The importance of listening

I prefer being the doctor, not the patient. After all I spent 8 years of my life learning to be a doctor, have practiced 2 years as a doctor and so it makes sense that's the role I know best. Having had 4 surgeries the past year though, I've learned a bit about being a patient.



This last surgery reminded me of the importance of listening to the patient's story. Taking the patient's history is one of the first skills acquired in medical school: you learn to ask open ended questions, focused questions, system specific questions, and learn to direct your questions based on what the patient is telling you. The patient's story should begin your differential diagnosis and in many times will make the diagnosis. Physical exam and testing should confirm what you already believe to be true. Granted there are times when things are unclear and we tend to blaim the patient as a "poor historian," but perhaps we're just not asking the right questions.



I left Crescent Lake certain of my diagnosis because of my history; I had not had a pregnancy test, ultrasound or exam. However, when seen by the doctor I felt I was convincing him that this was even a plausible diagnosis and should be considered on the differential. Maybe I was a "poor historian" from the pain I was in--but even that pain level points to a ruptured ectopic. As he started to talk about anovulatory cycles, thyroid dsyfunction and stress I finally fessed up that I was an Ob/Gyn and certain of my diagnosis. (Also, if some one shows-up in your office wearing yoga pants and a polar fleece when its 90 outside and hasn't showered for 3-4 days you better think something is seriously wrong!) While I still accepted his care plan and the right diagnosis was made I mostly wanted to know that I had been heard. That the testing was done because he believed me rather than to try to prove me wrong.

I'm finding that true with grieving as well. Sometimes the story just needs to be heard. So thank you to those that have offerred and willingly listened; it helps.

"Show your knees Sunday..."

I'm not saying it's easy Sunday after Sunday to preach and speak truth, but sometimes listening to a pastor try to be funny I start to cringe in my seat. Take last Sunday when we visited a church in Bend and the pastor, at length, talked about why everyone was supposed to be wearing sandals this Sunday (something about trying to wear the shoes Jesus wore). I had on 3 inch black heals with blue trim and thought at least the open toes were probably similar to Jesus' shoes. So the pastor continued on to explain that people were asking him about dress code as he also had on shorts to match his sandals so he declared next Sunday "show your knees Sunday."

Well, having lived the past 2 years in a society were showing my knees is equivalent to showing my breasts in the West I spent the rest of the service thinking about dress codes, the Bible and whether or not God would find "show your knees Sunday" humorous. Needless to say I don't remember the sermon.

Flights

If vacation had been as planned we'd be back in Kenya today. Thankfully we had travel insurance and were able to re-book our flights. However because of the class of tickets we had and because it's high-season the first available flight was September 9th. Our future plans remain uncertain, but we are using this additional month in the States to look at our options. 

Amelia and Meredith have been able to participate in vacation bible school this week. Both have enjoyed meeting other kids, crafts, and attending with their second-cousins from Bend. 

Water

Some of you might know that Malin is an Eagle Scout. I don't know much about scouting but I'm pretty sure the motto is still, "Always be prepared." Well, Malin and his Dad decided to go on a long bike ride yesterday starting at the top of Mt. Bachelor going to Sun River and then splitting up; Malin going back up to get the car and his dad going on to Bend. 

While Malin brought 2 bottles of water in 90 degree weather, heading straight up hill after 55 miles he found himself quite dehydrated. And with 6 miles left to go literally unable to go on. So he did the only sensible thing and hitch hiked. That's right he put his thumb out and the first truck that passed him stopped, put his bike in the back and drove him to the car. I still have yet to try hitch hiking although I have picked people up before.

Stuff Christians Like

Jonathan Acuff author of the book "Stuff Christians Like" also maintains a popular blog at (http://stuffchristianslike.net/).  An example of a few of his posts are: the youth minister who tries to talk like the kids, hand-raising worship-- 10 styles, wishing your testimony was more exciting, playing the G card, judging someone's faith based on their Bible underlining, always sitting in the same seat at church, and vuvuzelas at church.

