part-time

i'm such a bad mother.
well, today.
and while i know it's my fault, it's also because it's tuesday and tuesdays are the worst type of day.  the day i'm part-time work- part-time mom.

tuesdays start at 5:30 am when i get up before everyone to try to make their day better.  i get up and make coffee and hot chocolate and nutella toast and set the table and get the backpacks ready.  then i do the dreaded task of cheer leading my boys out of their deep sleep and into their school uniforms.  then i spend the next 30 minutes corralling them through the simple and basic and routine tasks of eating, teeth brushing, and putting on shoes- crocs none the less.  then we get in the car and drive an hour to school.

by 8 am i'm at work.  then begins the next chapter of the day.  listening to sick people tell me their symptoms so i can try to help them.  i'm sure it sounds simple.  but there are some tricky parts.
like what does "hmmmm" mean as a response to a question.  
"has your pain been going on for while?"
"mmmmm"  i'm guessing that means 'yes'.
"for how long?"
"mmmm"  i'm guessing that means 'i have no idea what you're asking me.' which then makes me question their first answer, so we're back to the beginning.  there are many circular discussions.  then if i've figured it out, and know what is wrong and what to do, i have to hope we have the medicine, or that they can go to the place to get the test.  by 1 pm, i'm feeling mildly panicked and very rushed because i need to finish and get the boys.  today at 1, i had an old lady with an eye emergency- really- and i'm pretty much it for the closest thing to an eye doctor that she'll get - at least until tomorrow.  i also had two nurses who needed help with their patients- someone with difficultly swallowing and some one else with chest pain and persistent cough and fevers.  in other words- not just refilling HIV meds.  so i left doing the best i could- but wishing i could stay around to see the chest x-ray i'd ordered and to write the referrals myself.

then i rush to get the boys.  i'm greeted first by bryn who has something to tell me.
"i was put in time out today at school."
"why, what did you do?"
"well, i was with some kids and we were spitting on someone."
LOW.POINT.
"why?"
"i don't know"
"brynnie- you know that is wrong.  what was your heart telling you honey?"
"that i shouldn't do it."  teary and wobbly voice.
"you need to listen to that voice inside bryn.  it's put there by God to tell you what is right and what is wrong."
"who were you spitting at?"
"mikey."
"who's mikey, was he being mean?"
"no, he's a big boy."
suddenly i knew who mikey was and my heart sank.
my son was spitting on a child like his sister- a child who is a bit different.  ouch.
VERY LOW POINT.
"bryn.  i'm very sad.  i know who mikey is.  mikey is different." he was again, teary.
"bryn, this isn't who you are.  this isn't what you were made to do."
"i know, but i forgot all those things you tell me.  i knew in my heart, but i did it anyway."
how well we all know that feeling. knowing and doing- similar but different.  i too struggle with the 'doing' part.
"honey i love you. we all struggle with this.  you need to learn from it.  you need to remember that feeling- listen to what your heart is saying- do what it says.  and remember this feeling- how bad it feels when you do the wrong thing."
"i will.  i'm sorry."
"i forgive you."

then we got in the car for the hour home (fearing because yesterday it took two hours).  bryn fell asleep; i worried about the old lady with the eye, i worried about my son behaving so badly, i worried about what mikey had to tell his mother; the other two kids ate oreos.

then i get home to hungry, whining, homework, soccer practice, dinner and mike away at meetings.  and after a few hours i just lost it and instead of giving myself a time out- i yelled at people.  i let all the annoyance of everything fall into little ears that don't need to feel the crap of an exhausted part-time working mom.  they don't need to suffer my early waking, my resentment at cheer leading, my traffic fatigue, my fear that i've made some lady blind, my intolerance of whining.  and my annoyance at that final straw of a liter of milk landing all over the counter, and inside cabinets, and on the kitchen floor,  mixed with glass shrouds from the pitcher when jude placed it gently on the tile counter (does pyrex have a specific expiration/explosion date?).  they didn't need that.  they didn't deserve that.  because they are little and should be allowed to whine sometimes.

so.  i did the only thing i could do.
i calmly cleaned up the milk.  i told them that i was sorry for being mean and yelling.  i told them that i was tired but that i still shouldn't behave that way and i hugged them and told them i loved them and that they were special even if i was a crabby jerk. i told them God had a special plan for them (as i silently prayed that i wasn't globally messing it up).  i told them we should eat dinner and read stories and snuggle and we did.

now the sun is gone, and the light is following, saying it's last farewell. night is coming.

part-time work is hard.  you have be fully on both games.

Mondays are easier. because even after a full day of clinic, and in two hours of traffic, i come home and it's just dinner and bedtime.  because i come home and i'm so desperate to smell their little heads, their sweet outdoor smell and hear their stories.  because when i come home after a full day, they've had a snack and  they've already finished whining with some one else.  because i've seen all the chest x-rays and finished my own notes and written my referrals and i've had at least an hour 'time out' in the car to process what i couldn't do for the people who only said 'hmmmm' or those who have only me instead of an ophthalmologist.  when i come home i'm just so happy to walk in that door.

because i love them. so. much.
because i want to show them that every minute of every day.
because they should have that.
but.
really, they have 'real'.  and i guess that is okay too.
let grace rain down on me.

sunday night top ten list

1. best TIA moment of the week -  a man, walking buck naked down the street.  not a crazy looking man, not shuffling, but striding down the street, as if he were carrying a briefcase.  not a minor street, not a highway, not a street in the slums, the street that my kids school is on, in a nice neighborhood. i'm not sure this falls in the catagory of This Is Africa- but i was just informed tonight that one punishment for theft can be stripping the person and forcing them to walk naked down the street- (either that or being burned alive)- i'd take naked.

2. best thing i heard all day, "YES!! i got the spot right next to mommy!" (jude) how loved does that make me feel?

3. sweetest little moment, although thankfully there were many, coming home from a great night out with mike to this on the door step. a la bryn

4. best good old memory zoe, "remember when you used to come to see me at preschool?  remember when you came for my birthday? i loved that."  probably most of her memories with me from ages 2-5 happened in that room that smelled of crayons and graham crackers (one of the best smells EVER) because i worked across the street as a crazy, angst ridden, migrainy and highly sleep deprived resident, who would crawl across the street to smell her little head every chance i could- as it was still with in beeper range. 
i think trauma memories get buried for a long time- zoe and i are now just now- recalling those years.

5. best bad old memory zoe, "do you remember kevin from my kindergarten class? he was SOOOO mean to me.  i still remember the smell of his lunchbox!"

note zoe pink princess in front, note kevin big kid in blue sweatshirt on right

 6. best food of the week,  the prawns in our entree special last night at mediterraneo. unbelievable, flown in from mombasa, and i don't even like prawns. 

7. best random attempt to know more than your little brother fact of the week, oh there are so many to choose from.  this one was over heard from my bed one morning. 

jude, "do you know what a leprechan is?"
bryn, "what?"
jude, "it's one of those lizards that can run really fast across the water!"
bryn, "no.  that's a Jesus lizard."
jude, "oh yeah."

