rest and reflection

Julie and I got back this afternoon from a long weekend away in Naivasha. It was a lovely three days, and while the spa treatments were certainly a highlight, I even more appreciated the time with Julie. We've been friends for over a decade, but we've rarely had this much uninterrupted time together, and it was full and encouraging and lifegiving. She is one of My People, and it was a sweet time.

I also spent some time in Naivasha trying to reflect on my time at Tenwek this month and my life and simply attempting to be still. To be perfectly honest, I mostly failed, at least at the latter. I can be physically still without too much difficulty (most of the time), but my mind is another story. I noticed this last weekend - not for the first time - when I was grieving that baby's death. My skull felt like an echo chamber for my thoughts, and one of the hardest parts of the process was feeling as though I couldn't hear anything God might be trying to say to me over the noise of my own thinking.

In our morning prayer liturgy, the confession is followed by this prayer: Grant your faithful people, merciful Lord, pardon and peace; that we may be cleansed from all our sins, and serve you with a quiet mind; through Jesus Christ our Lord. What would it really look like for me to serve with a quiet mind? Increasingly, it seems that I don't know the answer to that. Sometimes it's the weight of sin or other missteps that prevent my mind from being quiet, but it's just as often the concerns of my life or work that I perceive to be priorities taking up that space. I'd like to practice quiet a bit better. Lent is coming up soon: it's an appropriate season for reflection, and it would be good to devote real time to it then.

In the meantime, I'm officially in the last week countdown here that generally makes me sad and slightly panicked and certainly not quiet in mind or spirit. I'd appreciate prayers for peace, good moments at work with the interns and residents, and meaningful time with friends. It's been busy at the hospital, so whatever else it may be, I'm sure the last days will be lively, and I'm grateful to be rested going into them.

Lake Naivasha, home of many many hippos.

last weekend

I was so committed to trying to get an update in on a weekly basis when I first got here, but I’d forgotten how life can get away from me quickly once things start happening…

Clark was off last week, but I still had a family medicine resident and an MO (medical officer) on service and the census wasn’t dramatic, so it felt entirely manageable – and honestly a lot more like what I’m used to when I’m here, responsibility-wise! But Thursday evening I got paged by the on-call attending about a critically ill 7-month-old who had been referred from one of the nearby district hospitals after her twin sister had died there a few hours before, and I headed up to help out. The short version (because the long version is probably better told in person) is that we were able to get her sort of stabilized that night in spite of multiorgan failure, and in spite of myself, I began to hope that she could survive. I’m not sure I’ve ever pleaded with God so intently for a child’s life. But the following evening after a reasonably steady day, her heart unexpectedly stopped beating. By the time I got up to ICU, it had started back up, her status seemed back to what it had been, and I couldn’t figure out what had happened. I left about a half an hour later and didn’t hear any more that night, but the following morning it became evident that she had sustained a non-survivable brain injury. I spent Saturday talking to her relatives, and late in the afternoon, we removed her from the ventilator that was keeping her alive.

Every once in a very great while, I have an Indescribably Hard case, and this was one of them. They are always moments in which I feel ultimate responsibility for a child’s life and have to live with the decisions I made in their care. I think I didn’t really start processing that until Sunday morning, when I spent half an hour literally crying out to God, weeping over her death and my part in it. Have mercy, O Lord, for I am faint; heal me, Lord, for my bones are in agony. My soul is in deep anguish. How long, Lord, how long? But at the end of it, I had no choice but to wash my face, take a deep breath, and hike up the hill to my waiting interns for morning rounds. When I got back home, though, I found Julie and said out loud all of the hardest things that had been playing on repeat in my head all morning. It was an act of love for her to hear me out, and in bringing all of my dark thoughts into the light of day, they started to feel less impossible to live with.

There’s not a terribly satisfying end to this update: I believe God provided comfort for me in the form of friends both here and back home, and I cling to the knowledge that in being a doctor I am responding in obedience to what I believe he has asked me to do with my life. And as one of my friends here has pointed out to me, our fundamental hope is in the resurrection. If it weren’t true, this would all be in vain.

When there’s so much I can’t understand, I often find myself dwelling on this, from Paul: For now we see in a mirror dimly, but then face to face. Now I know in part; then I shall know fully, even as I have been fully known.

why i'm here

I'm back at Tenwek: I arrived last Saturday, I'm sleeping reliably through the night, and I'm starting to feel a little settled, so it's probably time to let people know what I'm up to.

I admit to generally having a preconceived notion of what my purpose is when I come here: be a pediatrician, take care of kids, teach trainees. Usually as the only consultant (i.e. doctor in charge) of the service. So when I heard that this trip corresponded to a time when Clark, the newish long-term pediatrician, would actually be around and working, it felt like a little bit of a head-scratcher. I'm so used to the lone wolf model of supervising pediatrics at Tenwek that the idea of working alongside someone initially felt odd. He's here, am I just redundant? Shouldn't I be here when they actually NEED me? But I think perhaps it's arrogant for me to assume that I know The Best Way for Carolyn to Serve. 

Reflecting and praying over the past few days, I've realized a few things. Clark is very smart and totally capable, and I'm not sure how much I'm really adding to the care of the patients at the moment. But my presence seems to be an encouragement nonetheless, and maybe I need to consider the idea that being an encourager is actually just as important a means of serving pediatrics at Tenwek as covering the service while someone is away. I also come with a lot of cumulative institutional experience at this point, which can be helpful, but only if I'm humble enough to remain open to the idea that there are things that can change and use my perspective to help figure out what they are. Over the thirteen years I've worked in pediatrics here, medicine has evolved, Tenwek's resources have increased, and Kenya is not the same. All of that combines to mean that we can likely do more for our patients than we currently are. However, there is still a lot we can't do, and I hope that my perspective on how to navigate the grief of that is ultimately also an encouragement.

I've been turning all this over in my head for the last several days and realizing that if this is how I can best serve this month, it's going to require far more prayer and humility than I'm used to practicing. Which is both exciting and intimidating. I'll keep you posted.

In a brief rundown of other first-week settling-in news: 

• I am loving being a part of the Ganey household. It's home and family and many other things that fill me with joy. 
• Eden Ganey (age 9) clearly sees me being here as an opportunity to bake way more desserts than we ought to eat in the course of the month. I hadn't been here 24 hours before she had me pick out a recipe from a cookbook (ultimately baked: vanilla cake with black currant jam and browned butter buttercream frosting).
• I am running! By which I mean twice so far. And my lately-delicate right knee is behaving. Exciting. (Please note: we're at 6500 feet above sea level. And it's not subtle.)
• I'm also supervising a second-year FP resident through her critical care rotation, which means a couple of hours each afternoon discussing ICU patients and making our way through her curriculum and discussion questions. We worked together on peds when I was here a year ago, and I love her dearly.

It's 9pm now, otherwise known as Missionary Midnight, and so I'm going to trundle off to my mosquito-netted bed. Prayers are appreciated, and maybe next time there will be pictures...