      July 10th Jonathan asked the blogosphere for a creative guest post.  There were 7 things he was looking for this post to do:

1. The topic has to be unique to Christians.

“Hating to wait in line” is a bad topic to write about on SCL because that is not unique to Christians. Bipeds hate to wait in line. “Singing hymns while waiting in line” would fit however.

2. It has to be true.

Honesty is the cornerstone of humor. Blow it up, exaggerate it, expand it, but try to start with something that is true. Write about something that happened to you or something that is real in Christian culture.

3. It has to be fresh.

Use the google search bar above to see if we’ve already covered your idea. (And it has to be original and not already published on any other site.)

4. It has to have a twist.

Although it’s technically true that Casting Crowns are stuff Christians like, I will never write about that band. And not because I’m trying to get in good with NeedtoBreathe. There’s just no twist. Satire needs a twist. Everyone knows lots of people like Casting Crowns, the challenge is to find a different angle to write about.

5. It has to be satire, not mockery.

Don’t wound someone with your guest post. Don’t be a Christian jerk. Don’t take a shortcut to an easy laugh at someone else’s expense. Mockery is a great way to get laughs now but it removes the ability to speak love later.

6. It has to be hilarious.

Don’t send a Serious Wednesday post. Keep it satire.

7. It has to be shortish.

Aim for 500 words. 

Spotting a missionary. (& Caption this photo)

Our blog was selected. The comments range from "say hello to Georgia the Giraffe" to "Dad why do we have to sit so close to that scary animal." Click on the Caption text above to see the guest post.

Reading

Besides quilting and running, reading has also helped with the grief. A book can offer an escape to an alternative reality or in some cases something that's completely unrealistic, or a book can offer suggestions which I can choose to agree with or completely ignore and not have to explain why like I would in conversation, or a book tells a story that I relate too and provides words to the deep hurt I feel but find hard to articulate. So I offer-up my reading list for the past few months and a few brief comments on each book and welcome any suggestions on books you've read and really enjoyed. 

Here if You Need Me by Kate Braestrup

 -Her humor and grief made this one of my favorites

Bel Canto by Ann Patchett

- unique plot and contains a lot about opera and love

The Reader by Schlink

- Can the worst crimes ever be forgiven or forgotten?

The Gospel According to Job by Mike Mason

- most helpful thing was the intro which said if you're grieving you should only read the parts of the book that speak to you and skim over the rest

When I don't Desire God by John Piper

- His book Desiring God was much better and the grand conclusion was to help others as a way to overcome the self-centeredness of grief

The Alchemist and The Zahir by Paulo Coelho

- his style of writing is like nothing else I've read and really detailed

Infidel by Ayaan Hirsi Ali

-since 25 percent of my patients are Somalian I found her story very interesting

Praying our Goodbyes by Joyce Rupp

- I'd just skip most of the book and go to the prayer section in the back

Just Do Something by Kevin DeYoung

- quick read, but probably better for someone less driven

Handle with Care and House Rules by Jodi Piccoult

- I loved her opening paragraph to Handle with Care about all that can break in life. House Rules was too predictable.

Call the Midwife by Jennifer Worth

- This is probably one of the few historical accounts I enjoyed reading.

The Checklist Manifesto by Atul Gawande

- We actually have his checklist at Kijabe, but it's only on the wall and not in use--that would probably make him crazy to hear.

When Helping Hurts by Corbett

-This book applies most to vacationaries (mission trips with vacation packages combined)

Outliers by Malcolm Gladwell 

-most people with "gifts" have actually worked 10,000 hours to be elite... loved all the statistics

When Crocodile Eats the Sun by Peter Godwin

- Beautiful Memoir set in Africa

Blood Sisters and To my daughter in France by Barbara Keating

-Loved these stories and their settings

Secret Daughter by Somaya

- Starts with the tragedy of pregnancy loss in a female doctor and I almost couldn't read it, but identified with how the character's view of medicine and hospitals changed being a patient.

Evolving in Monkey Town by Rachel Evans

-Her writing is like talking to a friend about her faith and also pretty funny.

