Advent

I saw this link on Pintrest and thought I'd post it. We got our tree today and things are starting to feel more Christmas-y in our house. I even put the lights up-I am still no match for Leah and Mark but I am getting a bit better.
It's advent season and this is a good read if you have the Jesus Storybook Bible. Apparently there are 24 stories in the Old Testament section of the Jesus Storybook Bible. Each ends with some reference to the coming of Christ, preparing us for what needs to happen. And then the 25th story is the birth of Jesus. Maybe she knew that and planned the book this way, but I think it is pretty awesome. And since I already love The Jesus Storybook Bible it all works out :)

Me

I have been learning a lot about who I really am and how to return to that place and find freedom in that place. This could be a way longer explanation but essentially in order to be the me I was created to be, I have to learn to be vulnerable, to let others' see my weakness, to not need to control everything. This is tough stuff! But also incredibly freeing stuff. In the moments
This blurb on courage sums it up well:
  It will always feel courageous to live from your true self, because it is letting down your guard, showing up with what you really have, it could be too much, it could be too little. It is what you have. It also may mean that I do not get the acceptance I was working so hard to get from others.

I Am

This song has been running through my head all day. It is one of my favorite Jill Phillips', I Am...so many great reminders of truth.

  O weary, tired and worn
  Let out your sighs
  And drop that heavy load you hold, cause mine is light
  And I know you through and through
  There's no need to hide
  I want to show you love that is deep and high and wide 

  I am constant, I am near, I am peace that shatters all your secret fears
  I am holy, I am wise, I'm the only one who knows your hearts' desires.

Weary

I think the events of the last month all hit me today at about 6 pm. I feel suddenly weary from all the busy-ness of the last month. I feel I haven't allowed myself time to process from being at Tenwek. I have been running from the stillness that I know my heart craves.
I am very much praying this verse for myself this week:
  Come to me all who are weary and heavy laden and I will give you rest. Take my yoke upon you and learn from me, for I am gentle and humble in heart, and you will find rest for your souls. For my yoke is easy and my burden is light. Matthew 11:28-30

Thanks

Geez, I have been a slacker this week!
I think I am about footballed out so thanksgiving break must be coming to a close.
In our small group on Tuesday we were talking about the verse in 2 Corinthians that talks about boasting in our weakness. In our discussion I realized that if I truly believed all things come from God, I would be more thankful. I probably wouldn't describe my usual posture as this. I have my days and moments but I usually have to remind myself to stop and be thankful.
I am thankful for so much this year. After what has been a very challenging year for me I am once again thankful for God's faithfulness to me. It continues to blow me away.

All Time Faves

This will be one of my favorite memories from Tenwek. Her beautiful smile. Her eagerness to share her heart. Her free spirit. Her lack of concern for what others' may think. Her desire to praise God. Love it.

Quote

This quote seemed to put great words to God's love for each of us:
“Then there’s a third way: to live as though you believe that the power behind the universe is a power of love, a personal power of love, a love so great that all of us really do matter to him. He loves us so much that every single one of our lives has meaning; he really does know about the fall of every sparrow, and the hairs of our head are really counted.  That’s the only way I can live.”
– Madeleine L’Engle A Circle of Quiet

Wonder

Our last night at Tenwek we had a quick wrap up meeting. At the end of our meeting, Russ prayed for the team, prayed in thankfulness for the 2 weeks that had happened and lifted up our continued involvement at Tenwek. During his prayer he basically praised God for caring enough about these few patients out of all the people in the world that he would reach down and work miracles and heal their hearts. It really is astounding. The idea brought tears to my eyes...that God would love any one of us so much that he would do such a mighty thing. These events are clearly a big life event for our patients, but it is amazing to me that He would give me something as simple as a sunrise or a bird singing or a moment to not be busy during the day to rest. They are all big deals and I speed through life not noticing the magnitude.
That is one thing being at Tenwek always teaches me...pole pole. This is the Swahili phrase for slowly. It is funny because we hear our Kenyan nurses saying it a lot-to our patients, to each other....everyone walks slowly throughout the compound, there are numerous chai breaks during a day. There is a lot of time for slowly and it always takes getting used to when I first arrive. But now that I am home I miss that. I don't like the constant busy, the constant entertainment world we live in of smart phones and distraction and noise. I want the quiet and slow pace back. Even though I work like a dog while I am there, this pace is in the background and it impacts life.
A week ago Dotta passed away, so I thought I would include some photos of him. I could never get him to smile for the camera or really to even look at it. These are a few of him during the first week when he was in the unit before surgery. I continue to pray for his mother, Deborah and the rest of their family in Tanzania.

