Wednesday, December 29, 2010


I saw someone I hadn't seen in 15 years. We were close friends in middle school, but as high school progressed our common interests in music, debate and swimming weren't enough to sustain our friendship. I chastised her for some decisions and suspect my attempts to talk about faith in Jesus were filled with personnel arrogance and righteousness rather than love. Nevertheless I always wondered how she was, what she was doing, and prayed that she was well. So, I can't describe the beauty of our reunion occurring at First Reformed Church Christmas eve. There we celebrated, together, the birth of our Savior Jesus. To see her worship Jesus brought great joy. And it turns out, when we met-up later that week we still have a lot in common 15 years later.

Merry Christmas

After nearly 4 weeks apart, the girls and I took the train to meet Malin and his family on the Oregon coast. We had a great time walking the beach, looking at tide pools, playing games and opening some gifts. The following week we returned to my parent's house and celebrated Christmas.

For now we have decided it's best for Malin to continue working in Oregon and Amelia, Meredith and I continue in Oak Harbor while I study. The girls are doing well in school here, but miss Daddy. Hope you all had a blessed Christmas.

Wednesday, December 15, 2010


I wanted to post what I shared with First Reformed Church's annual Women's Christmas Party so below is the text. It was a privilege to share my story with these women--some who have known me since childhood and in a church that generously supported us through the past two years.

We just finished singing some beautiful songs. I get somewhat excited at the anticipation each year of pulling out my Christmas music, playing songs I only treat myself to once a year and they always sound better than I remember and how much fun is it to go caroling or play Christmas music at the hospital or jusy sing aloud in the car with the radio. What is your favorite Christmas carol? Is it the words to, “Silent night, holy night, all is calm all is bright?” Or the words to “Away in a manger, no crib for a bed, the little Lord Jesus lays down his sweet head?” Or maybe, “Oh little town of Bethlehem how still we see thee lie?”

Do you like these carols that proclaim the peace of Christmas? Listen to the words again; “Silent night, holy night, all is calm all is bright.” “The little Lord Jesus no crying he makes,” “Oh, holy night the stars are brightly shining...” they speak of silence, stillness and calmness. Is that how you picture our Savior’s birth?

Many of you know that I am obstetrician and for the past 2 years have practiced in Kenya with an organization called Samaritan’s purse. I have attended a lot of births... while I believe birth is sacred, birth is not generally a silent, still or calm endeavor. Perhaps those of you that have given birth or have seen birth will also testify that it’s not silent. In fact I often sit as the patient pushes thinking about all that can go wrong: hemorrhage, shock, infection, shoulder dystocia, head entrapment, lacerations, and pray that it won’t happen. So when things go well I do rejoice. Picture Mary sweating, terrified, in great pain, wondering if Jesus would be alright as she gave birth. And after she gave birth how did she know Jesus was alright?

What is it that we do after a child is born? The first thing is to stimulate them. Obstetricians used to hold the infant by their feet and give them a swift swat on the rear: thankfully this practice has mostly been abandoned so that now we begin rubbing the baby’s back, drying them off, stroking their head: why? We don’t want them to be silent but rather we want the baby crying.... the mother and father wait at times with their own breathes held in anticipation of that cry. The cry that signifies all is well--the lungs are working, the heart rate is strong and then the pale, dusky skin turns pink and the limbs move as oxygenated blood courses through their little bodies.

So, I believe, even though the Bible doesn’t explicitly say it, that Jesus cried. And that Mary rejoiced as His first words as a person sounded in the world as a crying newborn. That His entry as a person into our world was noted with not only the sound of angels, but the crying of new life as He expanded his lungs and let out a sound signifying all was well. The cry that proclaimed God’s love for us in the form of a baby.