All the books of Marian Keyes, Sophia Kinsella, Janet Evanovich and Jennifer Worth. Really all I can say about these authors is that they are entertaining, but I hide their books on my shelves behind the ones with more literary value or return them to the shelf of my dear friend Jacqui (who has helped me explore British literature).

P.S. There are a few books I'll never admit to reading. 

A few pictures from Crescent Lake

Crescent Lake was filled with the usual activities: face painting, T-shirt painting, squirrel feeding, a bike parade, a talent show, water sports, and family meals. While I missed most of this, Malin and the kids had a fabulous time as the pictures show. Amelia performed her Dutch girl dance for the talent show and sang all the books of the Bible. Meredith was ready to swim at 7am every morning even though it was only 50-60 degrees outside. The girls were so excited to reconnect with their cousins. And while it took a little time for Meredith to keep the names straight she's now asking daily when they can play together again.

Gratitude

Thank you for the e-mails, face-book messages, blog comments, calls and flowers this past week! Each brought a smile to my face as a reflected on some of the amazing people in my life. 

My parents were able to come to Bend for 3 days so Malin could return to the girls and the rest of his family at Crescent Lake. Mom and Dad will leave today and Malin and the girls will return. I'm eager to see them. Until I'm medically cleared we will stay in Bend, Oregon. 

It seems I've been the patient too often this past year. And I really don't enjoy resting, never have liked to nap and don't generally sit still. Television really is not that entertaining; I mostly find myself annoyed: that people get rewarded for having filthy houses (like in Clean Sweep), can talk about how hard  it is to find the perfect home for 1 million (don't we all feel sorry for them), I certainly don't want to see 19 kids and counting, the news has had nothing on the constitutional election in Kenya, and my usual default--cooking shows, just makes me nauseated. But I will admit I'd still be happy to appear on What Not to Wear (who wouldn't want personal shoppers and 5000 dollars for new clothes).

So I'll keep reading, take some slow walks, and try to use the time to reflect on the past year. Or maybe I should try just to rest?

Enough

I am publicly declaring I have had enough. Enough pregnancy losses, enough disappoint, enough grief, enough sadness and enough wondering why.

Our vacation with Malin's family at Crescent Lake, Oregon was interrupted Monday when I started having severe pain and bleeding. Even though I had a normal sonohystogram 1 week prior my medical knowledge made me worry of ectopic pregnancy (although I really didn't think I could be pregnant). We waited a few hours and then drove the 1.5 hours back to Bend. In the end I had an emergency laparoscopy that evening for a ruptured ectopic pregnancy. How I had hoped my diagnosis was wrong! While I received good care and am now recovering at Malin's parents home, it's been overwhelming. The doctor found no obvious reason for the ectopic and called it a "spontaneous, random ectopic." Do random things happen or does it all come from the hand of God?

Further difficult news came today when I learned I did not receive a fellowship position. While I still have plenty of options for the future it's still hard to have this option closed. 

So the answer to the question, "What's next?" remains open. How do you navigate life in the midst of tremendous grief?  How do you derive God's will or plan through pain?  How do you decipher a divineness when the losses seem senseless? 

For now, perhaps all I can say and believe with confidence is that God still loves me, still loves our family, and still has plans for us.

Vacation

While in Kenya the past 20 months we've gotten 2 new nephews, 1 sister-in-law, missed 10 cousins' birthdays, 8 sibbling birthdays, parents birthdays and anniversaries, and major holidays with extended family. I don't write this feeling sorry for ourselves, just to say that the calender reminds us of what we are missing most: family. So when I asked Malin to plan our vacation time it was no surprise when he said we should come home to spend time with my family and to see all his family at their Crescent Lake Reunion.

Searching for the cheapest, missionary flight lead us to fly Nairobi-Dubai-San Francisco and then Seattle. Amelia and Meredith enjoyed all the new movies and TV shows on the 15.5 hour flight from Dubai. They also liked all the drink choices only managing to spill 6 of the drinks received! Amelia gasped in amazement as a toilet automatically flushed at the airport (Meredith thought it was a little scary). Both think Nana's hot pool is fabulous. Amelia was able to celebrate her birthday with a beach picnic and got to eat the shrimp and fish she's missed (yes, she has high taste and also asked for crab).