8.  best medical moment of the week, taking a sick child to IHK, the international hospital kampala, and seeing the oncologist, having blood work, a chest x-ray, and abdominal ultrasound, and leaving with an appointment the next day with a surgeon for an excisional biopsy, all in less than three hours and costing ~ 120$. giving me faith in some systems in uganda.

9.  best quote of the week: 

10. best face of the week:

 

beautiful

it's beautiful outside.  this place is beautiful.  i'm alone in the house which is fantastic. i made a salad, swept the floor, cleaned up, and am listening to the avett brothers.  which brings me back to the good old south- and of course to my porch.  those were beautiful days too. i'm so thankful for memories.  for how capable our minds are of recalling the details.  light on leaves, the sounds of movement when the air is dry, the chipped paint, the smell of winter, the slight metallic taste of snow.  i love that we can collect pieces with our senses and carry them with us.  that we can pull them out when we need them- when the light on the wild plants isn't familiar, although it's becoming known.

next week i'm going to kenya for a medical conference.  i haven't been to kenya since i was 17 and fell in love with africa. when i didn't like curry and lived off of cadbury chocolate bars and bitter lemon and had my hair braided into cornrows.  when i listened to paul simon and wrote in my journal as i walked through the tea fields looking for mambas.  when all the shops looked dark and smelled like wood and spice and people acted annoyed because we didn't give money away because we were american. when we road the 'lunatic express' train to mombasa and i was eaten by bedbugs all night.  where i got to learn windsurfing on the bathtub hot indian ocean.  where i saw wild animals and the rift valley and the enormous african sky. 

i'm meeting my dad in kenya, and we are going to the same conference we went to in 1988- we are even going to the same conference center.  it's a medical meeting for medical missionaries all around the world and it's perfectly timed. because i need to hear their stories.  to learn how they frame disparity- how they do what they can with little.  how they live it. 

i've been thinking about poverty and it's many faces.  fiscal poverty is obviously very present here- but i used to think that poverty of spirit was not.  that it was more of an issue in america.  the poverty of spirit being loneliness, or lack of community or lack of joy.  here people often have these things- so i saw their happiness as a richness that we often lack.  but poverty of spirit is what Jesus is talking about when he says- blessed are the poor in spirit.  it implies an awareness of helplessness, a lack of control, a sense that nothing can be done.  i think Jesus was talking about the importance of appropriate humility, of understanding our ultimate lack of control. but he also met the needs of the poor, heard  their voice, and advocated for justice.  fiscal poverty and poverty of spirit are linked.  and it's the loss of voice, and self worth; the idea that you have nothing so don't expect anything, that i have the hardest time with, because we all have worth.  more than worth- we are deeply loved by the God who made us- and it doesn't matter how much money we have, or give, or don't have, we are equal, and it breaks my heart how this is forgotten, or ignored, or not believed.

so i'm hoping in beautiful kenya to hear stories of hope and empowerment from other doctors who've done this longer, who've seen more and cried more and loved more.  to revisit the neighboring beautiful land that spoke to me so many years ago, and called me to come one day.  this day.

the whisper of the world around me

today we did what i would call 'communal home church'.  basically the expat kids came together at someones house to have a little kids sunday school as a change of pace from the large ugandan service/ and sunday school that we usually go to.  i was excited.  i figured, here it will be good.  it will be quieter, organized, smaller, more manageable especially for the one child who is so easily overwhelmed.  so i sat with zoe in a comfortable large leather chair ready to see how this new atmosphere would answer our sunday school problems.  but.  it didn't work that way.

why i'm continually surprised by this?

she interrupted.  she wanted to tell the teacher random things about how to observe butterflies.  she wanted to interject at every point when audience participation was sought, but there were 10 other kids. she wanted to already know the answers to every question asked.  she became mad.  she told me she needed to leave, as she fiddled with her 'engine helper' and i stroked her arm to help her calm.  and this went on for the entire hour.

i was not calm.  i was everything else.  i didn't want to stroke her arm, i wanted to pinch her really hard because it felt like someone was pinching me inside. i was sad and angry and a little embarrassed, and hopeless, and scared. 

we were learning about david. the great man of the old testament, the man after Gods own heart.  the man who was a shepherd, and musician, and poet.  the man who killed the giant with his slingshot, who became king.  the man who messed up a lot, who slept with other peoples wives, and even killed their husbands, a man who knew he was wrong, who was deeply sorry, who asked for forgiveness and was forgiven by the God he loved passionately.  a man who felt sad and  mad and ashamed and scared. 

so i muttered a little prayer of 'help' in my heart.  help me because i'm scared.  i'm so scared.  i'm scared that this is her life life.  that these obsessive, sticky thoughts will prevent her from living happily, from ever learning anything, from have healthy relationships, from growing, from connecting.  i began having visions of a full grown zoe who can't leave her house, which is filthy and filled with disney toys and littlest petshop pets, and probably several animals that have been rescued but not treated for fleas. because i'm scared that she will be one of those people in the world who live on the fringe, that talk to themselves and are avoided, that are so overwhelmed by life that they shut down. and i'm so scared that i just don't have the tools to help her process the overwhelm, that instead i become eaten by it too. 

it's hard when you see parts of your brokenness through the eyes of other people.  it's hard when you're emotional underwear is sticking out for all to see. it's hard when you feel guilty about your fears, that they are symbols of giving up, of a lack of faith in her.  so i try to step back.  to not just see what's in front of me, but place it in the big context.  when you analyze data you don't fall to bits over one data point, you wait, you trust that when all the points are gathered, the trends will be clear and there will be some outliers.  but that requires emotional maturity which in these moments, i gravely lack.  in these moments i only see a cat-lady who can't balance her check book, or get the temperature right for her shower, or peel a carrot, or unscrew a juice lid. and i feel the need to panic. 

after it was over, and i was walking down the banana plant path, i had another little talk with God, but less desperate and more annoyed. 
'really God?  i thought we were kind of done with these days? these sticky thoughts?  these intrusive thoughts that disrupted her life, my life, and the entire class.'  that was it.  i didn't have much more.  

and there was nothing.  just the sun hot and shinning down, just the soft wiggle of the tree branches in the wind, just the voice of the birds, just the white butterflies leading us home.  God in the stillness.  God in the cave with david.  God in the big leather chair with me and zoe.  God big enough to hear my 'help' and my annoyance. God in the whisper of the world around me. yet, that is somehow enough. 

you can't have your cake and eat it too

yesterday zoe and i went to the large nakawa market in attempt to buy some basic items for child we are sponsoring in the village. this market is one of the big outdoor markets that sells everything from vegetables to underwear.  there is no order, no ailes, it's just stands filled with stuff- most of which looks like the leftovers from Goodwill- the remains after being picked through in other richer countries. 

we walked, very inconspicuously (haha) through rows of women sitting on mats peeling peanut shells, through tarps lined with colorful plastic items and old dusty shoes, over the road of dirt and corn husks, dodging boda's and an18 wheelers (trying to turn around) and bicycles, trying to find sheets and a mattress and trunk. 

