained that God would not mind if they chose to repeat that sacrament as mature believers.  She was one of 9 kids who went through classes with the pastor this term.  Each gave a testimony of faith in their own words, then had one or two siblings or friends read favorite Bible verses aloud.  Julia chose Zeph 3:17 and Gal 2:20, read by Jack and Acacia.

 Julia's testimony declared that she wants to live for God's glory and spread His name throughout the earth wherever He will lead.  She said she desired to have one pure passion for Christ above all else, dedicating every breath and every heartbeat back to Him forever.

In the  baptism pool each baptizer said some other words from Scripture.  Scott spoke about the symbolism of death and resurrection and the way all of creation is being redeemed and renewed by the Gospel, and how this baptism signals Julia's participation in God's work.

 I prayed for her as her friend Savvy wrapped her in a towel, and mentor/teacher/friend Bethany gave a benediction.  This is a place where we see the beauty of a community who helps us raise our children, truly a group project.

Here is the prayer, please read it prayerfully for Julia today:
God our Father, Jesus our Lord and Saviour, and Holy Spirit our Helper, We give your Name glory today as we witness the life and testimony of Julia.

We ask that your Kingdom would come more fully to this earth through her life, and that you would bless your people and your creation through her, that you would so fill her with love that she would be a source of water for the thirsty and healing for the hurting.  May the word of her testimony and the abandon of her life in love be your instruments for transformation in this broken, beautiful world.

May your will be done in her life as it is in Heaven, bringing her the peace of your reign, growing her in wisdom and in stature and in favor with God and man.  May she ever be a tree planted by rivers of Living Water, fruitful and enduring in her faith.

Give her every day her daily bread, your physical provision and your sustaining word and presence.  
.

 Forgive her when she falls short of your best for her, and give her a generous spirit to forgive others

 Protect her in all her paths as she walks with courage and grace into a needy world, give her solid community and life-long friends, and deliver her from the Evil One.  When your ways are hard may she say "Let it be unto me according to your word."  Assure her of your goodness all the days of her life.

Lord we thank you for Julia from the deepest part of our hearts and pray she would be a jewel in your crown.

Now to Him who is able to keep Julia from stumbling, And to present her faultless before the presence of His glory with exceeding Joy,
To God our Saviour who alone is wise, 
Be glory and majesty, dominion and power,
Both now and forever.
 Amen. 

This is the stuff of Angel parties, the behold-I-am-well-pleased of God Himself.  And a reminder that all the other stuff, the late nights and early mornings and sorrowful stories and sweat and tears, pales in comparison.  So thankful for this daughter and all our kids.

An open letter, post failure/rejection

Or, a pep talk to myself, from a short time in my garden praying.

It's been another one of those weeks.  Last night as I held the sobbing mother of the fourth child I'd pronounced dead in a week, holding her hand, preaching, praying, aiming for firm compassion and sympathetic truth, I was spent.  I came home profoundly exhausted.  For me failure and rejection look like stiff grey dead babies, or the tense juggling of too few hands for too much work as another issue arises that means someone has to go.  For some people dear to my heart, it looks like this:  a limbo of not-yet-picked in the too-slow med school app process in spite of a near-perfect gpa at an ivy league school, a rejection for one of two summer programs in spite of being top 5% of class in an elite military academy, the SAT debacle and waiting to hear from colleges, being cut from a sports team early this term, and lastly being rejected by staff in an application for national honor society in spite of grades and activities and service.  Yeah, that's kids 1 to 5 lately.

So in case that rings true for others, here are the garden thoughts of today.

1.  It's not all about me, but God's glory.  My failure or rejection is a small subplot in a very large story that centers on bigger things.  Like the redemption of the world.  When Lazarus' sisters and friends said "If you had been here our brother would not have died" (a line that was unintentionally quoted pretty much verbatim to me after a death this week) they didn't know the bigger good that would come, for the glory of God (John 11).  I read this on a friend's blog  "we must seek to cultivate a mindset that will not accept the suffering, injustice, oppression, idolatry, sin, selfishness, materialism, brokenness, sorrow, misery hopelessness, bondage, apathy, compromise, division, sorrow, … that we should not accept this world in its fallenness as natural, normal or inevitable.  Passionate, persistent intercessory kingdom prayer dies when God’s people become insensitive or reconciled to the fallen world’s status quo. We saw we must nurture a proper faith perspective about our Father in heaven. "  That puts life back in perspective.  There are important battles being fought, and I can't see yet how it all fits together and makes cross-perspective sense.

