end part one

I've been a little bit slow to post another blog - I think it's been a week since I wrote last - but I'm going to put part of the blame on the internet, which has slowed to the point that progressing beyond the mere the thought of trying to get anything done online takes a certain amount of inspiration. But I've now passed what I considered to be the end of the first of three parts of my trip - though as it turns out, it's "ended" a little differently than I anticipated - and it seems like it's time to muster the inspiration.

After making a switch that put me on call the first weekend I was here, I had last weekend off, which was a welcome reprieve after being on call four out of seven nights. Thankfully, the last of those four calls was not particularly bad, but I still collapsed into bed Friday night pretty excited about the fact that I hadn't set an alarm. Saturday morning I did make a brief stop at the hospital to round on the two patients we had in HDU, but then I headed out for a walk. It was fairly overcast, but the recent rains have turned everything quite green, and it's always nice to get out of the hospital compound. I did a generous loop that brought me back across the hydroelectric dam; there was barely a trickle of water over the falls, but I was assured that it had been markedly better earlier in the week.

Shortly after arriving back home, I ran into the Fitzwaters, who were setting out on an adventure to Bomet and invited me to join them. I used to laugh at Bomet being called a big city, although apparently its population is over 100,000, so I'm having to rethink my position. We opted for taxi transport over matatu (the latter appeared to be in short supply) and were dropped at Radiant Supermarket, where you can find cheese, ice cream, and a few other delicacies, as well as a mind-boggling assortment of items like rice and cooking oil. I bought sugar, soap, and lentils. Less exciting, but necessary. (The Fitzwaters got ice cream.)

The rest of the weekend proceeded at a fairly relaxed pace: I finally made the sweet potato corn chowder Saturday night (Agneta came over to help me eat it) and on Sunday started packing for my move up to the guesthouse. I managed to transition most of my possessions by Monday morning and even unpacked and put most everything in its place. So when I returned to the Bemms' house for a late lunch Monday and to pick up a last load of food items, and their house helpers told me that there had been a change of plans and I was supposed to stay, I thought they were joking. But they got Amy on the phone, who called me a goofball and told me to have Peter bring my stuff back. It's hard to argue with that kind of hospitality from people I love - and being part of a family for two weeks rather than living alone definitely appeals to my extroversion - so I ran back up the hill, packed again, and got moved back in by evening.

The peds ward has continued to be sometimes very sick, and we've lost another handful of patients since the week started, but today almost everyone seemed to be doing better rather than worse, which was the kind of encouragement I needed. I've been pretty exhausted the last couple of evenings, and a 9:00 bedtime seems to be pushing it, so I'm thankful I have the freedom to indulge in that this week - in spite of how geriatric it makes me feel at times!

999

Tenwek has had pagers for several years now - a vast improvement over the days of needing to be tethered to my home phone on call - and there are a few shorthand messages that people here routinely employ. 888 indicates a request to return the page quickly, but 999 is the one that always makes my heart drop. It usually means that there is a resuscitation underway (either CPR or a child has stopped breathing) and if I recognize the phone extension, I don't even bother to call back before running out the door.

View out my "office" window at home

This weekend I was on call, and in spite of the fact that the service had been relatively quiet for the first two days after I arrived, I saw that code flash across my pager screen more times than I want to count over the span of forty-eight hours. It was heartrending, and my brand-new on-call intern, who had never certified a death before Sunday, ultimately certified three. We cried together in the doorway of the resuscitation room when the second patient died, a teenage girl with rheumatic heart disease who had come in walking and talking to casualty Sunday afternoon. And I had barely collapsed back into bed when the next 999 came from HDU, for young girl in bad heart failure whom I honestly had thought would die the night before. When it was over, we split documentation responsibilities over cups of chai, and I went to theater to receive a C-section baby while she finished up and arranged for transfer of another very sick patient with rheumatic heart disease to ICU. I lay exhausted on an empty gurney in the OR recovery room at 3am, waiting for the baby to be born, and thought, this is what it feels like to pray without ceasing... Lord, have mercy. But the context of that verse is even more challenging: the exhortation to pray without ceasing is flanked by two more - to rejoice always and give thanks in all circumstances. Which seems crazy and impossible without the grace of God. My pastor called it "defiant joy" in a recent sermon, and I think that's just about right. It's joy that looks the evil and brokenness of this world in the eye and stares it down, because of the hope we have in the coming of a kingdom that will wipe away every tear...

Honestly, it hasn't exactly let up since the weekend, but there have been many small encouragements that have given me a peace that I was lacking: dinner with friends yesterday evening, messages from home, and even just a full-strength pediatrics team and a co-consultant with whom I can process in the light of day. And after a full night's sleep last night, I'm back on call tonight, but it's been steadily rainy since early this afternoon, which may - if I'm fortunate - keep the foot traffic to casualty down tonight.

transitions

Imagine what this sounds like in a downpour...

Rainy season is in full force here at Tenwek. So far it’s not been too much of a tragedy that I was completely unable to find my rain jacket before I left Boston – it’s all about timing your dashes to and from the hospital properly – but it has been a little chilly, and I’ve been very glad that I decided to pack my flannel pajama pants. We arrived yesterday in the midst of a veritable monsoon: the rain started just as we were passing through Bomet and by the time we made the final turnoff to the hospital, it was a downpour, complete with thunder and lightning. But the dry season was very hot and very dry this year, and the rains were late in starting, so everyone is grateful.

I’m working on settling in and finding my rhythms again, and there have been a few surprises so far. On Monday morning before I left Boston, I got an email from the Bemms asking if I wanted to stay in their house while they were away. I had been scheduled to be in the guesthouse, and having a real house for a week and a half  (with a kitchen! and reliable hot water! and a kitchen!) made me very, very happy. Of course, that meant grocery shopping in Nairobi for two weeks’ worth of food, which is sort of a laughable task for someone whose idea of meal planning involves surfing the internet for recipe inspiration mid-afternoon and realizing that she has to stop by Trader Joe’s again even though she was there less than 48 hours ago. The result of my efforts? A bunch of random staples, three mangoes, the ingredients for sweet potato corn chowder, and a pound of sausage (because… yum). You know what I find to be the most challenging part of shopping for groceries here? The produce, whose price is listed in shillings per kilo. Doing two conversions at once always seems like more effort than it's worth, so I usually just buy the stuff I figure should be pretty cheap and hope for the best. (Sorry, Dad.)

The other notable surprise since I’ve arrived is that consultant responsibilities on pediatrics have changed since I was here last. With a pretty consistent staff of two pediatricians this year, they’ve divided the service in half: one consultant generally rounds on the ward and the ICU/HDU in the morning and the other rounds in nursery in the afternoon. Amy, the other pediatrician here, kindly offered me the ward, which was great, but I hardly knew what to do with myself when we finished rounds and chai time teaching by 11:30! But since I’ll be on service for three and a half weeks, perhaps I should accept this gift as a means to keep up with work from home and prepare well for my time in Nairobi.

Okay, this is already longer than I planned (short = readable, right?) so I’ll quit for now. Continue to pray for my transition – there have also been a few minor surprises that have been more frustrating than exciting – and for energy heading into this weekend. I’ll be on call Saturday and Sunday and have more stories to tell, I'm sure.