we came to a woman unloading a bag of linens so i asked her how much for the sheets-
"30,000 shillings" (this is about 13$ per sheet) and they were used.  so i told her truthfully that i knew i could buy them here new for 11,000 each.  she looked at me,  "30,000." it was her final offer.  i was annoyed.  i felt taken.  i knew that if i were ugandan, a ugandan who regularly comes to the nakawa market- they'd be 10,000 at the most.  so i walked away muttering something about things being unfair because i'm a muzunu and that i'm sick of it.

then i had an epiffany.  really?  you are surprised? you think it should be different?  you think you should drive in here in your "fancy" "new" 1996 car, with your leather purse and be treated the same as the people who live here, walk barefoot here, buy their airtime in 50 cent portions because they can't afford more? you think you should be asked to pay the same even though proportionally you have so much more than 3x their funds?

doh.  i had turned it into a 'white thing'  i had turned it into predjudice. i'm a muzungu, i'm getting taken advantage of.  but the truth is i am a wealthy foreigner, comparatively.  the truth is, i'm not ugandan, even if i live her for 20 years, and speak perfect lugandan, i will still be a muzungu, so will my kids.  i will still have more than the people selling tomatos and sheets at nakawa market.  i still am a US citizen with all the priveledge and rights and status that comes with that.  i am educated, i grew up in an evironment that taught critical thinking, i believe we have influence in what happens in our lives, that we can change circumstances, that we have power.  i believe these things because no one has shown me otherwise.  because i wasn't orphanged by another tribe slaughering my village.  because i know that if i get sick- i can and will receive treatment.  that if disaster were to strike- there are places i can go, people who would help. because i can move, because i can use a credit card, because i have choice. 

the bottom line is my muzungu-ness does mean something- like it or not.  so i really can't have my cake and eat it too.  i can't have all the priviledge that comes with being an american, and all the 'benefit' of buying  market products as cheap as the locals.  and i'm okay with this.

i'll keep my cake, and instead of eating it, i'll share it.  or maybe i'll open a bakery :). 

maybe the monkeys are up to some good

sometimes, i wish i was a monkey.  i mean they have so much fun.  today they were out in the big front yard tree, two little ones, falling from high limb to low limb, chasing each other, swinging from branch to vine, scurrying up a trunk- no worries. at. all.

i was looking at them and wondering about the actual benefit of evolution.  sure we can reason and plan and build structures but are we any happier?  

zoe often attempts to befriend the monkeys, and actually most living things, including insects. she does have a great love for animals and i think animals really love her, but insects? i'm just not sure.  and inanimate objects? i'm very sure not ("i think that must be a friendly vacuum.")

the other day we were outside reading an abridged story version of shakespeare's romeo and juilet.  we were sitting on these deliciously colored african straw mats, and it was a beautiful day, the only thing wrecking it were the ants that crawled everywhere (despite concern over large or highly poisonous insects in africa, ants are our biggest pest).  zoe says, "this ant must really like me!" as it crawls up her arm.  sometimes when she does this i think it's cute and i smile and just say nothing- and sometimes it bugs me (no pun intended) and i don't.  so i said, "you don't really think that ant 'likes' you, do you?  i mean it's an ant- it doesn't have feelings so it can't 'like' you."  but after i said it i felt like a jerk- like i'd said santa wasn't real- i'd wrecked her monkey fun.  stolen something she wanted to have. luckily she wasn't giving up the ghost.
"well, it likes me enough to stay on my arm."
"that's true zo."

it had been a very long time since i'd read the tragic love story of romeo and juliet.   young lovers, feuding families, quick falling, passionate professions, marriage, secrecy, separation, a plan to be united, foiled by bad timing, death because of the inability to be with out the other. i have to admit, i don't love it.  i get too annoyed by the poor timing- why did romeo have to get the news of juliets 'death' before he hears the friars message about the plan for them to run away together? i guess i do like at least partially happy ending.  i much prefer casablana, an affair to remember, or gone with the wind.


it got me thinking about how tragedy in love is still a love story, but tragedy in life is just hard and painful and sad.  i began thinking about what it does to people, how it's related to expectations or lack of expectations, how it's related to fatalism- the believe that one has no control over events.  in africa there is much tragedy.

tragedy- an event causing great suffering, usually involving death

most ugandans have suffered the loss of immediate family members, like parents or children; or they have had much illness, like HIV or AIDS; or things taken, like their childhood; or experienced a lack of something important, like clean water, good education, appropriate medical care.  most ugandans have experienced tragedy in a variety of forms.  after multiplied traumas, do things reach a new plateau?  does bad news become normal? are reactions blunted? it seems like that- like it has to- its survival. but i wonder what is the fall out?  what happens because of this?

i see this mostly among the poor.  there is an awareness that life is brutal and short- it's a reality here.  is that why the woman with the fungating vulvar cancer wasn't more angry when i asked her what the small local 'clinic's' were doing about this for the past 5 months that they 'cared' for her as it continued to grow and bleed and stink?  is this passivity, this acceptance, a result of an emotional system wrecked by repeated trama? 

is it why people waited for 20 minutes outside the lab, silently, when i marched up to the counter, knocked and asked loudly if anyone was available to help us, which prompted an immediate response, to the shock and surprise of those waiting on the bench?

is it why people say they have no questions after finding out their son might have lymphoma or lukemia?  how can you have no questions?  doesn't that imply blind acceptance of what ever comes next- doesn't it imply a lack of control?  but maybe after losing several family members, you stop having questions.  maybe you stop having expectations- once bit, twice shy.  maybe you stop having hope- maybe you're too tired, too defeated, too broken by the broken to get riled up.

i wonder if the real tragedy isn't the death itself, but the fall out from it. the lack of hope or involvement, or investment- the 'pawn-ness" of life here.  but maybe this is why people here live more in the present-, in the moment, in the now. because they can feel it and trust it as it happens in real time.

i don't know.  i just know those monkeys are having a ball.

just a poem...again

tonight the moon was that perfect sliver and beside her a star so bright it must be a planet and the rest of the night lay deeply dark, no clouds.  as the moon sunk the sky filled with so many lights. i wanted to bring out a mat, and fall asleep watching them, finding their patterns and stories.

 

 

Sleeping in the Forest

I thought the earth remembered me,

she took me back so tenderly,

arranging her dark skirts, her pockets

full of lichens and seeds.

I slept as never before, a stone on the river bed,

nothing between me and the white fire of the stars

but my thoughts, and they floated light as moths

among the branches of the perfect trees.

All night I heard the small kingdoms

breathing around me, the insects,

and the birds who do their work in the darkness.

All night I rose and fell, as if in water,

grappling with a luminous doom. By morning

I had vanished at least a dozen times

into something better.   

