FIT TO BE SEWN

ADAM

2011-12-31T21:26:00.000-08:00

The moon has gone down. I walk in the dark with only the stars and the promises
of yore to light my way. I make my way past the silent benches that all day
held crowds singing in French and Nangjere as the drums pounded out their
mournful beat. My body is as limp as the pillow I carry. Every last tear has
been wrung from my eyes. I make my quiet pilgrimage to the site of my greatest
sorrow. I enter the room that holds so many memories. As I open the rickety
lock I remember locking that same door from inside as I cared for two little
African babies struggling for their lives while outside men fought to end each
others. The faint odor of bat guano greets my nostrils and makes me think of
the time the winged mammal hit the fan and landed on the face of the baby
fighting for breathe in the clutches of an asthma attack. I shine my light on
the IV slowly dripping into the arm of my sweet little daughter, Miriam, as she
tosses and turns in a fitful slumber. Sarah lies by her side in the mosquito
net softly comforting her one remaining child. It seems like an eternity
already since the morning when two babies wiggled and squirmed and flipped and
grinned and giggled and squealed together in that same tent.

Sarah woke me up less than 24 hours ago. "The twins are really active and I'm
having a hard time. Can you come over?" I arrived to see Adam staring at me
with a silly grin right before flipping off the mattress between it and the net
and letting off a howl of frustration.

"You should have seen them. They both woke up, looked across the mat, grinned
and tried desperately to crawl to each other," said Sarah.

We'd arrived in Bere the day before. Thursday night, Adam had a fever of 104.
We were in N'Djamena and I bought a rapid malaria test. It was negative. I
wasn't convinced. I opened a capsule of Artemesia, poured it on his mashed
sweet potatoes and fed him despite his obvious preference for medicine-less
food. The next morning, I fed him another dose and we loaded up the scalded dog
and were on our way to Bere by 6:30am. By 2:30pm, both Adam and Miriam had been
diagnosed with Falciparum malaria and started on IV Quinine. Through the night,
they each got two of the every 8 hour doses.

I start Miriam's next IV perfusion and turn to Adam. I let 150 mL of 10%
glucose solution run from the IV bottle into the pediatric reservoir on his IV
tubing. The tubing has special air traps to avoid any accidental entry of air
into Adam's veins. I pull out 0.5mL to flush his IV and then carefully measur
90mg (0.3mL) of quinine and inject it into the top of the reservoir of 150mL. I
open up the IV, see that it was running well and slow it down to a drip.

I turn to look at Miriam and talk to Sarah.

"Is that a seizure?" Sarah interrupts our conversation and we turn to look at
Adam. He's not breathing. We start CPR. I run and get some 50% glucose
solution, afraid of low blood sugar. I text Olen who is there in minutes.
Still no breathing. Olen confirms a heartbeat, slow and irregular, but there.
Olen gets a bag valve mask and starts breathing for him while I do chest
compressions and Sarah continues to give glucose. Anatole arrives and checks
the blood sugar. It's high from all the glucose we've been giving him. We try
Adrenaline in ever increasing doses. His heartbeat never picks up. Every once
in a while he grimaces, groans, struggles for a couple breathes, giving us hope.
We work on him for over an hour. His heartbeat disappears. His pupils are
fixed and dilated. I'm praying desperately for a miracle. We stop.

Deja vu.

How many years ago did the same thing happen to my friend Gary and his little
boy Caleb?

It's 8:00 am and my life has suddenly changed for the worse. Sarah and I hold
Adam's still warm body. I desperately kiss his neck, my tears know no bounds.
My cries echo across the campus to join the thousands of others I've heard over
the years in this corner of Africa. Will I never again see his tongue half
hanging out of his silly grin? Will he never again wrap his legs around my
arms, brining my fingers to his mouth as he softly coos? Will he never again
thrash his arms in legs while staring at me with a look of pride and joy? Will
he never again take up the airplane position looking around for confirmation of
his abilities? Not in this life.

A day long ritual of African mourning begins as the news spreads like wildfire
through the village. People come to offer their condolences. Miriam becomes
agitated with all the visitors. I wrap Adam's body in my green and black
checked Arabic head scarf and carry him over to the house where friends have
arranged to let the mourners come in and visit. All day long the songs sung in
rhythmic Nangjere drift in as people make their way to where I am sitting on a
thin Nigerian mattress. So many people, so much collective pain and loss.
Salomon comes in and hugs me. A flood of tears bursts forth as I remember him
holding Adam so many times as we ate together in Moundou, enjoying one of his
famous sauces. Frederic kneels down and holds my hand long and hard in an
undulating shake of sympathy. Just last year I was at his house as he held his
son who had just died. The mother of the boy across the street who fell down a
well and died crouches and holds my hand as we share tears of sorrow and she
offers words of comfort and hope.

The steady stream of people brings me a steady stream of tears as I shake and
hold the black calloused hands of so many people who's lives have been filled
with loss. The strength of the grip and the power of the muscular arms of both
men and women combined with their roughened feet tell a thousand tales of woe.
Their is no awkwardness. They've done this before a thousand times. Tears come
from faces I've never seen before. But we now have a common bond of tragedy.
The only ones who seem uncomfortable are some of the westerners, but their warm
embraces make up for the lack of familiarity with death.

Gary and Wendy fly in from Zakouma just in time for the English portion of the
day long wake. Hymns of hope sung gently and powerfully by the many musicians
in our group of Nasaras warm my soul as Sarah holds Adam's now cold and
stiffening body.

"When the trumpet of the Lord shall sound and time shall be no more...when the
roll is called up yonder I'll be there." The rollicking song brings bursts of
tears from Gary, Wendy, Sarah and I as we remember Caleb's favorite song and the
other little foreigner buried in Bere what seems like ages ago. Now it's time
for last good byes. Sarah and I bring Adam's long little body into the house
and place it gently in the casket made by Jamie just this morning. I kiss his
cold brow one last time and we put on the lid.

The pathfinders are outside to carry the body to the grave site. Under a little
tree in front of our old house in Bere lies a volcanic stone with a little
plaque that says "Dinah Bindesboll Appel". Next to it is a deep, rectangular
hole waiting for our second child to return to the African dust. Noel gives a
stirring eulogy reminding us of the day when God will say "Viens" to both death
and the devil and both will be done away with forever. Then God will turn to
Sarah and James and say, "Here's Adam." And to Gary and Wendy, "Here's Caleb."
And the innocents will be restored to their rightful place.

But for now, we miss him terribly...

RIP Adam, June 25-December 31, 2011

MERRY CHRISTMAS

2011-12-25T12:20:00.000-08:00

"For unto us a child is born, unto us a son is given:
and the government shall be upon his shoulder:
and his name shall be called Wonderful, Counselor,
The mighty God, The everlasting Father,
he Prince of Peace."

Isaiah 9:6

6 PAC

2011-12-03T22:30:00.000-08:00

I always love when the Christmas season arrives each year. The lights, the beautiful decorations, the yummy smells, greetings from friends far and near and getting together with family just warms my heart. I have barely started my shopping but had better finish quickly because most of the gifts have to be mailed this year.

Tonight I should be working on figuring out just what I will get everyone but instead I am considering joining the 6 Piece Winter Collection that runs from November through January. Kinda crazy to start at this late date, but so fun to plan.

The requirements for this sew are as follows:

Winter coat - neutral
Overlayer top, jacket, cardigan - neutral
Overlayer top, jacket, cardigan - color
Underlayer top - neutral
Underlayer top - color
Trousers - neutral

Seems pretty doable so I looked until I found patterns I thought would work for each category.

The only pattern that I have made before is the top right jean jacket. I had to spend some time getting it to fit and although not perfect I made it out of a cotton stretch material that I just love. I will tweak it a little and make it out of a white corduroy that should go with quite a number of garments.

My closet is filled with lots of black and white so to change things up a bit I thought I would have my main neutral be navy. The only down side for me was figuring out what color of shoes I would need to wear with navy. The last time I was shoe shopping I did not see any navy shoes so having a navy wardrobe didn't seem like a really smart idea.

So I did some research on the internet to see if there was another acceptable color to wear if you didn't have navy shoes because I was taught that black was never worn with navy. To my surprise the dress code in 2011 allows for black shoes to be worn with navy as are brown and cordovan .

I think I'm going to like this.

Cabazon

2011-03-29T23:17:00.000-07:00

There's nothing like a trip to Cabazon Outlets to get a person thinking about sewing again. My daughter and I decided to meet at the outlets and see what fun clothes were waiting for us. Oh, my, what a disappointment! Things are bad when you would rather look at the purses and shoes that anything that was folded on a table or hanging on a hanger.

Is it my imagination or are stores carrying less merchandise that they used to? Ann Taylor had a small selection, Liz Claiborne - closed, Ralph Lauren - a darling white blouse with bias ruffles and our favorite - Tahari. Of all of the stores and merchandise we looked at, the dresses and jackets at Tahari were to die for. The workmanship and details on each of the pieces were beautiful making the garment look stunning on us regular people. But other than that stop the trip was a bust.

It may be next week before I get around to it, but it looks like I will be looking through my skirt patterns and coming up with a few possibilities so I can eventually find one to be my TNT.

The shopping trip might not have been such a bad thing after all!

No Sewing

2009-12-05T15:54:00.000-08:00

What was to be at the longest just a month stay in Tennessee to work on our store has turned out to be four months and counting. In this present economical climate that is so unsure we weren't quite sure what to do to make our store competitive so we turned everything upside down and have redone about everything...starting with painting every piece of wood furniture, then remodeling the furniture to serve other functions and adding beadboard to the backs of all of the wood shelving. We had to use oil based paint so that the paint wouldn't chip but the smell just about knocked me out. As bad as it was to complete this project while we still had the store open and were doing business I am thrilled that we did it. It looks clean and neat and it's a pleasure to go to work now. Monday we add deli items and until we can hire a good cook I will be spending my day doing the menu and cooking.

So......no sewing.....yet! Well, almost none - I brought my coverstitch maching and was able to get it to work sewing binding on an apron. It was so much fun and I can hardly wait to have more time to spend playing with it.

I found this video and video two on you tube that showed a method of making bias binding that I had never seen before. I tried it and was really pleased with how it turned out and how much I was able to get from a yard of fabric.

The good thing about being here in Tennessee is that I am getting to spend lots of time after work with the grandchildren so I can't complain at all.

Poop

2009-11-06T19:21:00.001-08:00

From James:

Silently the man slips stealthily through the shadows of a dark Chadian night. The Bere Adventist Hospital has become his temporary domain. His child is hospitalized for severe malaria and a blood transfusion is slowly dripping life back into his fever wracked body. The man has sinister motives. He really needs to go.

The hospital has had trouble for years with patients relieving themselves in piles on the ground in the tradition of the African bush. Despite the availability of latrines, the smell and foreignness of the cement structures is revolting to someone used to the pleasant peacefulness of natural surroundings and soft grass or sand. In the 90's a resourceful night watchman named Jairus made successful war on the perpetrators by taking the pile in a rubber gloved hand and moving from bed to bed wiping some of the stool on each bed until someone confessed or turned in the guilty party who then had to go out and bury the leftover turds.

The problem only got worse with the building of a fence around the hospital in 2004.

Now, this evening, maybe the tide will turn as our unknown man makes his way quietly past the operating theater to the outside water faucet. Taking a comfortable position squatting flexing and stretching his thigh muscles the man pulls down his pants and stretches out his hands to get a firm grip on the metal water pipe coming out of the cement slab he has chosen as his receptacle. Suffering from a common Chadian ailment, his knuckles turn white as he strains to force out the poop hardened in his dehydrated and constipated colon. A sigh of relief accompanies the success of his mission until a bright light suddenly blinds him and a harsh cry of "Ca c'est quoi?!!" brings to an end his devious deed.

Literally caught with his pants down the man hurriedly tries to cover his naked manhood as Jean-Jacques, our vigilant gatekeeper hauls him roughly to his feet. It's a little after midnight but our new administrator, Augustin, comes immediately from home.

Punishment is swift. The gendarmes are called. The man is forced to pick up his ca-ca and stuff it in his pocket before being escorted off to prison. He was last seen weeding the flower garden in front of the jail.

Moonlight

2009-08-05T23:39:00.000-07:00

Life has been hectic and there has not been any time to sew - haven't even really been able to try out my coverstitch machine! Two weeks of showing my dad and his wife the sights of SoCal and then hopefully I will be back producing something to wear!

From James:

I could never have imagined that things would turn out they did.

As I stare out into the moonlight filtering through the flamboyant tree branches casting shifting shadows with every breath of wind, as I hear the soft shuffle and breathing of our sweat-flecked horses outside the stable, as I draw my gaze back to the pile of pineapple carvings in front of the cutting board and bring the ice-cold pineapple to my mouth and slowly savor crunching into the juicy morsel, as I think back over the past few days I find it incredible to think of how this afternoon ended...I can only call it an unexpected grace, a surprising joy, a metaphysical moment when all things good come together out of the midst of all things wrong.

As I gallop through the forest, grasping Pepper's mane as fiercely as I hold to the reins; as I stand up in the stirrups and hug my body to the horse's powerful neck; as the leaves slap my face and a branch rips through the skin of my shoulder; as the full moon lights up the sandy trail like a river of silver stretching lazily out before me through the dark shadows of the trees; as my sweat soaked shirt clings to my back; as I am surrounded by the silence of an African evening in the bush I find myself carried way beyond the horrors, sorrows and sufferings of the last few days.

I can hardly remember the strong features of the handsome Arab man staring steadfastly upward with a look of incomprehensible peace as he is lugged up the ramp to the operating room in a vinyl stretcher with wooden handles held firmly in the grips of a dozen turbaned comrades his mangled body wrapped in a blood soaked turban in stark contrast to the serenity of his gaze. I almost forget the hours of working on his bilateral open fibula and tibia fractures uncovered on his right by a flap of skin running from his heel and achilles tendon up his calf and across the top of his foot revealing the anatomy of the muscles, tendons, ligaments and bones as I can only barely remember from Anatomy lab in medical school. The almost can't bring up the vague memory of him calmly complaining of neck pain since he can't move or feel the rest of his body is a silent grace to him allowing us to work on his tattered limbs without anesthesia after framing his chiseled face in a cervical collar. I thought I'd never survive the emotional roller coaster of the myriads of swishing robed, turbaned men and brightly wrapped head scarved women that filed incessantly in and out, many of the men leaving with tears unashamedly rolling down their cheeks as I had to console them to leave all in Allah's hands as only He can know the day of our death and we should trust Him. The memories flood in of fighting my way through crowds and over colorful mats and rugs to try and do his complicated dressings after spending what seemed like ages of emotional energy trying to get the swarming family and friends to respect visiting hours and hospital policies. When his paralysis didn't get better after three days I was almost relieved when the nurse came to get me yesterday morning to say "Ca ne va pas" and I arrived in time to see his unconscious, but still dignified face take it's last shallow breaths and feel his heart beat in his neck slow down and become weak. He was bound for a long road of suffering in this environment as a quadriplegic and it was certainly God's mercy that laid him to sleep.

As I stand on the bank of the river, looking down on the swirling eddies of the brown, engorged river; as I see the sun slowly set behind the great branching trees of the African plain; as I turn around and see the full moon rising through a circle made by two rounded trees and a small hill; as I watch the slow transformation of the day into moonlit night; as I feel the wet of the river slowly drying on my body; as I watch Stefan desperately trying to capture the moment on film; as Eddie slowly makes his way upstream against the current; as I pull on my jeans over my moist swimming suit and prepare for the ride home; as untangle Pepper from the bush I've tied him to I am amazed at how quickly depression and overwhelming burnout can be replaced by wonder and marvel and ecstasy.

Can it be that only this morning I found myself deep in a belly under the ribs carefully cauterizing a gallstone filled gallbladder from the liver of an elderly, lighter-skinned Muslim man? Is it possible that yesterday I was about to throw up and finally gave in and started taking malaria treatment only to go out immediately and take out an ovarian tumor stuck to all the intestines, omentum and uterus? Is it possible that only two days ago I didn't think I'd make it through the morning much less the weak because of fatigue I refused to believe was another bout of Plasmodium falciparum destroying my blood cells? Is it possible that only three days ago the hospital was full to overflowing while we spent all of a Sunday afternoon filling it up with sick babies needing blood transfusions and malaria treatment? Is it possible that only four days ago I spent all Saturday in the OR with two motorcycle accidents needing emergent orthopedic intervention? Is it possible considering how things later turned out?

I come back from work almost collapsing. It's been another day of neverending hospital rounds, complicated surgeries, ER patients, ultrasounds all pleasantly muffled with the ringing of Quinine in my ears. I feel a little nauseated and drink some cold water. I sit down and finish reading "Flying Doctor of the Philippines". I just want to sleep, but decide I better go out and feed the horses to keep my wife happy. The next thing I know I'm in the saddle trotting past the mud huts of Bere, around the pond, through the forest and onto the river road mounted on Pepper while Stefan rides Bob and Eddie rides Libby. Out into the open Stefan and Eddie cluck their horses into a gallop. I can feel Pepper tensing beneath me and I give him the releasing cry and squeeze and he quickly closes the gap and passes the others through a mud puddle as Bob goes left and Libby goes right around it. We're in the open now and I slow down. We arrive quickly at the river ride down the ridges gauged out by the rain leading to the cattle crossing and then climb up the hill next to it. A quick assessment confirms the possibilities and Eddie and I strip down and race off the cliff arms and legs flailing wildly before crashing into the swift moving current below. It's not enough for Eddie, so we find ourselves pulling our reluctant bodies up the bank using exposed tree roots before climbing up the tree as high as possible with still a path clear of branches to the rushing waters below. I crouch on two diverging limbs my hands in front as I propel myself through the gap, past the other branches below and into the welcoming arms of the cool, refreshing liquid beneath. I'm glad there are no crocs and lions in this part of Africa.

As Eddie and I climb up the bank for the last time after multiple jumps from different levels, Stefan's face is glowing. It's hard to believe just last night he was talking about maybe wanting to leave. Now all he says is, "the only thing that could make this better would be a little ice cream."

Later as I walk through the cool of the moonlit evening from my house to his carrying the plate of chilled fruit I think to myself, "well, cold pineapple could arguably be as good or better..."

Then the clapping comes again...it's Salomon...

"There's an old man peeing blood since this morning..."

And I'm off to the hospital as the moonlight leads the way.

Coffin

2009-06-12T09:34:00.001-07:00

From James:

When I first saw the coffin it was half-finished. Lying amidst a pile of saw dust, it was a crude little thing, but somehow appropriate. Hard, twisted redwood had somehow been fashioned into a 3 foot long box with bottom, back and sides just waiting for the front and top to be able to enclose a little boy's body.

As I walk up to the container where Jeremy and Jonathan are making the coffin, I am struck by the cold beauty of the surroundings. A steel blue sky with gray angry clouds releases a slight drizzle of rain onto the African plain watering the wet sand and scrub bushes. A smattering of mango and Shea butter trees break up the monotony of the flat expanse. A group of tired grave diggers rest against the trunk of a tree to the right. Straight ahead is the beginnings of Gary's airplane hangar with the two old 20 foot containers making up the end of the hangar. Around the half-open doors of one container is gathered a crowd of mostly children with a smattering of adults all peering intently at the two white men making a coffin.

The purr of a small Honda generator is broken intermittently by the harsh roar of a power saw and the shocking pounding of large nails into hard wood. A cool breeze tries to soften the atmosphere which is heavy with grief. I squeeze through the crowd just in time to help Jeremy and Jonathan lift up the coffin, measure around and make the final trimmings. The wood is so hard that holes have to be drilled before nailing or the nails will bend. We place the small head piece on and Jeremy hammers the nails home. The only thing left is to place a small boy, recently alive and well, into the interior and hammer it shut until resurrection day.

The Adventist Youth Society has arrived in their sharp olive and tan uniforms. Jeremy, Jonathan and a couple of local men pick up the heavy burial box and lug it over to Gary and Wendy's humble abode. They place the casket gently on a simple wooden bed on the porch and wait for the final step.

Cherise, Gary and Wendy's two and a half year old daughter, runs in with a smile proudly showing off the cartoonish horse and car that Sarah has drawn on the back of her hands with a green marker.