Baraka

I am back in Nashville...got home this afternoon and have a load of laundry going...back to the real world. I am really tired, so I am sure these won't be the most coherent thoughts...more once I process and sleep :)
Our last day of surgeries Friday went great-2 more sweet faces-Kibet and Chepkorir. Both did really well.
We had a wrap up meeting Friday night and the mutual feeling was that it was a great trip-things we needed to improve upon from the previous year happened, the teamwork was great, there was a lot of education progress..all in all a good 2 weeks.
On our way back from Tenwek to Nairobi it started raining. Our driver said rain is baraka, or blessing. I sit here, exhausted, jet lagged, worn out feeling like I have been showered with baraka over the past two and a half weeks. From our patients, to witnessing miracles of healing, to our teamwork, to the hilarious things the nurses and patients say, to the beautiful surroundings of Tenwek, to every busy shift and night without sleep, all the many meals of avocado and rice... I feel so blessed by the time there.
More processing and pictures to come, but I'll leave you with Mary-she stole all of our hearts with her absolute cute-ness! (headband is courtesy of us:)

Maggi

The rest of our night on Wednesday went well after Dotta's passing. Our little Truncus repair, Ian, whom I love, did great. I think he will be a runner some day because all night long his feet didn't stop moving. He got his breathing tube out right before we left in the morning. They also did 2 cardiac cath cases, which is a first and both patients did amazing. Their sweet smiles were a gift during the sadness of that night.
Last night, Leah and I got our booties kicked...it was really busy. There were 3 surgeries yesterday-Mary who is also the cutest little 9 month old, Kipchirchir and Chepkemoi. Between the last two we got asked for maggi or water about 100 times. Chepkemoi got her breathing tube out around midnight and it is like the child has never had a sip of water in her life. At one point she tried to stand up in bed because she said she was going to walk to the faucet to get some. (We have to wait a few hours after they get their breathing tube out before we give them water and then have to go slowly so they don't get sick to their stomach...try explaining that to a 2 year old) Kipchirchir was another miracle. He had a tricuspid valve replaced (for medical folks it was Ebstein-like) and they really didn't think he would be able to come off pump. When he came out of the OR he was sick-on lots of meds for his BP. Somehow we weaned those down enough overnight that he was ready to get his breathing tube out by about 5. Before then he was asking for water. When I told him he couldn't have any because of the breathing tube he said. Will you please take it out so I can have water. He is 8. Very sweet, patient boy. So we took it out and all he wanted was maggi. It is like they have never drunk before. The rest of the morning you just look over and his sleepy hand is beckoning someone to come get him water. He also requested bubbles as soon as he was extubated...hilarious!
When everyone came in this morning they were shocked to see him without the tube and off most of the meds for his bp...lots of people were praying for him last night. I believe that as much as we can do with our skills and our hands here, we can do equally as much in prayer for these patients. I have seen it work again and again-miracles happen, God provides in miraculous ways. I am astounded and grateful.
Made it through my night shifts. I am up again and will go up and stay til later tonight-they are trying for 3 cases to round out the week.
I can't believe I will be leaving this place I love so dearly again tomorrow. Praying about how God wants me to move and work with with the gifts he has given me.
    Ephesians 3:20 Now to him who is able to do immeasurably more than all we ask or imagine, according to his power that is at work within us

