skin deep

we celebrated expat halloween today. 

pirate, skeleton, power-ranger and two of three powerpuff girls- zoe as blossom and i'm buttercup.

we celebrated today because we can- and actual halloween, tomorrow,  is on a school night and following a school day.  today i was reminded that i also like m&m's and plain old hersey's bars, as well as the reeces and snickers. today i was reminded of how quick and fun the prep-time is and how long and slow is the clean up.  face paint. easy on, painful and slow to come off.

we also decided to have a first annual halloween party after the trick or treating.  it was our first time hosting a party here and it was good except for running out of drinking water and making the guests drink sprite despite being high on sugar from all the candy. 

the decor

so this morning, we needed to go into kampala to get the last items for the costumes, the food, and the party. our adopted weekend son cyrus, showed up early and ready to join us and we headed into town.  we got some gas, refilled the tires with air and were back on the road.  after about 30 minutes mike noticed the car was driving strangely.  everything was shakier than normal, noiser and we felt wobbly- especially on my side.  i rolled down the window and looked out at the tires- they looked fine but i agreed something wasn't right.

can you see the lopsided tire? it was like a tire aneurysm. the wall of that part of the tire had thinned out and enlarged- the next step would have been a blow out.  i was so thankful that we'd felt it, and that mike was driving, and is good at changing tires and knowing what to do.  seriously, another example of provision.  i pray every day as i head out on that road- for safety and protection- it was given again today.

i couldn't help but imagine what if this had happened on the way to school with the boys tomorrow in the early morning.  would i have pulled over?  what if the tire had blown?  what if we'd wrecked? do i remember how to change a tire? would i have known i needed too? damsel in distress. 

so much of life is like this- unknown.  so much of the time we are unprepared- or think we are.

about a month ago, i saw my first patient since arriving in africa.  it was one of those non-formal patients- the son of someone who works here.  someone called and asked if this guy could stop by with his son, if i would look at a rash.  a pediatric rash.  a pediatric rash with a fever.  now.  i'm not a dermatologist, and i'm not a pediatrician- so i felt a bit out of my league.  but i am a doctor and there are expectations and i think generally, i ought to know what to do.  but i was, nervous.  it felt like a test.  it felt like my first opportunity to show people that i knew something- that i could do something- that i had a contribution. but it could be my first opportunity to show them the true idiot i am, that i actually know very little and can't do much of anything for anyone.  so i wanted to get it right.  but why couldn't it have been an adult with chest pain?  or a bad cough, or diabetes or pain management?  really God?  my first patient, a pediatric rash?  thanks.

he showed up with his dad, his mom, his little sister and his twin brother.  it was late afternoon and the power was out so i had to meet with them on the front porch where the light was best for looking at rashes.  it was a nasty rash , in many places on his body, and the little guy looked sick- he was warm and scared.  i went through my questions- those ingrained questions that have walked me through years of medical investigation and always lead you through the process of ruling things out, and ruling other things in.  the medical history, the history of present illness, chronic medications, new medications, new foods, onset of rash, associated symptoms, sick contacts, treatments so far, efficacy, etc.

and while i'm listening to the mom answer these questions, i'm thinking that there must be 10 infectious diseases that this could be, that i don't know, that i should know since i now live in africa.  and i'm thinking of how sick they all could make him, and i'm thinking this isn't just some random kid i don't know, but this is the son of someone i see all the time, and i'm thinking about how different things can look on dark skin compared with pale white skin and i'm trying to remember what medicine i brought and if any of it will work and what i should do??  and as the time wore on- i felt indecisive and pressured and that hot under the collar feeling.  finally, i pulled it together.  i reminded myself that i probably did know what this was- that i needed to think clearly about what i thought, what was most likely, and to trust myself, even with a pediatric patient, even with darker skin, even in africa. 
i put my dollar down on impetigo- honey crusted lesions, infected, and i rambled through my luggage and dug out the antibiotics i'd brought for bryn (figuring the dose would be closest) and knowing it should cover staph and strep.  i handed them the medicine, wrote out how to take it, and the name of some topical medicines they could buy at the pharmacy, and my phone number and told them to call me the next day so i could follow up.  then i said a prayer that went something like this-
'please God, heal this little guy, and let me have done no harm."

the next day he was better- and it continued.

it's amazing how much a new situation can still throw me, almost 10 years out of medical school. it always takes getting used to.  it takes remembering that most of the time, we know it- it takes trusting yourself- trusting your knowledge, and experience and your ability to think.  but it also takes caring and follow up.

tomorrow i begin to be a doctor again formally.  tomorrow i start at Reach Out clinic.  tomorrow i'll be reminded of it all over again. why we came, why we are here, what we're doing, and probably that feeling of how little i think i know.  the 'transition' will be officially over.  this life here, will be more here than perhaps it has been.  

i have no idea what tomorrow will hold.  what crazy thing will walk through that door, or curtain, and how it will stretch me to learn more, to try harder, to understand in a new way.  but i'm ready- to jump in- to expand my days. and i'm thankful for the opportunity,  and for a replaced tire, and that the face paint is mostly off. thankful for a new day tomorrow and a goodnight of sleep right now.