2.  Your loss is likely someone else's gain.  In this world, not everyone can get into their choice of school or society.  There are quotas, and if you lose, then the spot goes to someone who might need it more.  Whenever I think of my colleague's baby NOT being born preterm I am GLAD to do some extra work.  Grace is infinite and God does not have to choose favorites, but in this world, zero-sum still prevails. (Rom 8:36)

3.  There are usually kernels of truth in even the hardest rejections.  When that 4th baby died, I presented the case to my expert Dr. Erika who was generally reassuring but also had some teaching points.  Try to look through the sense of injustice to find ways to accept criticism and grow.  We learn through loss, we grow when we come up against the scourging of life.  Even Jesus did (Heb 5:8; 12:3-7).

4.  Seize the opportunity to do good.  Literally, to those that have hurt you.  I am not good at this, I would rather punish them.  But smile, shake hands, and don't let them get you down.  Look for ways to actually serve them and make their life better.  This makes no sense, but Jesus told us to do it Matt 5:44-45.  I have actually tried it in small ways, and it is more powerful in changing MY attitude than anything else.  But it also might lead to breakthroughs in the hearts of others.  This is where the Kingdom shines.

5.  Embrace the cross.  Jesus was despised and rejected (Is 53:3).  We're not living in a popularity contest.  The rubber meets the road when you take up your cross after a man who was willing to take some heat and not change.  Yes, rejection and failure usually help us learn something important for growth.  But sometimes they are just part of being in the path of evil, of living in a fallen world, of other peoples' problems.  I like to make people happy, and keep people alive.  But (see #1) there are times when we have to hold on to our calling, to love, to work hard, and to not worry about what other people think.

6.  And last but not least, remember love.  Being loved, and giving love.  The absolute truth about us is that we are created uniquely gifted to reflect some aspect of God's truth.  God saw all that he had made, and it was very good . . our kids' first Bible memory verse from Genesis 1.  Sin has marred each of us, but fundamentally the deepest truth is love.  We are loved by God.  My five great people are loved by me, and when push comes to shove I prefer them to anyone else I know in a tough spot--they are loyal, strong, creative thinkers, tireless workers, with a clever sense of humor and an eye for irony.  They are the kind of people whom you want beside you when you're fighting a war, having a baby, cooking a meal, building a camp, living the Gospel.

7.  Bonus, because 7 is a Biblical number: spend more time with dogs than people for a day, and everything looks better.  Which relates to #6, because dogs help ground you in the reality of God's unconditional love.

More thoughts on Large Hearts

Beginning on Friday night when I got a quick panic call during dinner and ended up running into the hospital to admit a little girl to the ICU after brain surgery, up until 5 pm Monday when I walked out the door after work, it has been a harrowing weekend.  Nonstop, in a way that is unusual even for here.

Saturday morning rounds were still in their chaos of pending labs and confusing stories when I got the page to the operating theatre where 26-week twins were being delivered by C-section to save the life of their mother, who was dangerously ill, as well as their own lives.  We knew ahead of time they were identical boys sharing the same placenta and sac.  One was very small and sickly, only 530 grams.  The other had more than his share of the blood supply, and came out ruddy and relatively vigorous at 950 grams.  Thankfully the appendicitis colleague had not quite gone home so his wife who was waiting for his discharge agreed to run down and be an extra set of hands with these fragile twin boys for a while that morning.  We dried and resuscitated, intubated and gave surfactant, a medicine to help coat the immature lungs and make up for their difficulties.  I set up a little surgical area and inserted lines into both, then did something I've never done:  took blood from the baby with too much, and gave it to his brother with too little.  I spent most of the day fighting for their lives.  This was the mom's first pregnancy.  26 weeks is rarely survivable in Africa, even with our best care, the prognosis was not good.  530 grams is smaller than we have ever had a survivor. And the prenatal ultrasound was suggestive that the smaller brother had some congenital anomalies.