It's almost time. Neighbors and friends are gathering outside. The rain continues to sprinkle the event as lighting flashes occasionally in the background. Gary looks at me. We walk silently over to the coffin and pick it up. It's rough and twisted wood bites into my hands with the weight of it's import crushing me more than it's physical gravitational force.

Followed by Wendy and Cherise we enter the house, pass through the living room and into the bedroom to the left where Caleb awaits, cold and silent. He is peacefully lying on the floor next to the two mosquito net covered mattresses where he slept with his sister. A small, baby blanket covers most of his lifeless form. Gary and I gently set the coffin down next to him. Gary lifts him up while Wendy arranges the blanket and smoothes it out over his face. Gary picks him up gently in his arms, tears streaming from his red and swollen eyes.

"Let me hold him one more time." Wendy's voice is deep and broken as she hugs her first born son for the last time on this earth.

"Cherise, do you want to kiss Caleb one more time?" Gary asks softly.

"Yeah, daddy..." She approaches wiping away a stray strand of pure, blond hair from her cherubic face. She leans forward, lips puckered, and places a tiny kiss on the top of Caleb's pale head.

Gary covers Caleb up again and lays him in the coffin. He fits too well. This shouldn't be happening. I sob quietly, letting the tears flow freely.

We take the even heavier coffin out to the porch where Jeremy expertly pounds the last nails home with a devastating sound of finality. It's definitely time now.

The uniformed young people wait outside. Gary and I place the coffin on the shoulders of six young Chadian girls who will bear the honors.

"Left, left, left-right-left..." The solemn march begins as we all fall in behind while the young people sing a mournfully echoing marching song about following Jesus no matter the cost. The procession winds out the gate, around the fence, past the water tower and out towards the airstrip.
Gary's plane stares silently, it's windows covered with a tarp as if even it is too grief-stricken to observe the final steps of the young boy who loved so much to greet his daddy's return from mission flights or climb all over the cockpit dreaming of the day when he too would fly.

We march across the deep red laterite surface of the airstrip, cross a sandy path, pass through some low scrub brush and arrive at the six foot deep hole that will be Caleb's resting site until the end of the world. A pile of sandy clay with two hand made ropes strung across it lays to the side of the grave. The coffin is marched around the hole and deposited carefully on top of the ropes and dirt pile. A crowd has gathered. The wind blows. The rain falls. The universe mourns.

The service starts with a couple of French hymns that have never had much meaning for me until now.

"Jusqu'a la mort, c'est notre cri de guerre, le libre cri d'un peuple rachete, jusqu'a la mort nous te serons fideles..." (Even unto death, it's our battle cry, the free cry of a redeemed people, even unto death we will be faithful...) Even song off tune the deep feeling of those singing it penetrates to the bottom of my heart. We are free, we are at war, their are casulties, but we don't mourn as those who have no hope...we will stay faithful...my heart wants to believe it.

"Et mon coeur n'a rien a craindre, puisque tu me conduiras. Je te suivrai sans me plaindre en m'appuyant sur ton bras." (And my heart has nothing to fear, because You are guiding me. I will follow You without complaint, leaning on your arm). A cold chill runs down my spine as I feel the presence of God. He is present. He weeps with us at this tragedy. We have nothing to fear.

After I give opening prayer, Andre exhorts us with a little eulogy reminding us that death is a sleep, that our hope is in the resurrection when Jesus comes again to reunite all of us who have abandoned our rebellion against him. Caleb's suffering is over, it's those of us left on earth who suffer, but Jesus is coming soon to wipe every tear from our eyes and destroy our last enemy, death.

Then, Gary talks about how much Caleb loved to talk about Jesus and his second coming and then he had us sing together Caleb's favorite song in English:

"When the trumpet of the Lord shall sound, and time shall be no more...when the roll is called up yonder I'll be there!"

Unfortunately, as the local gravediggers go to lay the coffin in the tomb they realize they've made the hole too small. As they rush to and fro quickly to dig the grave larger, the chorale saves the day with a some traditional, echo and repeat style African songs. Finally, the modifications are made and the coffin is slowly lowered into it's final resting place with the help of the rough ropes.

As the dirt starts to be shoveled on top of the coffin, Cherise seems to realize a little what's going on. Her heart-breaking cries and tears tear us all apart. Gary crouches down gently beside her.

"What is Caleb doing right now?"

"Sleeping, daddy."

"And when will he wake up."

"Oh yeah, when Jesus comes." Her face lights up a little and she wipes her eyes as Wendy picks her up and holds her close.

As the crowd starts spontaneously singing in Nangjere, the grave-diggers expertly create the funeral mound. A handmade hoe, a stick and the end of a shovel pound and stir the earth into place as two other men shovel the earth in and continually pick up what has fallen to the sides. Then with some final pounding with the flats of the shovels a perfectly oval mound arises as only those who've seen much death and assisted many funerals could make it.

We then turn to follow the Advent Youth as they lead us back singing the same marching songs. Arriving at the house, we follow local custom by seating Gary, Wendy and Cherise in lounge chairs along with the other participants in the memorial service while the mourners pass one by one to greet. The women curtsy and bow while solemnly shaking hands, often with two hands or the second hand touching the forearm of the right hand as they shake as a sign of respect. The men shuffle and nod somberly as they hold the hands for a long time and silently let you know they feel your loss (and they all have lost children so it means something). One crippled man on crutches hobbles in and hugs both parents while tears stream down his cheeks.

Finally, the kids file in for their respectful shaking of hands as the adults take a seat on mats spread out behind the choral which has been singing French hymns without ceasing. Annie and some of the local women serve Kool-Aid. People quietly converse. Occasional sobs burst forth. Laughter is sometimes heard. Gary and Wendy are periodically called away by phone calls from well-wishers around the world.

Dusk approaches. Noel rises and calls an end to the wake with a prayer. They graciously don't insist on their custom of singing, dancing and drumming all night long. Instead, everyone files solemnly out shaking our hands one last time. About this time, Rich and Anne, our friends from N'Djamena arrive.

The sun sets on a day that started out as any other day and quickly tumbled into an early morning ER call, a desperate last ditch effort and the laying to rest of a four year old boy in a crude, twisted coffin, resting peacefully in the African bush through the rest of this world's turmoil until the end of the world and the beginning of the next when God will wipe every tear from our eyes and our last enemy death will die as we all are reunited with those we have lost.

Tragedy

2009-06-10T08:41:00.000-07:00

From James:

"Hurry to the ER! James! Run!" The familiar words come not in the usual African French but in the familiar English of our friends, Gary and Wendy Roberts (our mission pilot & his wife, based in Bere) as they whiz by the house on their motorcycle.

I'd just gotten up a little before 5:00am to write email when I heard the roar of the moto and the cries of the anguished parents.

I quickly pull on some scrubs and rush out the door where I run into Sarah who's just come to get me. She is just finishing up a night shift in the ER. It's about 6:00am.

The hospital is bathed with an early morning tranquility that would've been soothing on any other morning but this one.

I arrive at the ER and see Gary bent over his son, Caleb, giving him mouth to mouth as his pale, limp body wants to sink into the top of the desk he's lying on.

"He was still breathing as we were coming but he just stopped. He has no heart beat!"

I start giving chest compressions as I bark out orders to Sarah, Wendy, Koumabas, Hortance and Augustin who luckily happens to be there.

"Get some IV glucose and some IV tubing!"

"Someone look for an IV!"

"Call the lab for a hemoglobin and glucose check!"

"Get the pulse ox from the OR!"

As they rush off to find the material I look closer at Caleb. His body is flaccid, his face is pale and haggard, eyes closed, mouth half open, a mild gurgling coming out of his throat with each chest compression. He has no heart beat and his lungs sound filled with fluid. His belly is soft with an enlarged liver.

Gary takes over chest compressions as Hortance hands me the D5W attached to some IV tubing which I quickly insert under the skin of his stomach for a subcutaneous perfusion of glucose in case his blood sugar is low.

"Give him half an ampoule of IV furosemide IM.

Augustin is patiently searching for an IV on Caleb's small, white hands and arms. Sarah arrives with the pulse oximeter. We continue chest compressions. The O2 sat is 15%. I have Gary start rescue breathing again. The pulse ox stops working.

"Sarah, get some Adrenaline and Atropine from the OR!"

Still no IV.

"Koumabas, get me a blue IV catheter and a 5cc seringe!"

I keep doing compressions while Gary does two rescue breaths every 10 cardiac compressions.

Wendy has come back with an epi-pen and accidentally sticks her thumb with it instead of Caleb's leg.

Sarah gives Adrenaline and Atropine intramuscularly.

I listen and detect a faint, slow heart beat.

We continue CPR.

"Wendy, find me one of those small red, urine catheters in the OR so we can empty his bladder!"

Koumabas gives me the IV catheter with which I miraculously find his right femoral vein on the first try despite feeling no pulse and am able to thread the catheter in. I attach the IV glucose bottle and let it run in.

Meanwhile Mathieu has arrived and now has the results: hemoglobin a little low and blood sugar extremely low.

Wendy returns with the foley and Augustin drains Caleb's bladder. Calebs lungs are clearer. He still has a faint heartbeat.

"Sarah, inject the Adrenaline as rapidly as you can....now!" I quickly pump Caleb's heart has fast as I can with my external compressions to get the medicine to his heart.

"Sarah, take over chest compressions, I'm going to find some Magnesium in my office!"

The magnesium goes in the IV fluids and slowly trickles in.
Gary still does rescue breathing. Wendy offers to take over but Gary wants to keep going.

"Mathieu, can we do a Potassium?"

"Oui!"

I draw a milliliter of dark blood from Caleb's femoral vein and Mathieu hurries off to the lab.

CPR continues. We've been going for 40 minutes.

I listen to Caleb's chest. No heartbeat.

We continue CPR.

"Sarah, more atropine."

Gary speaks up after his 2 rescue breaths. "Should we stop?"

"Let's go just a little more."

Atropine is in. We continue CPR 5 more minutes.

I listen to Caleb's heart...

Nothing.

We stop.

Gary and Wendy collapse weeping into each others arms as sobs explode from within my chest. I grab Gary from the side my arm draped across his neck. Sarah is on the other side hugging Wendy.

Gary solemnly wraps up the still, little body.

"Do you want to use the van? We can drive you back home."

Gary turns to Wendy, "No, let's just put him between us on the motorcycle and go home."

"Anything we can do?"

"No, we just want some alone time. Then in the afternoon we'll have a service." The trudge out to the motorcycle, the quiet bundle in Gary's arms.

Tears streaming down my face I walk slowly back home thinking back to September 3, 2001 when I also found myself stopping CPR on someone I loved and sadly giving them up temporarily into God's hands. Just like then when I told my twin brother, "I know where you'll be...I just better make sure I'm there as well," I think the same thing about little Caleb and can't wait to see him again, maybe even by my brother David's side, when things are finally finished down here.

But, meanwhile, I'm back home sobbing like a baby. Sarah walks in and kneels down in front of me. We embrace and cry together. Outside, the wind is blowing, whipping up a storm. It starts to rain. God is crying too.

SWEAT

2009-04-19T12:05:00.001-07:00

From James:

I'm trying not to move. The feel of sweat trickling slowly down my face is not as bad as feeling the stickiness of my back against the cheap mattress. Crickets and other night insect sounds are the only relief from the otherwise oppressive heaviness of the still, hot Chadian night. I am lying down on Gary's porch listening to the Pineapple Story on Gary's MP3 player. Trixie, Caroline and Stefan are there along with Wendy, Jeremy and Annie. It's a boring Saturday night in the bush and we've just polished off the popcorn that Gary somehow thought would be better with left-over pesto sauce.

Gary's phone rings.

"It's for you!" Gary hands me the phone.

Jacques is on the other end. "We have an open tibia fracture that just came in."

I drag myself out of the pool of sweat that has gathered underneath my half-naked body and pull on my shirt. Stepping outside I feel a slight change in temperature from about 110 degrees Fahrenheit to about 100. I slip on my Tampa Bay Buccaneer Crocs and swing into the saddle. Sarah's in N'Djamena welcoming Dr. Bond and his team back to Chad so I'm riding Pepper, aka Mini Seabiscuit.

It's pitch black, no moon and while the stars are brilliant they only give a vague outline of trees and shacks from time to time. Pepper likes going home as quickly as possible and I can feel his muscles tense in expectation under my thigh as he stamps and snorts while I wait for Trixie who's riding Bob.

A slight release on the reins and Pepper starts out at a fast walk which quickly turns into a fast trot. Up and down, up and down I keep in rhythm with my fast little pony's cadence. Suddenly, things smooth out and the wind kicks into my face as Pepper leaps out into a gallop. Unknown dark shadows are hurtling by right and left. The road is windy and while Pepper somehow knows the path I can't anticipate in order to keep my balance. I'm hanging on by a thread when he suddenly turns left. My right foot pops out of the stirrup but I manage to stay on and with a quick pull Pepper comes to a stop. Sarah has trained him well and I'm grateful as I'd have certainly fallen off if I hadn't been able to stop quickly.

Feet back in the stirrup and we're off again on our mad dash to the hospital. The 2-3 kilometers whirr by in a matter of minutes as we pull up to the front gate. Lazare runs up to open up, I unsaddle at the stable and rush home to change into scrubs.

In the ER, a light-skinned Fulani man sits with his left lower leg twisted and contorted in a pool of blood draped with a dirty cloth. We hurry him off to surgery as Samedi calls Simeon and Abel.

Washed, scrubbed, prepped with Betadine, draped with sterile towels and anesthetized with Ketamine (aka Vitamin K or Special K for you US druggies) the leg still looks bad under the glowing overhead lights. We pray and I take a 10 blade scalpel and enlarge the wound inferiorly down the middle of his shin to expose the fracture. It's a clean, 45 degree angle brake. I wash, scrub and irrigate with liters of Dakins and normal saline. I put the bone back in place and have Abel reach under the drape and hold it in place while I suture up the wound leaving just the most superior part of the original cut open.

Breaking scrub but leaving one hand sterile, I grab a cordless drill and insert a threaded Steinmann pin. I slice open a tiny hole and start to drill the pin into the lower tibia. The drill runs out of power, it hasn't been charged.

Now what? I call for some hand drills, they finish the job on the lower pin but I can't get the two upper pins started. I completely scrub out and walk home. I find another drill with a cord, saw off a couple pieces of old PVC pipe, wash the mud out of the center of the pipes and come back to the OR. I put sterile gloves back on and drill in the last two pins. Then I make sure the bone is still aligned and drill holes through the PVC pipe so the pins can be hammered through holding the bone in position.

As I'm finishing, Simeon tells me that he thinks his jaw is broken. Sure enough, his mandible has at least two fractures leaving the front part of his lower teeth completely mobile. I search for and finally find some 4-0 steel sutures. I twist tie one of them around the tooth on the posterior side of the right sided fracture and another one on the anterior side. Then I have Jacques push the jaw into position while I twist the two ends together to bring the two teeth (along with the mandible) back together. I do the same for the left fracture. It's still unstable. I then do two more teeth on each side of the fracture and the corresponding teeth on the upper jaw and wire those together so his mouth is completely wired shut with his teeth coming together in a functional position.

It's then I notice that my shirt, pants, surgical cap and hair is all soaked despite the courageous efforts of the small AC unit. I take a few bried moments of pure heaven with my faced almost pressed against the cold air coming out of the AC before going home to my own personal pool of sweat.

COVERSTITCH II

2009-04-17T14:32:00.000-07:00

I really can't believe that I finished my search for a coverstitch just this morning. I have searched the internet, visited 4 stores in the area and finally drove to San Diego in search of the Babylock BLCS. Ah, the sweetness of success - I came home with the machine that I was searching for. So I will be spending some time getting acquainted with this little jewel because I am expecting great things from it as far as sewing knits and attaching bindings. Actually can't wait to do an update with pictures of sewn garments...we'll see!

COVERSTITCH

2009-04-14T19:09:00.000-07:00

Today was the day I had decided to compare three different coverstitch machines, the Babylock BLCS, Janome 1000 and the Brother 2340?, to see which one I felt the most comfortable using. I had tried the Janome before and thought it was okay although the one I tried didn't make a great stitch. I thought that there would be no problem finding these models at a store nearby, to see a demo and sew a few stitches myself to see if I liked how they handled. I found 6 stores in my So. Cal area that carried Babylock and only 1 store even has a Babylock BLCS to try. I haven't found a Brother 2340 yet. Who would have thought!

I did contact a place in the San Diego area that had the machine I was looking for and they told me that they could not sell to me if I didn't live in their area - in fact it was one of the first questions they asked - what's up with that?

Oh, well, I am off tomorrow morning to see if I can't snag me a coverstitch machine of some kind...I am really looking forward to bringing one home!

One More

2009-04-03T11:13:00.001-07:00

We are leaving for the last of the memorials for the plane crash victims. What a hard two weeks it has been for sure. On the positive side, there is great comfort in grieving with your friends and loved ones. Somehow you come back a little stronger and able to face life one day at a time. I am so glad for the hope of another grand reunion!

I finally put a couple more pieces of fabric through the washer and dryer in anticipation of really hitting the sewing machine on Monday...I only have to churn out 2 1/4 garments each week to finish on time for the SWAP. I'm thinking that the busyness of getting it done will be a great mind relief and I'm looking forward to it.

While at Hancock's one day I saw this great piece of fabric - rather like candy apple green or maybe chartreuse that was labeled as silky wool but on the selvage it had Donnegal Linen Ireland. I asked the help just exactly what the fabric was and of course they had no idea. It was really pretty so I bought it anyway. Well, before deciding how to pre-wash it I decided to do the burn test and cut a piece to wash and dry. The burn test indicated that it was actually polyester and the test piece that was washed and dried showed no shrinage whatsoever. Not what I thought but it is still pretty and I'll just have to figure out what to make from it.

Next week, I am looking to buy a coverstitch machine and have seen the Janome 1000 demonstrated. For the price, I guess it is a pretty good machine, although I wasn't totally sold on the stitch it made. Had thought about a commercial machine but just don't have the room. Any ideas about coverstich machines?

R.I.P.

2009-03-24T23:51:00.000-07:00

At my son's wedding in 2000.

The picture from their Christmas card that is still on the refrigerator. The memorial is this weekend and I know I have time to sew the black dress, tonight I am wondering if I have any energy to put in to it. It's hard to sew with a broken heart.

I Am Devastated

2009-03-22T21:20:00.000-07:00

The people killed in the plane crash today included friends of our kids! Our hearts go out to the sweet families that have lost so much today. There are five families involved and one family lost two daughters - at least that is what we understand now. The heartbreak is too much. Please keep all of the families in your prayers...

THE BELL TOLLS

2009-03-15T11:54:00.002-07:00

From James:

It's early Sunday morning and the drums are pounding. Deep, holding bass thumps with rhythic higher pitched hypnotizing beats wafting through the background. In a few minutes, a mournful call pierces the African pre-dawn calling the faithful to the first prayer of the day with a long, drawn out "Allahu akbar!" Finally, to complete the symphony, church bells start tolling across town as the dawn breaks. But the music is rudely interrupted by a harsh clanging on our sheet metal door that can only be pounded out by the bare knuckles of a nurse seeking a doctor.

"Yeah?!" I mumble.

"C'est moi, it's me, Augustin."

"I'm coming!"

I fumble for my shorts hanging over the foot of the bed and stumble out the door to the porch where I open the screen door and come face to face with our charge nurse bearing a flashlight and a small carnet which serves as our patients' portable medical records.

"I just received a young boy who has respiratory distress. His whole chest caves in and you can hear the noise of his breathing clear across campus."

As I hurriedly put on my scrubs and follow Augustin through the bushes, around Lazare's fire pit, under the mango trees, on top of the straw and horse poop, to the side of the container, and through the gate into the hospital compound I understand what he means as I can hear a high pitched rasping coming from the dimly lit emergency room door.

A young boy is slouched across his mother's lap as she balances on a stool holding him up under the arm pits as his lower chest literally caves in all the way to his spine while desperately trying to suck in oxygen as he lets out a stridorous breath. His eyes are bugging out and almost rolling back. I listen to his chest with my stethescope and hear practically nothing. I place it on his neck and hear loud stridor. I get him to open his mouth and where the back of his throat should be is a smooth, bulging mass.

