A Few Faces

Giving some thanks

I think every year when I return from Tenwek there is of course a different processing process. The first year I worked through different things than I have this year. This year was a little strange and I have to admit a little gross to see where my heart has been leading since coming back. A lot of times when I come back I am overwhelmed by all that I have and all that people there don't have. Which I think physically speaking is still the case...I have come back thankful for some of the things I have. But I have felt this glaring hole in places where I don't have what I think I need. So instead of coming back thankful I have come back maybe bitter is the right word for it. Which, like I said is gross. It is good this week was thanksgiving because I think that forced me into some genuine thankfulness by, oh Friday morning. And I think God has used some of my past few days off to remind me that in saying he has given me everything I need he is also saying he hasn't given me the other things that I may think I need. This doesn't totally take away some of the pain of the gaping hole but it does begin to mend things a bit. And hopefully my heart will continue to come around in time.
I think this year a lot of the hard stuff hit me harder...seeing patients around the hospital who died, seeing the kids and adults who we couldn't do surgery on...those things I had a lot harder time coming to terms with. Maybe before I have never really let myself think about them too much because it is hard to think about that stuff. It is really hard to think about people who will die because of something they don't really need to die from...if only they lived somewhere else. But I do come back to the truth that God knows each person and each heart and what they and those around them can handle and need in their lives. I don't think beyond that I will ever have any sort of answer for how hard a reality that is.
I am finally going through some pictures so here are a few.

This is Eunice...she is a trip! She had a harder post-op course and was still there when we left. She was the one who told me I was pounding her like maize while I was doing her respiratory treatment. I love that smile, though...it lights up the room!

This is Kiprono, or Kip from the first week. He touched a lot of people. He is I think 16 or so and when he was seen in the clinic Michael, one of the non medical guys helping out in there, was immediately drawn to him and knew he needed help. When they started anesthesia on him his heart was so sick it stopped and they brought him back. Once Michael heard this he went to the hospital chapel and prayed for him for a long time. The surgeons debated on whether or not to go on with the surgery. They finally decided he would die soon without it so it was worth trying. He did amazingly well...and proceeded to wear this Michigan hat Russ White gave him constantly after surgery.

More later!

Adjusting

Back in Nashville...seems fitting that it is rainy and gloomy outside. Our travels were good, though of course long (6 hour van ride, 2 8 hr flights, several layovers and an 1ish flight). Even though I have done this so much I still forget this adjustment time...this time of feeling a little bit numb to all my feelings, of not wanting to be back at home even though I love my life here, of being sad, of missing the green hills and warm smiles and hot ICU with all its Kenyan sounds and smells, of working til my body and mind are exhausted but knowing my work is not in vain. I feel confident that my life is here and not supposed to be thousands of miles across the ocean at this point in life. And I also feel confident that this experience is a part of my life in these few weeks every year. So I am hoping for some time to process and to allow my feelings settle in, to allow myself time to let my experience settle in since it whizzed by so fast.
I will post some photos maybe by later today if I get around to my camera. Until then Ephesians 3:20:
Now to Him who is able to do far more abundantly beyond all that we ask or think, according to the power that works within us. 

Heading home

We are waiting to leave..very bittersweet. Things ended out well. All the kids were on the floor by last night and Vincent one of the nurses had us to his house for tea. Very sweet. We had a good last evening of fellowship. And today we took a hike up to Montigo a big hill that overlooks the area. It was a beautiful morning. Now we wait and then travel a lot.
Last night was a sweet way to end things with tea and dinner together, laughing about our sweet new friends and remembering all that has happened these two weeks. So thankful yet again to get to be a part of this project.

Winding down

It is Friday morning here and things are winding down. Wednesday's cases did okay but one had to go back to the or thurs. we also did another complete tet repair and a double chamber RV, both older kids. The icu has 4 patients remaining all who are doing well and should be to the wards by tomorrow.
I am tired and having a mild RA flare up but still holding up. Marek found some new meds here for me to try :) This 2 weeks has been long but it is nice to be here and get so much accomplished. Russ said we have done more congenital cases this week than so far this year in Kenya.
Today Mary and John are working with us in the unit..they are two of my favorites. Mary is all about tough love.. When we asked if she would be here when we come back next year she said yes as long as Christ has not come by then. And John has some awesome phrases too. They both work hard and want to learn a lot.
We will spend the next bit of time inventorying. We gave the nurses a bunch of gifts today for their children which was fun and will save the passing out gifts on the wards for the nightshift crew. Ate some ugali at the canteen. Not much going on here. Part of me is ready to come home mostly to sleep and get some rest but the other part of me could stay here forever. So much joy and difficulty but good. This year I have had a harder time realizing how many people we cant help while we are here...we could do surgery for weeks and not run out of patients! It is hard when you put sweet faces with the hearts and names connected to them. But god knows each of them and their hearts and what their lives will look like.