- Mary Oliver

we'll get there

this week of home schooling has had days when being a patient at mulago might be slightly more appealing.  per mike and zoe's report, monday and tuesday hadn't gone too well, so i woke up ready to be flexible, to avoid conflict, to remain cool as a cucumber.  i even had a plan.  get the bad stuff out of the way first, but make it less bad and then the whole day will go better.  so we started with the dreaded copy work- only instead of copying the summary of her history reading, i chose to let her write out the song she'd been singing all morning repetitively, that old classic 'i lost my poor meatball'.  this was a good choice and instead of the 40 minutes of complaining i usually get, i had 20 minutes of singing and laughing.  but somehow it still went down hill and after about the fifth discussion about how 'learning is stupid' and me trying to convince her of it's importance - it ended in me deciding that i was done (for the day that is), that maybe 'teaching is stupid' at least when you have a student who doesn't want 'help' and doesn't care to learn (especially and perhaps only, when her parents are the teachers).  as i'm walking away, calmly down the hall, but inside cursing myself for jinxing us with said post, i hear her beginning to sing. then she goes into the kitchen and begins to peel a cucumber while in full song, thankfully not 'i lost my poor meatball'.  instead she is doing a talking therapy song, "ohh noo, i shouldn't have donnnneee that."  then i hear florence responding back in song- "eeeeaaat weeeel be okayyyyy."  like my own little operetta.  
thirty minutes later after apparently having practiced, she comes into the office in full song with hand gestures and to a made up tune, a little like 'elf',

"i'm sorryyyy mommyyyy.  i do want to leaaaaarn and i love you.  you can always help me-e-e-e-e, i won't mind.  i still neeeeed you, so please please keep on teaching me! i promise! i promise! i'll tryyyyyayayayay."

it was hysterical. 

i listened to the whole thing, loving it, and loving her.
then replied that it was lovely, and she was lovely and i love her but that actions speak louder than words, and songs, a saying which of course required an explanation.  one that i was happy to give. and thankfully, one that was happily received.  we'll get there.  

orion's belt

i am exhausted exhausted. 
(i did that on purpose- saying the word twice is ugandan for emphasis).

today was a very long day that began with a 5:30 breakfast with my three precious boys, a full day at clinic, and finally a trip to mulago hospital. after an incredible amount of work, we were able to locate the two patients i'd sent yesterday- basically by walking through ward after ward of sick, and i'm talking, sick people, and trying to identify them visually.  as suspected, being the only muzungu in the entire complex, i stood way out and was recognized by the patients.  and lets just say the 'information' desk wasn't the only thing missing. the other thing was, hygiene! oh, and sheets, privacy, infection control, food, medicines and doctors.  it was kind of a disaster.  it looked exactly the same as it did 8 years earlier when i'd come through as a medical resident.  i will say more later- it needs to settle.

i got home late and went to a talk at the university sponsored by the student group 'international justice'. there was a very inspirational ugandan radio host talking about changing the world, instead of dr. ian clarke who was supposed to talk.  i think he might have been too busy changing the world.  

i walked home in the dark under the beautiful, life giving, night sky. clear and dark and full of God's little white lights.  a sky that looks different and the same as it always has.  the air was cool and the moon was away and i could see orions belt.  those three steady bright stars at the top of the sky. holding things together, and i felt full of life and thankful.

 the take home message for the day is - yes, the world needs to be changed. 
it starts with each of us.  it's starts now.
okay, tomorrow, i'm going to bed.

it's time now

i admit it.  i've been completely avoiding mulago.

mulago is the big city hospital/ referral medical center for uganda.  i send people there all the time from clinic to get treatment or surgery or a diagnosis, because our 'little clinic-that-could', often can't.  but i've been avoiding it because i'm scared that i will be so appalled that i won't know what to do.  in other words, ignorance is bliss, or at least it allows me to hope for the best.

but i went to clinic today. and oh dear.  the number of eyeball poking experiences i had in the 4 hours i saw patients was impressive.  and the number of times i started to cry inside, was perhaps equally impressive.

what was it about today that changed things? that pushed me to the point of needing to know?

was it the man who was back again after i'd sent him to mulago in december - but now worse- his lung still filled with pus, or fungus or both, weighing even less, still febrile and tachycardic, but now with diarrhea, anemia and a few other complaints.  was it the fact that he'd been not properly diagnosed, not fully treated, and it seems like people must just not care that much? or is the system that overwhelmed, the resources so poor, that the really ill guy with a CD4 count of 50 gets blown off because he'll probably just die anyway?  i was mad mad.  i wanted an explanation.  i wanted to know why there was no pending plural fluid culture, why they'd discharged him no better than a few days before?  and did i mention that he now can't hear either and has ringing in his ears, i'm assuming he was given gentamycin- lets hope they had a good reason- and not just throwing antibiotics around- remember that first rule of medicine? do no harm.

then i saw the baby with the big head that i'd seen last week.  it was a little bit bigger, she hadn't been to the neuro clinic and said she had transport problems so the dad had taken her to the 'local clinic' where they had not measured her head or examined her, and were told they'd just have to wait and see.

probably the same 'local clinic' that has been "treating" the next lady i saw, with a massive, fungating, vulvar lesion, that was clearly super-infected, most likely malignant and oozing with malodorous pus and blood as she lay sweating and paining on the table.  i asked her how long this had been going on - 5 months- she'd been going there for 5 months, with no referral, no biopsy, but getting 'shots' of some kind or another.  i wanted to cry.  i gave her transport money and wrote another letter to a doctor at mulago - imploring them to see her, examine her, admit her and treat her.

i'm just done with hearing TIA (this is africa).  where are the standards? who is running these clinics that seem to be on every corner?  it reminds me of that line in an adam sandler movie, "we are all stupider now after hearing that speech."  people might actually be worse off having been to a health clinic.

so now i'm ready.  i need to know what is happening at mulago- how they do things.  i'm ready to know if they admitted the lady with the lesion, if she was examined, or sent out with an appointment somewhere, at sometime, at best.  i'm afraid, but ready, to face that guy with the lung infection and go to bat for him, if he's lying in a hallway - getting more antibiotics without any diagnosis or drainage of the pus.

on the way home from clinic i was surprisingly full of hope.  i had that excited feeling like, 'there is so much good to be done'.  there is so much room for change or growth or improvement and it needs to start with me.  me not being overwhelmed or sad to the point of stagnation or avoidance, but me doing the best i can for each person i see.  me caring, following through, not giving up, letting people feel loved, valued, and attended to- and teaching these things, that this is good medicine.


instead of crying about it, or complaining about it, or running from it; i need to be in it, see it, learn about it, work with it. i need to “Be the change that you wish to see in the world.” (Gandhi)
otherwise i should pack my bags and go home. 



