Tonight I Bake Cookies

 

Tonight I bake cookies with my kids by my side, but my heart is not in it. All day I have fought off tears, feeling my chest tightening and my breath catch in my throat. Equal parts flour and sugar are landing on the floor and remaining in the bowl, but that barely matters as I look at my sweet girls. The one in pig tails holds out her tiny hand hoping for a few more chocolate chips to pop in her mouth. The mischievous gleam in her eye tells me she knows she is pushing her limits. I smile slightly and put three more in her palm.  I am standing here in my kitchen simply, quietly, peacefully making cookies, but half a world away tonight women are clinging to their children and saying their last goodbyes.

Kabul has fallen and men with machine guns are going house to house to reap destruction on innocent families. No one is baking cookies there.  I can’t imagine the conversation parents must be having as they wait for their home to be invaded and their family to be ripped apart. Do you prepare your children for what is to come? Do you hope that when your door gets kicked down they shoot all of you at once? An unthinkable atrocity that I cannot even fathom.  Would that be more merciful than letting the Taliban have their way with your little girls? I shudder and pull mine in closer kissing the top of their heads.  I can’t imagine.  Thankfully, tonight I don’t have to, but somewhere out there a woman just like me does.  She is not so unlike myself delighting in that mischievous toddler smile, her heart bursting with love for the little ones God has given her. Yet, at the same time it is being shattered into a thousand pieces when she thinks about what the night might bring.  My emotions are overwhelming as I grieve for her, my prayers have been unending.  I stare blankly into the kitchen as my mind is filled with desperate pleas for mercy. I am jarred back into reality once again as the kitchen timer goes off.  It just doesn’t make sense.  Tonight I am baking cookies.   

Homecoming

It is hard to believe that our time with Samaritan’s Purse is coming to an end.  Two years has gone by in the blink of an eye.  We will be returning to the US on November 20^th to start the next leg of this incredible journey.  

Though we are looking forward to coming back, to spending the holidays with family and to being in our own culture once again, this is a transition full of emotions.  Never has the question, “Are you excited to come home?” been a more confusing one.  A friend of ours going through this same transition said it well when she put it something similar to this:

We are coming home, but we are leaving home. 

We are moving closer to family, but we are moving further away from people that have become our family. 

We will be reuniting with loved ones, but we will be leaving people that have loved us fiercely.

We will be entering back into our own culture, but we will be leaving the birthplace of our daughter.

In our minds, much of “home” has stayed the same, but we have missed weddings and births, graduations and celebrations.  Much has changed. 

Moving to Kenya was full of emotions, tears and many goodbyes.  Leaving Kenya will be much of the same. 

Our time here was rich.  God blessed us more than we ever dreamed possible.  We don’t regret a single minute, but it is time to say goodbye for now.  The laughter and joy, the tears and heartache that have been these last two years have changed us forever.  We have seen God more tangibly than ever before. Our hope is to come back, but for now we must move forward.  Thank you for your prayers, encouragement and support.  The Lord has used you in more ways than our few shared stories will ever tell.

Amazing Grace

Kristen here….

Working with patients in a remote mountain village of Africa brings with it some of the deepest heartaches I have ever known, but also some of the most incredible triumphs.  This past week was a triumph. 

Several weeks ago a young women presented to us for evaluation.  She was pregnant, but her story wasn’t a typical one.  As we reviewed her history it became clear that she had waded through a tragic past.  This was her third pregnancy, but she had no living children.  Her first baby died while she was in labor and her second one when she was 5 months pregnant. 

Since the delivery of my own daughter many people have asked me if experiencing pregnancy and delivery personally has changed anything in my clinical practice.  Honestly, not really, other than I have a better understanding of what the acute pain of searing loss must feel like.  The emotional connection between mother and unborn child is real, and I cannot imagine the depths of despair experienced in delivering a child that was once alive and well and kicking inside you that now lays lifeless in your arms.  Oh God, that you would spare us all from that!

This young woman had hope in her eyes, despite so much pain, as we discussed this pregnancy and how to proceed with delivery.  Her baby was breech and she was almost term.  We elected to proceed with a c-section. 