Already Wed!

Wow. The week is going fast. Yesterday I flipped back to days and didn't work but for a few hours which was needed. Our patient from the first day, sue, had to go back to the or today because the vsd wasn't totally fixed and there was a spot on the aortic valve that needed fixing. She went back today and is doing okay still on the vent but looking good. Our other patient from yesterday was tony who we did a partial fix on two years ago and finished fixing yesterday. He looks great! Yesterday's other patient still needs some tuning up. Last night he screamed for water telling anyone who would listen and volunteered to walk over and get it himself. He has some feistiness to him. The plan is still to do two more cases today a shunt and a double chamber RV. We will see it is almost 6.
Today I donated blood at tenwek which I have never done before. We have had to give more of our patients this year so after walking to the blood bank one morning to get blood for someone and seeing how little blood they have I braved it. Nancy was great and it was a fun experience. I even convinced 3 people who have never donated to do it. So I made them stickers and we took tons of pictures.
One thing I have noticed here is how stoic these patients are. They rarely complain. There are so many things I love about this culture but I do think they could learn a little about expressing suffering. Or maybe suffering is so much a part of their lives that they expect it and don't need to scream about it like I do. Or maybe they scream to each other about their pain and don't need to complain. I know I need to talk about my suffering to let others in or it becomes a giant monster that runs wild. I am thankful that I have people who welcome that. And thankful to see how suffering is an expected part of life with God.
Some of our patients from last week are going home. Duncan left...he has been ready to go for a week. And the others are getting there slowly by slowly.
As always it is so beautiful here and I love my moments outside. More later.

Week 2

The weekend was quiet which was a blessing. All our patients were on the wards by Sunday after lunch so had some downtime! The new team got here Sunday afternoon and we got all their supplies unpacked and the icu ready. We did some more teaching today while we waited for the or. Our two patients today did great. I am working nights with Leah tonight and things have calmed down. Blessing our first patient was a 3 year old tet repair. She is feisty and from the Congo so only speaks French. Sue is our other patient who is an 18 month old vsd repair. She is also doing really well. Both are resting coughing and stable so good start to the week.
I am tired. I think all the nights and days are catching up to me. I know when tired my patience and love tend to be harder to come by so just praying that I can rely on god for strength rest love etc in this next week.
Not much to report today. More later

Tenwek

For every house is built by someone, but the builder of all things is God. Hebrews 3:4
I came upon this verse yesterday before going in to work at the hospital last night. It reminds me of Tenwek's motto for lack of a better word which is We treat, Jesus heals. Before each surgery the team in the OR prays with the patient, entrusting the outcome to God. This verse is applicable to really anything in life but has been a particular reminder to me here as I fight for control of everything. I have lead up the nursing portion of this trip ever since the second trip here. Those who know me well know I tend to carry responsibility heavily at times (something I have been able to see more and more lately, especially with the help of friends pointing it out...yes walking in community is a joy, right). In my role here I am asked a million questions about how to do this, where to find this, can we get this med or this piece of equipment. But I tend to carry the responsibility further in terms of is everyone having a good trip, do they enjoy this, is it overwhelming, are they doing everything right, how will this all reflect upon me? So yes, I may be in a leadership position, but ultimately God is in control of each patient we care for an is in control of each person on the team and their experience and in control of my idenity. I am glad I do not have to carry that weight.
I sit right now in the ICU. Kristen let me borrow her computer for the long nightshift. Long because all of our patients are doing so well and are resting. We have four left in the unit but hopefully they will all go to the floor by tomorrow so we will start the week fresh. Our patients from Friday, Jehosophat (or Jo-Jo as Anna nicknamed him) and Micah both had great nights and great days. Today they did one surgery on Chelea and repaired her mitral valve. She has already taken chai and sat up in bed.
Last night I went through all our patients' charts to learn more of their history. I learned about how many years (yes years) they have been experiencing symptoms of heart failure. What this means in real life terms for them is that they cannot work or go to school or have a job. Many have had symptoms for four or so years and have just been on medicine to try and help their symptoms. Having this surgery means literally new life for them.
Crazy things happen in this place...patients do remarkably better at a faster rate than we see at home. As I witness this each year I still wonder if it is the Kenyan people or simply God working in each case to enable many to get helped during these weeks. Eunice, one of our patients who sleeps in front of me now had work done on multiple valves and had horrible lung pressures before her surgery and was on bypass for four hours (a very long time) yet she got her breathing tube out a few hours after surgery and was drinking water and talking.
We are a skeleton crew this weekend...the first week people have either gone home or are on safari and the new team will be here tomorrow. Today I pulled my hair up into a bun before work and when I got here both Kenyan nurses asked me if I had shaved my head...they are fascinated by my coil as they call it.
We went to see all our patients tonight and all are doing well. Duncan suffered a small stroke but his symptoms seem minimal...he wanted to make sure we knew what had happened and kept lifting up his weaker arm over and over. And he wants to know when he can go home. We went by the women's surgical ward to visit 2 of the women and had to shake a ton of hands and got a huge good-bye when we left. That is it...hoping the rest of the night will go by quickly!