I'm afraid I won't get him to the OR in time. I call Caroline to help me and pick up the child in my arms as I jog over to the OR, flip the padlock to the secret code, insert the key in the door and burst into the OR. Fortunately, this morning the batteries have held their charge through the night and we have light. However, I'm afraid the power will go out any minute so I send Augustin to wake up Steve to turn on the generator.

Meanwhile, I lay the child on the operating table and give him a shot of IM Ketamine while Caroline searches for an IV. Just then, power goes out but I hear the slowly increasing thump thump thump of the Lister engine starting up and in a few seconds I can turn on the overhead OR lights and we are back in business.

I dump the cardboard box of endotracheal tubes on the floor as I rifle through them searching for one small enough for my patient. I finally find a 6.0 uncuffed tube and grab the laryngoscope out of the bottom drawer of the anesthesia machine as I slip on gloves. Caroline now has the IV running and the boy is now under Ketamine anesthesia. I find a guide wire, put it in the ET tube, check the light on the laryngoscope, raise the bed and open the kid's mouth. There is no way I'm going to see the vocal cords, the entire back of the throat is swollen shut.

I toss the equipment aside, grab a 15 blade scalpel and a suture removal kit, slice vertically down the middle of the neck, find the space between the tracheal and cricoid cartilages and poke through into his wind pipe with a hemostat. I spread it open, suction out blood and shove in the ET tube. I then hook up a bag and give him some breaths. The chest rises and I see vapor in the tube. I check with a stethescope hear breath sounds only on the right. The tube's in too far. I pull it out slightly, confirm there's now bilateral breath sounds, suture the wound closed, suture the tube in place and continue bagging.

His oxygen saturation is now up to 92% from the initial 35% so I stop bagging and just let him breath through the tube. His sats hover around 84-88% which isn't great, but without a ventilator and labs to follow it's more dangerous to bag him then to let him breath on his own.

I then try to place a nasogastric tube so he can be fed past the obstruction in his throat. It won't pass the mass. I stick my finger in his mouth and try to shove the tube in through his nose while feeding it past the mass with my finger. Suddenly, pus gushes out his mouth. I've ruptured the peritonsillar abcess. I quickly suck out the foul smelling pus and am relieved that it was so easily taken care of.

We wheel him out to his room and give his family instructions.

Later that evening, I go to check on him and find his tube choked up with secretions. We have a suction with a trap that allows me to put one end down the ET tube and then by sucking on the other end pull out the gunk into a chamber between the two ends. Very high tech. He starts to breath easier. I tell Jason to check on him every hour and suction as needed.

The next morning, he is awake, but tired and breathing fairly easily through the tube. I have the family members sit him up, suction him one more time even though it's pretty clear and move on to the other hospitalized patients.

In less than 15 minutes, Annie comes running up to me.

"Stuff's coming out his trach, he's not breathing!"

I run back to his room, chase out the family members and see instantly his tube is clogged up with pus that's dripping out. As I grab the suction to clear his airway I see he's not breathing and his eyes are rolled back. He has no pulse. As I suction, Jacques starts chest compressions. When the airway is clear I attach the bag and start breathing for him.

We take him to the OR quickly. We attach our cardiac monitor. He finally gets a heartbeat back with a pulse but after a few minutes it slows down again until we do more chest compressions to bring it back. We try multiple doses of Atropine and Adrenaline. His oxygen saturation stays in the mid to upper 80's when we bag him. But he just doesn't want to come back. Finally, after 90 minutes we are forced to stop. We wrap him in a cloth and call in the family. The dad nods, he's been expecting it. He wraps the boy up in his arms, carries him out and the family mournfully walks out the gate.

The drum beats on. The call to prayer continues. The bell keeps on tolling.

OSTOMY

2009-03-15T11:54:00.001-07:00

From James:

"Doctor, you need to see this baby." Samedi calls me to the ER. "She's only 7 days old, but she's never had a bowel movement."

I pull back the curtain and see the frightened mother holding her newborn baby in her arms. The infant's belly is markedly distended, but still somewhat soft. I listen and hear good bowel sounds. The mother says she breastfeeds well and goes on to prove it by feeding the baby right in front of me. I examine the perineum and the anus is present.

"Samedi, get me a glove and some lubricant."

He comes back in a few minutes, I slip the glove on my right hand, apply some goo and gently press my pinky into the tiny anus slowly dilating it until my finger can go all the way in. It's a blind rectal pouch as I suspected.

I inform the parents that their little girl will need surgery immediately and they agree.

Without x-ray, I'm forced to guess exactly the extent of the malformation of the colon. I'm hoping it's just the sigmoid (the last part of the large intestine). Sarah and Simeon tag team the anesthesia calculating the tiny doses of Atropine and Ketamine for it's small, 2.4 kg frame. We strap her into the "papoose" so she can't move, prep her distended abdomen with betadine, scrub and drape and before cutting, pray.

I decide to gamble that I can make a colostomy from the descending colon so I cut a small circle out of her skin to the left of her bellybutton, cut through the fascia and muscles and enter the peritoneal cavity. Small intestines burst out under pressure and I can't get them back in. I move to the center and make a midline incision releasing the pile of intestines to the outside air. I then bring back those that have gone out the side hole and explore inside. The colon hasn't formed (atresia) all the way from beginning to end. The whole thing looks like a long appendix running from cecum to rectum.

Everything is so tiny. I take a part of the ileum about 10 cm from where it joins the cecum and clamp the bowel with non-crushing clamps. I divide the intestine and slowly identify the miniscule vessels in the mesentary and clamp/cut/tie them. I then open up the distal end and suction out all the meconium resting there and suture it closed in two layers. I then pull out the proximal part through the side window, sew the wall to the strong fascia, evert the gooey mucosa and suture that to the skin. I then suck out all the stool from 9 months in mommy and 7 days in the real world and close up the midline incision after irrigating profusely.

I write post-op antibiotic and immediate breastfeeding orders and go home.

Except for a fever the next day found to be malaria and treated with blind rectal pouch quinine suppositories, she has a routine post-op course and is just waiting to have her sutures removed in a few days.

LEARNING A BIG LESSON

2009-03-10T10:32:00.000-07:00

I have just gotten off the phone with a representative from Bridge Terminal Transport discussing a settlement for an accident that was caused by their truck driver two years ago. Since we were driving at least 70 mph it was only by a miracle that my Tahoe only scratched on the back door. My injury was soft tissue and I was in bad shape for 3-4 months. Trying to be fair to their company, I had a family member treat me and since it was no cost to me, I did not add that into the out of pocket expense. All of this to say that they are offering me less than half of what my out of pocket expenses actually were.

Of course, I am devastated because it was a horrible time for me physically and mentally, but beyond that I am sad that our society has come to this point. How is it that we have gotten to the point that responsibility only has a time frame attached to it - statue of limitations - if we're responsible, aren't we responsible until we have made restitution? If we know we are responsible don't we take the initiative to make sure that the innocent party is taken care of without making them seek legal counsel and try to ring even the out of pocket money out of them?

I am sad that my son said "I told you to get a lawyer" and I told him that I wasn't trying to get anything but my out of pocket expenses that I could document and I was sure that it was so straight forward there would be no problem. What in the world are we teaching our kids about how to do business and take care of our responsibilities without having to be made to by the courts.

Still thinking that someone would recognize their responsibility, I have called Bill Maleski in claims, who was very nice but passed it off to some one else, and Ivitte Melillo in claims that thinks she is being gracious still offering the original offer. (Which I am sure is really a concession on the part of the company and I am grateful that they are still talking to me - BUT - it isn't what if morally right or even fair, in my opinion.)

Thanks for letting me vent...I am still sad that we are at the point when we can't deal in confidence with others in businesses in fairness without going for the throat to just get what is documented. It's not the kind of thought and action that I wanted to pass on to my kids...

LUBAMBASHI

2009-03-08T18:17:00.000-07:00

From James:

The plane has stopped. I thought we were going directly to Lubambashi but we suddenly find ourselves on the ground at another airport. Apparently it was planned since I see people getting up and climbing down the stairs that open up from the tail of the old 727 airplane. I was actually extremely cold during the flight so I decide to take a breath of Congolese air outside. A sharply dressed young Congolese man is standing at the foot of the stairs just under the middle engine. We strike up an easy conversation until he notices something dripping on his suit.

I think it is fuel at first, but on closer inspection, it turns out to be simply water. The man is very friendly and I explain that we are with Adventist Medical Aviation and are doing some research on maybe doing some medical work in Democratic Republic of Congo and in Congo Brazzaville.

At this point our attention is caught by a large mobile staircase being pushed past us to the right engine of the plane a few feet away. Some men scramble up to the engine and start taking off the bottom enclosure. As jet fuel starts to cascade out, the ground crew rushes around collecting plastic buckets to catch it in as a small lake starts to form and flow off the runway.

A man in a suit rambles up lugging an ancient, twisted metal tool chest that folds out from the middle into several trays carrying some large, simple tools. He selects a large screwdriver and climbs up the ladder to the now-exposed engine as a couple of blue-overall wearing maintenance guys scrape out the fuel left in the bottom of the casing.

The mechanic tinkers around and eventually manages to pull of what appears to be the fuel filter. He takes off the filter and examines the cover which appears to be missing a gasket. He shows it around to a few other people amidst the shaking of heads and then puts it right back on. He tightens it up well as the blue guys mop up the remaining jet fuel with rags. Meanwhile, more ground crew have sloshed the tarmac underneath the engine with buckets of sudsy water.

The engine cover goes back on and we are escorted back up the stairway into the plane. Miraculously, we take off and land again at Lobambashi without further incident.

A thin, lighter skinned man with a huge smile, blue ringed brown eyes and a warm handshake greets us at immigration along with a short, stocky dark man who speaks some decent English. We breeze through passport control and are taken to the Adventist Surgery and Gynecology Clinic in a Toyota Hilux Surf SUV. The Hilux Surfs are everywhere but unfortunately no boards or waves are to be seen anywhere.

Most of the vehicles in town have the steering wheel on the right side of the car even though they drive on the right since most of them are imported from British East Africa.

We arrive at the clinic and are told there is an emergency. They are just waiting for the surgeon, Dr. Delgado to arrive.

When I inform them I'd like to assist, they drag me up some steep winding stairs to the attic which serves as pharmacy and stock room. I'm given a pair of elastic waist band scrubs and slippers too small for my feet and I quickly change and enter the OR.

It is small and long with tile running from floor to ceiling. Xrays showing obvious bowel obstruction are illuminated on a viewer straight ahead over the operating table. On the table, covered in a hospital gown is a young, 14 year old girl with a nasogastric tube coming out of her nose attached to a bottle of 5% dextrose for gastric lavage.

At the foot of the table is a metal table covered with a dark green cloth covered with shiny instruments and presided over by the surgical assistant robed from head to foot in the same dark green. His white surgical gloves rapidly arrange the instruments guided by his barely visible eyes behind a blue mask and protective goggles.

At the head of the bed is a jolly, pudgy man in ill-fitting scrubs whose large smile can't be contained by that silly piece of paper trying to pose as a surgical mask. In answer to my inquiries he shows me his anesthesia setup.

The archaic monitor is black and green with erratic QRS complexes running together on the EKG lead making their form, rate and rhythm almost impossible to interpret. But that is child's play next to trying to read the systolic and diastolic blood pressure and heart rate which for some reason are projected as mirror images of themselves.

The anesthesia machine consists of a metal table with bars on the back. An oxygen extractor behind the machine runs a jerry-rigged tubing apparatus up to a canister attached to the bar. The inhaled anesthetic is put in the canister and regulated with a twisting knob that the anesthetist proudly says he made himself. He shows me the scoring marks on the knob that let him roughly know the concentration given.

Laid out in an orderly fashion on the table are 4 endo-tracheal tubes, a laryngoscope and three unmarked syringes containing, according to him, Valium/Atropine, Thiopental and Succinalcholine.

Just then, Dr. Delgado bursts into the room. An Argentinean of Peruvian descent, Delgado has been in DRC for over 20 years. He started at the Songa Adventist Hospital before moving to Lobambashi and opening this surgery and gynecology center. He is known all over the region as the best surgeon around, is personal friends with the governor, has performed over 12,000 major operations there and has trained countless young, Congolese physicians and medical students in the art of surgery.

But I was to learn all that later. For the moment, Delgado was focused on the task at hand.

"What's her story?" He asks the resident who called him in.

"She was sick since Friday, went into another clinic on Saturday, was given malaria treatment and sent off for a bunch of lab tests and x-rays. After three days, she was getting worse and the family brought her here. When we examined her, she had an acute abdomen with signs of obstruction. As soon as we told the family she needed an operation, they wanted to evacuate her to South Africa until we assured them you would come yourself and do the operation."

"Ok, well she obviously needs surgery, it's too bad they waited. I'll go scrub."

Soon the operation is under way. On entering the abdominal cavity, we find pus everywhere with the small intestines stuck together. It takes awhile to clean things up and separate out the intestines to find just what we suspected, a perforated appendicitis.

After the appendectomy, massive irrigation and placement of a drain, Delgado leaves the closure to the residents and he starts telling me about his latest project: a new surgery hospital on the outskirts of town.

The girl is extubated and wheeled off to post-op recovery in stable condition.

The next morning, Delgado is flying to South Africa himself so we meet him at 7:30 in the suburbs of Lobambashi. He has been given 100 hectares by the government where he's built himself a beautiful house and is almost finished with his new surgery hospital. A local Muslim business man from Lebanon has financed the project to the tune of over $1,000,000. The equipment and initial medications are a combination of donations from the AMALF (Adventist Medical Association of the French Language) and purchases from a Swiss company that refurbishes medical equipment.

There will be two full functional Ors, a minor procedure room, a post-op recovery room, an ICU, private rooms, and an outpatient center. Everything is beautifully tiled and the solid, hard wooden doors have been imported from South Africa. It will probably be the best surgery center in between Nairobi and Johannesburg.

Also, on the 100 hectares, Delgado is helping build a Conference Office for the local SDA mission and an Adventist Church.

That evening, I check up on our young patient and she is lying comfortably with no fever and only slight tachycardia. Her abdomen is still slightly swollen, but soft and I already hear a few bowel sounds. I talk with the father who is eternally grateful and tells me that his son has just returned from a visit to Orlando, Florida where my parents live and his daughter wants to go there for nursing school.

As he gives me a ride back to the Union offices where I'm staying, I offer to put him in contact with the SDA nursing school at Florida Hospital and he likes the idea and takes my email address. He insists we come eat at his restaurant the next day but unfortunately, we already have plans.

The last day before heading back to Kinchasa, I make my final rounds and find the girl in even better condition having already passed gas letting us know that bowel function is returning. I pray with the family one more time leaving her in God's hands.

KINCHASA BALL

2009-03-08T17:50:00.001-07:00

From James:

Kinchasa has a sort of sport found maybe no where else in the world. I don't know if anyone has actually named it, but it seems the rules are well known. I'll call it Kinchasa-ball and it's played out every day on the wharfs of the city where the ferry crosses to Brazzaville.

There is a walkway from the street to the pier that is enclosed by steel bars that serves as the playing field. The game starts as the ferry prepares for crossing. Somewhere out on the street, the visiting team starts it's preparations as the trucks arrive bearing all kinds of cheap, processed goods for the markets of Brazzaville. Hordes of "runners" gather. Yellow and blue vests are handed out. The players have the option of wearing them over their shoulders and backs, tying them around their necks, or wrapping them around their heads as turbans. Most wear pants cut off just below the knees, ragged t-shirts and flip-flops. The players come in all sizes and shapes, but all are wiry tough and most are quite buff.

Meanwhile, the home team gathers at the elbow where the walkway curves around through a gate, runs parallel to the river for 50 feet before making its final turn down the gangway to the rusted out ferry boat teeming with spectators. The home team consists of a couple of player-coaches and five or six large, uniformed port authorities. The one who appears to be the head coach is of average height, has a scowling face and wears Arabic robes. His piercing eyes glare out from behind small spectacles perched on his flat nose. The "assistant" coach is a huge man with a beer-belly and a large, pocked marked face with a smug grin permanently hovering ready to pounce.

Gary, Jeremy and I have stumbled upon first row seats just behind the home team where the passengers wait to cross over the Congo River into Brazzaville on speed boats.

The first member of the visiting team pads around the corner, his slippers flip-flopping across the cement in cadence to his labored breathing as he struggles under an enormous load of yellow soap bars balanced on his sweaty scalp. The home team is just warming up so they let the first one pass.

The second is not so lucky.

A smaller man, with a 8 foot wide plastic wrapped burden of cracker rolls perched on his head, jogs down the gauntlet towards the corner where the uniformed home team waits. Each of the port authorities carries a doubled up rope in his hand which he occasionally fondles with the other hand in eager anticipation of feeling it zing down on another human beings flesh.

As the man approaches, the head coach steps out and grasps the side of the opposing teams load. There is a brief struggle as the unfortunate man desperately tries to keep his precarious balance. Finally, he is forced to drop down his load next to the leering home team members. He argues briefly and half-heartedly as if it's the thing to do even though he knows it's hopeless. Meanwhile, the same scene is repeated over and over. Most get through the gauntlet, but randomly, someone will be pulled down using their top heavy loads as leverage against them.

The game continues as those who have been pulled aside run back to the street and come back shortly with something in their hands to pass on to the home team in the form of a "secret" handshake. However, they don't seem to take too many pains to make it secret and don't seem to be ashamed at all of the blatant bribery and corruption.

In fact, after a giant, hulk of a uniformed man on the home team pulls down a tiny man half his size carrying double his wait he lifts his massive head into a victorious grin as he air boxes like Rocky his fists pumping the air in jubilant victory.

The worst is still to come. The visiting team has recruited some new players. A line of 5 blind people walk slowly up each left hand placed on the shoulder of the man in front with a guide showing the way. In their right hands, they carry some small bundles of merchandise for which they will be paid a few cents allowing them to honestly earn a living playing Kinchasa-ball.

There is no mercy. The coach himself steps out with an evil grin and pushes them back. They stumble trying to keep their balance, sightless eyes rolling around in their lolling heads. Kinchasa-ball is not for the faint of heart.

Next is a man in a wheelchair. It is a tricycle that allows him to pedal the front wheel with his hands. The chair has been loaded with goods and he is perched on top pedaling furiously. Surely, he'll make it through the gauntlet! But no! Our brutish giant lumbers a few steps forward and places his beefy hand on the cripples chest as he sneers out his order to stop! He too must pay to get through.

After about half an hour of intense competition, the game winds down, the gates are shut and the ferry pulls out slowly from the dock. The home team gives each other satisfied smiles as they finger their fat pockets as the visiting team, slowly climbs back up the gangway, sweat dripping from their soaked shirts and glistening on their ripped, but tired bodies.

STUCK

2009-02-17T12:17:00.001-08:00

From James:

I'm calmly chatting with Doug in the air-conditioned OR in Bere. We are just finishing up a routine hernia operation. The external oblique is closed and we are preparing to close the skin. Before starting the surgery, I'd passed by the charge nurses, Augustin, deep in conversation with the midwife, Hortence. I briefly caught the words "breech presentation". I almost stopped to ask what was going on, but ignoring that still small voice I continued on to surgery rationalizing to myself that it must just be a prenatal visit or something or they'd come and tell me for sure.

So Doug and I take our time on the iguinal hernia repair which I do with mosquito net mesh as usual. Suddenly, Hortence's head pops into the OR through the swinging doors.

"There's a woman...the legs and body're out...the head's stuck...been that way for awhile...we can't..."

"I'm coming! Doug, close up the skin." I cry as I strip off my surgical gown and bloody gloves and race out through two sets of swinging doors, a screen door, around the corner, under the veranda, through another screen door and right into the tiny delivery room where I see a floppy set of legs and arms with no head plopped on the delivery table between a woman's bloody spread legs. The room is packed with Augustin, Hortence, a mid-wife student, another nurse, Dr. Jacques, a family member and now myself.

I start to shout out orders.

"Augustin, get me the symphysiotomy kit!"

"Hortence, bring me some gloves."

"Prudence, I need a syringe and some lidocaine."

"Jacques, a 20 blade scalpel."

As everyone goes off running I slip my hand in and with a few futile tugs confirm that the baby's head, extended on it's neck, is stuck.