After the second dose of surfactant, as I felt I was losing the battle, I got this xray (only by physically going and pushing the xray machine myself into the nursery).  Almost no lung tissue seen.  An hour later, this tiny twin died.  The mom decided to name him "Success" and his brother "Blessing".  

Who would call an 8 hour life for a tiny tiny baby a success?  This struck me as a Kingdom paradox.  In his mother's loving eyes, he was a success, simply by existing.  Very sweet.

We pray his slightly larger brother, Blessing, will have a longer life, for the mom's sake.

It was an emotional weekend.  Nonstop admissions, I lost count, but about a dozen including Friday night.  Another teen with AIDS whose parents' denial and neglect meant he was starving.  Neurosurgical patients with acute infections, malnourished toddlers, unexplained seizures, jaundice, more prematures.  An 11 year old whose fear and sweet despair just got to my maternal heart (see below).  I ran home a couple times to find my kids foraging leftovers from the fridge. Once on Sunday I managed to mix up pancakes, but they were pretty much on their own.  The only half hour I spent out of the hospital from 8am to 11pm I found Julia making cookies:

These pretty much accounted for survival.  

I had four babies who qualified by their lab values for exchange transfusions, an hours-long technical and risky procedure for severe jaundice.  It took every ounce of courage and the Spirit to NOT do these transfusions and doubt the labs which seemed way worse than the babies looked. I held my breath to know whether I was doing harm or good, until today when the lab manager recalibrated and everyone's tests dropped back towards normal.  Whew.  I lamented missing RVA's play, but there was no way to leave.  

By this morning, after a 2-3 am bedside vigil for two more deteriorating patients, I was pretty fried. There were some happy stories, like a 13 year old girl with diabetes who had moved from death to life, smiling and alert and looking great. I had about four patients well enough to go home, and was juggling their issues, 23 babies in nursery, 18 on the ward, one in casualty and one in private clinic, two in ICU, not to mention the outpatients just grouping.  I would have been shot without rescue help from the inimitable Pete Halestrap, our ER doc who is spending three days to step in and lend a hand.  That's another story, but I am so thankful for his cheerful can-do willingness.  But when the little boy who had severe brain damage after a complication during surgical debridement at a local hospital last week of what should have been a simple, curable infection in his leg finally died, I was thankful to have the chaplain show up to help me comfort the mother.  Then this afternoon the post-op brain tumor little girl, a 5 year old, also died.  These and little twin A all had unsurvivable issues by the time they came to us.  But 3 deaths in 2 days takes a toll.  And as the father of the 5 year old said, straight out of the Gospels, "If only you had been there in August when this illness started, she would not have died."  Meaning the entire hospital team, not me specifically.  If only she had not been stuck with her resectable brain tumor for 3 months in a public hospital waiting for a surgical date.  If only we could do more, for more people.  

Which brings me back to the prayer for a largeness of heart.  

In the midst of chaos and overwhelming patients and not only lack of doctor staff but on Saturday only half the needed nursing staff, I want to pray to become a person who exudes grace.  When I told the 5-year-old brain tumor patient's father and aunt she had died, they did not hesitate.  Their first words were, "Thank you for all you did."  Thank you?  She died!  But they were able to look at me large heartedly, with grace, to be thankful.  Amazing.  In life's moments of harsh tragedy, I want a heart large enough to look beyond my loss, my exhaustion, my grief, to show kindness to others like these people did.

And when the next sad story comes into my responsibility, I want the largeness of heart to care.  To feel the tears welling up in response to his own.  To imagine my child in this position, to be willing to go the extra mile for cure.  

To not give up, not close off.  To hold onto hope, which becomes elusive, but is the only sure thing.