Pole (pronounced po-le, in Swahili)

Pole means slowly in swahili. The Kenyan nurses will say it to our patients as we get them out of bed or give them water. They will say pole pole. I think I need to write pole and post it on my wall, my mirror, in my car...I need this reminder to slow down.
Yesterday I was walking somewhere and in my usual way was speed walking. I didn't need to walk fast...my patient didn't need the lasix from the pharmacy stat, but I was walking quickly. I got stuck behind three Kenyans strolling through Tenwek and I realized how hurried I always am even in day to day life. Not to mention in my mind or in how much I want to run ahead of God.
Our patients from yesterday are doing well. Eunice got off the vent right before I went to bed last night and as we were pulling her breathing tube out she was already saying water (or wata as they say it). So she perked right up and had a good night. Right now she is sitting in a wheelchair with beads on playing a recorder.
Teresia was our second patient of yesterday who had her mitral valve replaced. She came out of the OR last night extubated and is also doing well.  She is still pretty sleepy but I am sure she will perk up today.
Beauty is still with us and is looking a little more alive today. Everytime you say her name she says hallo. Our other friends moved onto the floor today. Caroline walked outside before she left and was ready to run.
They are going to try and do 3 cases today to make the most of the week, so hopefully they will be fairly speedy as I will be the only nurse in here after about midnight tonight.
Going to get some rest now before I come back tonight. This weekend there are a few of us running the ICU so prayers for our patients having no complications and for good working dynamics and rest for each of us in our time off. The next group of people will arrive on Sunday.
This morning before the nightshift nurses left Caroline called them over and wanted to pray with us. I have no idea what she said, but it was so heartfelt and dear. I love getting to spend this time with each of these sweet people.

Still one patient left to come out of the OR. I am taking a dinner break and will go back up to the unit to help admit the next patient.
Today was a good day. I got in to work at noon to find all three of our patients out of bed in wheelchairs with Hope for Hearts tshirts on. Caroline was decked out in her mardi gras beads playing a recorder. Kipkoech (the second case from yesterday) was out of bed with a Michigan hat on just grinning away. And ole Beauty was up out of bed but she is just still very tired. I think these older patients just have a harder time bouncing back. But she is doing better. Things are a lot more like normal.
As always it is so fun to work with the Kenyan staff. The nurses are picking up on things really easily and we are working with many different nurses than in previous years. The other ones have all graduated to be head nurses or work as first assists in the OR. They were really quiet when we did education Monday but now they are asking questions and picking up on stuff left and right. They are all so dear. Eva is one of the dayshift nurses and she is great...jumps right in with things. And has a great sense of humor. We spent a lot of today laughing.
Went to visit Duncan (or big D) today and we couldn't find him in the surgical ward. We then saw hand shoot up in the air waving us towards him. He had spotted us first. He looked better and had a sparkle back in his eyes. He told me I was a good woman! I think he misses all the attention we gave him.
Caroline has become my new favorite in the unit. She is 28 and lives 20 km from Tenwek. She told me today that she has been unable to pick tea leaves for her family and she is looking forward to working when she leaves the hospital. She has 4 children and wants to have another boy. She started singing spontaneously today a song blessing us. She also kept playing her recorder spontaneously. She is feisty!
Oh yea, our first case from today is Eunice and she had work done on three valves. So far okay but got some work to do on her.
I feel very humbled to be part of this trip and a part of all these experiences. I am reminded so much of how I am not in control and it is amazing to look around me and see what is possible if I am willing to get out of the way.