Everyone back in a matter of seconds. I slip on the gloves, draw up the lidocaine, open the instruments, inject quickly over the pubis, put the scalpel on the scalpel handle and speak directly to the woman.

"Don't move whatever you do if you want this to work! Augustin, Jacques, grab her legs and pull them up and out!"

I slice through the skin and cartilage and feel the pelvis pop open. The baby slithers out. I clamp and cut the cord. I whisk him off to the exam table. He has no heartbeat, tone, movement, cry, respiration, color, nothing. I try and clear out the gunk in his mouth and nose and do chest compressions for a couple minutes before silently covering him with a rag.

I turn my attentions to the mother. I start to examine the position of the placenta and notice two things at once.

First of all, her belly's still really big. Secondly, there's a bulging bag of water in her vagina. Twins!

I break the back of water and out pop's a full head of hair. Within seconds the second twin is delivered, pulling up his arms and legs, grimacing and screaming his little lungs out. He's alive!

NIGER

2009-02-16T20:38:00.000-08:00

From James:

I am back in Africa but this welcome is far different than the one I'm used to. Sarah, Gary and I have just flown 8 hours across the desert from N'Djamena to Niamey, the capital of Niger. We cross dry grasslands, rocky outcroppings and fingers of the Sahara itching ever southward. Arriving over Niamey, we circle the Niger river and the new bridge being built by the Chinese before making a smooth landing at the airport. As we taxi up we see large men in black suits and dark glasses walking over to meet us. Dick, Kari, Scott and Mindi are huddled together with Bill and Barbara Kirker in front of the VIP welcome center. Are bags are taken over on carts and the men in black whisk us through immigration and customs and out the front where black mercedes and land cruisers wait with chauffeurs leaning casually against the front fenders.

Hazard lights flashing we make our way through the city ignoring lights and stop signs as other cars pull over to the side to let us pass. We arrive at the President's guest house overlooking the Niger and the irrigated fields crowning its banks. A sumptuous, yet simple supper awaits us. Air conditioned rooms, white table cloths, sodas and cold water on the side and comfortable couches welcome us in style. Conversation flows easily as we are from time to time interrupted to meet more important people in dark suits.

The next morning starts with a tour by Jason Brooks of the ADRA office and school where bright kids in sharp uniforms smile and shout out English phrases they have learned. The school is an impressive combination of underprivileged kids sponsored to go where they'd never have the opportunity to go otherwise, and rich kids who pay big to get a good education. All have become equals in their matching uniforms.

Then we're off to see the big wigs starting with President Mamadou Tandja himself. Circling around the winding, well-guarded roads up the the governmental palace is a little surreal. We climp up the massive steps and enter through a metal detector into an inner courtyard with high ceilings, traditional carved horses on stands, pictures and maps on the walls and a 10 foot giraffe carved out of the twisted root system of a tree.

We are finally ushered into the President's office where we are presented by Bill Kirker as the group possibly willing to take on the management of the Maine-Soroa Hospital, which just happens to be in the President's home town. I translate for Dick as he presents the President with a gift from Loma Linda University. The President is very gracious, poses for photos with us all at the end and decides on the spur of the moment to give Dick on of the carved horses in his lobby.

Whirlwind tours with more Mercedes and Land Cruisers and flashing hazards take us through the turbaned Tuareg Minister of Health, the distinguished, glasses-on-the-nose Minister of Education, and the plump, take-no-prisoners US Ambassador.

The next day we fly 800 km across the desert, east towards Chad with a quick stop at the only Christian hospital in Niger. A quick, chicken dinner probably providing the source of our later diarrheal illnesses and a too short crash on floor mattresses inspected by a mouse and many mosquitos and we take off again the next morning for the last 600 km to Maine-Soroa. Two flat tires and mostly good roads later and we are stopped at the side of the road in the middle of a desert with widely spaced scrub trees, and goats, sheep, donkeys, horses and camels wandering through.

As we get out of the cars, a crowd gathers around as we are welcomed by the governor, the mayor, the prefect and a host of other dignitaries from the region who then escort us into town in front of the king's quarters, in front of the central mosque and next to the market. A crowd has gathered. Brightly decorated horses mounted by robed, spear-and-sword-toting cavaliers prance on the sidelines. School kids in uniforms wave and chant. Turbaned, shirtless boys twist and contort in front of drum-pounding musicians beating out a fast rhythm accompanied by a bulging cheeked flute player. We push through the crowds to where chairs and couches have been arranged. The toothless, ninety-year old king nods and shakes hands as his eyes bulge out from behind coke-bottom glasses.

Speeches are made, kids dance and sing and recite and shout poems and slogans, horse-men dress out and shake their weapons, traditional dancers move and shake, and Dick is crowned "Wokil". He is brought crosslegged onto a mat in front of the king while his side-kicks circle around dressing Dick in a traditional, blue robe with elaborate embroidery, a red, felt skull cap and crowned with a turban. The "Wokil" is the king's new ambassador to the world, and in the absence of the king, his word is law. The ceremonies ended we end up at Bill and Barbara's for a feast of goat with couscous cooked in it's belly.

The next morning is another whirlwind tour of Barbara's Second Chance School for kids who have never been to school and are passed the country's maximum age (9 years old) for entering elementary school, the king's court, the Prefect's office, on to Diffa to see the governor and back to Mainé to check out the ancient air strip. Friday morning we finally get to see the hospital newly named the Kirker Hospital in honor of Bill and Barbara's efforts as first Peace Corps volunteers and then as the only doctor for years in this extreme eastern city of Niger founding a hospital where before there was none. Now, the hospital is being revived after years of neglect with some new hospital wards and the hope of a new management team, nursing school and maybe even specialty services to serve the underserved populations of Eastern Niger, Western Chad and Northern Nigeria.

We all crash Friday evening and Saturday with staggered episodes of vomiting and diarrhea. Another feast of splayed roasted sheep and couscous goat on Saturday night with the hospital staff finishes off our stay in Niger. Sunday morning, Sarah, Dick, Kari and I head off in Bill's Land Cruiser across the desert, up north and around the top of Lake Chad. 13 hours of desert, many camels, much sand, a few Lake Chad thick-horned cows, one gazelle, one desert fox, a large bird whose name I forget, clusters of white brick mud huts with flat, horned corner roofs, one half-hour stuck in the sand barely getting out episode, one border crossing where we are the only car to have passed in two days and we arrive in Chad at Bol.

I am welcomed back to my host country by a couple of moto taxi-men trying to scam us into believing that the airport is a long ways away and only they can show us. We ignore them and continue through the one road town to the hospital where the charge nurse who happens to be on duty informs us that Gary and the Bere Hospital chaplain, Noel, have just arrived and are over at the regional medical officers home.

The regional medical officer is a friend of Noel's and he welcomes us with a big smile and a feast of macaroni and tomato goat sauce which we partake together on a mat on the floor with the tray of noodles in the middle. Everyone digs in with his own spoon and washes it down with bananas and cold water. The next day, we fly off with Gary over the vast expanse interconnected lakes which is what remains of the great Lake Chad. Massive herds of cattle wander in long lines like ants across the green fields watered by what is still one of Africa's largest lakes only to end abrubtly in the sands of the Sahel. After landing in Moundou and showing Dick and Kari the progress on our Surgery Center project there, we finally arrive back in Bere.

2009-02-15T11:51:00.000-08:00

Not much sewing happening at my house these days. I did sign up to participate in the SWAP on Stitchers Guild, found patterns to sew, made a story board, looked over material from my stash and haven't gotten any further. It's the middle of February and I am still at point 0! We have a store in another part of the country and trying to figure out how to make it stay afloat in this economy has taken much time, energy, thoughtful consideration and prayer. If all goes as planned, I should be able to start the sewing next week.

During this down time I have been hand knitting a little sweater for the granddaughter. It has been some time since knitting anything by hand and so I have had to rip out many, many rows. I am now trying to decide if it will look like a used garment by the time I have it finished.

As you know, there are all sorts of questionnaires that go around on Facebook, and for the most part I just press "Ignore" and go on. For some reason while I was reading Ann's post this morning I decided to do her little High School Questionnaire - my answers are boring but I had fun doing it. Here goes:

1. Did you date someone from your school? No

2. Did you marry someone from your high school? No

3. Did you car pool to school? The first two years I rode with my father and the last two years I was at boarding school.

4. What kind of car did you have? You've got to be kidding

5. What kind of car do you have now? Chevy Tahoe - I haul everything and when a semi hit me from behind going 70 mph while I was driving it in Tennessee, I was spared serious injury so I just can't part with it yet.

6. It's Friday night...where are you then? Home with the family.

7. It's Friday night...where are you now? Home with the family.

8. What kind of job did you have in high school? Babysat, worked in the library. The library sound boring but we had so many fun people working there that everyone wanted to work there.

9. What kind of job do you do now? Own a health food store, manage rental properties, one that we rent every nine weeks specifically for patients with cancer coming for Proton treatment.

10. Were you a party animal? No

11. Were you considered a flirt? If you don't tell my kids - yes

12. Were you in the band, orchestra, or choir? Of course!

13. Were you a nerd? Oh, no.

14. Did you get suspended or expelled? With my dad as principal for two years - he always took care of "things" when we got home.

15. Can you sing the fight song? We didn't have one

16. Who was/were your favorite teacher(s)? Mr. Mayhew

17. Where did you sit during lunch? The first two years wherever we chose, the last two we sat where the hostess placed us at each meal. So we tried to place ourselves in line to make sure we could sit with our fun friends.

17a. Who did you usually sit with? Tried to sit with Sue, Laura, Judy, Kerry, Sharon, Roy, Jeff, Ron, Derick

18. What was your school's full name? Kansas City Junior Academy, Sunnydale Academy

19. When did you graduate? Oh, please.

20. What was your school mascot? We had none

21. If you could go back and do it again, would you? We had a great time, but I would never want to repeat it.

22. Did you have fun at the Prom? We had banquets and I always had a good time

22a. What was the prom song? None

23. Do you still talk to the person you went to the Prom with? Nope

24. Are you planning on going to your next reunion? I only go when my good friends go as it is a long trip

25. Did you play any sports? I could barely pass P.E.

26. Did you have a senior class trip? That's what they called the bus ride to St. Louis and a visit to the planetarium. The bus broke down and we spent hours on the hot bus waiting. Sound like fun?

28. What were you voted Most Likely? Nothing official that I can remember.

EARTHQUAKE!

2009-01-09T15:03:00.000-08:00

Well, the holidays are over and I am getting things back in order, rested and getting my body cleansed. On Monday I, along with my daughter, started a 7 day liver cleanse. The first two days were tough with only lemon water and herbal teas to drink. It got better on the third day as we were able to add fresh fruits, vegetables and some rice to the menu. I must admit that I am feeling much better but it isn't without the process being painful. I find myself looking at recipes online and almost drooling just reading the ingredients.

Along with the eating we are to exercise an hour a day. Last night we headed out and I dragged myself through the city for an hour and was loving back safe in my house. That feeling was short lived when all of a sudden the house began to shake, there was a strong jolt and a loud "boom" noise. Usually I know where I want to be when an earthquake hits but the latest information says that you shouldn't get under things like we have been taught for the last 30 years, but be right next to a heavy object so the object doesn't crush you. Makes sense, but I just hadn't put any thought into how I would change my under the table safety plan. So...I just stood there with a panic stricken look searching for what looked like it matched the new "you'll be safe" model.

By the time I could get it all together, the shaking had stopped and only a few picture frames had fallen over. There were several other little aftershocks that we couldn't feel but there was one that set that panic feeling racing all over again. For now we are all safe and the nerves are calmed down and we're thankful we survived another earthquake in So Cal.

No One Plans Emergency Surgery

2009-01-09T15:01:00.000-08:00

From an SM with James:

Hi friends,

I had all these good intentions of writing each of you personal long
newsy emails before we sent and received this week. I didn't realize
that this lazy Tuesday afternoon would find me hooked up to another
IV, recovering from surgery.

I had an appendectomy last night, sometime around 9:00 pm. Dr. Bond,
a visting surgeon, tells me that surgeries come in threes. Last week
we did three emergency strangulated hernias, in a matter of three
days. And this week was appendix week. There were two Chadian women,
late Sunday night, one inflamed appendectomy after another. I would
have never guessed that the third would be me.

I had had a gnawing lower right abdominal pain for three days. I'd
wake up at night, nauseated and sweating. But it would go away. I
went horseback riding and watered my garden. Dr. Bond told me he
thought I had appendicitis, but I was in denial. "If it was
appendicitis, I would be hurting a lot more than this. Maybe I have
worms," I thought.

Finally, an elevated white blood count convinced him that waiting any
longer was just increasing my changes of rupture. We called my
parents, and, after a few biting-on-my-lip-to-hold-t

hem-back tears, I
went to surgery. Kristin and Emily tied me down to the same table
that I had tied other patients to, just earlier that day. They hooked
me up to the monitors, and gave me shots of promethazine and diazepam.

I'm so thankful that they were there, in their masks and bright red
surgical caps, holding my hands. I'm thankful that I was able to have
a surgery performed at the best hospital in the whole country. Not
many people can say that.

I was given spinal anesthesia, so I could be awake during the
surgery, and skip the bad side effects of ketamine, the main general
anesthesia drug that we have here. Ketamine makes people crazy. They
talk, they sing, sometimes they drool excessively, they say all sorts
of weird things in different languages, they have awful dreams.
Ketamine is an old drug that isn't hardly even used in the States
anymore, and I've never wanted to know what it would be like to be on
it. Please no ketamine, I had told Dr. Bond before hand.

But the spinal didn't work. I could clearly feel him pinching my
abdomen with the forceps, right before he was about to cut. "Kristin,
give her 150 mg of Ketamine, now." I heard Dr. Bond say.

As I drifted off, Simeon, the Chadian nurse who assisted, leaned
over, sterile gloved hand on my tummy. "Ansley, God is so big," he
said softly in French, "He will take care of you, he will hold you."

It's twenty four hours post-op. I'm doing okay. I'm sore and tired.
I've slept all day long. I'm taking tylenol and getting pentazocine
injections for the pain. I am not allowed to eat or drink until tomorrow.

Emily said that the ketamine made me speak only in French, and that I
didn't say anything bad, or embarrassing. (I guess I'll never know
for sure). She told me that I kept asking, "Was it a good appendix,
or bad?" I was worried that the operation had been in vain, that my
appendix was fine, after all, and could have been left alone.

It was a bad appendix, all red and angry, ready to burst. We're all
glad that it is gone.

I love you all, and thank you for your prayers. God is so big, and he
does care for us.

Christmas Week

2008-12-23T22:03:00.000-08:00

After the wedding, the daughter and I made a quick dash to Tennessee to welcome the new grandbaby. I have to admit he is a real cutie - but then what would you expect me to say? He seems to be quite content to sit and look around until it's either time to eat or sleep. It was hard, but we said goodbye today and started on the way back to Texas. When checking the weather and road situation for the trek back the word was snow and/or freezing rain so we stopped in Nashville and got a room at the Gaylord Opryland for a night or two. Not the trip or Christmas that we had planned but we'll see how the weather thingy works out and hopefully only be here for the night. If not, we're determined to have a great time here anyway.

Sending Merry Christmas wishes to one and all...be safe, happy, and hug those you hold dear - and even those you don't!

Breach

2008-12-21T15:38:00.000-08:00

From James:

I didn't realize it was urgent till I burst through the door into labor and delivery.

I knew the woman in labor had a fetus in the breech position with one foot wanting to come out first. I'd told the midwife to alert me when she was completely dilated so I could assist the delivery.

Sarah came and told me that the woman was about to deliver so I wandered back over to the hospital.

When I opened the door, I sized up the situation instantly and sprang into action.

I saw a woman lying on metal table with her legs spread apart and coming out of her was an abdomen with two legs attached, flopping down onto the bed. No arms or head was visible. My first thought was gloves but as I reached for the ones I'd washed and hung to dry earlier I realized they were still too moist to get on quickly so I dove in with my bare hands.

When the baby comes out feet first it's very important that she deliver quickly because if not the umbilical cord coming out of the abdomen will be compressed by the fetal head blocking off the blood circulation and its crucial supply of oxygen to the baby.

I had no time to lose since who knows how many minutes had flown by with the head stuck before I arrived.

I reached inside to try and free up the first arm. It wouldn't budge. I twisted the baby around so the other arm was on top. This time I was able to hook it with my index finger and drag it down and out. I turned the baby over again and freed up the other arm. Then I stuck my finger in the baby's mouth and pulled his chin down to his chest all the while pulling with my other hand firmly grasping the baby's feet between my fingers.

The head popped out and the baby flopped to the table. No tone. No cry. No breathing. Grayish blue color.

I quickly clamped and cut the cord and moved the limp mass over to the reanimation table. I started rapidly pressing the chest with one had while I quickly grabbed the bulb suction with the other and tried to clear his airway. He had a faint, slow heartbeat. For those of you who know, APGAR at one minute was one.

I kept doing chest compressions while the midwife dried, stimulated and sucked the gunk out of his nostrils.

After what seemed like hours, but was really minutes the heartbeat started to pick up. He grimaced a little and seemed like he wanted to cough.

We continued our efforts.

Slowly but surely he started to pink up and his heartrate became normal. Still pretty floppy and no breathing.

Don't stop now.

Finally, his legs and arms started to curl up. He was getting some muscle tone and his body was now pink.

At last, after I turned him over and gave him a good whack on the back he started screaming like a banshee.

Amazingly enough, APGAR at 5 minutes was nine! He was discharged home in good condition two days later.

The Dress for the Wedding

2008-12-16T12:04:00.000-08:00

What a whirlwind week it was last week. I drove from So Cal to just south of Ft. Worth arriving in 19 hours. I was surprised myself, but glad that I wasn't on the road for the 24 hours that I had planned on. There was hardly time to do anything but run here and there making sure that all of the decorations for the church would work, finding enough food to make sure that all of the out of town guests would have something to eat and just tying up all of the loose ends that are always there for special events like the wedding.

It was a wonderful 73 degrees the day of the wedding and I must admit that I was second guessing my choice of stretch velvet for my dress when I was fanning myself to stay cool during the wedding. The pattern, Butterick 5280, turned out to be a great pattern. I decided to do a FBA just to make sure that it would fit better and not so tight even though it was designed to fit snuggly and I was glad that I had. An adjustment for square shoulders and adding to the length were the only other adjustments that I had to make.

After making the FBA I remember reading on someone's blog about the two sides of a wrap top not matching after making that adjustment and then showing the solution. I finally found the information here: http://thesewingdivas.wordpress.com/2007/03/09/adjusting-for-a-full-bust-on-a-wrap-top/, followed the directions and it worked perfectly. All that being said, I will be making this pattern again as it fit great and was really comfortable.

This is my niece, Kristen and her new husband, Wil. The only reason I am in this picture is because I capitulated and agreed to be my sister's gofer for the wedding. It was fun and we had a great time.

We are now stuck in Texas as the weather it the big news here. Freezing rain, sleet and icy roads are all over the area until sometime this afternoon so we are sitting tight in front of the fire until things warm up a bit.

Blue Baby

2008-12-12T07:59:00.001-08:00

I finished my dress for my niece's wedding and will post pictures next week - after the event. Even though I could only find black stretch velvet to make it out of, the dress went together quickly and actually is a fairly decent fit. What a crazy time it is around the holidays to be doing weddings! Oh, and I have a new grandbaby. Jonah Keith, 8lbs. 7 ozs. born Dec 5. No pictures of him yet. (No, he is not the blue baby this post is about!)

Now from James:

Dr. Jacques knocks on the door.

"I just assited an uncomplicated vaginal delivery, but the baby is having
respiratory distress. The nares are flaring, the intercostal muscles are
retracting and he's just having a hard time. I tried aspirating to see if
he had any mucus but it seems his nose is blocked...it's like there's just
no connection to the throat."

In my mind I'm thinking, "yeah, right, he must just not know how to stick a
tube down a baby's nose..." but my better judgement says I should just go
and look.

I enter the dimly lit corridor and push open the labor and delivery room
door into a brightly lit, but small chamber. A quick glance takes in a
young woman lying comfortably on the bed, not much blood around, and
breathing and glancing around normally. She's fine.

I turn to the baby reanimation table and see a chubby, bluish gray baby with
a disproportionately tiny head (normal newborns heads are huge compared to
their bodies) lying staring up and grunting but not really breathing.