  

Dignity

Tonight has been a hard, sad night. The patient who we did surgery on Monday, Dotta has not been doing great. He came to us last week for a few days so we had gotten to know him some last week. He was an old man in a 12 year old body...very shy, observant and stubborn. On Monday when they saw his heart everyone realized it was sicker than they thought, but we proceeded to try and help it as we could. He was doing okay the day after surgery until the afternoon and developed some GI bleeding. Then this afternoon he arrested. They got him back but he was so sick after. By tonight we knew there was nothing more we could do for him-he was on so many blood pressure medicines and still he was on the verge of arresting again. So we decided to withdraw the medicines and the breathing tube and let him be with Jesus.
I think he would not have lived much longer if we hadn't tried surgery. And I think that we did all we could for him. I will never understand how God works, but tonight I felt a lot of peace in the situation. We allowed him dignity-a chance to fight to live and a chance to die with peace and not suffer any longer.
It was an emotional night. His mother, who has 7 other children, was so strong all day. She finally lost it and just wept and mourned outloud for her youngest son. Those of us here shed  many tears.
Dotta loved to be prayed with, as did his mother. I know he is with Jesus. His mother told me the day of surgery that she trusted God and that he knew Dotta. I know that God knows Dotta and knew how his life would play out. I am confident in that.

Manna

I have been feeling discouraged this week. I think the weariness of last week, the weight of all these patients and only so many days and hours to work to fix them have been wearing on me. I am forgetting who is my strength, forgetting who is doing the work, forgetting who is my stronghold, my fortress and my deliverer.
I emailed a friend last night just to ask her to pray. Then we went back to our place and stayed up too late laughing...my soul needed the laughter and silliness.
My friend emailed me back and reminded me about manna, how God provides. So I looked up Exodus 16. Here is what it says:
Then the Lord said to Moses, “I will rain down bread from heaven for you. The people are to go out each day and gather enough for that day. In this way I will test them and see whether they will follow my instructions.  On the sixth day they are to prepare what they bring in, and that is to be twice as much as they gather on the other days.”
God will provide what I need, what our team needs for this day. He will rain down his provision. I am not to worry about tomorrow, or even my night tonight (we are doing the smallest child and the most complicated surgery we have ever attempted at Tenwek).
Praise the Lord for this... 

Boys

Last week we did surgery on primarily women. This week we have 3 boys in the unit. Our first patient from yesterday did awesome and left early this morning. Our second patient, Dotta is still in the unit and doing okay, but having some complications this afternoon. Then today we did 2, one who did well and will hopefully get extubated soon and the other is still limping along a little. Pediatric cases are just a lot tougher than adults. It is hard not to feel a little disappointment that things are slower going and that we are not getting through as many cases, but we are here and I am trusting we will get to the children we need to. One of the big criteria when we select patients is will they be alive and operable by next year.
I am tired...feeling the long days back to back. My patience was wearing thin by this afternoon...I was not feeling like teaching and was frustrated that I have to explain things when the nurses shouldn't really know these things yet. It is challenging.
Praying that God will give me strength for each day, patience for each moment of teaching and rest that feels longer that it actually is. I work nights again the next 2.
Here is a pic from the top of Montego...sorry it isn't more. Tomorrow I should have more time to post since I will have the day free.