Day 2 and 3...much better!

Well, last time I wrote I know I left a lot of things hanging. To pick up...surgery did finally proceed Tuesday but the mood around the hospital was tense and somber. Everyone was affected by Roger's death. They operated on a middle aged woman and replaced her mitral valve. She came back late and was really sick all night long. The team last night worked really hard at staying on top of everything with her but compared to our previous years she was sicker than most patients we have taken care of. In general I was just left thinking what is going on this year...things are not the usual way. All around us we were witnessing death. There was Roger. Before Roger there was a patient who was ECHO-ed on Sunday as a potential candidate. They admitted him (Edwin was his name) to get tuned up a bit because his heart failure was severe...well Monday he arrested and passed away Monday night. Then last night while we were recovering our patient, Beauty, a gunshot victim came in who eventually died. Then today I briefly went by to see if they needed help on another young man who passed away. It has just brought this reality back of how much we have at home...how many resources, how many priveledges that we assume we should have. And here it is so very very different.
Back to our world..Beauty, who is a mother of 3 from Zimbabwe, turned the corner around 1 today around when I got up to the unit. We finally got her breathing tube out which was a fiasco to say the least (almost got it back because she had gotten too much morphine prior, there was some vomit that may or may not have gotten all over me, and lots of humorous situations) but she came around and is doing much better.
Then today the 2 cases have done beautifully. First there is Caroline, a 28 year old Kipsigis from around Tenwek who had work done one two valves. She got her breathing tube out after a few hours and of course was immediately asking her for water. A friend gave me some Mardi Gras beads to give out to patients so I brought some over to her and asked if she wanted them. The nurse translated for me and she replied yes, i want you to place them over my head. Ha...she is funny. I know she has atleast one child, a 7 month old girl. Our second patient was a young man who is so skinny from his heart disease. He is fifteen and weighs about 80 pounds...just these scrawny little arms and legs. His surgery started out rock but he is doing great so far. I left around 11 and he had been back for a few hours and had no bumps. After his surgery the mood has shifted and everyone is feeling much more upbeat and okay about things.
There have been some other challenges along the way but all in all today has been a very busy, but good day. I have been working a swing shift to make sure we have 3 nurses there to admit the second patient who comes out after dinner so I am on the weird time schedule. But it has been working out well.
There have been the usual enjoyable moments here of meeting patients families or other patients and receiving their warm smiles and appreciative handshakes. Of hearing funny phrases like she looks smart or instead of saying xray the man says exposing. For some reason I love that.
I wish I could post a photo but Duncan, our first patient the 62 year old had to go to the floor today. When I came in to work at noon I went over and said hi and are you feeling better today. He said no. The Kenyan nurse nearby told me he didn't want to leave the ICU and go to the floor. So on his way out tonight we wanted to take a picture with him. So here are four of us crowded around him and his face is grump-tastic. It is amazing. I will post it eventually.
They are going to try and do some cases Saturday which I think we will be able to handle. But whew I forget how busy it is here and how it is pretty much work and sleep work and sleep. Tomorrow I am going to wake up early before going in to walk around the compound some.
Sorry this is  a long one.

Day 1

Yesterday was the first day. As I said we decided to do 2 cases Monday instead of Tuesday. While they were doing surgery in the OR we had a day or 1/2 day of nursing education for staff. Things went well...we talked about Rheumatic heart disease, valve repairs, basic heart info, respiratory info, some hands on to assess breath sounds and heart sounds and then we did a nursing lecture for their education requirement on how a patient goes from start to home when they get surgery at tenwek. The first case was slow going luckily so we got everything taken care of.
Our patient is Duncan a 62 year old who had coronary artery bypass. He did pretty well in surgery and was off the vent in 2 hrs and on some mess for his blood pressure overnight. He is a very sweet man and great to work with. There was the usual craziness when they first get back of figuring out which monitor can do everything we need and losing battery power on iv pumps but all in all good.
They decided to proceed with the second case evn though it was close to 5 when the first case finished. We went home for the night and came back this morning to find it had been a very bad night. The patient got out of the or at 2am and had trouble in the or but was doing okay. Had a lot of fluid on his lungs which was exPected and some prOblems with his blood pressure. Then around 4 am the oxygen in the hospital shut off. I guess we had over exes the system with the two long cases and used all of it and the back uP. The Parker arrested and oxygen was really the thing he needed most to help with his lung problems. So without that nothing they did could bring him back. So Roger, our sweet nurse patient from the Congo, passed away this morning.
This issue has brought things to a halt this morning all over the hospital and in thee or stopped all over and they have been working on the problem. They finally decided to do one case today and have gotten us back up oxygen tanks for our icu (the one we had last night was quickly emptied when the problem started).
It is a very hard way to lose a patient to something so easy to find at home. It is a hard way to start the week so prayers for our team here and for oxygen supply to be constant. More later.
Oh our patient today is named beauty and should get a mitral valve replaced.