“For what it’s worth: it’s never too late or, in my case, too early to be whoever you want to be. There’s no time limit, stop whenever you want. You can change or stay the same, there are no rules to this thing. We can make the best or the worst of it. I hope you make the best of it. And I hope you see things that startle you. I hope you feel things you never felt before. I hope you meet people with a different point of view. I hope you live a life you’re proud of. If you find that you’re not, I hope you have the strength to start all over again.”
― F. Scott Fitzgerald

why somedays i want to poke my eye out

i had started this post in my head last night as i lay in bed thinking about my zoe and the challenges that we seem to continually face.  it's not that they are massive, terrible, or earth shattering, it's that they are slow and gnawing, like chinese water torture.

is it the number of times that i've heard myself say "stop eating with your fingers!!" and "what part of stop playing dolls and put the doll stuff way, do you not understand? i've asked you five times in the past hour." while her younger brothers use utensils and might need 1 or 2 prompts to clean up.

or is it the fact that she'll get completely worked up about a 'stranger' at my friends house- the stranger who happens to be another mother with her kids present- but will happily and fearlessly spend an hour talking to a random guy sitting alone in the coffee shop who happens to looks like hitler?

and thus my desire to poke out my own eyeball in frustration.

so i remind  myself of  'the rule of 300'.  that it takes 300 times longer to teach her something than a neurotypical child- in other words that there is hope, eventually.  and i remember that she has a gift of reaching out to people.  and i say a prayer that no one will harm her when i'm not around to protect her, or act as a filter, before she reaches the 300th time and finally understands who really is a stranger, maybe even a strange,stranger. 

but we are entering that tricky age- we are at 'tween' and heading toward 'teen'.  so there is all the goofy that goes along with that- the gangly, awkward, pimply, hormone-y, stuck somewhere between child and adult- stuff that we all fondly recall.  but it's overlaid with a wide differential between the areas of maturity and those of great immaturity that kids with learning differences live with. tricky because there are now more variables, more volition, a greater desire to reach emotional independence- which seems to point and laugh at the other areas of continued dependence.  and instead of this adorable little blonde girl- flapping away while watching clifford and understandably using her fingers because her tiny hands can't hold a spoon, i'm dealing with all the struggle but she's wearing miss-matching clothes and has underarm hair.

so i was thinking that in addition to lowering expectations this new year, i also need to have a better sense of humor.  i was having visions of talking in that calm, sweet, sing-songy voice and saying to zoe in full sincerity, "oh honey! did you forget to use your fork again?" and not letting it get to me. at. all.

because i want to be that person- or at least not the yelling, ranting, nut-ball that i can become when i've told her 5 times to use the fork! i want to just laugh about it and let it go, and hope that when we get to 300, she'll listen the first two times she's asked to do something, or better yet- not have to be asked at all.

yes i want to get to that place of zen.  i want to go all in with love, and all out with annoyance.

because i need my eyeballs, both of them.

not unhappy, but sad

i'm missing my old life right now, badly, and i don't even know why.  as i said to mike while crying after skyping with my parents, "i'm not unhappy, i'm just sad." which makes perfect sense to me.  things are good, they are, they're really good, but sometimes it sneaks up on me, and i'm just sad. 

i miss the fries and dipping sauces at leons in decatur. i miss the porches of my friends.  i miss going for a walk in a pretty neighborhood and seeing families that look like me, doing the things i did when i was growing up.  i miss grabbing a pizza at osteria with the kids and seeing 5 families from school.  i miss zoe having a host of trained, professional adults around her who understood her brain and helped us both to live with it.  i miss the women i got to know in the waiting room of the offices of those trained professionals, who also lived my life, but usually with their sons.  i miss the change in weather that fleshes out the passage of time, unlike this stagnant equatorial constancy. always. the. same.  i miss people calling me on the phone to talk.  i miss pre-washed bagged lettuce, and the kind people at trader joes, and buying store bought gluten-free bread even if it cost $5 a loaf.  i admit it, i miss the reliable taste of a starbucks latte.  i miss the light changing each evening.  i miss my comfortable couch and a TV and the opportunity to watch 'american idol'.  i miss my local friends so much. sara can we sit on your porch and have a glass of wine?  erin can we watch the kids play and eat your homemade guac and laugh? shannon can we go for a long walk? heath, can we live life together down the street? kim can we go to murphys? mom and dad can you come for dinner? bill can you come for the weekend?  linds can we talk on the phone everyday?

it's not that i'm unhappy here.  because i'm not.  i like it here, i even love it here.  but today i'm homesick. simply. so i cried a bit.  i listened to music with harmonicas- that barrier breaking soulful instrument, and i got in my car and drove down to mukono to buy some lemons at the local marketplace from the lady i always by fruit and vegetables from. tried to call a friend at home to say hi, but didn't reach her, then i went to the store and bought some toilet paper because life needs to go on.  at the check out counter the power went out, and the lady at the check out counter asked me how my sunday was.  i told her in the dim light that it was fine,  but then added that i was actually homesick. she smiled. 

i wanted to tell her why i was homesick- what i missed- one thing which might have been reliable lights and expiration dates that haven't usually past.  but i didn't, i smiled back.  this is africa.

so i got in my car, and drove up the dirt road as the sun set, again, reliably at 7, knowing that even though i'm a little sad today, i'm not unhappy.

putting it on paper makes it real

i'm a big list maker.

it's how i order the random things flying around in my brain.  i catch them and put them on paper so they can't escape.  today the list is one of those onerous ones- it's the dreaded todo list- because the things on it have been around so long and have been ignored for so long.  this is what happens.

there are things that need to get done. i don't want to do them. so i wait.  after a few weeks i begin to notice that i'm kind of annoyed all the time- for no obvious reason - or that i have anxiety that will periodically surface wearing the face of one of those things i have to do. so i'll ignore it again for a week- which builds the baseline level of annoyance or anxiety.  at the magic point when the emotion over rides the dislike of the task- i'll sit down, put it on paper- and accomplish the task.  then i feel better.  and then it starts again.  pretty pathetic - but that is the way i go through life (only with the annoying bits). 

what classifies as a dreaded or onerous task is pretty much anything that requires or involves:
a) money
b) large bureaucratic systems
c) phone calls involving teleprompts
d) tasks that require significant research and thought, or multiple steps, so rarely result in a conclusion the first time they are crossed off the list. 
e) tasks that tangentially affect me, still float around in my head, but i have little control over (ie: require the assistance or total effort of mike)

for example-  today's list

* signifies task made much more difficult and onerous because of living either overseas or specifically in uganda

1. coffee with joellyn- (this is a good one- i like to start positive- but, it's the only one like it on the list)
2. apply for federal public service loan forgiveness program - (about as bad as you can get- see a-d *)
3. register for the internal medicine board pre-exam modules (i don't even exactly know what this means which is part of the problem- see a, b,c, and d*)
4. get medical supplies needed here for clinic - b/p cuff, stethoscope, other medications that are available locally and frequently required by patients ( d*)
5. purchase promised supplies to small girl in village to go to school (a, d, but made marginally better by goodness of task*)
6. send Christmas cards- (i know, this is ridiculous- but definitely causing anxiety*)
7. look over all possible courses in the health science department at this university and decide where to lecture and on what, then contact course director, plan lecture, etc. (d)
8. retrieve or reset old password for email at Emory (b, c*)
9. order zoe's math books (not onerous- i've just been lazy)
10. get gifts, yes, Christmas, for family to send back with Dad when see him in 2 weeks in kenya
      (i have some, just keep forgetting the rest!*)
11. order family meds from canada that are unavailable here and about to run out (a,b,c,d*)
12. get passport size photos for drivers license here (only annoying because we've done this and lost them*)
13.  create organizational system so as not to lose things like passport pictures again (d)
14.  remind mike to pay his traffic ticket so i won't get pulled over since we share the car (e)
15.  pay school fees for boys school term 2 (a- e, because of transferring funds etc.*)
16.  go to market b/c out of all essentials including toilet paper (only painful because will require several trips to several markets to find basic and essential items*)

so you can see why i've been avoiding things. and how i avoid them (note present activity). but now that i've written them down, i've made them real. rats.

and i'm the one trying to teach zoe about organization, and life skills- she might be doomed. 

a saturday morning poem

Wild Geese

You do not have to be good.