I grab him around the chest, flip him over on my hand and slap him hard on
his back. He starts to cry vigourously. I think that must be it. They
just are afraid of these supposedly fragile little beings and don't
stimulate them enough.

I flip him back over on his back on the green, brightly patterned cloth
underneath him and reach for the aspirator. A tiny tube goes into a small
canister with a slightly larger tube coming out the same top. I slip the
bigger end in my mouth ready to suck and slide the smaller tube into the
baby's nose. It only goes in 1-2cm and is stuck. I wiggle it around and
then try the other nostril. Still no passage. I stick my finger into the
newborn's mouth straight back into his throat. He starts to gag as I feel
around and confirm, there's no opening between his nostrils and his airway.

Now, here's the problem. Instinctively, a newborn is an obligatory nose
breather. This allows him to nurse and breath at the same time, two very
important things God makes sure they now how to do instinctively because
there's just no spare time to have to learn it in. He only breaths through
his mouth if he cries.

We can't just make him cry all the time, he just won't do it. He cries a
little and starts to pink up and then goes back to sucking in impotently on
his blocked up nostrils.

What to do? I think quickly and go to the OR to find some probes and see if
there isn't some passage back there after all that's just blocked up.

The probes go nowhere. I've brought the hemorroidectomy kit as that's the
only one I know of with probes.

I call the father in and explain the situation.

"He can't breath through his mouth because it's against his instinct and he
can't live without breathing and we can try to poke a hole through but he
could bleed a lot and die or we could damage some important things, but the
bottom line is he won't live if we do nothing. What do you think?"

"Do what you have to, it's in God's hands."

I grab a Kelly clamp and probe downward in the right nostril to where the
palatte seems thinnest between the nose and mouth. I poke through. I then
do the same on the other side. However, he still can't breath because the
mucosa of the mouth just falls back in place. We need something to keep it
open. I grab the aspirator and cut off a piece of the bigger tubing. I
reach the clamp through into the mouth, grasp the tube and pull it out
through the nose. The first time it pops all the way out. I then attach
another clamp onto the mouth and and pull it through again, this time the
clamp prevents it from coming all the way out. I repeat it for the other
nostril.

I suck up some blood out of the nose and mouth and down the tubes using
what's left of the newborn aspirator. He's still struggling but I can hear
and feel air coming out the two tubes.

I then insert a feeding tube in the mouth and the mother starts squeezing
out breastmild which we feed the baby through the tube with a syringe.

He's already pinking up, only his hands and feet stay blueish gray.

Yep, he's in God's hands all right.

Morning

2008-11-29T15:41:00.001-08:00

From James:

It's early morning and I can't sleep again. This time, though, it's because I'm excited. For the first time in several weeks I'll actually be doing something. My ankle wound that just won't heal has kept me from doing just the bare minimum. I go up to the hospital, quickly see the hospitalized patients, do all the scheduled surgeries and then retire home to elevate my swollen foot. My day revolves around how fast I can get home to make the swelling go down and do a dressing change and take antibiotics. I even got so scared for a few days that I had Sarah start an IV on me and give me IV antibiotics.

This morning, though, my ankle seems to have turned the corner and I'm up, happy to be doing something I want to do. I'm going flying with Gary to N'Djamena. I'd needed to go to N'Djamena for a while, but with my foot, the idea of a long, bumpy ride in the back of a Toyota mini-bus just wasn't that appealing. With Gary's return after a 6 month absence, getting to N'Djamena has turned into a two hour pleasant flight over the African plain.

It's still dark, but since I can't sleep anyway, I get up and fix "breakfast" which consists of frying up some day old rice and beans with little bit of curry. Not a typical American breakfast but sometimes you have to eat for strength and not for sport (as some of my friends used to tell me in the early days when I was first in Tchad).

With the roosters having started their crowing since about 3am, the dogs barking and the drums and dancing having just stopped, the morning is quiet and peaceful with just the lulling, rhythmic sound of crickets breaking the early dawn's silence. I step outside into the desert cold. I quickly go back in and put on a sweatshirt. I pull my small North Face backpack over the sweatshirt and slip on my Crocs.

The ankle is a little stiff, but it feels good to be out on the deep, sandy road towards Bere's laterite airstrip. It's a 2 km walk and I have the village mostly to myself.

An early morning fog rests over the tops of the thatched roof, brownish red clay huts combined with the pungent smoke of wood and dried grass fires. The only ones awake are a few women pounding millet in homemade wooden mortars with 6 feet long wooden pestles. The dooomp, dooomp of the pounding of grain into the base for the typical Chadian breakfast porridge echos across the stillness. A few children are also up trying to chase away the night's chill around hastly gathered grass and stick fires. Their dark faces hidden amidst the white smoke wafting from the incompletely dried weed fires break into toothy grins as they see the "Nasara" walking steadily and gingerly away from the hospital. It's not every day that something this new and exciting happens!

They are mostly dressed in ragged shorts, holey pants and torn t-shirts. It's no wonder they're cold as the dry season has descended upon us leaving us with the extremes of up to 40 degrees Fahrenheit difference between day and night temperatures. The luscious greenness of the rainy season has rapidly evaporated into the brown, dead grass powdery dusty dryness of the majority of the year here in the heart of Africa.

I approach some of them, who eye me warily with looks of mixed curiosity and fear. I extend my hand, palm up. Several of the bigger, braver ones approach to shake hands. I shake my head and show them how to "give me five."

"Tak kebeng (slap my hand)" I encourage them in Nangjere. When they finally get up the courage to try, everyone wants to get in on the action and they all start giggling and laughing. What a privilege to really smack hard the hand of a grown-up, much less a foreigner!

I finally get to the airstrip where the early morning sunrise colors the mostly white plane with a tinge of pink. Gary is testing the oil and fuel and filling up the wing tanks with his bright red cans of Cameroonian gasoline. A few kids have gathered around as usual, but not the usual crowd since it's still so early. After Gary eats a "late" breakfast, we slide into the tiny Cessna loaded up with empty fuel and propane containers and after a short taxi we are soaring up and over where the 10,000 inhabitants of a Chadian county seat disappear quickly into the groves of mango trees with just occasional glimpses of thatched or rarely, tin roofed, houses give us a clue that there's actually a village hidden in this vast plane. We bank over the hospital to get a good aerial view and it also suddenly seems so small and insignificant when seen from on high.

We're on our way to N'Djamena...

Thanksgiving

2008-11-29T00:42:00.001-08:00

From James:

It all started with a little lying. I had too, otherwise I would've spoiled the surprise.

Monday, I went to Moundou to check up on the remodeling project for our new outpatient surgery center in Chad's second largest city. The route is simple: follow the bumpy, dirt road to Kelo and turn left onto the paved road until you hit Moundou. In Kelo, as we turned left, I saw the post office. I decided to stop. I found 14 packages waiting for our student missionaries. I paid for them all, loaded to car and continued to Moundou.

The project is going well, I talked over a few details with the builder and then he joined us for the ride back to Bere so he could look over our existing operating room to better understand what we were shooting for. It was when we were back on the road to Bere that I had the wonderful idea for my surprise. Little did I know how much deception I would have to employ in order for it to succeed.

The first thing was to swear our driver, Levi, to secrecy. We then had to quickly unload the packages into my house without the student missionaries seeing them. Since Thursday was Thanksgiving but American holidays tend to get neglected or rolled into one, I decided to turn it into an early Christmas surprise. I wasn't going to tell them I'd picked up their packages sent from home, not until Thanksgiving morning.

I didn't count on our volunteers' desperation to have those goodies.

The very next day, Stephan came to me to explain how he'd arranged everything with our Administrator, Andre, to have the day off so he could take a motorcycle taxi to Kelo to see if they had any packages. They were all expecting some that would have things to make Thanksgiving dinner with.

I put on my severest, coldest boss face.

"Stephan, did you come here to work, or to get packages. You should've told me yesterday. I passed right by the post-office and could've easily checked to see if there was anything for you guys. We're really busy right now, besides, how are you going to get a bunch of packages back on a motorcycle. It's just not a good idea. I'll probably be making another trip early next week, I can pick them up then."

Stephan's face falls, but he has no choice but to accept.

"Well, ok, but Kristin was going to go with me, maybe she can just go. She's not scheduled till this evening so she wouldn't miss work."

Thinking quickly, I'm amazed at how easily I continue the deception. "Stephan, do you really think it's a good idea for a girl to go by herself to Kelo? It's just not very smart. It'll be even harder for her to carry all those packages back. Plus, this is Chad, it could be dangerous." I'm lying through my teeth, but somehow keep a straight, concerned face.

Stephan turns sadly away to go back to his accounting office. I smile inwardly at my success. It is short lived as lies tend to pile on top of each other; once you start it's hard to stop.

I have to repeat a bunch more to Kristin later on as she is unwilling to accept Stephan's explanation and feels that if she talks to me personally, maybe this mean boss will change his mind. I hold firm and convince her it's just not a good idea. Besides, there's other things already planned and we won't really have a real Thanksgiving anyway, we might as well just wait and have our Thanksgiving next week sometime. She's crestfallen but also has to accept.

Tuesday night, I find myself chatting with Kristin and Ansley and, unfortunately, they've come up with a solution that I can't lie my way out of. I'm forced to spill the beans. They are excited but agree with me to keep it a secret from the others. Ansley joins to lying as she announces to the others on Wednesday that due to her 6 episodes of explosive diarrhea the night before she's just not up to a trip to Kelo and Emily shouldn't go by herself.

Early Thursday morning, I pull the 14 packages and numerous letters out of my closet and carry them over to the SM's common room in the middle house. I leave a note that says "ho, ho, ho, merry thanksgiving, merry thanksgiving." And it turns out to be just that...after a long day at work.

Work starts out with rounds on a completely full hospital with no beds to spare. Then, I have a tubal ligation, a D&C/tubal ligation combo, a rectal polyp to remove on an 8 year old Arab boy, a bilateral inguinal hernia repair with mosquito net, another emergency D&C for an incomplete spontaneous abortion and finally finish at 4:30pm just in time to go to Gilbert's going away party that Jason has organized.

I slip into the courtyard where many of the staff and Gilbert's friends are already seated on a variety of chairs and stools and mats. I slip off my Crocs and settle onto a mat. My ankle is aching a little and somewhat swollen after a long day upright in the OR, but it's not too bad. I exhange pleasantries with Job and Koumakoy and nod at Simeon and Abel who I've spent all day with in surgery. Gilbert slides onto the mat next to me and we have some decent small talk as Jason serves us the best "bouille" I've had in Chad. Zachee, our cook, is the best and Jason contracted him for the feast. The "bouille" is a rice porridge with milk, sugar, cinnamon and peanut paste. I grab the crude metal bowl from Jason and slurp it up without a spoon.

The second course is either roasted goat or chicken in a tomato sauce with boiled sweet potatoes, all served over mushy rice. It's quite tasty, but I'm trying to save room for Thanksgiving dinner later.

At 6pm, we all head to my house to prepare the feast. We have invited Gary and Wendy and their volunteers (Steve, Jeremy and Annie) as well our our 6 student missionaries, Maria (our Danish volunteer) and Sarah and I. Jacob's mom has sent 5 packages stuffed with everything needed. The menu is impressive: Fri-Chik, garlic mashed potatoes and gravy, cranberry sauce and relish, anti-pasta salad, stuffing, spiced apple cider, candied yams, and a pumpkin pie spice squash dessert with real whipped cream! Gary and Wendy add some real (not powder) mashed potatoes, more gravy, a cranberry-like hibiscus flower sauce, and some stuffing made from scratch. Jeremy and Annie bring a fresh garden salad of tomatoes, lettuce, cucumbers and sprouts; fresh squeezed lemonade; and boiled beets.

Jacob's mom has also sent Thanksgiving-themed plates, napkins and decorations and with the half-cut into pumpkin-like squash in the center of the table we're only missing NFL football to make it feel like a real American holiday.

Right before eating, Sarah comes over to tell me that she's already hospitalized 5 kids with malaria, 3 of them with severe anemia needing blood transfusions. Luckily, Samedi is on with her until 9pm so they're managing, but the hospital has been filled back up despite being cleared out by me in the morning. She refuses my offer to eat with us, saying she'd rather I just brought her something later.

We all sit around the table and go around with each person saying one thing they're thankful for for each of the 5 kernels of corn placed before them. We pray and then we chow down.

Just as I'm finishing my overloaded plate (the first one done of course) Hortance, the midwife, comes knocking to tell me about a woman, 8 months pregnant with vaginal bleeding referred from the health center 2 days ago but just now arriving. She is severly anemic with a hemoglobin of 4.8 g/dl and has a placenta previa where the placenta wants to come out before the baby. I think I find a fetal heart beat so we quickly resuscitate her with two large bore IV's and a lot of IV fluids, give her anti-biotics, and take her to the OR. Fortunately, her blood type is AB + making her a universal recipient (i.e. she can take blood from anyone) so we have both her brother and father give blood while we prep her for surgery.

We start the first bag of blood running as we pull out a dead baby with skin already peeling off meaning he's been gone for a few days. Fortunately, there's not much bleeding and we quickly close her up as the second bag runs in. Her heartbeat is almost normal now and her blood pressure has come up. We wheel her into the wards almost running over some Arab women who've spread their sleeping mats right across the entrance and then are forced to leave her on the gurney for the night since there are no available beds.

I come home at about 10pm and we play Settler of Catan and Citadels until almost 2 in the morning when I fall into a deep, contented sleep.

Happy Thanksgiving!

Wedding Dress

2008-11-22T19:12:00.000-08:00

It is only two weeks until I leave for my niece's wedding in Dallas. It seems like I just returned from there and the thought of packing everything up and heading back makes me want to just sit down and eat some cookies! But I will resist the urge and start thinking about what to wear.

I can't wear any shade of winter white, the bridesmaids dresses are red so that is out, and black is not socially correct (unless you live in California...) That being said, when looking for a pattern for a new dress I found this one

The one on the right is made from a beautiful brown stretch velvet and it is a classy look. A trip around town looking at the local selections of stretch velvet have left me with the choice of.............black. The only other option is a trip to the garment district but I'm not sure there is time. I will get the pattern ready tonight and see how we are on time this week and then decide on what to do about the fabric.

Since I will be coordinating the wedding I really need something that is comfortable, warm, appropriate and of course, chic. (oh, and I forgot, slimming!) We'll see if this is the magic dress.

There was another choice

but with all of the moving about, up and down and all over the church and reception hall, I was afraid I would need to do more adjusting of the top to make it comfortable to do all of those things. I really like the lines of this one so maybe it will be just a holiday dress in any color of my choosing.

I am so glad that it is Thanksgiving week as I have so much for which to be thankful. Even with all of the happenings in the United States and the world and despite my personal circumstances, I am blessed and every day I have to remind myself to list those things in order to keep life in perspective. I hope you all have a chance this week to take inventory of your life and surroundings and find even the smallest things for which to be thankful. If you happen to be reading this - I am thankful for you.

Tragedy

2008-11-16T19:24:00.000-08:00

Today we were notified that 4 college students, at a small college in Northern California that both of my children attended, were killed last night. Our hearts and prayers go out to the parents, siblings, other family members, friends of these young men and to the faculty, deans and other staff at the college. Life is so precious - hug your kids a little tighter and longer tonight.

To Vegan or Not to Vegan

2008-11-13T01:54:00.000-08:00

Our family has vacillated between eating vegan and not eating vegan. We are now beginning once again to pay attention to what we are eating so that we will reduce our risk of heart disease and stroke. Tonight I made a recipe out of a vegan mediterranean cookbook that was definitely a hit so I thought I would post it here for any who might be interested.

2 tablespoons extra-virgin olive oil
2 bunches scallions (12 to 16), white parts chopped, 1/2 cup thinly sliced green tops reserved.
4 ounces (about 2 small) carrots, chopped
1 stalk celery, chopped
2 large cloves garlic, finely chopped
4 cups vegetable broth
1 cup water
1 cup lentils, rinsed and picked over (I use the red lentils because I love their flavor but any lentil would work, I'm sure)
1/4 cup brown rice
1 (14 oz) can whole tomatoes, drained, seeded, and coarsely chopped, juices reserved
1/2 teaspoon dried thyme leaves
1 large bay leaf
Salt and freshly ground black pepper, to taste

In a medium stockpot. heat the oil over medium heat. Add the white parts of he scallions, the carrots, celery and garlic; cook, stirring often, until softened, about 5 minutes.

Add the broth, water, lentils, rice, tomatoes and their juices, thyme, bay leaf, salt and pepper, bring to a boil over medium-high heat. reduce the heat and simmer gently, partially covered , until the lentils and rice are tender, stirring occasionally 50 to 60 minutes. Discard the bay leaf. Serve hot, garnished with the reserved scallion greens.

To complete the meal, we just added fresh baked wheat bread and a fresh salad. Oh, the hard part of being vegan is what to use on you bread if you don't use butter - tonight we used roasted red pepper hummus - delicious!

Here's to health - our most valuable possession in this life!

Sweater Refashion

2008-11-10T20:09:00.000-08:00

Last week I went through my closet and reduced the bulk by about half. Even though I know I won't wear some of the remaining clothes with their current look, I still couldn't bring myself to put them in the give away bag.

One of those left is a pink sweater that I have had for years, yes, many years, but I still love it.

So I got on the internet and looked to see what was out there as far asrefashioning sweaters goes. I found some helpful sites that gave me more confidence to cut into my treasured sweater and turn it into a cardigan. So today I took the plunge and cut right up the front of the sweater. The first thing I did though was iron some fusible interfacing on the back and 1" on either side of the center of the sweater front.
I then made sure that I was following the same knit channel from top to bottom and whacked away.
It was easier that I thought it would be to cut that knit and it didn't start to ravel immediately. But just in case I serged the edges and then pinned a separating zipper in the front. Next I turned under the serged edge, making sure to follow the same knit row, and pinned it to the zipper. Although I hand basted and machine basted one side I am not completely happy with the way it looks so tomorrow I will take the basting out and start again to see if I can accomplish a better, non-homemade, look. We'll see what happens.

Buttonhole Attachment

2008-11-09T00:27:00.000-08:00

I happened to read The Sewing Divas blog tonight where Gigi showed buttonhole attachments that she has recently acquired. When I saw the pictures of the buttonhole attachments she was recommending I wondered if there might be one that was similar in the sewing cabinet that I inherited from my mother-in-law. Because everyone else in the house is asleep, I only looked briefly and quietly and found one that I hadn't seen before...it looks like this

The instruction booklet was first published in 1939 with my copy being a 1946 version. I am excited to get up tomorrow and play with making buttonholes! This should be fun.

Silhouettes That Will Work

2008-11-08T21:30:00.000-08:00

I have way too many patterns for one thing and having to go through them all and find silhouettes that work together for the SWAP 2009 was another. That being said, it was actually fun trying to put things together and then once it was all on the storyboard, it was exciting to think that I might really like these pieces together - and might even wear them!

One of the tops is my TNT pattern that I really like and the others, well, I have never made any of them! With my niece's wedding and a new grandbaby before Christmas I am at least hoping to get the patterns fitted and maybe muslins made by then so I can start the sewing after the first of the year.

In looking through my fabric stash, I have to admit that black and white are the predominant colors and will probably be the basics of my SWAP unless on a second look through I can come up with something else. The bright other color decision hasn't been so easy so I will spend some time this week figuring that out.

I had really wanted to make a white shirt (you know Tim Gunn says that is a must!) to go with the SWAP but can't figure out how it will look with the collarless jacket. I love that jacket, but it really limited my choices for tops. I loved this top but after looking at the storyboard saw that it wouldn't work with the jacket and had to x it.

Well, here is the latest version of my storyboard - we'll see how it goes!

SWAP 2009

2008-11-03T08:07:00.000-08:00

I had a little time to spend reading some sewing blogs and websites last night and came across the SG SWAP 2009. I have been following the SWAP Contest for the last couple of years and had decided to join this year but had not seen the official rules until last night. The nice thing is that the contest covers a longer period of time to complete the sewing - I'm thrilled about that!

Since I haven't been even thinking about this before last night I need to double my efforts to see what I can come up with today in the way of a plan for these garments and their fabric. I would love to use what I can of the fabric in my stash and then fill in with a trip to the Garment District in LA.