Babies sleep silently too... in fact a lot of a new mother’s time is spent trying to calm and still the newborn. And isn’t there anything more sweet than seeing a mother nurture her child or to hold a baby while they sleep? So the Christmas hymns aren’t wrong. Christ also rested, peacefully as a baby. I want to use this time with you to discuss the communication of God both in the stillness of a baby and the crying of a newborn named Jesus the Christ. Listen to the words of

John 1:1-51In the beginning the Word already existed.
The Word was with God,
and the Word was God.
2He existed in the beginning with God.
3God created everything through him,
and nothing was created except through him.
4The Word gave life to everything that was created,a
and his life brought light to everyone.
5The light shines in the darkness,
and the darkness can never extinguish it.b

What does it mean that the “Word became flesh?” Interpreting this mystical, magnificent passage isn’t easy. Words are written or spoken but not usually embodied in flesh. So as we try to picture this miraculous birth were the word becomes flesh hear the cry of Christ at Christmas as God’s longing to communicate with us. God communicated LOVE in a way we best understand--a person named Jesus.

If you believe in Jesus and believe that God has a purpose and a plan for your life than you long for God to communicate that to you. Sometimes the Word, the communication is desired for practical questions like: where are we supposed to move to? should I marry him? is this the profession you’ve called me too? should we adopt?

Other times it’s the harder, philosophical questions we long for God to answer, you know the questions that usually start with WHY: why does God allow evil? why did God allow me to go through that? why did they have to bury their child? why am I sick?

I’m not sure what questions you’re asking God right now however, I do hope that you are engaged in conversation with God. I’d like to share a little bit about the questions we’ve asked over the past two years working in Kenya. My hope is that the part of our story I share today will demonstrate and represent God’s profound desire to communicate with each of us.

It’s probably the most popular question we get asked, “Why did you go to Kenya for 2 years?” I could give a long, winding, winded answer, but the simple truth is that God made it clear we were supposed to go. However, we thought we’d be going to Cameroon, in fact we sent over 80,000 dollars of donated medical equipment to a hospital there along with one box of toys for a few Christmas surprises for our girls ahead of time, but when we didn’t get our visas to Cameroon and had reduced our life to the size of a mini-van we asked to temporarily go to Kenya. While in Kenya 3 different missionaries spoke to us--telling us not to go to Cameroon. Each one gave a different reason: They will work you (Sara) too hard. The church and the hospital are fighting. Your children will not be able to play outside without an armed guard. It was clear to us that God protected us from a harmful situation and wanted us to stay in Kenya. It’s great when God’s word and direction is that clear.

So we stayed in Kenya and 7 months into our time at Tenwek we were asked to move, to Kijabe Hospital nearer Nairobi where I would replace the 3 ob/gyns that were leaving and Malin would assume primary responsibility for the existing dental clinic. There was also the added bonus of a mission school on campus that Amelia could attend and to be quite honest we were failing at home schooling. So again the answer and direction seemed clear and we moved to Kijabe.

At Tenwek and Kijabe there were many nights my sleep was disrupted. In particular I remember one early morning where the conversation went something like, “Daktari, there’s a patient here that insists you deliver her.” “Tell her I’m not the doctor on-call.” And I wanted to add, and I’ve been-up for the past 4 nights, and frankly I’m just too tired. “Daktari, you have to come; she refuses to let us do anything unless you come.” Quite honestly, I initially fell back asleep for a few minutes and then awoke with urgency feeling that I had to go. What happened was that her delivery was one of the most difficult C/S of my career as I had to do several things I’d only read about to extract the baby from a uterus overgrown with fibroids. I have no doubt that baby would not have survived had I not been there--and I don’t say that with arrogance rather with the reality that I was the only obstetrician and therefore the only person truly trained to handle the difficult and challenging cases. So afterwards, when the patient said, “God told me you had to be there.” I added, “He told me too.” Also privately noting that initially I tried to resist and continue sleeping.

God also “speaks” in the events we see around us. What things have you seen in your life that defied natural law, things you knew were clear signs of God’s love? Which reminds me of one of the most poignant cries I’ve ever heard. It came from the baby of Bila and in that cry I heard the rejoicing of God. The first time I met Bila she presented with her 8th pregnancy loss. The next time I saw her she was expecting again. I always thought her name was this horrible irony as Bila in swahili means “without” and here was this women without any children after 8 pregnancies. I saw her frequently during the pregnancy and tried nearly everything I could to help her achieve a pregnancy past 6months; much of what I did had already been tried. And so we also prayed together and committed to continue praying in between visits... I have to also add that her husband came to every single appointment something I didn’t experience with any other patient in Kenya. So that when their son arrived with vigorous crying at 37 weeks we all rejoiced and gave thanks to God. As we heard this baby’s cry it rang as proclamation from God that He had heard her and her husband’s cries and prayers and here was their child.

