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.