You do not have to walk on your knees

for a hundred miles through the desert repenting.

You only have to let the soft animal of your body

love what it loves.

Tell me about despair, yours, and I will tell you mine.

Meanwhile the world goes on.

Meanwhile the sun and the clear pebbles of the rain

are moving across the landscapes,

over the prairies and the deep trees,

the mountains and the rivers.

Meanwhile the wild geese, high in the clean blue air,

are heading home again.

Whoever you are, no matter how lonely,

the world offers itself to your imagination,

calls to you like the wild geese, harsh and exciting 

over and over announcing your place

in the family of things.
- mary oliver

the orthodontist?

the other day i was driving to school with the boys and my phone rang.  for some reason, while this was often illegal in the US and it never stopped me, here, i NEVER talk on the phone and drive.  yes, partially out of fear of getting pulled over, by mostly for fear of dying or killing someone in the one second that i'm reaching for my phone and a goat jumps across the street.  but this morning, the phone was beside me and i was stopped in traffic, so i looked to see who was calling.  it was the orthodontist.  there was no reason for them to call as we just saw them, but i answered.

"hello, this is the orthodontist's office- are you with zoe?"

"hi, no i'm not with zoe, and i'm driving so i shouldn't talk on the phone." i said, sounding all good citizen-ish.

"i mean is zoe yours?"

"yes,  she's my daughter."

"well she has called us just now, crying hysterically, and she has said she was left all alone, locked in the house."

"oh dear." gone was the 'get on with it, i'm trying not to run anyone over while you're keeping me on the phone' voice, and out came the apologetic 'please don't think i'm a horrible parent' voice. "okay. thanks so much for calling, i'll call her right now."

really zoe, the orthodontist? couldn't you have just called me? or anyone else?

how she even ended up getting the orthodontists number out of mikes phone is beyond me.

the thing is in uganda leaving a 12 year old at home alone, even leaving a seven year old at home alone, with 5 little siblings to care for, isn't weird- it's normal.  but i'm sure the fact that she was going  berserk and that it was the orthodontist's office that was reached, which must have implied that several others were tried first to no avail, suggests that i am in fact a terrible mother who had abandoned her child with out a plan.  but it wasn't me!

mike is guilty.  he had gone for a run and she'd been so asleep that he'd not wanted to wake her to tell her that.  when she woke up, the house was empty and the door locked.  i don't know why this instilled pure panic in her- but it did- poor thing.  she felt trapped, and even though she probably knew where we were, the trapped feeling let her imagination run wild.

and i get that.  because when i feel trapped, that is what happens to me.  i can get a little panicky and a little crazy too, even if i know know what is real.

the most trapped i think i've ever felt was inside the giant magnet of the MRI machine in the breast imaging center.  now i've had an MRI of my head and i had several of jude when i was pregnant with him- and they aren't fun, but as i lay on my back in the small space, i felt relatively okay.  but this breast MRI was different.

first of all i had to have an IV to get the contrast injected. then i had to lie face down in superman position, with my arms over head and my breasts hanging down into these circular cut outs.  i was then strapped down so i wouldn't move, the IV tubing taped trailing down my arm, and i was given a small 'panic' button to hold in my hand as the slab i lay on, sucked me feet first, into this machine where i was told to lie completely still and follow the directions i was going to hear about when to breath.

you're going to shove me into a small space, while restrained and tell me when to breath, and you only want me to hold this button? as soon as the table started to move backwards i could feel myself starting to panic slightly- i began to sweat and feel the need to breath very deeply and very quickly.  suddenly everything itched and needed to be scratched and the thought of not moving my arms for the next hour furthered the panic.  i'd been instructed that i would be told when the contrast dye was being injected and that i might feel strange - hot or cold or tingly- but that it would pass after a few minutes.  none of those feelings sounded good to me, especially not  when you're trapped, tied down and inside of cave of a machine with no room to even move an inch- i know because i tried.

i couldn't help it.

i thought if i could wiggle just a little, i'd be reassured by the space around my limbs- surely it can't be that small a space.  it was- and as i raised my fingers up and they bumped into the wall of my cave- i felt complete panic.  but before i could push the panic button, a voice came in the machine and told me to stop wiggling.  so i responded by saying that i was pretty sure i was panicking and would need to be removed- immediately.  but the voice responded like a parental threat, "if you DO push that panic button, we'll have to start All over again."

so i started imaging the ocean, i was floating on it, the sun was shining.
"okay," came the voice, "i really mean it with the wiggling! now i'm going to inject the dye."
oh dear.  i do feel hot and tingling, or is it cold? i think i'm having an allergic reaction....and i'm trapped- oh help, i need to push the button...i can't feel my toes.. i'll just wiggle them to be sure i'm not paralyzed...
"STOP moving in there!" came the voice.
 oh how is wiggling my toes going to affect a picture of my breasts? come on. 
"are we almost done?" i needed to know.
"almost.  if you'd stop moving."

think peaceful thoughts- you are free, you are a bird, you are flying.  no i'm not. oh no.  what if there is a fire or an earthquake and i'm abandoned in here?  the machine will break, it will be stuck with me in it! and i'll die here in one of the more dehumanizing positions.  
"hold your breath."  hold my breath? i'm suffocating!
 more rapid breathing.
"just once more. then we're done."
okay i can make it.  i can be done with this and i'll NEVER do it again. 

when it was finally over and i slowly emerged from the magnet, i leaped off the table slab and hurried out to the technician.

"i thought you said you'd had an MRI before?  and aren't you a doctor?" she scowled.
what does that have to do with being trapped in that machine which defines claustrophobia?


yes, i know all about feeling trapped and the crazy that can be unleashed.  who knows, if i'd had a phone in that MRI machine, maybe i would have called the orthodontist-and begged her to call my mother too.

just being a mom

today was fantastic. beautiful. the best all week.  i'd like to say it was because home schooling went really well with zoe, or because i saved someones life in clinic, but it was the opposite.  it was fabulous because i didn't have to watch her spend 40 minutes copying 4 sentences, or tell me she didn't want help, and i didn't have to see sick small children who can't get the treatment they need.  today i ran away, kind of.  today i didn't home school zoe, or go to clinic, but i spent the day with mike in kampala. today, i took a break.

we are beginning our sixth month in africa.  we are beginning a season of discernment.  the process of gaining keen insight or judgement.  we are praying for wisdom here, guidance, as there are so many amazing opportunities to serve, that we'll know the right ones, that we'll focus well, that we'll do what we should do, and not just do what is easiest or what comes up first.  that we'll have vision and perspective.

so as we bumped along the road into the city, with zoe happily behind with florence and a list of schoolish things to do, i blurted out the keen insight i think i've been given over the past few weeks.  and it went something like this,
"i don't think i can do much more of this home school thing!  i think i might be done! i mean after 2 years, i think i'm ready to just be zoe's mom, because at the end of the day, after being with her all day, and listening to her nonstop talking, dealing with her absurdly slow pace, and her inability to focus on anything,  i kind of want to throttle her.  really.  and i don't want to feel that, or say that, or be that.  i just want to be the one who listens to her day, and tells her it's okay, and is excited to tuck her in bed at night.  i want to do the other stuff, the things i was trained to do, i want to be a doctor, and teach highly motivated and eager-to-learn graduate students, and i want to write.  is that awful? am i terrible?"