Another baby that deserves mentioning is the twin that survived severe pre-eclampsia (a condition in which blood pressure becomes too high from a pregnancy), death of the other twin at 30 weeks, and he was born to a mom who had already delivered 3 still-births. She had carried 5 children; only this one lived. How beautiful was his crying!

Last Christmas Eve delivered a special blessing for my patient, Leah. She had seen me numerous times during her pregnancy and I had been doing weekly testing and exams to evaluate the health of the baby because previously she had delivered a baby that died 1 hour after birth and had also delivered a stillbirth at 38 weeks. After much worry about when I should do a repeat C/S to deliver her 3rd girl, she started complaining of decreased fetal movement. And so at 36 weeks I decided it was time. Leah sobbed seeing a live, crying little girl and of course that made me start to cry for joy as well. How we prayed for this outcome and God graciously gave Leah what she desired most last Christmas... in the crying of a baby.

In the crying of a newborn we experience joy just as when God’s communication seems clear, prayers are answered, solutions are found, the way is made straight. But as you’ve listened to these stories have you heard the paradox; the joy of the crying newborn juxtaposed with the silence, emptiness and deep pain these women previously experienced. Times of questioning what God was doing and wondering where He was in the midst of such deep, numerous losses.

Sometimes the stories I heard I didn’t even want to even believe because it seemed too cruel, too much the suffering these women had faced. Yet we know God is love and that God sent Christ to communicate that love. As we are assured that God loves these women; it’s still hard to resolve the love of God with the hardness, unfairness, and even evil in our own lives and the lives we see around us.

And so we go back to the Christmas carols proclaiming silence, stillness, and calmness as we experience the silence of God. It’s baffling how we associate peace with the silence of Christ at His Birth and yet when we hear that silence in our own lives we feel anything but peace.

The claims made against me by a patient while in Kenya often kept me awake at night wondering what God was, or rather what God wasn’t doing. This woman claimed that I had held her down against her will, hit her, slapped her and forced her to have a hysterectomy. While profoundly untrue, her family’s anger towards me really made feel physically threatened. Then as she sought criminal charges against me through the corrupt legal system I really became worried. Particularly as we were in a country where laws are arbitrarily made and followed. The lawsuit continued to progress regardless of the absurdness of the patient’s claim. When the hearing came all the witness supporting my claim that I acted professionally and did only what I believed the patient had consented for were asked to leave the room. And so before the patient, her lawyer for 1 hour I was grilled, questioned, interrogated about the case. I struggled to remain calm as the medical board didn’t even ask the patient whether or not she had been truthful. Can you imagine the board didn’t even question her claims? The reality was that my team was forced to abandon me and I wondered why God did not intervene and stop the nonsense. I know God could have spoken ONE word and it would’ve ended. God’s silence can even make us feel like we’ve been abandoned. And while I believe there was a greater spiritual battle going on with this patient and I knew many people were praying I am left saying that God remained silent. My name was not cleared, peace was not restored and the hearings continue in my absence. Yet I still can say with confidence that I know I am alright before God, who does love me.

The most piercing silence came from the questions I asked after losing 3 consecutive pregnancies during our time at Kijabe and a 4th pregnancy while at home vacationing this past summer. There is no satisfying reason that I can’t seem to hold a pregnancy past eight weeks. No comforting explanation for having three D&Cs at the hospital in Kijabe and certainly no understanding as to why this has happened. Moreover, I’m not sure that being a doctor who knows all the ins and outs of pregnancy, conception and fertility has helped me. It definitely doesn’t help to be surrounded all day by pregnant women, some who don’t want to be pregnant, some who shouldn’t be pregnant, and some who have tried to end their pregnancies. Even the presence of women like me who have recurrent pregnancy loss is of no comfort.