The day for delivery came.  As she was being prepared in the OR for surgery I put on my favorite playlist of music and set it on the shelf against the wall.  We prayed together and the surgery began.  As I was going through the layers down to the uterus I just kept thinking about all of the emotions that must be running through her as she waited for her first ever live born child.  The uterus was opened and I began pulling the baby from his warm home as the timeless hymn of old, “Amazing Grace,” began to play spontaneously in the background.  I couldn’t help but smile.  How fitting.  God truly does have amazing grace and there is no sweeter sound than the first cry of a newborn child.  What a perfect reminder. 

Hope for the Hopeless

Kristen here…..

I groaned as I groped in the darkness to find my ringing phone. The clock said midnight as I answered in my half-awake state.  The voice on the other end spoke in broken English that was further garbled by a bad connection.  All I could really get from that conversation was that there was a preterm pregnant mother with abdominal pain.  I hung up the phone with a sigh.  Better go investigate. 

I heaved myself out of bed and changed into my scrubs.  Our dog, Moto merely groaned at me as I walked past him sleeping in the hallway.  I was thankful it wasn’t raining as I grabbed my flashlight and set off down the dirt path to the hospital. 

I walked into the maternity ward to find a young girl sitting on the bench waiting for me.  I could tell she was uncomfortable by the look on her face.  I brought her back into the office and began my examination.  The ultrasound confirmed a live baby dating at approximately 26 weeks gestation and weighing 833 grams.  I was peppering her with questions as I tried to sort out the story.  This was her fourth pregnancy, but she had no living children.  Each pregnancy had ended much the same way this one was going tonight.  She had lost every baby to preterm labor – 2 months, 4 months, 5 months and now 6 months. She knew the pattern.  She had been here before.  Each one started with an all too familiar pain and ended with the delivery of a baby too small to survive. 

As I finished up my exam it became clear that history was trying to repeat itself. The cervix was already 4cm dilated and the amniotic sac peered back at me with an eerie blue/gray bulge as I examined her. Not good.  Exposed amniotic membranes encourage infection and preterm delivery.  My heart ached for this patient in front of me.  Her face was grim. She knew the outcome before I even said anything. We could probably count on one hand the number of babies born at 800 grams here that have survived. The odds were very, very poor and we both knew it.

With a deep breath I began explaining the situation.  She nodded, knowing all too well. I told her that we would do everything we could to keep her pregnant longer and to give her a living child, but that we must pray because it is only God that is truly going to save this little one.  I spoke with the nurses giving them orders.  I was going to throw the kitchen sink at this patient to get every hour I could out of this pregnancy. We had to try. This was the closest she had ever come to having a live child. We held hands and prayed together as the nurses gathered supplies and started IVs. 

As I walked home in the dark, I knew that if she was still pregnant by daybreak we had a fighting chance.  This baby needed to gain as much weight as possible before being introduced into this harsh and unforgiving world.  Every day mattered.  I crawled into bed and spent the next hour pouring out to God over this mother and her tiny, unborn child before falling into a fitful sleep. 

Early the next morning I called up to the hospital to check on her status.  Still pregnant! No more contractions! Praise God!  I brought this patient before the other missionaries at our morning prayer time and we again lifted the plea of this young mother before the Lord. 

I have never seen a patient with this presentation last more than a week before delivering.  Day 6 of her admission proved this to be true with an early morning phone call.  She had begun contracting and now was completely dilated.  There was nothing else to do to stop the process.  I hurried up to the hospital to check the position of the baby. Breech. We prepared the patient for surgery.  One of our family practice physicians and a visiting pediatrician came to attend the birth.  We needed a full team to care for the immediate needs of this little one.  As soon as the baby was delivered we stuffed him into a ziplock bag. Weird, I know, but in order to keep him warm enough so that he could focus his efforts on breathing this was an essential step.  The gallon size ziplock seemed to swallow him with only his head showing out of the top. The first little peep from his tiny lungs made the whole OR sigh in relief.  He was trying to breath on his own and was even making an attempt at a cry.  Quickly, he was whisked off to the NICU and we continued to pray for this little life.

