Uphill Run

You know that feeling when you’re running up a really big hill? You put your head down, focus on your breathing and increase the power in each stride. Four steps as you breathe in and four steps as you breathe out (at least for these short legs). Watch that log, and that rock, just keep going, don’t slip. In and out, you’re almost there. Muscles are burning, lungs start burning, but you’re so close. Once you reach the top you gasp for air and you may even pause as your lungs and muscles scream, but you have to keep going. At least now you can raise your head. The run for the moment is not as strenuous, and maybe even enjoyable. Now your head is high and your focus is the incredible scenery around you and not how hard it is to take each step. As you allow your thoughts to consider the beauty of the stream that runs beside the trail it almost feels like your feet are gliding across the path. The intensity of the run has changed but what really changed is where you kept your focus. 

            Since last Monday things continued to be just as busy and adrenaline producing as the first few days. Thankfully however, I was not on call nearly as much. One of my pneumonia kiddos passed away shortly after I last wrote. Her heart just gave out. We had a new child come in with blood pressures that were super high, and I had a good time teaching the students and interns how to think through the differential. On Wednesday we almost lost a teenager to severe malaria as her blood level dropped severely low and her body was both clotting and bleeding at the same time. A condition called DIC. We were able to effectively treat the malaria, but the damage that had been done was incredible. Her lungs filled with fluid, her liver and kidneys shut down and she was bleeding like crazy. Then her temperature spiked so we filled gloves with cold water to place on her body. However after the first few gloves, the water turned warm and wasn’t helpful. We had students running to other sinks in the hospital for cold water. On top of this, in Kenya the options for treating her kind of bleeding are few and not ideal. We needed fresh whole blood and at the time did not have any. So, I walked down to the blood bank and started filling out paperwork to give her my own blood. But just before I gave we found some fresh blood for her. I was relieved when I came in the next morning and she was still alive and even a little better. 

We almost finished rounds that morning without a crisis. . . almost. I was waiting for my intern to come to the NICU to finish rounds but we finally had to page him because it was taking him way too long. And of course he was at the bedside of my original pneumonia infant who was awake again and dropping his oxygen saturations. The one IV line we had stopped working, and so he was no longer getting any of his sedation. This time it wasn’t as easy as before. We worked for a good 3 hours total. We were unable to get an xray because we couldn’t get the portable xray down to where he was and we were also unable to move him to xray because he was too unstable. We got an ECHO bedside and it showed that the pressure in his lungs had significantly increased since his first ECHO. My heart sank, because I knew this meant he has a very small chance of recovering from this. While this was going on we were trying desperately to get another line in him. But no one could get one. We called anesthesia who came with an ultrasound and finally got one line, but couldn’t get another. We got a few medicines in him but still he was not settling. His heart rate was dropping and we had to give multiple medications to keep it up. Then that line failed. I really thought that was it for him. Finally one of the surgeons came and put in a central line for us. Once this happened and we could actually get medicines in him he finally settled down and his oxygen level and heart rate stabilized. But now it was taking multiple medications to sedate him and multiple medicines to help his lungs and his heart rate. We all knew that his prognosis was very poor. That was a very hard conversation with his mother. That night on call he did okay though his heart rate still dropped a few times requiring extra medicine. I slept some but woke up every hour or so out of anxiety more than anything. Friday morning just as I was getting out of bed for the day I got a call that another of our kiddos was having trouble. So without brushing my teeth, or changing out of my scrubs from the day before I ran back up to the hospital. One of our kids came to us a week ago from another hospital with multiple abdominal abscesses and a horrible pneumonia. He was, until that morning, the most stable of our critical patients. We rushed him to xray and found out that essentially only one of his lungs is working currently. 

            I left after ICU rounds to get about 30 minutes of sleep, get ready and then left with the physio department to deliver a wheelchair to a child with Cerebral Palsy out in the village. We were able to custom fit the wheelchair for him. Watching him smile was incredible. Due to his condition he cannot sit on his own and spent most of his life lying in bed. I watched him grin as his eyes looked all around. His entire family and many members of the community came out to welcome us. We were able to share that this chair was a gift and that God loved this child as He does all people. We shared that Jesus died for each of them and prayed over them all. And then of course in normal African fashion we had chia before heading back to Tenwek. It was a nice end to a very busy week.

            Yesterday I had my first day off since arriving at Tenwek last week and it felt very similar to the description of running up a hill as described above. To be honest, I don’t mind working a lot. And I even considered going to the hospital yesterday just to help. But I knew that since arrival I had not really had time to sit before the Lord and just be still. I could feel it in my soul. I had been living in survival mode just trying to keep up with the medicine. My worst fear coming here is that I would make things worse by my incompetence. And several times in the past 10 days Satan has played on those fears making my pride roar loudly. But I knew God wanted me here. What I’m realizing however is that He wanted me here so He can work on me, not because I am needed. He will accomplish His work in the lives of these children with whomever is available to serve. But He invited me here to refine me. Most times when I serve overseas it seems so much easier to hear God and I ‘feel’ closer to Him. Typically there are less distractions and more time to be still. I guess I just assumed that would happen again as effortlessly as before. But all last week as I would pray He felt distant and my time with the Lord was always rushed (typically because most mornings I had at least one critical patient trying to code on me). But yesterday morning I could just be still. I woke up that morning on edge with every little thing making me way too anxious. I knew I needed the Lord to intervene, and He did. 

            It is always amazing to me how much peace and joy come when you simply shift your focus. I remember when I started medical school my prayer was that no matter how intense and overwhelming medicine became that it would not cause me to lose sight of the God who called me there. For those of you in medicine you know that it can easily become all consuming. But there is only One who is an All-consuming Fire. Just like Peter in the midst of the storm as he walked on the water. The circumstances and situations around us may require attention and may  be drastic (code after code after code and all the alarms). But the focus, and the center of our universe should never shift from Christ. The Lord knows these circumstances and situation better than we ever could. He knows the exact pathophysiology of each patient I encounter and how it has been corrupted by disease (ultimately sin). He knows exactly what each patient needs and exactly what I need. And He has promised to supply all of those needs for His children, whether here on Earth or ultimately in Heaven. And it is a supply that never runs out (something I have learned to not take for granted because that happens often here). No, His supply is according to the riches of His mercy. Riches that we could never comprehend. In fact He says to seek Him first and then all these other things will be added. So this weekend with the rest and downtime the Lord has given me, He is using it to redirect my focus and refine me. He has pointed out idols that I have allowed to creep back into my life and areas where I have lost my footing. He is humbling me, and I am so thankful. For those whom the Lord loves He chastens. I know He has work for me to do here that is not medical. Work on myself and maybe some encouragement for others. As I have been praying through things it seems I am to pour into our pediatric team: make disciples who then make disciples. And of course always be ready to give a reason for the hope that is in you no matter what situation or circumstance. I have been brushing up on the Gospel and rememorizing many of the verses and it has been water for my soul. I pray the Lord brings you to such a place no matter what circumstances you find yourself in.