our painted glory

it's about to be a beautiful storm.  the wind is cold and there are a few leaves blowing- like the fall in new england.  the far sky is a dark smokey grey and the left over light close by looks like the light in winter- filtered and quiet and about to be overtaken.  i love these transitional moments most of all.

there is something about being outside that i need.  something in the sounds and the space - it's life giving and freeing, even in the heat, or cold, or the rain.

today was filled with more good things.  bryn got a reading award at school,

we celebrated the opening to the library mike designed,

and zoe and i had a good morning at the orphanage. (oh do i love those littles).

the library opening was a big deal.  it is a project that has been in the works for 5+ years from beginning to end- and it came with much work in both fundraising and design.  it is mikes biggest and best work, but what's more, it's what he's most proud of- because it's where his heart is.

“The place God calls you to is the place where your deep gladness and the world’s deep hunger meet.” buechner.
this project exemplifies this.  being here, is the place.

there were many 'big wigs' at the event, and in typical ugandan style it was full of food, pomp and circumstance, and ceremony.  i love this about uganda.  i do.  at every celebration or even meeting it seems there is a formal opening, by a designated MC.  the beginning includes announcing several people and welcoming several more and not leaving anyone important out.  people matter more than time (not a very US concept).  there are many speeches, much applause and a formal closing.  often things start and end late- and that part was a little hard to adjust to, but today, everything ran on time.

it was lovely- the building is fabulous, people were impressed, all were happy and thankful and mike felt very appreciated and honored to have designed such a major building at the university.  i would guess it was a high point in his career.

and then we came home. to a funny, but low point of our parenting career.
the boys had spray painted orange everywhere.  on the porch, the porch furniture, each other's hair and arms, zoe's shoes, judes shoes, even my new boots!.  the side of the house had a giant line of orange paralleling the ground- it was on the posts, on the bushes- everywhere.  it looked like that scene in 'the cat and the hat comes back' when they get pink everywhere before their mother comes home.

let me explain about the orange paint.  to be fair, it is washable, water based and meant for temporary costume hair color.  because this weekend is halloween and i have three eager american children who are bound and determined to celebrate it, even though they live in africa where no one celebrates halloween.  zoe and i are going as two of the three powerpuff girls.  she'd decided to be blossom who has orange hair. now the problem with celebrating halloween in uganda is the costumes and lack there of. but, i must pause to share some halloween baggage.

when i was growing up, i trick-or-treated every year since age six, with one of my best friends, erica.  in general this was a great experience except for the few years there were rumors of razorblades in candy bars or injected poison and we had to painstakingly check all the candy for small holes in the wrappers prior to indulging.  the only problem with trick-or-treating with erica was the costume differential.  erica's dad started working on their amazing homemade-better-than-store-bought costumes, in august- fo' reals'.  i mean, these things were incredible.  a giant dole banana costume, a TV set, a robot.  these costumes were large and complicated and had harnesses inside.  i had my fair share of planned costumes, one year i was a caterpillar- made of felt, once i was a bag of chocolate chips (a painted 30# dog food bag)- but many years i was whatever i could scrounge together that week or even that night before we went to get our candy.  i'll never forget the year that we went house to house and were greeted again and again with "OH! a Heinz Ketchup bottle! how cute!! and what are you dear?"  "i'm a hobo" i said.  my costume consisting of a hat, some mismatched clothes and rouge on my cheeks. 

you might think the appropriate response to my inferior dress up experience would be to retaliate with my children's costumes- to make them the best ever, the most well planned, but instead i seem to prefer the fly-by-the-seat-of-your-pants approach.  this might have something to do with the fact that the only thing i really like about halloween is the candy- and even then, really , only the reese peanut butter cups and snickers.  i mean, if i'm honest and willing to be unpopular, i don't like being scared, and i don't like carving pumpkins.

this halloween bryn wants use his power ranger costume from last year (score!), jude says he thinks he wants to be a vampire, and zoe wants to be blossom, the powerpuff girl with orange hair.  i was in town trying to buy vampire teeth (no luck), face paint (yes! located) and hair color spray.  i eventually found it, but it was ~$12- which i thought was outrageous.  ps- it was really the only thing i was purchasing for halloween.  anyway- i couldn't buy it, but then in typical fashion- regretted it when i got home.  today my friend was in town and picked it up for me- sending it home with the boys after school.

cut to scene arriving home from highlight of mike's career, library opening.

so there we were- one boy covered in orange paint- another one who had clearly eaten the canary- and the hairspray paint can now empty.  that was the part that got me mad.  mike jumped into full dad mode and talked about vandalism and consequences and while the boys were scrubbing the walls and shoes and everything else insight and lamenting loosing their friday 40 cent cinnamon bun allowance for the next 10 weeks to pay for it,  mike and i had to laugh about the highs and lows of our days.  about how quick are the moments of glory- and how fast the reality of life in all it's painted glory settles on us.

but all those moments, like the darkening sky before the storm, are beautiful just because they are.