Monday, again

Whew! I am beat! We did get a bit of rest in yesterday...all our patients were out to the floor by lunch time on Sunday and my alarm clock broke Sunday, so I got more sleep than I was supposed to, which was pretty awesome.
The rest of the team is here and yesterday we had a big group meeting to go through the patients for this week. They had a list of 28 patients, which was not including many patients who they have either decided are too sick for us to do, are too well to need it now, or who are too far past us being able to do anything. It is really hard to sit there and make decisions-not that I am really making decisions-but it feels like such a heavy weight. I know we are not ultimately the ones making decisions, that God has placed certain children here and certain children on the surgeons hearts and minds, but man it is really hard to know how to make these decisions.
Before the week got crazy we decided to go for a sunrise hike up to Montego, the hill about an hours walk from Tenwek. I have been up there several times and it is gorgeous, you can see for miles around, plots of land, the hospital. But sunrise was unreal. It was amazing! We had to get up and start hiking at 430, but it was worth it. Eventually I'll get some pictures on here (I put a few photos on heartsofeastafrica.blogspot.com).
We got back in time for me to go get 6 of our patients from last week to go get a follow up ECHO. They should have all gone home today, but transportation was an issue for many. I love those ladies..their smiles, how they greet us. They are so thankful and praise God for all that He has done. It was a good morning.
We got a bit of education in before the patients came out.
We got through 2 cases today. A sweet VSD who came out with personality, yelling at us because she had been pricked too many times and wanting water. She got sweeter a few hours later and is doing great.
The second case went differently than we thought, but the patient was doing okay when we left the ICU tonight. Prayers for his night.
I am struck over and over by how we are not in control here. It can feel like we are and that we have all this pressure to decide on these, but we are not. I went out to pray with our second patients' mother and after we finished praying she said in Swahili, essentially that God knows her son, that he loves him and will take care of him and do his will. 
Going to get a bit of rest!

Week One Down

Saturday evening here and I am sitting in the unit with our last 2 patients-Charles and Chepkoech. They are both doing well and could really go to the floor but there isn't space. We were hoping it would run smoothly so those of us staying over for the weekend get a little rest.
Today we went around to see all our patients on the floor...this is one of my favorite things to do. Their faces light up and the love to give a hug or a handshake. Today was extra special..I have been trying to take some videos of our patients for Hearts of East Africa and I was interviewing my favorite patient, Dorothy. I asked her about her faith and her church. She told me she loved to sing so then she asked may I sing and proceeded to sing some lyrics from her favorite song. I am going to try and upload it tonight when the internet is less full. The song revolves around God healing and bringing one through trial. Such a sweet song for her to love.
I know I have written about Caroline, the awesomest nurse, but we spent some time hearing from her on how the week had gone. In September Dr. Galat, the surgeon who is with us brought a skin and bones team (himself, a perfusionist, an anesthesiolist who doubles in the ICU, 2 nurses-one for days and one for nights). Caroline was here during that week, as were a few of the nurses. She told us this past week has been really nice to have so many nurses and ICU physicians in the room so that we can do more teaching. The September week she said it was crazy and she was having to pull teeth to get nurses to come and work during the week. So she has enjoyed having extra staff who can teach and spend time with each one of them. This is encouraging to hear. This year we have made so much progress in terms of the nurses learning, taking over care of the patients and getting used to the care so they can manage the valve replacement.
My brain is so fried right now, so I will try to be more coherent tomorrow.

Hillary with Amy and Cynthia

Chepkoech, our final patient, getting some recorder time this afternoon

Med Supply-looks just like home, right?