After finishing up in the OR I went down to the NICU to check on this baby’s progress.  Still in the ziplock, under the warmer they were getting our bubble c-pap apparatus set up.  Bubble c-pap is a method of delivering oxygen to our premature babies that encourages breathing with positive pressure ventilation.  It is the most advanced method of oxygen delivery for our babies available in Kapsowar and it was working like a charm.  He was taking to it well and breathing as he should.  I sighed with relief.  Keeping warm and breathing are some of the biggest obstacles in these first few hours of life and so far he was doing both with flying colors.  His weight on the scale came in at 900 grams. Smaller than I was hoping for, but not out of the realm of possibility for survival.  He would need a lot of prayer. 

In the the NICU with C-pap on

C-pap apparatus made out of an old Ragu jar, plastic ruler,
tubing and tape

The next morning I hurried to the NICU to check on his progress.  Still alive!  He had survived the first night.  The bubble c-pap was still going as I watched his tiny chest rise and fall.  Thank you Lord, for this gift.  I walked by the bed of his mother who had not yet been made aware of her baby’s progress.  The day before had been one big blur for her as the drugs from the surgery slowly left her body. She had been too sleepy to hear his tiny cry in the OR that had brought relief to the rest of us.

I sat on the edge of her bed and began to explain that her child was alive.  For the first time, she had a child that was alive.  I told her that he was very small and needed help breathing and staying warm.  We talked about how the fight was not over yet and that we needed to pray for him continuously. Tears filled her eyes. She had a son – as small and tenuous as his life was, she had a son.  I encouraged her to go to the NICU to see him and the light in her face illuminated the room.  She probably never had the chance to see the faces of her other children as culturally this isn’t done if they don’t survive.

Proud mama standing next to her baby. Her smile is radiant!

This is now day 3 of life for this little baby.  He is still alive.  His weight has dropped to 700 grams, but he has begun to tolerate very small feeds.  Keeping the bubble c-pap going and functioning properly continues to be a battle. His mother is frequently by his side enjoying caring for a baby for the very first time.  Please continue to pray for this baby and his mother. The road is going to be long and there are many obstacles. It will be the Lord that will sustain this baby into childhood, but there is a glimmer of hope for this childless mother as the Lord continues to hold and guide them both.

***story and pictures posted with permission from the patient

It is a ........

Kristen here….

 

Last night we had a special gender reveal party after Bible study with the other missionaries that live here.  We were excited to introduce them to Taylor Ann Bracy, the newest addition to the Bracy family!

This pregnancy is a much prayed for blessing, but it is true that pregnancy is not for wimps.  It has been a long time since I have posted in part because at 19 weeks pregnant it has only been in the last week or two that I have felt human again.  Projectile vomiting despite being on all of the medications possible coupled with migraine headaches has been a whole new experience for me.  I have also been battling an upper respiratory infection for almost three months that despite being on two different courses of antibiotics I just can’t seem to kick.  It is the running joke at the hospital that people can identify me and my location from anywhere by my hacking cough.  Prayer for healing would be so greatly appreciated. 

Throughout it all though, Dan has proven yet again to be a saint and I have been blessed with some amazing colleagues that have been incredibly patient and willing to step in and pick up the slack when I just couldn’t do it anymore.  I don’t know how I could have done this without them. 

Last night was the first Bible study I have been able to attend in months where I felt relatively normal and could enjoy the community around me.  Kapsowar is particularly full right now with all of the long term staff currently here and numerous short term volunteers here as well.  When we were counting yesterday we now have 21 adults and 16 children living on the mission station!  It is so great.  As I looked around the room last night I felt so blessed to have this gathering of people from all over the world here for a common cause with a common goal.  We have a surgeon, two family practice doctors, a family practice resident, a pediatrician, a urology resident, a nurse practitioner, a CRNA, a clinical officer, an engineer, a computer systems administrator, a computer programmer, two premed students and numerous spouses supporting the activities at Kapsowar hospital.  It was so incredible to get to worship with all of these individuals, all from different backgrounds and all in love with the same God. One of the songs we sang had lyrics that repeatedly talked about how strength will rise as we wait upon the Lord and He does not grow weary.  I could not help but just thank Him for that.  Knowing that in the last few months when I have been weary, He has not been.  Ministry has been continuing despite my lack of energy or ability because He is stronger than me.  I needed that reminder last night. 

