Making A Home

Bouldering

The Sandia foothills are essentially in our backyard. Amelia and Meredith have taken to evening hikes and climbing as many boulders as they can. Barley follows along and I'm often trying not to watch as they ascend something bigger. Meredith astutely commented, "It seems easier to go up, up, up but then tricky to get down." Yes, they both want to hike in dresses or skirts. And the camelback makes ever hike much better!

Settling In

Few Pictures of the highlights of our road trip to Albuquerque


Dinner with Auntie Kiersten and Uncle Jason


Movie night with the cousins


Great Sand Dunes National Park-- a little detour on our road trip to Albuquerque






Auntie Ana treating the girls at the American Girl Doll Store Denver






We arrived in Albuquerque 10 days ago and are beginning to settle into our home. It's good to have arrived here and reflect on the path God brought us on to get here. How would we sum-up the 2 years in Kenya?--I can't answer that question. How would we describe our time there? What did we think of the experience? What did we see God do? We intended this blog to continually answer those questions. The answers aren't short and the questions continue because they can and should be asked where ever you live and work.

Amelia and Meredith attended a new school last week; overall the experience was good. Malin began work and I will be starting on some research prior to starting the fellowship. We appreciate prayer as we seek out community here.

On the road....

We're in Rawlins for the night heading to Denver tomorrow. After an extended weekend there visiting family, we'll be heading to Albuquerque. Malin begins working April 4th. Amelia is traveling with us keeping Barley under control. Meredith flew with Grammie to Denver to spend some extra time with her cousins (but the real reason is that she's just not so great on road trips). Amelia has been bribed with a dollar per day she doesn't ask, "Are we there yet? or how much longer?" She's been creative and has asked, "What town do you think we'll eat in? What state will we sleep in tonight and are we in that State yet? Do you think I'll have enough time to watch Enchanted before we get there?" She's also reading out-loud to me in the car which is quite enjoyable. I was surprised when she asked me to continue home schooling her the next two months before I start fellowship. I'm still thinking about my answer.

As we drive I think of all that needs to happen once we arrive in Albuquerque, I find the extensive highway of 84 to 80 a perfect time to agonize over all that's coming, but it does seem that the speed of the car correlates with my anxiety level and so I'm reminded we are commanded by God to not worry, not to be anxious. So instead I think of all the ways God has provided in the past, confident He will continue to be faithful in the future.

How to get a puppy....

1. Find a breed that doesn't shed (this was #1 for me)
2. Ask your parents for 3 years.
3. Write a letter to your daddy about all you'll do to care for a puppy and that he can even decide on the name (because as much as you want to name him Fluffy--maybe daddy doesn't.)
4. Check-out library books about dogs every chance you get.
5. Look endlessly on the internet at dog breeds and tell your parents about them in detail.
6. Promise your parents that you won't ask for another animal (like a horse) after you get the dog.

So meet the newest member of our family... BARLEY!

"no wrong doing.."

It was more than I expected, but I am very grateful to have received an official letter from the Kenya saying there is no validity to the claims made against me and the hospital. Honestly I didn't believe resolution or even a favorable outcome was possible. And while I had committed this to prayer, along with many others, I did doubt that God would provide vindication. But there it is, written, clearly. How much peace this news brings!

A break..

I planned to take a little break from blogging, but that quickly turned into an entire month!

We just traveled from Oak Harbor to Bend to start what I see as the final phase before our move to Albuquerque. We did get to use snow chains for the first time crossing the pass today and so it was a long journey.

Thankfully Amelia was still able to say, "Goodbye," to her friends at Oak Harbor Christian School as last week the school closed for snow. We've resumed home-schooling for now. Meredith is eager to join in after going to pre-school the past 3 months.

These are the easy things to write about--the facts of our day to day life since returning to the States. The harder things, the things we're still working through and processing I'm not ready yet to commit to words.

Together again

Amelia, Meredith and I flew to Bend, Oregon and reunited with Malin for the next week (it's been just over 5 weeks since we've seen each other). While he's working, we'll still enjoy some cross-country skiing, swimming, running, and just being together. And of course the girls are excited to play with Grammie again. The girls and I left Papa to fend for himself until my Mom returns from Haiti Feb 2nd. It really has been so good to be geographically closer to our family for a while.

Haiti

By the time this is posted Mom will have already been in Haiti one week--which means I was remiss and should've posted sooner. For quite a while my Mom has actively supported and participated in a ministry called Children of the Promise (childrenofthepromise.org) which provides care for orphans in Haiti. They both seek adoptive parents and support Haitian family members trying to care for orphans. I've lost track of the exact number of times Mom has been to Haiti, but sufficient to say she has made a long-term commitment to this ministry through short term service, constant fundraising and awareness. Her passion for these children testifies to Christ's call to care for orphans and I'm proud of her service. This time she traveled with her sister Julie and we appreciate prayers for them and the team they are working with. Meredith's prayers for Nana go something like this, "Dear Jesus, Help Nana in Haiti. Help her know she can't stay with the babies forever that we need her here. Don't let her stay there forever. Amen."

God made me that way....

As I carried Meredith to the car after swimming lessons she said, "Wouldn't it be great if we had a bathroom in our car?" I said, "No, it wouldn't be great because guess who would have to clean it!" She retorted that then we could not only "tinkle" in the bathroon, but in the car as well and that would be fun particularly since "we can't go potty in the hot tub or the pool." I teased her about being one of the silliest 4 year olds I've ever known. She said, "Mom, I just came out like that. That's what God made me."

I think she's right. But have often wondered what parts of my personality God made and therefore are pleasing before Him and what parts of my personality arise from a sinful heart. Sometimes the answer is obvious. Other times I'm not so sure. When does driveness change from admirable to annoying or harmful to people around you? And there have been times I've heard, "God made me that way," as some pseudo-religous reason to engage in something like gossip. It'd be convenient if that phrase provided a spiritual exempt when we don't want to aknowledge wrong-doing.