it felt so good to say it out loud.  i think it had been stirring for a while, brewing around in me, and i was pushing it down and feeling badly for thinking it.  but once i heard myself say it, i didn't feel badly anymore- i felt kind of free. and thankfully he said no, that i wasn't awful or terrible.

this year, he started helping with the home schooling.  he does two days, i do three.  i'll admit, there was a part of me that was really nervous that he'd be better at it. because he's really smart and good at most things, and much more patient than i am, and able to hold back whatever impatient words might come to his mind.  i imagined that she'd love monday and tuesday and thrive in the beginning of the week, only to fall apart with me in the end of it.  that mr. patient would serve to emphasize my impatience, that i would be the bummer parent, that i'd hear, "why can't you just be like dad!" basically that i'd fail in comparison.  but.  the joy of sharing the responsibility of her education, of not being the one holding the keys, quickly outweighed my insecurities. and it turns out he is really good at it- thankfully, and he really enjoys it (for now) and zoe appreciates both of us.  but the best part is, i realized i don't care if he's better at it, or if she likes him better as a teacher.  turns out, i care most about just being her mom.  i care so much about being her mom- that if home schooling is getting in the way of me doing that well, maybe it needs to go. there are lots of people who could teach her- i'm her only mom.

i spent the first hour talking this out, and once i'd said it, i felt better.  we didn't reach any big conclusions or make any sort of decisions- but we had a great day. and i came home and was so happy to see my kids, even and especially zoe, because today i was just her mom. 

the front porch

the other day i wrote about my absence of a back porch. how i miss the quiet and the space that comes with life in the back yard. but i think that i misrepresented life a little- there is a good side about life lived out loud.  you're never lonely.  people abound and are happy to share their hang out time.  and, i do have a lovely front porch.

today i came home from the market- and my front porch was full.  there were my boys and several other children, and zoe having a conversation in her version of sign language with a deaf ugandan guy.  i know he's deaf, because i've met him before, on my porch, a few weeks ago.  the problem is that when i see strangers on my porch or people who are one step removed from strangers (those who were strangers before the last time they stopped by the porch) they always want something- which is almost always money.

this poses a problem.  i had a hard enough time with people begging on the street in america.  i mean i am unable to walk by with out having a massive internal conflict.  i either give, or feel terrible that i didn't give, or feel annoyed that i'm being asked to give when i just want to walk by and not have to  deal with someone else's problem, when i don't want to be possibly contributing to their problem by giving money that they can spend on alcohol or drugs. but then of course i feel terribly guilty about thinking those things.

i've run through various scenarios in my mind, trying to come up with a standard response- a plan- i want a solution- to come up with the perfect, 'what i do is...'.  i'd thought about just always giving everyone something- having dollar bills in my pocket and giving them out- with out a thought.  i'd thought about carrying around macdonalds gift certificates so at least people would have food.  once i thought about creating little care packages with clean socks, a t-shirt, granola bar, water and even enlisting my kids to make art for the final touch.  but my attempts were more about alleviating my discomfort -than helping the other person.  while appearing generous, i was really trying to find a way to ignore it nicely. to avoid thought or engagement. sometime action can remove you further.

here the situation is on steroids. instead of just walking by it on the street, it comes right up to the front door. again and again.  here when you give someone something they always come back for more. i find this surprising.  i just paid your school fees for the term and now you are coming back with a medical problem, and more school fees?  where does it end?  and we're not talking about spare change- we're talking about boarding school fees, or a hospitalization (it's much cheaper than in the US- but still).  the thing is- i've been fooled before.  fully taken.  found out later that the guy who cried about his health and his poverty and his family- had told the same story to many other people- had never gone back to the village as promised- and was drinking in town the next day.  it's hard not to become bitter about it- not to judge. it's hard to live in a place with such disparity. i want to be generous- i want to be helpful- i want to know peoples stories.

but i do want them to be real.  i want to be able to trust.

i find myself doing the same thing i did at home- wanting a standard response, or to create clear boundaries to protect myself from being duped or even from having to engage.  but that seems so rigid and removed.  florence gave me a wise piece of advice- she said the people who lived here before, only gave to people they knew.  that was their rule.  this makes sense- i know plenty of people with need, don't need to go looking for them or to wait for them to show up on my doorstep. 

i still haven't figured it out and i'm not sure i ever will.   it's holding the tension of the opposites again- allowing myself to be uncomfortable and exposed to things when i'd sometimes like to turn away. it's being flexible, but wise.  letting the moments be what they are on my front porch- letting myself be okay with saying no- or saying yes with out expectation.

the best nest

today i was spending the afternoon with my littlest.  it just ended up that way- a quiet house with only me and bryn.  this is rare, and special.  he wanted us to read books so we did. 

this book, the best nest, is a snap shot of many seasons in my life, and many seasons in the lives of most of my friends.  it's about a bird who decides she hates her nest.  so she and mr. bird, go in search of perfection. they find many places that look good at first but won't work.  when they finally settle on their ideal in a clock tower, and go to work building their nest, it is ruined with the first ringing of the bells.  so they return to their original nest and realize that it is best.

there is a lot of talk about where people are going.  there is a lot of questioning what is next.  there is this idea of finding utopia.  there is this idea that the grass is always greener, that ultimate satisfaction is possible, that somewhere holds the key to happiness, that moving closer to ones family or farther from ones family will bring the answer.  but what is the question?

for a long time i thought this was just a built in part of the medical education and training process.  we'd move every 4 years, from college, to medical school, to residency, to fellowship.  then we were finished and the rest of our lives could begin.  but we realized that we now lived far away from where our lives had begun.  we lived far from our families and our friends and our memories.  but the problem was, many of our families had moved away from where our lives had begun too, or we really liked where we'd landed, or we now had kids that had begun their lives somewhere.

but this isn't just about doctors, or even people who've continued in years of higher education and training, it's about people having choices and expectations and the availability of mobility.  and while all of this sounds good- i wonder, is it? 

i mean when you're stuck in toledo for residency (where i've never been and i'm sure is quite nice), you just make the best of it.  but if you've moved there on purpose- with an expectation- and with small ones and a partner- suddenly toledo has a lot to live up to! 

it's not the place, it's the people. and there is one person you're stuck with.

here's a little secret, a little something i've figured out along the way. 
you can't ever get away from yourself.
scary isn't it.
but it's true. 

what is too bad in all of this searching and moving and discussing and planning and stressing and calculating and researching is that we lose the 'now'. we're tripping right over today.  we don't dig in because we're sure we're probably leaving.  we treat all soil like sand- can't have long roots.  and with all of the possibility we lose the stability.  how can a community really become a community when everyone is either leaving or talking about leaving? i should know because i've spent a lot of time here- i mean in this place of wondering, ruminating, imagining and not being satisfied.