Nights

I just woke up from sleeping...it is 2 pm here, nice gentle rainstorm for me to write to as I sit on the porch. Hopefully I can rest some more this afternoon before going back in at 7 pm for a nightshift.
Last night went well. I had gone up to the unit during the day to give them lunch relief and to take some pictures of our patients. When I went up I heard that the patient in the OR, Hillary-a 19 year old boy-was having a hard time in surgery. He was not a mitral valve replacement...he had a place right by his aortic valve that was bulging that they were to remove. The tricky  part about this is your coronaries, that feed your heart muscle, lie in the spot they were to remove, so they had to mess around with those, first, one wasn't long enough to stretch when they removed the portion of the aorta, then they think part of it kinked...basically the patient had a lot of arrhythmias and time where the heart muscle wasn't getting good oxygen supply which can permanently damage your heart. Everyone was very concerned. They ended up taking a piece of blood vessel from the leg to bypass this coronary, so the procedure was long-he was in the OR around 11 hours. This was the scene we walked into last night.
Since that case was taking so long, Russ (the Tenwek surgeon) went ahead and did the mitral valve replacement on his own in the second room, so both patients came out right around 645 pm.
The valve replacement, Sabina, did well. And Hillary had a great night, woke up, was asking for his breathing tube to come out, came off blood pressure medicines and by the morning we took his breathing tube out! In many ways a miracle. I think he will still be slower to leave the hospital but all in all he is doing better than he should be!
We worked with Cynthia and Aaron in the ICU last night...neither is normally in the recovery or ICU for that matter, but they are catching on fairly well. They can do all the steps right, they just don't always put the pieces together in terms of I am seeing this, I should tell the doctor or I should think about doing this...this is one of the pieces that is really hard to teach because I think it is a cultural thing...something they have never been taught to do.
It is crazy it is already Friday and that some of our team leaves tomorrow!! It flies by here once we get going! There will be 4 of us left here to man the ICU but hopefully all of these patients today will do well.
In the midst of all this busy-ness and spending so much time and effort teaching I feel weary in my brain by the end of a 12 hour shift. But being here with such a strong group has been encouraging and seeing moments of breakthrough has been encouraging. Glad I am here with others who continue to remind and encourage me in what we are doing...Hebrews 3:13 But encourage one another daily, as long as it is called “Today,” so that none of you may be hardened by sin’s deceitfulness.

Lillian, all smiles!

Nightshift crew

Wednesday

My blog titles are pretty boring here, but I don't usually end up posting until the day after and I am trying to keep up as much as anyone else :)
About a year and a half ago our perfusionist, Tom met another perfusionist, Bob while both being involved in a legal case. They somehow starting talking about Tenwek and Bob has now been coming as a perfusionist. He is a part of our team this year. Before he even came, he sent a pallat to Tenwek that contained, among other things, 2 newer heart lung bypass machines (the one here is 20 ish years old, these are about 8 years old). That pallat got stuck in Mombasa (on the coast of Kenya) for literally this long. Ever since we got here on Friday we have heard that it may be released so we have been praying that it would get released while we are here. The palate arrived here on Tuesday, complete with the pumps. This has allowed us to up our surgeries to 3 a day. Because we have two pumps, while one case is finishing up in OR 1, they are already bringing the next patient back and getting them ready to go on bypass in OR 2...basically it cuts out a lot of turnover time for the room to get cleaned, for anesthesia to get the patient ready, for the surgeon to do all the work before they are ready for bypass.
Sorry, long explanation, but all that to say I don't doubt that the timing of this pumps arrival was a part of God's plan for this week. We had 2 successful days and felt comfortable pushing to 3 cases for the rest of the week. Yesterday, as the rest of the week went very well: 2 more women with mitral valve repairs, Julia and Chepkorir and a man who had TB in the past that caused the sac covering his heart to become thickened (this should feel like paper but his felt more like thick leather-yes we got to touch it). They went in and took out this thickened sac so that his heart now has space to pump effectively. All have done very well.
I know I will never be able to put into words what it is like to be here, to be surrounded by so many people who sacrifice and work so hard to not just try and help people heal, but long for their souls to know a God who loves them so deeply. I am always so struck by it and desire for my life to look more unselfish.
We have been doing nightly nursing devotions, which I have really enjoyed the time for us to all be together since we all work different hours, to stop, to hear a bit of someone's heart and to be still and pray with each other.
Last night Amy shared from the Jesus Calling episode from the day I left...what stood out the most to me was this: "He chose you because of your weaknesses. He knows you needed Him. Depend on Him for everything." I am so arrogant to believe that God chose me because I am particularly good at one thing or another, but the truth is, he chose me because I am weak, because I need him for all, because I can do nothing out of myself. Big reality to think on!
I work nights for the next two, so today I will be trying to rest...I am really bad at this.
I think this years' trip is going to be a bridge to some changes in how our trips look since they are starting to get the hang of things on their own, which is amazing. So prayers for wisdom as we discuss these things.

Peris and me prior to taking her to the floor yesterday