Tonight Malin and I are going away for a night to celebrate our 10th anniversary and the girls will be spoiled by Nana and Papa. We pray this time refreshes us, reconnects us with family, and allows us to solidify what God wants for our family in 2011.

Thanks to Christian Hospitality Network

It's been a fun week. We were invited by Christian Hospitality Network to come relax and enjoy a Kenyan Getaway on them. After the 45 minute drive to Brakenhurst Conference center we were warmly greeted by Southerns (at least I think Tennessee is part of the south coming from Washington). There's something about a drawl, a warm hug and a huge smile that draws you in but what really got the girls was an enormous gift bag filled by families who don't even know them. The spoiling continued as Malin was taken golfing. Amelia, Meredith and I went to a tea farm, enjoyed a four course lunch and walk in the forest. Then there was the jewelry give away (you can see me telling the girls just one piece). And of course haircuts, massages, hand massages, physical therapy and a chiropractor all at our disposal. Sometimes being a missionary is rough and sometimes its just plain fun. We're so grateful for the many people, none of which personally knew any of the 150 missionaries there who freely gave us a time and place to rest and relax.

Who do you write like?

Occasionally readers of our blog tell us they can't determine if it is Sara or Malin blogging (unless the blog title is Marvelous Molars or Lithotomy Position) of which case it becomes quite obvious.  Sara and I think differently.  I tend to use deductive reasoning (observations about the world).  Sara is a stronger writer using inductive reasoning (observations within one's self).  Sara's blogs often tell a story to convey an emotion; grief.  My blogs are filled with statistics to lend power behind an argument; poverty.   Ask me (Malin) to describe an Apple: red, round, about the size of a fist, hard.  Ask Sara to describe an Apple: you can use it to make Apple Pie, Granny Smiths taste sour, in the Autumn they can be made into Apple Cider. It should follow that our writing styles would find our own voices.  I thought I would put that claim to a test.  

"I write like" (http://iwl.me/) is a website that claims to find which famous writer you write like.  The process is simple. Cut and paste a story, blog, e-mail, or letter you have written and you will find your author-double. 

As I clicked on the site I began to wonder who would be my author-double-ganger(Malcolm Gladwell--great sociologist, JD Salinger--recluse, Rick Reilly--humorous sports journalist).  So I pasted 8 different blog entries into “I write Like”  Five of those said Malin you write like Dan Brown (The Lost Symbol, DaVinci Code).  I’ve heard literary gurus claim Brown is  hack, but on the upside he’s popular, entertaining, but also hard to decipher between fact or fiction.  

Sara's author double-ganger is split between Earnest Hemingway (novelist-A Farewell to Arms) and Mary Shelley (Frankenstein).   

So who do you write like?

Amelia's Blog Interview

1- What do you want to be when you grow up?

I want to be the first one to make dogs and cats dance.

2- What was the hardest part of 1st grade?

Meeting new friends.

3-  What do you like best about Africa?

My friends all live close together.

4- What do you miss most about America?

I miss my cousins, aunts, uncles, grandmas, grandpas, and friends.

5- What is your favorite food?

fish and shrimp

6-  What have you learned about God this year?

If I memorize my bible verses I get a trophy.

7- If you could change one thing about your little sister Meredith what would it be?

That she would not talk so loud in the morning.

Manners

Meredith has a way about her that's all her own. Probably every parent appreciates the uniqueness found in each of their children and look at certain traits in their children and wonder, "Where did they get that?" or "What possessed them to do that?"  

The other night Meredith got down from dinner stood near me with her hand raised and bowed as she said, "Queen mommy, may I please be excused from the dinner table." Last night she said at dinner, "Mommy, would you be so kind and please just get out the strawberries for me from the fruit salad?" I'm not sure what has triggered this fantastic and funny display of manners, but hope it continues!

"Have Missionaries Lost Their Chariots of Fire?"

Does the term missions itself hold a negative connotation?