Joy

Kristen here…

With the exiting of summer season and the entering of the Christmas one there have been some cases at the hospital that have left my heart soaring as I walk home from work at the end of the day.  The stories of the two patients I am going to share with you actually come on the coattails of the last blog I posted.  The mother I blogged about that had lost her baby, let’s call her Grace, had a great deal of influence on these patients.  Her influence started a chain reaction that resulted in, what I believe is the preservation of two lives that would otherwise not be here today.  God is so good.

Grace had gone through a harrowing emergency c-section of her premature baby.  When she had come into the clinic that day her blood pressure was so high she was in danger of having a stroke.  She was already on the max doses of oral blood pressure medication that we could give her and wasn’t responding to our IV drugs.  Her baby showed signs of imminent death and in a last ditch effort to save this precious life we did an emergency delivery.  The following day it was proved to us that despite all of this, God wanted this baby home as we watched her slip away. 

I had a heavy heart as I was seeing patients that day in clinic.  That had not been the outcome I had hoped or prayed for.  It was devastating.  It was these thoughts that rolled around in my head when Monica walked into my office.  She looked tired and sick.  She was in her second trimester, but clearly this pregnancy was taking its toll on her thin frame. 

Here, the appearance of a person often gives you some insight into their standard of living and occupation.  Monica’s cheek and collar bones stuck out from beneath her skin in a way that most movie stars back home spend hours at the gym to obtain. Her legs were long and slender, and her worn dress hung loosely on her thin shoulders.  This was not the work of a well- used gym membership.  This was the result of hours upon hours spent in the fields tending her farm –tilling the rows of crops by hand, hauling water manually from the river to do wash, carrying a load of firewood on her back every evening from the forest so heavy that she would be bent over double due to the weight.  The cooking and cleaning and tending of her children would also be her responsibility.  Her hair was “natural,” meaning not braided or decorated, another sign of little money.  This woman knew hard work, this woman’s daily struggle was for basic survival.  Here, it is the women that do all of the farming.  They are the ones that work the soil, plant, weed, and harvest.  They are the ones that collect firewood and water.  They are the ones that keep that house running and the kids in order.  They are the ones that do the manual labor.

I started looking through the records she had brought with her and I could feel my eyes get large and my heart start to race.  High blood pressure.  Really high blood pressure.  Not again.  Hadn’t I just had this problem yesterday and the outcome was heart breaking?  What was I going to do?

I started talking to Monica and discussing her critical condition.  I told her I wanted to admit her to the hospital because she was very sick and I needed to get her blood pressure down right away.  She looked at me skeptically.  “I wasn’t prepared to stay here.  Let me go home and prepare things and then come back.”  I knew if I let her go I might never see her again and “preparing things” would mean working overtime to get things ready on the farm and with her children to be gone for a few days.

“No,” I said. “You can’t go. I am very concerned about you and this baby. I need to admit you to the hospital.” 

She looked at me with a frown. “How long will I have to be here?”

“I don’t know.” Given the look of this patient, I knew that she would not go home and rest if I ever discharged her from the hospital.  Her baby was too small and young to deliver safely if I needed to.  I had hoped to keep her in the hospital for the rest of her pregnancy, but I knew that was wishing upon a star.

“I can only stay a few days.  I have children at home and I need to harvest my maize.”  I considered that a consent for admission and quickly got the paperwork completed and IV lines started to bring down her blood pressure.  I wasn’t sure what I was going to do beyond a few days, but I would take it one moment at a time.  The type of physical labor that this woman endures every day would surely make her blood pressure skyrocket out of control despite my best efforts and force the events of yesterday to repeat themselves all over again. 

Her blood pressure slowly started to return to the normal range.  I placed her on the max dose of medications available with a heavy sigh.  I had nothing left if the situation worsened which I knew it would in a few days when I sent her home. 

The following day I was going one by one through the patients on rounds.  I saw Grace and reviewed her labs and vitals.  I cried with her over the loss of her baby.  She was still having some medical problems and would need to remain in the hospital for a few more days.  After finishing with Grace I pulled out the next chart and looked up suddenly.  The patient in the next bed over was Monica.  I wondered how Grace felt about this.  Someone in a very similar situation to her, still pregnant, still with a live baby, laying in a bed so close to hers you could reach out your arm and touch the patient next to you.  I walked over to Monica and began going over her labs and vitals.  She was barely being managed on her current medications and beyond this I didn’t have anything else to offer. 