Boards

Taking the oral boards in Dallas last Thursday was one of the most stressful experiences of my life. It started with snow in Seattle (seriously, how often does it snow in Seattle?) and an hour delay which meant normally I would've missed my connection in Denver, but we had an "unusually strong tail wind" and made-up over an hour of time in route. Then Laura's Aunt Judy graciously met me at the airport in Dallas and showed me the highlights of the city and took me out for BBQ and a souffle. I don't think I've ever had souffle before and it was exquisite. Nothing like an amazing salvatory experience to distract from a test. After a near sleepless night, followed by a morning run, I put on the suit and shoes on the my friend Jill lent me (I'm so lucky to have a friend with good taste and a suit my size!).

The next part was 3 hours of gruelling questioning. Some questions I anticipated, most I did not. Naturally there were questions I thought of much better answers too after the test which ate at me for the next 5 days.

I boarded a plane that night and went to Denver to visit Ana for an extended weekend. Ana did everything she could to distract me from the obvious question: did I pass or fail? We had a great time eating-out, attending a canvas and cocktails class, running, shopping and generally just being together. She was patient with my perseveration on several board questions.

After returning to Seattle Jill brought me to the ferry and Dad drove me home. Amelia had waited-up and greeted me with chatter about all the fun they had with Nana and Papa and the exciting weekend staying with Auntie Laura, Uncle Dan and Si. Meredith was asleep and only said, "I'm too tired to pray tonight."

As much as I tried to concentrate on other things the only thing that eased my anxiety was reading this morning the word "Passed" on my ABOG page.

Reflecting on the studying, travel and test I see how many people supported and encouraged me in this process... perhaps you see a bit of that in reading this. I know also that there were many people, not as obvious to me, but just as important praying for clarity, calmness and confidence as I took the exam. Thank you.

Miscellaneous Pictures

Making Gingerbread houses with Grammie (and snitching a little candy too).

Papa pouring out Washington State Clams, Mussels, & Shrimp steaming hot!

Christmas Prime Rib...enough to make a vegetarian tremble with fear.
Malin giving surfing (longboard) a try at Cape Kiwanda on the Oregon Coast. Let me say if it was me vs. the waves..the waves won the battle.

Meredith, Amelia, and Sara hiked the Sand-Dune twice.

Partial Cichowski family picture (and Whidbey the dog).
The cousins with Amelia, Meredith, & Josiah.

So what is my job

It seems only fair after the last post to describe what a specialist in Pelvic Reconstruction does. First, the terms "vaginal rejuvination" and "designer vagina" are not recognized by the American College of Obstetrics and Gynecologist and the procedures are also not sanctioned (although they are commonly presented on a certain TV real life series). So while it may be sort of funny to think of titles for cosmetic surgery of the vagina, that's really not what I am training to do.

Reconstruction is not synonomous with cosmetic. In fact the patients I'll be focusing on are patients with fecal or urinary incontinence and/or vaginal, urethral, bladder, uterine or rectal prolapse. These problems often occur from childbirth and are certainly not funny. And where medical care is limited, women can also develop fistulas from traumatic childbirth.

Sometime I'll write more about why I've chosen to focus on medical issues that predominantly impact quality of life, but for now I hope that clarifies my future area of expertise.

What do you do?

I think there's certain jobs out there that when mentioned sort of end the conversation. Perhaps I'm entering a career like that, here was a recent conversation that occurred when I picked Amelia up from school.

"Are you Jan's daughter?"

"Yes."

"Hi. I'm .... I served with your Mom on the school board. You're a doctor right and you've been in Kenya?"

"Yes, I am."

"What are your plans, are you returning to Kenya?"

"Well, we are still interested in medical missions, but I'm going to start a fellowship in pelvic reconstruction."

"Oh, so you're an orthopedic surgeon?"

"No, I'm a gynecologist."

A look of surprise, a slight smile and then, "Well, I better go get my kids."

Obedience

Yesterday, when I found Amelia's Christmas gift in disarray I asked Meredith, "Did you play with your sister's American girl doll?" Meredith cowered and said, "Mommy, it takes a lot of time to learn how to be obedient." I tried to hide my grin and remind her that that isn't an excuse to do something you know is wrong.

But Meredith is right. Obedience takes time to learn and involves failure. Particularly when it comes to obeying God. Scripture is filled with examples of people failing to follow God and God's forgiveness following, but only after repentance. And perhaps that's the bigger lessons I'm trying to instill in my children, not that they can be perfect and obey every rule, but that repentance is part of obedience.

2010 Friess Christmas Picture

At Cape Kiwanda near Pacific City, Oregon on a sunny but cold windy day on the Oregon Coast.

New Year

Happy New Year! We celebrated by playing games until 930pm. That was late enough for Meredith and Amelia and then I decided I shouldn't stay-up too much later. Good thing I went to bed because Meredith woke-up early as usual and came to say, "I need breakfast and I can't wait until Papa is up." We're looking forward to starting the year with family the "thing" we missed most over the past 2 years in Kenya.

The girls have noticed a lot of things that are different about America. Amelia, in particular, notices all the signs and names of stores (in part because there are so many more choices of places to shop). She asked me why AM/PM was named that, I explained it's because it's a convenience store open all the time, day and night. Later on she said she didn't want a job where she worked all day and all night. I said, "Like Mommy's job as an obstetrician?" "No," she replied, "Like the people who work at AM/PM." Amelia enjoys a good night's sleep so I think New Year's will never be one of her favorite holidays!

Reunion

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.

Talk

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.