Awwww, then there is the fitting of the pattern to think about - it is still a struggle for me to get garments to fit me the way I think they should - guess I had better start on that right away too so I am ready to sew as soon as possible.

I am off to the sewing room to see what I can dream up.

Mistake

2008-11-02T09:31:00.001-08:00

From James:

Have you ever been glad you made a mistake? I was sure the elderly man had
a gallbladder problem. I mean, I'm no ultrasound expert, but there was
obviously something inside that gall bladder that shouldn't have been there.
Besides, he was complaining of pain right over that spot that was worse when
he ate. And his bilirubin was elevated, another sign that could point to
gall bladder problem.

I was hesitant to operate, though, because he was a friend. In fact, he is
the chief of our neighborhood here in Bere. Totho Timothée. His brother
has AIDS and is a motorcycle taximan who takes us often back and forth to
Kélo when our car isn't running or the rainy season makes the roads all but
impassible for anything except a moto.

But, I finally decided it was the right thing to do. I was sure he needed
an operation for his gallbladder. I was wrong.

I stand to his right side. Franklin has given him a "high spinal"
anesthetic so I can make a somewhat relaxed incision right below his right
ribs. We pray and I start cutting with Abel and Jacques assisting. I've
decided to splurge today, since it's a gall bladder, and have set up the
electrocautery. Soon the smell of barbecuing human flesh fills the room as
I burn through the abdominal muscles before entering the peritoneal cavity.

We also are using the air conditioner since it's about 110 degrees
fahrenheit outside. Jacques, however, having just recently arrived from
Togo where it's relatively cooler, is having a hard time as the sweat runs
in rivulets down his face. I usually don't notice until afterwards when I
pull off my gown and find my scrubs are soaked with my own sweat.

I have Abel retract the liver gently and I get a good look at the
gallbladder. It looks normal. I pinch it between my fingers. It feels
normal. I'm starting to feel sheepish. Especially since on entering the
abdomen I found a lot of ascites fluid and now I see that he has advanced
liver cirrhosis. Of course the bilirubin was elevated! I'm starting to
realize I was wrong to operate on him and it could've maybe even endangered
his life. Better close and get out of here before I do more harm.

Then I notice something out of the corner of my eye that gives me pause.

"Jacques, pull the stomach back a little again. Yeah, just like that."

I see a small black spot on the first part of the small intestine coming
right out of the stomach. Before my brain can even formulate it's idea of
what it is, the spot confirms itself by opening up right before my eyes and
letting out a stream of clear, gooey liquid.

A duodenal ulcer just perforated before my very eyes! Abel quickly
aspirates up the stomach acid with the suction tip and I call for some
suture.

I place some interrupted sutures along the edge of the ulcer and leave them
untied till I have a whole row ready to close the wound. I then pull some
of the omentum back from the stomach edge and lay it across the perforation.
I tie the sutures across the omentum patching up the hole. I irrigate and
suction and then close up the muscle, fascia and skin of the abdominal wall.

I've just witnessed a miracle to save our friend, Timothée's life. If I
hadn't mistakenly misread the ultrasound I wouldn't have operated. If I
hadn't mistakenly thought it was the gallbladder I wouldn't have made the
perfect incision to allow me to see and close the ulcer. If I'd have waited
half and hour more it would have perforated letting stomach acid all in the
stomach to burn and irritate the intestines and cause all kinds of
complications. If it had happened a day or two before I did the operation,
he'd probably be dead...especially with having already liver cirrhosis.

Sometimes it's ok to make a mistake!

Too Late

2008-11-01T10:29:00.001-07:00

From James:

I squat on the ground outside the operating room. A thin Muslim man squats in front of me, his green Arabic robe pulled tightly across his knees as he hugs them with his arms. He is staring at the blue basin between us. The insides of the basin is covered with a blood-soaked, brightly-patterned yellow wrap around skirt. I lift up the cloth with a gloved hand covered with dried blood. Underneath is a dead infant with a huge head (hydrocephalos). His blank eyes stare up at us as his neck bends back at an impossible angle. Underneath is the placenta still attached to the child by the umbilical cord. All is cold, lifeless and bloody.

I do my best to explain to him in Arabic what happened.

"The child, dead, when arrived, dead already. The head, big, not come out. The house of the child broken, the child come out here (point to my stomach). Blood come out, a lot, here also. The woman there, she not have much blood when she arrive not have. Si there is not much blood, she found death."

"Both of them, the two of them, both dead?" The man asks in disbelief.

"Yes, both dead, all dead," I repeat a million images of the last two hours flashing through my head...

"Doctor, doctor!"

I slowly stumble out of a deep sleep and a pleasant dream. "Yeah, what is it?"

"It's me, Augustin, I have a case to present to you."

"Ok, I'm coming." I pull on a pair of scrub bottoms and feel my way through the dark to the door and out onto the porch. Augustin is standing outside the screen door with a headlamp and a "carnet" or portable medical record.

"There's a woman, referred, in labor for two days..." Augustin stumbles through presenting the woman. He is one of our laziest nurses and often does as little as possible. I'm a little irritated.

"Whoa, whoa! Start over, give me that!" I take the labor and delivery sheet. I glance quickly over it and it's incomplete. I see the vital signs, heart rate 60 bpm, blood pressure 100/70, temperature 37 degrees Celsius. I'll regret later not noticing how generically normal they were.

"What? What's going on?" A voice comes from the room next to us where Jacques, our newly arrived doc fresh from medical school in Mali, has been sleeping.

"I'm talking to Dr. James," replies Augustin. Jacques quickly appears outside just as I'm telling Augustin to go get more information and come back to see me with the chart completely filled out.

As Augustin and Jacques walk off together I almost yell after him to check a hemoglobin. I catch myself, thinking I'll be over to see her shortly anyway. The second thing I later regret not doing.

I go back to my room and decide to lie down, after all it's been a long week filled with tons of surgeries and the training seminar I've been doing for the village health care workers on HIV and tuberculosis. I'll just close my eyes for a few minutes until Augustin and Jacques get back. The third thing I later regret.

"Docteur? Docteur?" The soft voice of Jacques floats across my subconscious. I go to the door. I glance up at the clock. It reads 4:25 am. I didn't look at the clock when Augustin first came, but I did hear the fridge running which it's programmed to do 4 times a day for an hour at a time: at 6am, noon, 6pm and midnight. It's been 3-4 hours since I saw Augustin and Jacques walking off together. A strange sense of foreboding falls over me.

"I've examined the woman and I think she has a ruptureed uterus."

"Go call Abel and Dr. Franklin and I'll be right there."

I pull on a scrub top, grab my keys and I'm out the door. I stop by the other house real quick to make sure Franklin's awake and then make my way across the compound to the labor and delivery room just past the OR.

As I walk in the room and glance at the patient, my heart skips a beat. A tiny Arabic woman lies stretched out on the table with one knee bent in the air. Blood has pooled between her legs. An IV with Glucose and I quickly assume Oxytocin is dripping into her left arm. Her thin abdomen is grossly distorted with several large, not normal pregnancy looking lumps. But what arrests my attention is when I look at her face.

Her head is flopped to one side and her eyes are rolled back in her head. She is pale and her only breaths are occasional sighs. She is on death's door and I see it instantly. I quickly feel for her heartbeat which is present but slow. I flip down her eyelids with my finger and my blood freezes. Her conjonctiva is white. She has practically bled to death in our hospital.

"Augustin, quick call the lab, we need blood! Abre, run and get me some Ringers!" Franklin arrives and quickly starts looking for a better IV. Then she stops breathing and I start chest compressions. Franklin has found an IV in her neck and we get fluids running. Abel has arrived and we take turns with chest compressions.

"Franklin, what about the monitor from the OR?" He runs quickly and arrives. We get no blood pressure and a weak O2 sat.

Finally, after what seems like hours the lab guy arrives.

"Abre, what blood type are you?"

"O positive."

"Mathieu, just check to see if she's positive or negative and if she's positive Abre will give."

She is B positive and Jacques and Abre run off to donate a bag of blood each. Augustin is B positive and refuses to give.

Abel and I keep up the chest compressions while Franklin guards her airway.

We get the first bag which is only a third full of Abre's blood. We hang it up.

"Abel, you and Abre get the stretcher and lets take her to the OR."

We flop her bloodied body onto the stretcher and Abel and Augustin carry her quickly to the OR while I continue chest compressions and Franklin carries the blood and IVs.

We get her all set up on the OR table with blood splashed everywhere. Still no heartbeat so we continue our ressucitation hoping that if we can keep her oxygen circulating until we replace her blood loss maybe we can save her.

We try some Atropine to start her heart. We try shocking her. Nothing. We have no Adrenaline. Then I remember we have some spinal kits. I open up two kits so we can use the adrenaline inside. Nothing works so we continue CPR.

Finally, a third bag of blood is running and I decide to take out the baby. We slosh Betadine on the belly, I quickly open up a C-section kit and put on a gown and sterile gloves. One slash and I'm in the belly. I cut the baby's face but he's dead already. His head is 5 times normal size with hydrocephalus. That's why he couldn't come out. Her uterus is in tatters. I pull out the baby and placenta. Place some clamps across what's left of the uterus and cut it out. I tie off the clamps, dump some Celox in the pelvis and hold pressure for 5 minutes. The whole thing takes about 15 minutes. All the donated blood is in, we've been working on her for almost 2 hours and she still is flatlined. I tell the guys to stop CPR, I sew up the belly and I go out to tell the husband.

As I'm kneeling in front of the Muslim husband, having just told him his wife and the unborn child between us are dead, I'm not sure how he'll react. A brief image flashes through my mind of the violence of two weeks ago with Arabs stabbing and killing Africans and vice versa and the chaos in the hospital trying to save as many as possible. But there is no revenge taken on me today. Instead, a gentle chanting in classic Arabic rises from the depths of his sorrowed heart.

"Illallah le Allah wa rassulloh Mahamat." The Muslim creed repeated over and over seems to soothe the sorrow. "Al hamdullilah" (Allah be praised) breaks in occasionally. A fellow Muslim from Lai comes and kneels down beside him reciting some Koranic verses in a low voice.

"Find me some brothers of Islam here. All the believers here in the hospital." The other Muslim goes off and soon a small group of robed and turbaned men surround us.

I ask him if he'd like to see his wife. He nods and we go into the OR where Abel and Jacques have been cleaning and covering the body. A portly Arab with a beige robe and white turban accompanies us. The woman is lying on the stretcher covered with a black, Muslim woman's cloth with intricate Arabic designs in gold woven into the fabric. The husband uncovers the wife's face and asks for water.

I get some water from the faucet and bring it to him in a small basin.

"Put a little over my hands," he asks me in Arabic.

I pour water over his right hand and he uses it to gently wash and wipe down his dead wife's face closing the eyes. The other Arab also moves his hand down the face to close the eyes and then they cover her back up. As we take her out to the morgue I hear some low sobs coming back from the OR.

15 minutes later, the brothers from the Mosque have arrived and I carefully explain in broken Arabic again what has happened.

"Xalas, inshallah, mashallah, al hamdullilah" come out in intervals from all present. The accept and comfort and then take the body off to be appropriately buried as soon as possible in the Muslim fashion.

I go home.

HOME AT LAST

2008-10-25T22:08:00.000-07:00

After almost 2 months I am home in my own bed with my own bathroom...doesn't get better than that! And I was able to spend my birthday at home - doing what I wanted - nothing! It only lasted a day so I am not worried about turning into a doorstop that doesn't do anything.

Everything from Dad's house has been taken care of - either with Dad to his new house, to Janet's house, or to mine, or sold or given away, and we are all happy. What could have been a relationship destroying activity turned into a bonding time with my sister and me. I couldn't have asked for anyone to be more caring and willing to give and take with others in mind that my sister, Janet. I was truly blessed.

Remember the patterns I told you about that she bought for me? I'll start adding pictures of them so you can what treasures were in my bag. The sizes and their measurements are a little shocking...according to what is printed I would probably be a 22 or so.

The 14's have a bust of 34 and the 12's a bust of 30. The size 12 1/2 is size 33 ????? This is just a start of the patterns as I will add some each time I post. It might be after the first of the year before I get a chance to try any of them. Can't wait.

And now to bed - in my own bed!

CRIPPLE

2008-10-12T23:32:00.001-07:00

From James:

My life as a cripple began insignificantly enough.

As far as I can tell, it started with digging that latrine last Sunday
morning.  I must have accidently hit the inside of my right ankle with the
pickax.  Whatever the cause, by Sunday night it was swollen and painful.  By
Monday morning, I could barely walk and it was red and angry.  I tried to go
to work, hobbled around on lightning rounds before I couldn't take the pain.

At the same time, I was hit with the worst attack of Malaria since the first
time I got it in 2004.  By the time I hobbled home my muscles were twitching
so badly and my teeth chattering so hard you'd of thought I was in the midst
of a Danish blizzard instead of 110 degree sub-saharan Africa.

I slammed down 8 anti-malarial combo pills straight in from China and
huddled under the blankets desperately trying to fight off the cold.

Did I mention my ankle was killing me?

After a day or two, the malaria was better, but as of last night, I hadn't
walked in a week.

I'd been hoping there wouldn't be any surgical emergencies as you can
imagine.  Despite two symphysiotomies performed resting my bum leg on a
stool on wheels in order to bring in two floppy, but eventually revivable
newborns, things had been relatively calm.

Until last night...

After a leisurely Saturday lounging around with my foot elevated to control
the edema listening to David Asherick talk about living in the End of Time,
I found myself strangely drawn to the window around 5pm that evening.  I
picked up my crutches (hand made in Chad and borrowed from a bed-ridden
patient) and limped over to the screen door facing the fence between us and
the Emergency Room.

It was hard to see because of the two screens and the distance between me
and the action, but I saw a group of people gathering hurredly.  A couple of
push carts moved back and forth.  Two people were carrying a stretcher.

I was not surprised to see one of the Intern nurses, Aimée, coming up the
path a few minutes later.

"There's a situation," she blurted out, gasping for breath.  "There's been a
fight at the market.  They've brought in a bunch of victims.  One woman's
dead.  A man has a huge knife wound to his neck.  This other woman is all
beat up around the head and unconscious.  There's a baby that's been
wounded..."

"Ok, ok, I'll be right there."

I pull on some scrubs as quickly as a cripple can and somehow cram my
swollen foot into my crocs and hobble over.  Crutches over moist, sandy soil
is not easy.

I pull aside the curtain to the ER and see groups of people huddled around
bloody clothes with arms and legs sticking out everywhere.  Some are on
beds, some on the ground.  Sarah looks up.

"I think this one is the most critical.  She's pregnant too.  We can't get
the baby's heart beat.  She has a huge wound on her head."

In the midst of a bloody pile I see a slender, young Arab girl with a
bulging middle sticking out of a brightly colored dress made even more
bright by her life's fluid spilled all over it.  Her face is irrecognizably
swollen, contorted and bloodied.  One eye is completely swollen shut and her
long, tight braids are matted with the dark, drying human liquid.

Jason tells me one pupil doesn't react well.  I don't bother to confirm.

Samedi and Abel have arrived.  Simeon is there shortly.  Ansley, Kristin,
Emily and Jacob are also there.

I start shouting out orders.

"Get IV's started on everyone.

"I want one liter of Ringers running full speed.

"Give them all 2 grams of Ampicilline.

"Where's Stephan?  Stephan, get a carton of those 1 L Ringers that just came
yesterday.

"Is there a pharmacist?  Where's Pierre?"

Andre has arrived and speaks up.

"I'll call him and get him right in," he says already punching in numbers on
his cell phone.

"That guy there is probably the second sickest," Sarah shouts across the
room as she attaches IV tubing to the arm of the first woman.

A young man is staring at me calmly.  His once white pants are now tie dyed
in his own color of red wine.  A bundle of gauze has been taped under his
right jaw on his neck.

I pull it off and see a 10cm laceration cut neatly from right under his chin
to under his ear.  It's about 5 cm deep and oozing a lot of blood until I
push the compresses back in the gaping wound.  It doesn't appear he got his
jugular or carotid though.  And he's breathing fine.

"Nathaneal, come and push on this as hard as you can...right there in the
center of the wound.  Don't let go."

IVs are running and nurses are frantically mixing up and administering
Ampicillin.

"Jacob, you and Jason...et Abel aussi...go get the gurney from
surgery...ABEL...LE BRANCARD...AU BLOC!"  I yell at Abel since he's almost
deaf, but one of our hardest workers and head nurse in surgery.

"Jacob, never mind, Jason and Abel can get the gurney, here take my keys and
bring me the ultrasound from my office."

I briefly look at the other two women who are beat up and bruised but
otherwise look ok.  One is pregnant and I quickly do an ultrasound
confirming the fetus is doing well.

Justine walks in with the baby who's mom had been killed, strapped to her
back.

"She's not injured at all luckily, we just thought so at first because she
was covered with blood."

"C'est bon!" I quip and head off to the OR.

In the OR, the lights aren't on so I hobble into the battery room/solar
panel master control room and flip on the switch giving us solar power to
light up the OR.

People scrambling around.  IVs going up and flowing in.  Needles, seringes,
gauze, scalpels, instruments, suture, gloves, scissors, razors, shaved
braids, and blood, blood everywhere.

After Abel finishes taking off a life's worth of braided African hair in a
few minutes time, Samedi gets going suturing up the huge upside down V
shaped gash in her scalp.  She starts to moan, she had been unconscious we
thought.

"Simeon, get her some Ketamine and Diazepam and put her under."

Meanwhile, there's a baby with anemia that no one has been able to find an
IV on all day.  They'd brought him to me at the house and I had tried
putting a needle into the bone marrow of his tibia, but I didn't have the
right needle and the others just kept bending.  It was about this time that
I was called for the mass casualty.  Now, the baby is before me again.

"Jacob, give the baby a milliliter of Ketamine IM and strap him into the
Papoose."

As Samedi starts suturing up the head wound, I slice into the baby's ankle
and dissect down to the saphenous vein.  I find it and slide in an IV
catheter.  We hook up the blood, see it's running in and I suture the wound
closed around the IV.

They've now brought in the young man with the neck wound.

"Kristin, you and Ansley take this baby off to peds.  Simeon, you and
Jackson (Jason) move the man onto this gurney."

"If it wasn't for Allah, I'd be dead."  The young man stares at me
earnestly, speaking in Chadian Arabic.

"Alhamdullilah!"  I reply and he nods and closes his eyes as he starts
softly repeating Koranic verses.

I stay seated on my stool as Simeon puts him under anesthesia with the usual
meds.

A couple sutures to bring the muscles together after washing it out well and
a few loose skin stitches and I'm done.

"ABEL...PANSEMENT!"  I point to the gauze bucket and to the man's neck.
Abel and I have our own sign language between us.  He nods and dives right
in.

Meanwhile Emily has brought the ultrasound in to the OR and I do a quick
ultrasound on the woman that Samedi has just finished stitching up her
scalp.  Her fetus is also doing well and at 32 weeks should survive even if
the mom dies if we can do a C-section quick enough.

I grab my crutches and swing outside.  Sarah is coming from the OR.

"They've just brought in another guy...a Nangjere man.  The sous-prefet's
truck is out looking for other victims.  This one doesn't look too bad."

He's got some cuts on his hand and a stab wound to the shoulder blade that
isn't deep.  I leave it for Samedi and hobble home with the volunteers.

After a game of Settlers of Catan our second game is quickly interrupted
with the arrival of more victims.

This time there're people scattered all over.  Camouflaged gendarmes armed
with AK47s and Kalishnikovs are unloading people from the truck.  I just
head straight to the OR and tell them to bring the worst one's in.

Samedi is just finishing up with the man I'd left him.

"James, I just heard the story of how it all started.  It started with this
guy..."

Apparently, the man was out in his field and saw some cows eating his rice.
He challenged the herdsman, an Arab nomad.  The nomad started to pull out
his bow and arrow so the Nangjere man rushed him and grappled with him.  The
Arab pulled out his knife and the Nangjere grabbed the blade with his hand
(hence the cuts).  He quickly let go and the Arab stabbed him in the back.
The man fainted and the Arab fled.  The women watching assumed the Nangjere
man was dead and ran to the market screaming bloody murder.  When their
relatives heard that their "brother" was dead, they attacked a group of Arab
women just leaving the market.  Hence our first wave of casualties.  Now
both sides were on the prowl and apparently a group of Nangjere had headed
to the Arab village going from door to door dragging women and children out
and the Arab men were organizing their reprisals.  There weren't enough
gendarmes to control it so they were just picking up bodies and wounded.