“Monica,” I said. “Your blood pressure is still not very good and from the ultrasound I did yesterday I am worried that your baby is too small to survive if we have to deliver you early.  I really would like to keep you in the hospital for a while, maybe even for the rest of your pregnancy to insure that you rest.  I want to give this baby the best chance at life that I can.”  I was sure I would be hit with resistance.

Surprisingly, though she looked up at me and smiled.  “I know.  Grace and I have talked.  She told me her story.  I will stay for as long as you think I should.”  My jaw dropped.  What a transformation from the steel gaze and stubborn determination I saw yesterday.  That was one battle I wasn’t expecting to win, but I was so grateful she agreed to stay.  At least in the hospital she could rest and be relieved of her physical duties back home.  This would give her the best chance at staying pregnant the longest.  She didn’t have a plan, there wasn’t anyone to look after her farm back home.  She didn’t have money to pay for a huge hospital bill.  She would likely lose this season’s crops.  The stakes were high, but she chose her child, she chose life and I can only contribute that to the long, midnight conversations that she and Grace must have had.  The prompting of one childless mother caused a reprioritization of this pregnancy over all the other pressures pulling at Monica’s attention.   It was God that placed these two women next to each other.  It was not the compassionate thing to do in my eyes, but it was the right thing to do to change the course of events for this patient and her baby.

Over a month went by and Monica remained with us in the hospital.  Day in and day out she patiently rested and did everything I asked of her.  We watched this baby grow and gain weight on ultrasound. Each day was a victory and a gift.  Eventually, it became clear that it was time to deliver.  The baby had grown well and would do fine.  I was so incredibly thankful that day for Grace’s input and influence on Monica.  It changed everything for her.

Monica and her beautiful baby

While Monica was recovering from her delivery over the next couple of days with her baby at the bedside another patient walk into my clinic.  Lillian, had legs the size of tree trunks and a headache that was incapacitating.  After going through her history it became clear that she had a blood pressure problem as well.  Untreated chronic hypertension in pregnancy can be a death wish.  I discussed with Lilian how concerned I was for her and that she needed to be admitted to the hospital.  She hesitated.  She was a teacher and needed to leave to organize time off from teaching.  “Give me a few days.  Just let me get your blood pressure under control and then we can talk about what to do from there,” I pleaded. 

After some prompting she agreed to stay, but only for a few days.  At least that was something.  I would take whatever she would give me.  Over the next 6 hours it became clear that we were perilously close to needing to take drastic measures.  I maxed her out on medication and prayed that would hold her through the night. Ultrasound told me if we delivered her now the outcome would be much like that of Grace.  A nightmare none of us wanted to relive. 

I walked in the following morning and grabbed Lilian’s chart.  Her blood pressure had remained where I needed it to be!  The medication had worked.  I walked over to her bed and stopped short as I realized where the nurses had placed her.  She was in the bed next to Monica. 

Lilian looked up at me and smiled.  Pointing to Monica, “She told me about her pregnancy and her problems.  She told me how she stayed in the hospital and how now her baby is fine.  I can be patient.  I will stay here for as long as you need.”

I smiled and was relieved.  The upward battle to saving this baby didn’t look so steep any more.  It was over a month later that Lilian delivered a beautiful baby girl. Both went home healthy and full of life.

Lilian after delivery

 

 Grace suffered so much during her time at Kapsowar Hospital, but her presence here was not a mistake.  She left with heartache, but it was this heartache that gave life to these two babies.  I don’t know if I will ever see her again, but overtime it was the sorrow of her story that brought joy to these two women and to my heart as well.  An incredible lady with an incredible legacy.  I am so thankful that God brought her to Kapsowar.

 

*Pictures and stories shared with permission by the patients

Compassion From The Brokenhearted

Kristen here….