Pray for Patrick

Image one day noticing some tingling fingers and toes, and then that you can't pick up firewood that you would normally gather, then a rapidly progressive weakness, then complete paralysis.  Patrick is a bright articulate 11 year old who was a normal kid a week ago, and tonight is in the ICU on a ventilator because his breathing muscles are too weak to sustain his life.  His symptoms and tests point to a diagnosis of Guillain-Barre Syndrome, a rare illness in which the body's own immune system attacks the nerve sheaths until the muscles have no impulse for movement.  A once active boy over a matter of days has become a limp and helpless patient, without enough power to even breathe.  But if we can keep him alive, the paralysis should recover, and he should slowly regain strength.  Problem is, that might take weeks, or months.  And staying alive on a ventilator, avoiding malfunctions and failure, escaping infection and sores and despair, in Kenya, is no small task.

Similar in some ways to my Dad's slowly progressive ALS, this is a disease that leaves the brain perfectly aware and intact as the body slips into a helpless passivity.  So Patrick can talk to us, can ask for help, can listen, can cry.  Saturday night as he panicked about his failing breath, I called Scott in to help me intubate him and put him on a ventilator.  Today I told him with more conviction than I felt that he was going to recover, that this was temporary, that he would be out of the ICU within a month and playing football within a year.  His tears of resignation and desperation as he looked at me pretty much made my sleep-deprived heart melt.  

Would you pray for Patrick?  Pray Is 40:31, which I asked Acacia to write out for him as God's promise.  Those who wait on the Lord will renew their strength. .  Pray that his heart would not give up as he faces uncertain weeks of complete dependence. Pray we would be able to keep him alive.  His parents face a long course and a huge expense, and would be grateful for your prayers.  Pray that Patrick would once again run and not grow weary, walk and not grow faint.

A shout-out of thanks from a few vulnerable kids

 This is Daniel, looking feisty on his final day with us.  When he was admitted 58 days ago, he was hours from death.  His mom had defaulted on her own care and seemed completely unable to deal with his AIDS.  I agreed to pay his hospitalization costs from our Needy Children Fund, never guessing how long he would stay or how expensive it would be.  He was so malnourished and had so many infections.  As we started to pull him out of the TB dwindles, he had a reaction to anti-retrovirals that meant we had to stop them. After nearly two months he is finally off oxygen and gaining weight.  But the real story is his mom.  Daniel saved his mom's life.  Because over these two months she slowly came to accept her diagnosis.  To allow herself to be helped.  To resume her own treatment.  In the last two weeks I hardly ever found her without her Bible open on her lap.  She found life.  I don't know how long Daniel will survive, but I do know his hospitalization was worth every shilling.  Two lives were impacted, and I'm grateful for that.

 Jonah continues to improve, very slowly.  His spine is now stable, and he can be wheeled out into the sunshine.  His mother came all the way from Samburu to this place where she knows no one and barely speaks the language of Swahili.  She is brave.  I am afraid Jonah is blind since his near-death in one of his operations.  But he definitely hears, and stops his restless moaning when I talk to him.  Jesus made the lame walk and the blind see.  Jonah needs that kind of miracle.  Kijabe and the Needy Funds have kept him alive and shown him love, putting him in the place where he can wait for the angel to stir the water, for the healer to pass by.

We've had a photography team at the hospital documenting stories like Daniel, Jonah, and this cute 4 year old who was brought to our outpatient Maternal and Child Health clinic Thursday. He is severely chronically malnourished, with very stunted growth due to his mother's inability to feed him enough every day.  But here he is having the time of his life seeing his face in the camera.  A kind pastor in his town brought him in for care.

Lastly, another vulnerable child, this one a refugee from the largest refugee camp in the world located in Dadaab, Kenya.  The NGO's that work there send kids like this to Kijabe for diagnosis and treatment.  I believe she has a genetic dwarfism syndome, something that is not easy for a family with seven other children to deal with in a refugee camp located in barbed wire fences in the desert.

So many children who live with too little care, space, food, medicine, opportunity.  So many who dwindle without resources or care for too long, and come to us too late.  But these four were helped, by our Needy Children's Fund, the Orthopedic Vulnerable Patient Fund, a local Kenyan church, and the UNHCR and other NGO's.

Thank you to all who have donated in the last month.  The income and expenditure when I checked on Thursday were almost exactly matched.  God knew our needs.  I just keep spending the donations on these kids as fast as they come in, knowing the more we help, the more will be provided.  THANKS.