What do you think of Francis Assisi's often misused quote, "Preach the Gospel always, and if necessary, use words."?

Has the pendulum of missions swung too far from spreading the Gospel to the ends of the earth to fighting social injustice?

How has missions changed in Africa now that the majority of the pool of potential converts is not up for grabs (90% are already Christian or Muslim)?  

Are we directing Christian Missionaries to the right locations (82% of missionaries go to the Christian 3rd World)?

   If you have ever wondered about some of these questions go to:

http://online.wsj.com/article/SB10001424052748704895204575321101671590716.html

to read Brad Greenburg's column in the Wall Street Journal entitled "Have Missionaries Lost Their Chariots of Fire?"

By all means if you have an opinion share it in the comments!

How Can A Church Support Its Missionary Kids?

  Yesterday back at our church in Ohio (Westminster Presbyterian) over 100 kids "Gathered At The Baobab Tree" for Vacation Bible School, just as Amelia & Meredith did at WPC in 2008.   Denise and the other VBS coordinators picked an Africa themed curriculum (Baobab Blast) to help bring their VBS kids and our kids (Meredith & Amelia) together in God's ultimate mission even though we are continents apart.

So how could a church bring its VBS program and our MKs (Amelia & Meredith) together?  A skype date was arranged.  Below you can see Meredith talking in our back-yard on our computer in Africa with the entire VBS crew back on their projection screen at our church in Akron, Ohio.   

The kids at VBS had a lot of good questions about what it is like to be an MK in Africa for Amelia & Merdedith:  What is your desk like at school?  What is the name of your dog?  What season is it now in Africa?  What kind of animals do you see?

      The VBS kids sang us their "Babobab Blast" theme song with lots of spirit.  Amelia taught her friends how to say "school" in Swahili.  To end the VBS kids packed up a box of stuffed animals and toys they gave and are sending to Africa.  This generous donation will be graciously received and distributed in the Children's Ward here at Kijabe Hospital.  

Amelia & Meredith say Asante Sana (Thank-you very much) to the VBS crew at WPC!

Imagine... A Day Without Chai

Chai (Kenyan tea) which is a mixture of milk, sugar, tea leaves, and boiling hot water is served daily at 10:30 AM.  I don't know of a Kenyan (baby, teen, or grandmother) who doesn't take Chai (you don't have chai, you don't drink chai, you take chai.)        

First rule of Chai: If you come, you must take.  Try sitting without a mug of chai in your hand and it quickly becomes awkward...Doctoriae no Chai today?... Doctoriae will you take chai?...Doctoriae why don't you take chai?...Doctoriae how can you not take chai?    

Second Rule of Chai:  You must retain the mug in your hand at all times like the ladies above.  Like a Nascar fan and his beer, a fisherman and his rod, or a prom king and his queen, a chai-drinker and his mug are inseparable.  

Third Rule of Chai:  If you think something is more important than chai time...take a look around.  At Chai Time (10:30 AM) everything in the hospital stops.   Doctors in ER retreat to the chai room.  Clerks disappear to the Jiccho.  Scrub Techs descrub.  Nurses are suddenly done rounding.  For a brief moment the earth stops rotating.   

Fourth Role of Chai: Chai is the high-octane petrol that keeps one going.  It's served piping hot to warm the tummy.  It's loaded with sugar for instant energy.  It's loaded with whole milk (straight from the cow) for high fat long term energy.  Lastly, the chai leaves are loaded with caffeine to keep you alert.  

I did ask a friend; Would you go a day without Chai?  "That, I would even remain a single day without Chai....it would be unimaginable."

Would You Take This Job?

Your pay starts at 800,000 KSH ($10,500) per month.  That's your base salary.  If you actually come to work (because absconding from the job is the norm) you will receive a daily bonus called a "sitting fee".  On top of your generous salary you will receive keys to not one, but two brand new BMW cars.   Because you must continue to ride in style, we'll replace the Beamers with a brand new set each year.  And for your family full health care, a vacation allowance, and all private education from grade school to professional school will be paid.   A modest mansion awaits your family once you are hired.  The importance of your position dictates that you will not pay income tax.  If the new Beamers did not seal your decision, maybe this will.  A referendum is in place (you get to vote, not the public) to increase your monthly salary to 1.2 million KSH ($15,000 USD) per month (or $180,000 USD) per year.  Will you take the job?  