We are here!

We have arrived...after 36 hours of travel. Travel was fine (other than being long) and all our many many suitcases arrived. We are set up mostly in the ICU and will do a partial day of nursing lectures tomorrow...only partial day because we are starting surgery tomorrow instead of Tuesday (I had a feeling this may happen).
It feels a little crazy because we just got here and tomorrow is so full. And we are a bit short staffed...but I feel it is in these ways that God shows up in big ways doing things that we could never do on our own. And that is a reminder I need in a huge way right now. As my heart and head are feeling stressed and full of details to remember I instead need some time to stop and remember who is doing every detail of this week...to take the pressure of myself and to enjoy the ride. So glad I got this chance to jot a few words down even to remind myself of some truth.
Prayers for rest for us all and a smooth first day. Cases are a CABG (yes, you peds people you read that right) Coronary Artery Bypass and then an aortic valve replacement and mitral valve repair for the second case. Be praying for these patients to feel at peace tonight in the anticipation of tomorrow (they found out around 6 pm tonight they would be operated on today) and for their recoveries as they start tomorrow.

Whew....Here we Go!!

Part of our team leaves tomorrow for Kenya. Some of you know the back story to these amazing trips, but I will give a short recap.
A physician who used to be at Vanderbilt went to med school with a physician who was living and practicing as a surgeon at Tenwek hospital in Kenya. They started dreaming about what could be done to help kids with sick hearts in Kenya. See there isn't a reliable way for them to get surgery to fix their hearts. Nairobi has a cardiac surgery program but half the time they cancel things or it is way too expensive for anyone to afford. They do a handful of cases in a year. So the dreaming continued and 4 years ago we took our first team to Tenwek. We had a bypass machine and a ton of other equipment shipped over. Our first team was small...I think around 10 people total to cover the OR, the ICU and clinic. We finished that week off doing I think 11 surgeries to help children and young adults who have congenital heart defects or valve problems resulting from Rheumatic Heart Disease and have gone every year since. The trips have continued and have grown not only outside of Vanderbilt but our patients each year are coming from further away.
This year we are expanding the trip and doing two weeks of surgery. The first week will be primarily valve related older patients and the second week will be kids with congenital heart defects. Some of our group leave tomorrow and some leave next week and some of us (that would be me) are there for the whole trip.
I am going to try and blog while there and fill you all in on the journey.
Here is our nursing team across the two weeks (minus Lisa)

You can continue to pray for safety for the team traveling, for our patients who are getting ready to be operated on...for peace for them and for our interactions with them, for our team...the first week we are a little short on staff so we will all be working extra hard, and for each person on the team and their experience.
Can't believe that we are already heading out!!
Will write again early next week once we are there after our 2 days of travel and settling in! We may do our first surgery Monday afternoon...either that or Tuesday morning.

Still

As I finally chose to sit and be still today (it is almost 7 at night) I am reminded as always how much my heart needs these times of silence...that I spend so much time avoiding my thoughts and fears and in the case this week nerves. I guess I think if I don't sit and spend too much time thinking about it they aren't as real, which really seems like the mentality of a 3 year old (I won't go into the nursing theory behind this), but I guess that is still where I am. Acknowledging these fears really does the opposite for me...it reminds me of the truth, it reminds me of who is in control, it reminds me of my inability in, well in everything, and my need to rest on God. Yet I run and run until I am worn out and forget that the Prince of Peace is beckoning me to come and sit, come and eat, drink, enjoy and rest and be freed of the worry and fears that I carry with me.
One of my favorite Psalms is 62:5-8
My soul, wait in silence for God only,
For my hope is from Him.
He only is my rock and my salvation,
My stronghold; I shall not be shaken....
Trust in him at all time, O people;
Pour out your heart before Him; God is a refuge for us.
(For Adrienne and Danielle, there is a Selah at the end of it too).