Samedi finished and wheeled the man outside.  At some point later on, he
wisely dissappeared.

Now, they bring in a wiry Arab with the face of Kobe Bryant who has a huge
slash across his right lower chest.  It's about 25 cm long and all the way
down to the ribs God gave him to protect his liver and lung.  The other Arab
is a wizened middle aged man with cuts all over.  His main complaint is
they've taken out his left eye but closer examination reveals a 10cm slash
across his cheek and a left eye swollen shut.  Small laceration cover his
body and arms.  An open dislocation of a finger I quickly "pop" back in.  He
also has a stab wound to his leg which has broken his tibia.

I put the tibia back in place, wash out the wound well, slosh some Betadine
of a gauze and place it over the wound.

"Jacob, hold that tight.  Jackson, keep pulling on his leg and hold it in
this position.  ABEL...PLATRE...PPPPLLLLLAAAATTTRRREEE!"  He doesn't
understand so I point him to the wound which he holds pressure to.

"Jacob, go get all the stuff for a cast.  Just like we did last Saturday
night:  webroll, tubing, plaster, a basin of water, scissors"

"Simeon, Diazepam and Ketamine for this guy too."  I point to the man with
the chest wound.

"Ashadu Allah illaha ilalallah, wa ashadu ana Muhammador rasullallah."  He
starts to repeat over and over his Muslim creed until he drifts off.

But he doesn't go quietly.  He starts to have a reaction to the Ketamine and
tenses all up not wanting to breath.

"Sarah, get me some Chlorpromazine."  She can't find it.

"Someone get me some from the Pharmacy."

"There is none."  replies Samedi.  "I needed some last night and we're all
out."

Just then Sarah comes out of the inside OR, "I found one ampoule."

The man finally calms down and I do a running subcutaneous suture to bring
the muscles and fascia back together and then some loose interrupteds to
bring the skin partly together, still allowing it to drain since it's
contaminated.

"ABEL...PANSEMENT!" and I turn back to put the cast on the other Arab's leg
while Samedi finishes suturing up all the lacerations.

Meanwhile, Kristin and Ansely and Augustin (who's just joined us) are
working on another man just brought into the room on a stretcher.

"His intestine is sticking out his side and he's got a ton of cuts."

"Start an IV with Ringers.  Simeon, Ampicilline 2g, Gentamycin 4 ampoules,
Flagyl 2 bottles!  Augustin, urinary catheter.  Abel, nasogastric tube!"

I turn back to the fracture and Jacob has already wrapped it well.  I wet
the plaster and quickly wind it around the leg while Jason holds it in
position.

"Hold it there until it's dry."

I turn to the guy on the floor.  They've got all the antibiotics and tubes
in and an IV is running well.

"Simeon, start the generator.  Let's move him into the operating room."

A few minutes later I hop in on one foot having just scrubbed my hands and
arms.  I dry off and Abel puts on my gowns and gloves.  The room is lit just
by the two overhead OR lights focused on the betadined abdomen.  Jacob slips
me my stool and I position myself on the right side of the patient.  We
drape him and then Augustin prays.

I open him up from his sternum to his belly button and dark blood surges
out.  I suck it up and start exploring.  There's no major gusher anywhere.
In fact, I don't see any injury.  The liver is fine.  There is no stool in
the abdomen.  The stomach and intestines are undamaged.  I pull out the
omentum which is what had come out his side and cut off the contaminated
part, tying off the vessels.  As I can now examine the spleen as well I'm
surprised to see no damage to that either.  Where's the blood coming from?

Finally, I get Abel to give me a good look at the wound and I see air and
blood spurting into the abdomen with each breath.  Of course, it's coming
from his lung through the punctured diaphragm.

That would also explain his poor oxygen saturation.  Duh!

I suture up the diaphragmatic tear.  Suck out as much blood as possible.
Re-examine the spleen since I can't believe the knife left a 3cm laceration
in the diaphragm right over the spleen without touching it, but the spleen
is clean.  I leave in a drain and close up.

Then I poke in a chest tube, hear the welcome rush of released air and a
smattering of blood, hook him up to the water-seal/suction apparatus, suture
up the large gash on his arm, the three small gashes on his back, and
finally come to the left buttock.

Jacob and Abel hold him as we roll him on his right side.  The wound is 15cm
long and 10cm deep and bloody.  I use a huge needle to bring the deep
muscles together and then sew the fascia shut.  I leave the skin loosely
approximated and Abel and Simeon dress all the wounds.

It's a half hour after midnight when I get home.  The truck drives up again
an hour later but since no one comes to get me I fall back asleep.  At six
o-clock, my haggard, yet still beautiful wife shakes me awake.

"Well, they brought in a bunch more Arab women but they all only have minor
injuries so I didn't wake you.  They also brought in three more bodies.  "Do
you want to continue antibiotics or anything else on that guy you operated
on?"

Oh yeah, post-op orders would be nice.  Sarah smilingly holds out an OR
order sheet that I quickly fill out.

She comes back at 8am showing me her lab slip.

"Yeah, not only was that the craziest night shift I've ever done, but I had
malaria the whole time!"

An hour later, I limp over to the hospital on my crutches to see the
patients.  Everyone is doing well.  All the women are awake, and while in
pain and swollen all over are able to sit up and take some water.  The neck
and chest wound men are also awake and praising Allah.  The man with the
punctured lung is also stable but not too awake yet.

Just then, a huge group of robed and turbaned Arabs flows in accompanied by
a bunch of soldiers with machine guns.  They go through and out the back
gate to the morgue.  I continue to the ER to see the other patients who'd
arrived after I'd gone back to bed.

I've just started and Djibrine, the nurse in charge of supervising our
district's health centers comes in.

"The governor and the sous-prefet want to see all the wounded."

I find them in the wards packed in with Arabs and gendarmes.  I send most of
them out with the full support of the sous-prefet except for a couple of
guards for the governor and the rest of his team.  I show them around as
they take town everyone's name and injuries and put them either on the
Nangjere or Arab list.

I finally make it home at noon and my ankle has ballooned.

I think I might always be a cripple.

Can't Believe It!

2008-10-10T21:45:00.000-07:00

I love to read sewing blogs and learn as much as I can. Lately I have been reading the discussion of vintage patterns. To be honest, I hadn't given "old" patterns much thought but was interested to see the patterns others were purchasing. The styles are wonderful but I was intrigued by the pages of instructions. Don't get me wrong, I love to have patterns that can just be zipped up quickly, but the intricacies of these old patterns that are posted really drew me in.

When I was at my Dad's in Texas my sister and I were discussing sewing and I told her how I thought maybe Mom had had some of the old patterns that were listed on e-bay and that I would be interested in them. It was disappointing to go through everything and find that she had gotten rid of all of her vintage patterns and that was the end of the discussion.

Today I received a call from my sister telling me that I owed her and she would take 2 dresses in her size and in the fabric that she would choose. Of course, I had no idea of what she spoke. It was then that she told me that she had been to her FIL's girlfriends garage sale and was able to purchase 36 patterns from the 50's to the 70's. One of the ones she wants has buttons down the side and she said the pattern is beautiful. She doesn't sew clothes but she was excited after she saw the dresses. When I get back to Texas next week and get the patterns I will post some pictures of my newly acquired patterns. (She only paid $.25 per pattern!) I am so excited!!

Not Sewing but Having a Great Time

2008-10-07T09:42:00.000-07:00

It should be a bit of relief to leave the intense heat of Texas and arrive in the cool breeze of the plateau of Tennessee - but I am a heat lover! and am having to grab the blankets to stay warm. But it is worth it to be with our son, his wife and two children for a few days. We don't get to be with the grandkids too often so we are having such a great time playing games, going to the park, cooking and singing until the hour they are whisked off to bed by the parents.

While here I was able to take pictures of some little backpacks that I made for the kids about 6 months ago. I had forgotten all about this pattern until I reorganized all of my patterns and found it at the bottom of the pile. They were fun to make and the kids seem to love them. My DIL is expecting the third child, a boy, in December and just let me know that she would be expecting a backpack for the new little one....a frog! There was no frog pattern included so I will be staying up at night to come up with, design, create, copy, a frog backpack.

Le Weekend

2008-10-06T09:57:00.000-07:00

From James:

Boy, am I glad I went to bed early Friday night!

It was still dark and sticky when I woke up around 4am thanks to the pitter
patter of little rat feet running back and forth directly over my head as I
lay in a profound sleep.  Now, I can't go back to sleep.  Every time I'm
about to find dreamland again I hear the scurrying or the flapping of a bat
outside my screen window.  I give up and get up.

I put on a headlamp so I don't wake Sarah with the overhead light and go out
to the kitchen table.  I grab my French Bible and finish preparing the
sermon I'll give in church later on this morning.  At 5am I'm finally able
to catch a few more winks before the pink early morning light filters in the
windows accompanied by the ever vigilant roosters.

I eat a simple breakfast of local peanut butter on toast with guava sauce.
Meanwhile, Sarah has gone out to feed the horses and locked me in!  I stare
out the bedroom window waiting for someone to come within calling range.
Kitty hops up to the window sill to join me in my quiet contemplation of the
African dawn.  Some purple, pipe-cleaner type flowers have shot up just
outside the screen and a zebra looking bee is buzzing merrily amongst the
bristles.  Everything is green and the guavas are getting bigger and bigger
although they're still very green.

Finally, I spot Emily, a volunteer just arrived yesterday who responds to my
pleas for freedom and unbolts the outside latch on the front door.  I pack
up my books in a tiny bag and hoist my heavy, hollowed out tree trunk drum
to my shoulder and head off to the church.

The ancient French hymns sung off key that come wafting out of the church
are soon replaced by a more African rendering as Allah, our new nurse
Augustin's 10 year old son, starts pounding out some rhythms on the drum
accompanied by my little tambourine.

I have a very interesting discussion with a bunch of young people interested
in finding out what Christianity is about.  We talk about the Bible and how
it came about and who wrote it and why it's important because it's a
collection of stories telling us how God interacts with people despite all
their warts and wrinkles.

Then I preach my sermon in French with Nangjere translation.  Afterwards,
Simeon is waiting for me outside.

"There are a couple of patients you should come see."

I hurry home, change into scrubs and mosey off to the hospital.

Our friend, Polycarpe, the child with the bleeding disorder we've been
transfusing almost every week for the last few months is having severe
abdominal pain.  He also had some bloody diarrhea.  I'd been saving the
plasma part of other people's blood transfusions by storing them in the
kerosene freezer.  Yesterday, they were supposed to thaw it out, let any
remaining red blood cells filter out and give Polycarpe the plasma.  It
hadn't been done.  I quickly hook him up to the plasma and give him some
malaria treatment.  I hope to avoid another transfusion.

A three year old child with a hemoglobin of 4.3 g/dl still hasn't got a
blood transfusion.  Seven family members have been tested with no one who
can give her the blood she needs.  Her blood type is B-, the same as me.  I
just gave blood last week, but what the heck.  I tell Simeon to call the lab
guy, find an IV and I'll be back.

I figure I'd better eat something first.  I go home and Sarah has heated up
yesterday's eggplant spaghetti sauce.  We eat and then I drink another liter
of water and head back to the hospital.

Mathieu is waiting for me.  I lie down on the examining table in my office
as Mathieu prepares the blood bag, wraps a tourniquet around my arm, uses
alcohol soaked cotton to wipe off the skin over the big vein in the middle
of my arm and slides in a huge needle effortlessly into the vein.  I pump my
fist to make the blood go out faster and I've quickly filled up the 450ml
bag.  Mathieu takes out the needle and puts a cotton ball over the puncture
wound.  I flod my arm up, sit up and get ready to go.

"Already?"  Mathieu asks, astonished.  "Aren't you dizzy?"

"No, I just ate and drank a bunch so I'm fine."

I head out the door and meet Sarah at the house where she's already saddled
my horse, Bob.  Sarah takes off on her horse, Pepper, while the volunteers
follow on foot.  I change into jeans, grab some water bottles and jump on
Bob.  Allah, my drumming friend from this morning is coming with me.  I
swing him up by his arm into the saddle behind me and we take off at a trot.
Allah bounces around and we have to stop and walk often but eventually we
catch up with the others.

The rice fields are completely swamped and the path is nothing but a swath
of still water meandering amongst the rice stalks already starting to bend
at the neck from the weight of their kernels.

It's blazing hot and the water splashing up from Bob's hooves is a welcome,
mild relief from the sweltering heat.

The river has way overflown it's banks swallowing up all the familiar
landmarks except a few trees bravely sticking their branches up from the
swirling eddies.  We wade out towards the current through what used to be a
large field leading down to the cattle crossing.  Jason, Jacob and Nathaneal
have already almost reached the current as I start out and they are quickly
swept downstream.  I find the current and swiftly catch up to them where
they rest holding onto some branches sticking out of the water as the water
rushing by makes it sound like we're in a mountain stream rather than a flat
river winding through the African bush.


I'm vaguely scared of hippos, though they probably won't like the fast
current, and am again glad there are no longer crocs in these rivers.

After several bends we pull ourselves up the bank by grabbing onto piles of
tall grasses and follow the sketchy, grown paths through the bush on the
bank of the river trying to be as loud as possible to scare off vipers.

Back where Sarah and the others are playing with some of the Chadian kids,
the guys and I head up river just a tad where we see a tree coming out of
the river near the bank and then bending out conveniently at a right angle
where we can jump off.

After some jumps to test the depth, we dive and do back flips venturing ever
higher on ever thinner branches until we've exhausted the possibilities.

Heading home on Bob with Allah I have a hard time holding the horse back as
he smells his dried corn at home already!  Packs of mosquitos buzz along
with us in the twilight as the sun has gone down over half an hour ago.
Finally, Allah can't take any more so once we hit the first huts of the
village he gets off and I let Bob go rushing off through the approaching
night with the wind whipping around me leaving the mosquitos far behind.

I arrive in time to see Augustin returning from church.  He informs me that
Samedi is looking for me as there was a motorcycle accident.

I quickly pull off the muddy saddle and harness from Bob, open the door,
strip off my soaked jeans, take a fast shower and pull on scrubs to head
over to the hospital.

The ER is dimly lit by it's one flourescent bulb crowded with buzzing
insects.  A small pool of blood has formed at the foot of the bed where the
middle aged, portly woman lies with her left ankle at an impossible angle
like it's been shifted completely towards the middle.  A blood soaked gauze
pad is tied on tightly over the lateral ankle where I assume the bone came
poking out.  She has no other injuries.

They've also just brought in another elderly woman in a push cart who I can
tell needs an amputation just by the smell and the sight of the left foot
wrapped in dirty rags over a mud soaked gauze wrap.  Sure enough, cutting
off the rags and gauze reveals wet, blackened toes with the calloused skin
on the sole peeling off and a large, pus filled central wound on top
revealing the tendons and bones.


The guy driving the motorcycle that had fallen over causing the woman's
broken ankle has a swollen hand with probably some fractures.  As I wait for
the two women to pay for their surgeries, I quickly apply a combo plaster
and fiberglass cast to the man's hand and wrist, give him some Ibuprofen and
tell him to go to Moundou and get some x-rays.

The family of the woman with the broken ankle are having internal conflicts
as to who will pay so since the son of the woman with the rotten foot has
paid half and put his bicycle on as collateral, we start with her.

Hoping to do a midfoot amputation only I squeeze the blood out of her leg,
apply a blood pressure cuff as tourniquet and slice through the bottom of
her foot right into a pocket of pus.  Her foot is gone.  I quickly move up
to the middle of the lower leg and slice down to bone.  I scrape the tissue
off the bone as far up as I can then painfully and slowly saw through the
tibia and fibula with a tiny inch long saw that keeps clogging up with wet
bone paste.  Finally, I get the leg sawed off, identify the major vascular
bundles, clamp and tie them and close the muscles and skin over the stump.


The second woman has finally found a solution so we find an IV, give her
some Ketamine and Diazepam and I pull her foot down and out into position.
The fibula gets stuck on some tissue inside but with some manipulation I
free it up and get it into anatomical position.  The medial malleolus (the
part of the tibia that makes up the ankle joint) is crushed in several
pieces.  The fibula part of the ankle seems to have only one break, but it's
an open fracture.  Abel mixes up some diluted bleach solution and I wash it
out well.  I close the subcutaneous tissues, apply a dressing with Betadine
and while I try to hold the foot and ankle in as good a position as
possible, Jacob wraps the foot and leg up to the knee with web roll and then
applies a plaster cast.  I am able to mold the ankle some more and get the
foot in a good position.  The cast hardens and we take her out to her bed.

It's 11pm.

I go home.  I haven't eaten since lunch, since giving blood, since riding to
the river, since swimming and jumping off trees, since riding back and since
doing two operations.

I'm slightly hungry and am so grateful to find a skillet filled with fried
rice and eggs.  I devour it.  It's only later that Sarah informs me that was
supposed to be enough for supper and breakfast the next day.

I fall fast asleep until the rat wakes me up again at 5:30am this time.
Sarah and I get up, grab the shovels and pick and go out behind the church
to dig a latrine...a typical weekend is half over in Bere, Tchad...

Police

2008-09-28T10:41:00.000-07:00

From James:

It's strange, because if I'd been in the US and the same thing happened, I'd be scared spitless. It happened like this...

I'm in N'Djamena to pick up Sarah from the airport. My friend and fellow AHI board member, Chief Justice Aimé, has lent me his Toyota 4-Runner. I take Sarah and her Danish sidekick, Nathaneal, to the central market. I park right in front of the Grand Mosque, just ahead of where the taxis pick up and let off passengers. I roll down the windows and sit back to watch the passersby.

A few kids come up with their metal bowls asking for alms for the mosque. I chat a little with them in my broken Arabic. One sticks his hand in and is fascinated by seeing the locks go up and down with just the push of a button. Finally, I can't get rid of them, even with the usual "Allah eftah" (God will provide) which should be followed by an "Amin" but instead these kids just say "Ma fi" (no way). Finally, I grab a bowl and toss it to the side and put on a fierce expression. They get the hint.

A young, beak-nosed Arab greets me from behind on the left. I turn my head and greet him back. As I turn back I see Sarah coming up to the window. She's just finished changing money and is about to head out to buy vegetables.

"Who was that guy and what was he doing by the window?"

"Nothing, he was just saying 'Hi'."

"Oh, he just looked suspicious."

"Don't worry about it. See you in a bit."

She heads out again with the green army duffel bag accompanied by Nathaneal.

A brand-new dark green pick up approaches from the left. "Police" is written in bold letters across the door. There are machine gun toting gendarmes in the back and a camo-wearing man with a maroon beret sticks his head out the passenger window, spots me, turns back and says something in Arabic. I hear the word "Nasara" (foreigner or "whitey") and the truck pulls in just in front of me and parks.

"Oh, boy," I think. "Here we go again."

Sure enough, the beret man and a couple of Kalishnikov bearers hop out and approach the right side of the 4-Runner. I'm a bit surprised, however, by their next move.

A young, gap-toothed teenager with his old school Russian automatic weapon opens the passenger door and gets in beside me, his gun slung loosely by his left side.

"Let's go to the police station!" barks the beret-wearing man, obviously in charge. "You're illegally parked."

I guess if I had recently arrived in Tchad I might be soiling my britches at this point, but for some reason I'm not afraid, just exasperated. I try not to sound angry and frustrated as I reply that I didn't know I was illegally parked since there is no sign and I've seen others park there often before.

The chief doesn't budge. I try a new tactic.

"I can't go because my wife is in the market and how will she know where I've gone and how will I find her?" I can see he's not convinced. "Now that you've done your job of informing me that one can't park here, I'll just move the car. Tell me where I can park and thanks for the warning, I won't park here again."

"You can park there on the other side."

I start up the car and back up and cross the one-way traffic to the other side right in front of the mosque, which seems to me a more likely spot to have a "no parking" sign, but I keep this thought to myself.

My passenger is still with me grinning stupidly at me from time to time.