i must admit.  i'm one of the antsiest people i know.  i enjoy change and like new experiences.  i like rearranging the furniture- sometimes i even need to rearrange the furniture.  so sometimes i wonder if i don't chose places to be or people to be with, who also like to rearrange their furniture, or their lives.

for now, i'm glad that i'm in a season of really loving my nest.  i mean there are plenty of problems with it- it doesn't always have electricity, it lacks a tv and a dishwasher and cozy rugs and a comfortable couch, and it's very, very far away from the people i love the most.  but i've decided to try to rearrange only the furniture.  to dig in.  to speak and live and be here today, with the plan that it will also be tomorrow and quite possibly many years, and maybe even, dare i say it, forever.

what are we so scared of?  what is it that we think we're missing? what is it that we're hoping for? and why are we so sure it's not sitting in our nest, or in our heart or beside us on the couch?  i think it might be. 

let your light shine

i don't think you can know rich, until you know poor.
yes, i was at clinic today.
wealth has less to do with bank accounts and more to do with access and options.  i mean access to many things.  today i mean access to health care. 

access- the ability to approach, or enter or make use of.

this gets complicated. 

today i saw a baby. a cute, smiley, 7 week old little girl who i knew in once glance had something 'off'- more in the way a mom would know, than a doctor.  her mom explained that she was there for an HIV test- her first DNA PCR- to see if she'd contracted it from her mom.  but.  then she added - by the way, her head always flops back.  so i peeled away all the blankets- even thought it's so hot here now- and her head just kept on going.  it was too big, too long, measuring to the size of an adult head.  no wonder she couldn't manage it.  but the question becomes 'now what?'

in the US, primary care is a gateway to something.  here it's not.  this can lead to great dissatisfaction with ones job.  i had an easy time with the hypertensive cases, and the those needing antibiotics or not, even with diabetes we have some options, but this child?  i wanted neuro-imaging, a pediatric neurologist, and the availability of a pediatric neurosurgeon, and i wanted it to be affordable.  but she won't have any of these things. 

availability is a very different thing than access.  here we don't always even have availability, but when we do, the people very often don't have access- they can't 'make use of' because of poverty.

what shape does reassurance take in this situation- what shape does hope take?  what is the point of knowing the problem if you can't fix it?  or perhaps worse, if it's fixable, but just not for her. 

i promised myself i wouldn't cry in clinic- i even prayed that i wouldn't.  i didn't ugly cry, but my eyes got pretty wet. this is why i never wanted to do pediatrics- i can't deal with sick kids- it breaks my heart in little pieces.  or is not the age, but the absolute lack of real access?  what good is knowledge if it won't help.

the mom was looking at me- but her head is fine right? she said.
no.  her head isn't fine.  it's too big. 
and i get it, because i've been there. right there. i've been there with my baby. holding my boy with his big head.  but when i asked her what she was most worried about, she said 'money'.  and money was the farthest thing from my mind when i held my baby and his head. and i knew in that second, how truly rich i am and have always been and always will be.  i have options.  i have availability and i have access.  and i have people that would work extra shifts to pay for access if i couldn't. 

poverty steals something from people that i might not have thought about before- it steals the little bits of control that we have over things that we ultimately have no control over. 

that is the difference.  i am rich- we all are. 

today a group of students from the US are coming to our house to talk to us about why we moved our lives to africa - why we took small children and sold things and ended up here.  we'll give them cookies and tea and fresh juice and then we'll sit down and tell them.  a long time ago we fell in love with east africa.  we knew there was a need and we knew we had some tools that might help. because it pulled and pushed and called out.  because life isn't about being comfortable, it isn't even about being happy all the time.  life is about giving of yourself where you can- where you feel you are supposed to be.  because in life, you do the best you can.  you try to break enough so that you care even more, but not so much you fall apart.  you work and you learn where the systems break down and where you can plug the holes.  you pray every morning that you'll be given the wisdom to know when to make it fixable for one- and for which one.  you allow yourself to cry and you can get up and do it again.

and maybe we do it because we are so very rich in so very many ways.  maybe we do it because my baby boy, who i held in my arms as this woman held her child, just ran across the yard; my healthy, happy, smart almost 7 year old with his no longer big head.  maybe we do it because of a small church in mbale who prayed for that boy- because that is what they could do. maybe because we serve a great big God who answered those prayers and who loves us so dearly and asks us to be lights in this world.  because sometimes being lights takes the form of trying and working in a broken system.  sometimes being lights takes the form of telling that woman my story- to give her hope- in a God who is bigger than the broken system- bigger than her poverty.  sometimes being a light is just being with someone who is standing in darkness.

seeing the trees dance

today i was thinking about pictures and time.  you realize when you're far away from people you love, how important pictures are, to help you feel connected, to remember, to share your lives, to show the moments.  i was thinking how pictures are of the past, even just the recent past.

BRYN AND ME 5 MINUTES AGO

 

 

 

 

 

and how we live only in the present, but spend an awful lot of time not in this minute, not even in today, but in time past or in tomorrow. i thought about how we don't know what tomorrows pictures will look like. someone might have a broken leg or a haircut or piece of new information that breaks their heart.  i thought about how we have no control over the pictures from yesterday or 5 minutes ago, we can't change anything that has happened. at. all. 

but.  we have some say in this minute.  this moment.  (i say as i refuse to respond to bryn tapping my shoulder right now- in this minute- of his new fifth year - on the gorgeous day- on this porch- with this breeze- this lugandan praise music in the distance- this country of uganda.  this moment when he is right next to me, his soft head on my arm, the sound of him chewing bread, bare chested and loose-toothed saying, when i finally turn, "mommy, the trees and the plants were dancing! did you see them?") 

reminding me of this.  of now. of the hair on my arm tickled by the movement of the air, of all the sounds and the scents and the five white butterflies fluttering before me.  reminding me to turn, always, and hear the things inside of that child or the other ones.

and it is these minutes, how we live right now, the choices we make, how we respond, what we see and hear and listen to, that impact the future pictures- or might.  these minutes right now, they are what we have.  because yesterday is gone and we don't know about tomorrow. 

listen to the ones who live so vividly in the present with their wide eyes open.  and look for the dancing trees. 

the journey

it's always interesting to me, when i've started several posts, but finished none of them- and i'm only speaking of the ones i've written down.  i think it means seeds have been planted- that there is a lot brewing inside and it makes me curious- what is in there that needs to come out?
because there is so much in a day. there is so much i want to do- and to be in a day.
but sometimes my life gets in the way. 
so here are the words of someone else, another saturday morning poem.

The Journey - mary oliver

One day you finally knew

what you had to do, and began,

though the voices around you

kept shouting

their bad advice--

though the whole house

began to tremble

and you felt the old tug

at your ankles.

"Mend my life!"

each voice cried.

But you didn't stop.

You knew what you had to do,

though the wind pried

with its stiff fingers

at the very foundations,

though their melancholy

was terrible.

It was already late

enough, and a wild night,

and the road full of fallen

branches and stones.

But little by little,

as you left their voices behind,

the stars began to burn

through the sheets of clouds,

and there was a new voice

which you slowly

recognized as your own,

that kept you company

as you strode deeper and deeper

into the world,

determined to do

the only thing you could do--

determined to save

the only life you could save.