If you took job you just became a Kenyan MP (Member of Parliament), which there are about 200 in this country of 30 million people.  A Kenyan MP is the US equivalent of a Senator.  Being sympathetic to the MP's, you could argue that a US senators annual salary ($174,000) is equivalent to an MP.   But let's put it in perspective.  A US senator makes roughly 5 times that of an average joe American ($34,000 per year).  A Kenyan MP makes 574 times that of an average joe Kenyan ($314 per year).  If the salary raise referendum passes Kenya will shift its pay scale for MP's to second in the world, only lagging behind the UK.

Missionaries are encouraged to abstain from politics.  In one sense I have abstained.  I don't vote.  I don't have a voter card.  I don't campaign.  I don't wear political shirts. I don't have a sign in my front yard.  I haven't run for any offices here.  

But in the other sense politically, I can't be silent.  But it's their country, not mine.  So I asked a colleague of mine Michael, What do you think of this referendum?   

 "It's wrong.   They have BMW's, and we are grappling for peanuts.  The MP's trade free Mendazis (scones) for votes.   Our nation is struggling economically from the post election violence.  Even the educated can't find jobs.  It's a disgrace to see MP's get a raise, while the poor sit in IDP camps." 

Christians should react to disparity (a loaded term...but 5 times vs. 564 times?). We are called to be distinct from culture and engaged with culture.  We are distinct because our lives have been changed, turned upside down by a new covenant ushered in by Christ.  We engage culture because we recognize that sin has broken individuals (theft, drugs, abuse) but sin has also broken systems (greed, dishonesty).  We engage to show that Christ offered a better way.  And the better way is adorned if we are distinctly Christian.  

The Numbers

 In some ways I think the statistics for the past year speak for themselves. Sharon and I have together done more than either of us was capable of individually. But honestly, we have been responsible for more patients than a group practice of at least 5 people. 

Sharon began her journey back to the UK yesterday where she will complete a fellowship in MFM. So, this blog post is not only a chance to share what we did together, but a plea for someone to come help! I can guarantee you a GYN surgical experience you will never forget, an opportunity to teach Kenyan interns so work can continue after you leave, obstetrical problems rarely seen in the developed world, and would gladly help arrange a safari or trip to the Indian ocean if that would make you come.

Summary of the work of Obstetrics and Gynaecology Department AIC Kijabe Hospital, 1 July, 2009 – 30, June 2010

Total Surgical Cases: 1303

Total Majors: 336

Abdominal hysterectomies – 165

Vaginal hysterectomies – 26

Ovarian Malignancy – 37

VVF/RVF – 21

Tuboplasty – 24

Repair of ruptured uterus – 1

Caesarean hysterecotomy – 13

Myomectomy – 32

Vulvectomy – 1

TOA – 6

Abdominal pregnancy – 5

Ectopic with partial uterine resection – 3

Total Minors: 395

D&C – 165

BTL – 81

Ectopic – 18

EUA – 62

laparoscopy – 9

Other minors – 60

Caesarean Sections - 572

Outpatient load: ~2000 patients seen per month in gynae clinic, MCH, casualty, and labour ward as outpatients.

Maternal child health clinic: average 350-400 patients per week

GYN Out patient clinic: average 50-70 patients per week

Summary of Obstetrics Data

Total Deliveries – 2133 (previous 12 months – 1990 deliveries)

Caesarean Section – 572 (26%) (previous 12 months – 32% CS rate)

Instrumental – 33

Vaginal breech – 23

Twins – 57 sets

The Don't Song

I want to post this 3 minute video (Sara found it) but a link will have to do.   If you are married, and you occasionally have a hard time holding your tongue, then you will enjoy this video.  How many of the don'ts are you guilty of? If only I could have seen this video before I was married!

http://www.ignitermedia.com/products/IV/singles/886/The-Dont-Song