So this summer as I signed a consent for the procedure to remove the pregnancy and read the listed complications: bleeding, infection, injury to other organs. I quietly ask, “Where can I sign saying that I’ve had enough?”

I believe at some time you have experienced the longing for someone to be present with you in tragedy or grief, but wanting them silent. Just letting you be. Comforted by their presence but not by words. And when something horrible has happened words often fail us, or what we say sounds trite so that silence becomes the wiser option. Maybe God’s silence shows this too. That we think an answer will help heal us, when God knows it won’t... or maybe the answer can’t be given with our limited understanding on earth or maybe the answer is this pain is what it is-tragic, deep, anguishing, and God is silently present out of reverence for our hurt. However you interpret the silence, remember that God is present. Encourage those hurting to continue engaging God even if all that can be said is “Lord, have mercy.”

I’d like to ask each of you to close your eyes, and I promise I’m not going to ask anyone to raise their hands or stand-up, rather I’d like us, together, to meditate on Christ’s birth and what God is communicating this Christmas to you. Some of you need to hear and picture the Christ-child crying and believe and trust that God longs to communicate with you. Believing that God knows, cares and will answer your questions. See Mary and Joseph in stable amongst the hay with a brilliant star shining above them, holding a newborn baby, stroking his back and rejoicing in His crying as they begin to dry him, swaddle him and nurture him. Hear His crying cease, see Him slowly and gently drifting into sleep and silence; at the same time note the silences of God in your own life- fuse those silences with the picture of Christ sleeping peacefully. Let that sleeping, Christmas child fill the silences with peace, calmness and stillness.

Let us remember this Christmas season that God sent Jesus to communicate His love. That even in the crying of a newborn we can hear God’s voice and in the pierce of silence that God is present because His love is a word that never ends.

Monday, December 13, 2010

The Countdown

Meredith turns 4 in December 16th. She can hardly contain her excitement and asks several times each day when she can start opening presents. I reminded her that getting her ears pierced was her present; she retorted, "Mommy, real presents are the secret kind with wrapping." She also asked Nana the other day, "What is your rule about going potty in the hot-tub?" On her birthday her preschool will also present a Christmas pageant. Meredith got the lead role as angel after she kept correcting the previous angel and telling her what to say. She'll be wearing the extravagant, white, wedding style dress she received from one of my patients in Kenya. And when I asked if she could have anything in the world what would it be she smiled and said, "Sparkly wings."

Saturday, December 4, 2010


1) She taught her class the first day of preschool the Rolling Stone's song, "You can't always get what you want..."

2) She says, "You don't say push, poke, buy me a Coke--that's bad to say because Coke isn't a healthy choice."

3) She made two friends at school and when asked their names she says, "There's the small one and the big one."

4) When her Mother goes to pay for groceries and realizes she's forgot her wallet she says, "Silly Mommy. We better hurry home and get your money so no one steals our cart."

5) She gets her ears pierced and exclaims, "That didn't hurt one bit. Look how sparkly my ears are."

6) She talks and talks and talks to her cousin Si until he finally says, "She's loud and crazy."

7) She gets a new haircut and says to the stylist, "Be careful with those scissors, scissors are sharp. How do you not cut yourself?"

8) Her newest aspiration for a career: "make-up artist."

Wednesday, December 1, 2010


Perhaps writing this on our blog will publicly commit me to study regularly now for the oral boards. The oral boards are the final step in obtaining accreditation as an OB/GYN. My exam is scheduled for the week of Jan 10th and will occur in Dallas. Anybody know anything about Dallas?

Part of the exam is reviewing the patients I took care of from June 2009-June 2010. As I begin reading over the list and reviewing the specific aspects of each case I'm reminded how different medicine was in Kenya. Even finding information about some of these problems is challenging.

I am also reminded that I did see and experience both the tragic and triumphant in the lives of these patients. Even though my list no longer has their names I remember them by their stories and I remember seeing God's healing hand in many of their lives. It is good to be reminded of this having left Kenya immediately after the hearing.