August was a hard month. As I have tried to put my thoughts together about all that happened it has been hard to figure out how to put it into words. With the hospital understaffed and all of us taking extra call, working for almost a month straight without a day off and with more than half of those days being on call led to a lot of sleepless nights and exhausted days.  August, September, and October are some of the busiest for labor and delivery in Kenya due to a lot of social and cultural factors that occur 9 months earlier. 

The steep increase in patients also lends itself to an increase in difficult cases.  Each case takes its toll.  At one point there was a series of three days where I lost 5 babies.  All for different reasons, all incredibly painful. I found myself one evening curled up in my husband’s arms sobbing and asking permission to quit.  Not wanting to be a doctor any more, not wanting to have the weight and responsibility of human life upon my tired shoulders any longer.  Of course, out of his love for me that permission was not granted and I trudged on.

Returning to work the next day, I found a rare quiet moment that afternoon and sat down on the back steps of the maternity department to breath and process the tragedy after tragedy that had occurred over the last several weeks. 

My mind wandered to a young, first time mom that I had been treating for high blood pressure. She was on the maximum doses of blood pressure medication available and had come to the clinic for a routine blood pressure check and fetal monitoring.  She was feeling sick and with legs swollen to the size of tree trunks. Her blood pressure was suddenly extremely high, the fetal heart rate tracing was a Category 3 leaving a pit in my stomach.  On the dopplers of the umbilical artery there was absent end diastolic flow.  This was a recipe for stillbirth, but at 27 weeks and 1.2kg the chance of survival if delivered was slim. She had received steroids two weeks ago, there was nothing else I could do to make this better.  I explained the situation to the mother and with a heavy sigh she told me to proceed with delivery.  An emergency c-section is what came next and resulted in a beautiful cry from her baby boy.  My heart sored, only to cry in anguish the following day when at 24 hours of life this precious baby stopped breathing and went to be with the Lord. 

I knelt beside the bed of this grieving mother.  Tears rolling down her face and all I could do was put my arm around her head whispering ‘pole sana’, I am so sorry, over and over again in her ear.  Another death.

I hate things like this.  I hate losing babies. I always find myself second guessing my management when things like this happen….wondering if there had been another doctor here would that patient have survived?  The reality is, there isn’t anyone else. God didn’t put me here at this hospital because I am perfect, but because I am willing.  This, however, doesn’t make the sting of every loss any less painful. 

As I was sitting on those back steps with all of these thoughts swirling around in my head this young, now childless mother sat down next to me.  I smiled at her through the tears welling up in my eyes.  What else could I say to her?  Little did I know that she wanted the chance to talk, I didn’t have to.  As she started to talk she presented me with a package of milk she had bought in the center.  “This is for you,” she said in her broken English. “I saw you sitting out here and knew that I must come talk to you. When you came to tell me about the death of my baby I could see the hurt on your face and I know that you cared too. I know you did everything you could and I know that God is in control. When you told me that I needed a c-section, I was scared, but when we made it to the OR, I had peace.  I knew everything was in God’s control. This was His will for my life and I must just accept. I wanted to thank you for all of the work you do here. I want to give you this because it is good to share, especially with those that are here struggling with us. I appreciate your work.”

I sat there stunned.  This simple act of compassion and kindness was so unexpected, so undeserved. What do I say to her?  Two days after her baby died she comes to console me.  I was grieving this loss, but surely my grief did not match that of this childless woman.  Where did her words come from?  How could she see through her own pain to reach out and comfort me? I don’t know how that is humanly possible, but it was exactly what I needed. God knew this broken heart needed help, and He picked the most unlikely person to be His angel to do it.

Dealing with grief at the hospital has been an interesting journey for me.  Grief is so much more common here.  Death and bad outcomes happen far more frequently than I ever experienced back home.  It is important to feel the pain and to be gripped with sadness. It keeps you human, it keeps you grounded, it keeps you compassionate, it makes you a better doctor.  But, it also can be crippling.  Out here there isn’t time for that because there is always another patient that needs you.  You must push on.  I am human too and the pain does not escape me.  Quitting though, is not an option.  It has become this delicate balance in order to stay healthy and to be able to keep going.  It is learning to accept loss without becoming complacent.  Letting it bother you without letting it beat you up.  Some days this is easier than others.  Some days it seems impossible and God sends you an angel in the form of the broken hearted to pick you up and push you forward.