The head honcho follows us over.

"Well, now that you've told us about Madame," he begins the negociations. "We'll let you off easy this time with just a 6000 francs fine."

I then pull out what I think is my ace. I reach into the glove compartment and pull out an invitation signed by the president of the republic to the year end meeting of the Supreme Court.

"This isn't even my car," I suggest. "Do you really want to haul off one of the supreme court justice's cars? One who's intimate with the Head of State himself?"

"Well, you're the one driving it now!" he retorts, "So it's you who gets to pay the fine."

What is it those Frenchies say? Touché?

At this point, a young man approaches me from the left with a bag of something.

"Are you Dr. James from Bere?"

"Yes." I reply, grateful for the distraction as time is an important element of the bargaining process.

"I've been looking all over for you. I'm the son of the man with the broken femur you operated on last week. I tried to find you earlier at the Mission guest house but I was told you weren't there. Then, my dad told me you were at the National Security Counsel office but I barely missed you there too."

"Yeah, I was there registering our new volunteer for the hospital. He just came back from Denmark with my wife. I called your dad back and told him to have you meet me here."

"So what's up with the gendarmes?"

I explain the situation to him and he starts up with explaining how I'm new to town and don't know the rules and that I'm the big doctor from Bere who just operated on his dad who is also a gendarme and one of there compatriots, etc.

The chief officer seems to be convinced...a little.

"Well, since you didn't really know and since you're here helping us out, we'll only make you pay 3000 francs."

My new friend has now gone over to the other side to talk more intimately with the police. He starts off in French but the officer quickly switches to Arabic saying he doesn't want me to hear their negociations. Unfortunately for him, I now understand a little Arabic and reply in Arabic that I understand him fine, thank you very much for asking.

He looks at me surprised and starts to laugh good-naturedly.

"Well, you obviously have money since you're driving a car so just share some with us for our tea."

"I have no money," I respond in Arabic. "If I did, why would I come from Bere on motorcycles and the common market car?"

The young, ugly, armed gendarme next to me now has a huge gap-toothed grin. He shakes his finger at me in wonder "You...you...you..." and gets out. They all walk off shaking there heads and laughing. Right before getting into their truck they turn one last time and offer a friendly wave goodbye.

As I thank my new friend and offer to carry his sack of homemade pasta to his convalescing dad, Sarah returns with Nathaneal.

It's then I realize that my cell phone has been stolen. In talking more with Sarah, it seems the guy she saw was on the right side of the car and was just pulling his head out of the window. Apparently, his partner greeted me from behind on the left so I'd turn my head long enough for the other guy to reach in the open window and take the cell phone from the central console. A slick manoeuvre.

Just when I thought Tchad was gettting boring!

It's Finished

2008-09-27T07:28:00.000-07:00

After 4 weeks of looking through, cleaning, sorting, choosing, and selling, everything down to the last piece of paper has been taken care of at my parents home. It was an emotional and tiring journey and I am glad to be done. We thought that just two weeks would be enough to have it all done so it was a bit of a surprise to still be hanging around a month later. We had planned the garage sale a week earlier but the forecast predicted a day of rain due to Hurricane Ike so we postponed it a week and wouldn't you know, it turned out to be a beautiful sunny day anyway!

While I was here I thought there would be some time for sewing at least a little knit top but it looks as if I will be taking my patterns and material back home the same way that I got them from the store. The only sewing I did was to put new elastic in a garter so that my niece can wear her mothers garter when she marries in December - she was thrilled so I count that has productive sewing.

Roadtrip

2008-09-27T07:27:00.001-07:00

"I dont' know, I really want to pick you up in the airport, but it'd be hard now. It's pouring down rain, the roads are already bad, the car doesn't start, I'd have to go by motorcycle and public transport. I'd like to see you as soon as possible, but I'm exhausted, plus the extra expense...couldn't you just take a taxi from the airport and then come back on public transport?"

Sarah is supposed to arrive tomorrow in N'Djamena, but with the rainy season and all, I try to excuse myself. Deep down, I feel I should go to meet her though, but she doesn't have to know that!

I haven't decided for sure one way or another, but I get a text message from her later that evening telling me she understands and I should feel free to not come to pick her up, I'll just owe her a ton of back rubs later!

I call Ndilbe, our nursing student who has just finished his 3 month internship and is ready to go back to N'Djamena.

"We leave tomorrow at 5am. Can you arrange some motos for us?"

At 3am, Augustin knocks on my door.

"There's a kid in respiratory distress, can you come see him."

Sure. I haven't been able to sleep anyway thinking about surprising my wife at the airport.

The kid is grunting, wheezing, retracting and has nasal flaring. Severe asthma. I open my office and find a few vials of expired Xopenex that we put in the nebulizer. I tell Augustin to give him some Dexamethazone IM while I hook up the machine.

The kid suddenly comes alive and it's all the mom and I can do to hold him and the mask in close enough proximity for some of the medication to get in his lungs. Despite his best efforts, something must be getting in those tiny lungs as he starts to breath easier. I tell Augustin to start a Quinine drip for malaria, add some Ampicillin in case it's pneumonia that provoked the attack and return home.

I'm too wired now for sure to go back to sleep for a few minutes so I make some egg gravy and toast and finish packing my small backpack, a skirt and t-shirt for Sarah and an army duffle bag to bring back fresh vegetables from the N'Djamena market.

The predawn glow appears. It's cool and humid and a little haze rests across the African plain. Two old Nigerian motorcycles with dim headlights waxing and waning with the speed of the engine and spewing out white, burned-oil-smelling exhaust, limp up to the front gate.

Ndilbe wraps himself up in a turban and we strap on our bags to the back of the motos with old bicycle innertubes.

We're off, with the cool air whipping gritty humidity into our faces.

The road is one long series of mudpuddles with improvised footpaths around most of them extending sometimes into the rice fields. Often we have to just plow through green, muddy water up to midway on the tires. We cross the new bridge and down the other side where the gravel buttress has mostly fallen away with the rains leaving a small middle section carved up with a few metal beams tied together with steel cable barely holding things together. We're through the barrier at the bottom and pass through Tchoua on our way to the hippopotamus lake.

The elevated road through the lake with a central drainage pipe is pock marked with a million ruts carved out by heavy trucks and a billion ridges carved out by the draining rainwater. It's confounded by being made of clay, slickened by the rains making it a bumby slip and slide experience wondering when we'll just slide down into that wide open hippo mouth.

The last stretch before Kelo is completely submerged and we plow our way through and wind our way through the early morning mud streets lined with tiny mud brick shops just yawning a good morning to another day of fasting in this month of Ramadan. A few lonely robed figures stroll through the red tinged early morning fog as we finally hit the pavement and pull up to the "bus station" on the side of the road opposite the air compressor and rickety wooden tables lined with various shapes and sizes of glass bottles filled with an assorted variety and mixture of fuels.

After paying the moto taxi-men and for our bus tickets, a young, turbaned man approaches and greets us. He is chewing on the typical Ramadan teeth cleaning stick. It's the son of the builder constructing our new junior high in Bere. He's on his way to Cameroon to study. I buy some bananas and then confirm his fasting by offering him one which he politely refuses.

We get on the bus and have two of the back four seats. Ndilbe takes one window and I take the other. Next to Ndilbe is another flowing robed, turbaned Muslim spitting occasionally out the window to keep from violating one of the Five Pillars by inadvertantly swallowing his saliva. A fully covered and veiled Muslim woman with dark gloves and stockings makes her way down the aile towards the back. A young Arab in front of me seems concerned that this obviously pious woman may be forced to sit by an obviously foreign and thus necessarily infidel white man. He shouts in Arabic to Ndilbe and the other man to move over which they do.

"Da bas adil" he responds nodding his approval as the deeply perfumed, modest example of virtue makes her way to the seat as far away from me as possible in the same row on a tiny bus. I'm relieved too.

The rest of the four hours passes quickly with a "Tale of Two Cities" and an occasional nap to keep me busy. We arrive without incident in the midst of a vusy market in N'Djamena.

I had planned to catch a taxi straight to the mission guest house, but decide to go with Ndilbe instead and try and arrange to see his nursing school and pay the school fees for the next year.

We walk down the crowded, noisy market street and turn the corner. We try and catch a taxi, but as we're putting our bags in the back, three people have got in the back seat and two in the front. There's only one space left. We start arguing as we have to travel together since I don't know how to get to Ndilbe's place. The woman in the back who'd stolen my spot doesn't budge and just smirks in reply. Finally, a young Muslim girl is kind enough to get out of the front seat leaving me crammed next to a very large woman occupying the other "half" of a tiny Peugot taxi passenger seat.

The trip is short and we take another road with a drainage ditch in the middle filled with small, bare-footed boys searching for something in the muck.

We open the gate to the house and enter the courtyard where we thankfully dump our bags under a shade tree and I thankfully relieve a very overworked bladder in the corner latrine.

The woman of the house, the wife of one of Chad's chief justices, generously lets me use her car which takes us on a bumby ride through the suburbs of N'Djamena to a Goudi looking three story structure where two secretaries sit doing their nails and gossiping in front of empty adminstration offices. Strike out!

I then get a call from Babana Benzaki who has arrived from Nigeria. A former Muslim, originally from Tchad, who converted to Christianity while studying in Nigeria and who is in his last year of public health at Babcock University, Benzaki has come to get the financial support voted on by the last AHI committee. We have many very interesting conversations about health, life and God. In the meantime, Kaitama shows up to get the letter I brought from his brother and Dieudonne shows up from work so we can discuss how I'm going to take off the lipoma from his neck tomorrow and how maybe in return he can let me borrow his car to pick up Sarah from the airport.

It also happens to coincide with the birthday of the four year old son of the Chief Justice who's mom had prepared a birthday feast even though she had invited no one. With nothing but a couple of boiled eggs and some bananas in my stomach since 4:30am I am more than happy to be part of the celebration! We finish off with a deep red Jus d'Osei (Hibiscus flower tea) and some strong, cold homemade Ginger drink.

I finally head to the guest house in the judge's Toyota Four-runner for a few hours rest before the 9pm arrival of my Danish wife.

I stand patiently outside the barred entrance to the baggage claim as various "important" people are let through while others are kept out. Finally, they seem to be letting down their guard and I slip through with the next batch let in.

I wait in front of the door leading to the immigration booths. I had glanced in quickly to see if I saw Sarah's red head without her seeing me and I succeeded. Finally, after an eternity, she appears at the door and looks at me with a shocked look and then starts laughing and saying "no, no, no, I can't believe it." Unfortunately for me, it's not a pleasant surprise at seeing me that has brought on this reaction but shock at seeing my recently smoothly shaven scalp that makes her incredulous. She is very cute with her long red hair pulled up in back with a few ringlets of curls escaping to the sides to run down her cheeks and forehead. I give her a warm hug and breath in the fresh smell of her hear as I kiss her head. It's good to have her back and definitely worth it all!

Add a co

Shocking!

2008-09-15T19:50:00.001-07:00

From James:

I stand at the foot of her bed. Kristin and Augustin are the nurses on duty and the three nursing students, Ndilbe, Honoré and Innocent are gathered around, white coats spotless, notebooks and charts in hand.

The patient has just come out of surgery two days ago for a walled off, perforated appendicitis. At first glance, she seems to be doing fine. She's staring at me with understanding eyes and breathing rapidly but easily. Then, I notice beads of sweat all over her chest, face and arms. I pull off my stethescope from around my neck and press it against her thorax. The heart beat is rapid and irregular. She's mid thirties and shouldn't have heart disease. What is it?

I look at the chart. Her vital signs there are listed as normal. Then I notice that she's been still kept NPO (nothing to eat or drink) but hasn't got IV fluids in 24 hours. I quickly have the nurse put up some Ringer's lactate IV solution. I think maybe she's dehydrated and has some electrolyte imbalances. We can now at least check his potassium thanks to the Danes and I go ahead and give him a little expired Magnesium that I've been hording in my little stash in the pharmacy.

Then, I remember the heart monitor/defibrillators that our two young volunteers for the summer brought over. I go to the OR stock room and find one that still has a charged battery despite never being charged since arrival in Tchad three months ago.

I hook it up to the patient. The screen is so small and the heart beat so fast it's hard to tell for sure, but it looks like atrial fibrillation or atrial flutter.

She's gotten a couple liters of fluid and the magnesium and now the potassium comes back normal. She seems stable enough so I leave the monitor hooked up but turn it off to save battery and move on to the next patient. Maybe she'll come out of it on her own.

It's 9:30am.

After finishing rounds and seeing the first batch of ER patients I perform a hernia operation with mosquito net mesh and repair to my office for some ultrasounds.

Augustin knocks on the door.

"Ca ne va pas," he says "Bed 10 is in respiratory distress."

I hurry over to the ward, worried that she's already dead (which is what "ca ne va pas" usually means coming out of a nurse's mouth). Fortunately, not only is she still alive, but she's consious and not really in respiratory distress. However, as I turn on the monitor, I see that her heart beat is still 150-160 and irregular. I feel I should do something but it's been a long time since I've had to deal with cardiac patients and I'm not exactly in the best equipped place to deal with it.

I hurry back my office to look up my little "cheat sheet" on electrical cardioversion. It tells me I should sedate the patient first if possible, put the defibrillator on "sync" and start with 100J. Ok, I feel a little better, it's starting to come back.

I hook up the defibrillator pads, give her some Valium IV, turn on "sync" and see the little dots appear over the QRS complexes on the EKG, turn the knob to 100J and hit charge. I hear the whirring of the charge and then it's ready. But now, I don't know how to make it decharge. I look all over and see nothing. Great.

I turn everything off, take off the pads and return to the OR where I find the paddles with their large, curly-cue phone cable like cords. I hook it into the defibrillator, check out the little buttons and place one over her sternum and the other on her left side under her armpit.

"Everyone back," I announce. "Don't touch the bed or anything!"

She's still staring up at me wondering what the heck I'm doing (as do I). I see that everything is well sync'ed. I hit the charge button and then the two "shock" buttons. Just like in the movies or on TV she bounces a little off the bed, her head thrown back, and then flops back down. The EKG makes a big wave, a brief flat-line and then a normal rhythm of 110 beats per minute starts to play across the little green screen.

I almost can't believe it. I know it's supposed to work according to all I've read and been told in my ACLS courses, but come to think of it, even in the US I don't think I've ever been present for a synchronized cardioversion.

My heart is full with thanks to God for bringing everything together to make it possible for us to save this woman's life first with the operation and then with what I had considered mostly useless defibrillator monitors.

Shocking!

Update

2008-09-05T10:41:00.001-07:00

So sorry that I haven't been able to post anything. I drove to Texas to help my father go through all of the things left in his house since my mother died a little over a year ago. Although he remarried in February of this year he had kept his house that he shared with my mom until now. So it has been a little of an emotional roller coaster going through the things and dividing them up and making a stack for a garage sale.

I am staying at his old house where he has disconnected the internet so I am going through a withdrawal from reading all of my sewing blogs! My sister lives just down the street, so I have hit the computer while waiting for lunch to cook.

My dad and sister left early last night so I did cut the pattern out of Burda # 7764 and am hoping that this next week they will need to quit working early so I can actually get the muslin cut out and stitched up.

As I look at all of the things that were so precious to my mom - and really not to anyone else but my sister and me - I am so thankful for the humble home that I was born into and for the strong foundation that they took the time to build in us kids and for the great sacrifices they made in our behalf. I would say that it is one of those things that VISA really cannot buy.

FIXIN DA BONE

2008-09-05T10:40:00.001-07:00

From James:

Considering I'd only done it once before in my life, it's hard to believe that this is the third time this month I'm slicing open a thigh. This one should be the hardest one to date.

Abel helps me stretch a sticky, yellow plastic covering over the thigh where we'll cut to try and get to the unhealed femur. As I poise with the scalpel over the now yellow window of thigh in the surgical field the first two cases flash through my mind.

The first was a large man hit by a motorcycle two years ago. His twin brother came to our hospital for some other reason and then asked me if I could do anything for his brother whose leg had healed badly leaving him crippled hobbling around with the aid of a crutch thanks to his now shortened right leg. Surprisingly, the traditional method of bone setting hadn't worked leaving him only with a circomferential scar where they had attached a cord too tightly.

Maybe it was the twin angle, but I told him to have his brother see me when I'd be in N'Djamena next. Sure enough he showed up with several sets of xrays showing his femur shortened by 4 cm and angled at about 25 degrees. It was well healed though. When he came to Bere I was able to break the two fragments apart and then put him in traction to pull it out to length. He's been here for a month now.

The second was an 8 year old girl referred by the first patient. In fact, she was his niece or something, also with a right femur fracture 3 months old due to a motorcycle hitting her. Basically the same procedure and she's been here for a couple weeks now. She also ended up with malaria needing a blood transfusion. She is stoic and looks me directly in the eyes every time I do rounds lifting out her hand solemnly for the obligatory greeting and exchange of "Ca va's". I look forward to seeing her every day.

As I slice through the yellow plastic, the black skin and the light yellow fat turning quickly red with blood, I think again that this one won't be as easy...

Again another call came to me while I was in N'Djamena last week saying he also had heard that we'd operated successfully on two of his relatives with right femur fractures and he hoped we could do the same for him who had the same problem. Yep, the right femur broken by a motorcycle hitting him while he was riding a bicycle.

As I held up the xrays in the faint rays of light filtering through the slats of the ER windows I could tell instantly that this was complicated. The two fragments of the femur were separated by about 4-5 cms with a separate fragment also to the side and no evidence of any type of callous or new bone formation anywhere. It was a year already after the accident. His fracture had also been an open fracture with a draining would for 3 months before it closed. As I looked again at the thigh I saw the healed scars from where the bone shard had pierced the skin. As I picked up his leg I found he had an extra joint mid-thigh. I could move his lower leg in all for directions without his hip moving at all. Not good!

I cut through the fascia and the red muscle wells up into the wound as Abel retracts. As I continue down through the muscle, I see the fibers twitch and retract. I hit some nice arteries and scramble to clamp them off. I call for a suture and tie off the bleeders. I can feel the proximal fragment of bone with a muscle spilling over it down into a cavity where the other bone has to be somewhere. I keep digging until I find the distal part of the femur. There is about 2 inches of muscle and a ton of scar tissue all around. I try to free it up with various instruments: scalpel, scissors, periosteal elevators and various others. I get into part of the scar tissue that has walled off some yellow inflammatory liquid like a cyst. It is clear though and happily doesn't look infected. The distal part just doesn't want to free itself.

I'm kind of a little nervous as I know somewhere around the back or medial side of that deep bone are the big arteries and veins that supply the leg. I don't want to have to resort to a Celox miracle again.

I have the scar tissue freed up superiorly, medially and laterally, but behind the bone I just can't seem to get to it. Finally, I find some dangerous looking pincher-like instrument and manage to grasp the fragment and pull it up enough to cut off the scar tissue keeping it from moving.

I then grab some Rongeurs and start ripping and tearing and biting and cracking off pieces of calloused bone over the two unhealed ends. Finally, I'm down to pretty fresh, raw, bleeding bone. Klevin and Gabrielle have been taking turns putting some traction on the foot and now I really have them tug with all they've got. The bones are still overlapped by a centimeter. I wedge in a chisel and with my prying and the boys' pulling the distal part finally slips over the proximal and meshes together with all the sharp edges left after my gnawing at them.

As Klevin and Gabrielle maintain tension on the leg I suture closed the fascias and the skin and place a sterile dressing.

I then take out a sterile, threaded pin about 20cm long and put one end into a very not sterile cordless drill. I make a small incision on the skin over the tibia and pull the trigger. The pin barely moves, the battery is weak. It makes it a few millimeters into the bone before conking out completely. I ask for the other battery. It is even deader since the charger hasn't been plugged in. I try an old rusty hand drill. Doesn't move at all. Finally, I send Gabrielle to my house to get another cordless drill. After a long five minutes he's back and I drill through the bone, nick the skin on the other side and let the pin work it's way halfway through before detaching the drill. I then attach a U-shaped wire onto it so we can attach a bag of sand to work as traction to keep the leg out to length.

After transferring him from the OR to his bed and attaching the sand bag, I do the final manoeuver, I put two empty Ceftriaxone vials over the sharp edges of the pin, make sure the legs are the same length and go home.

Little Gwame and Bob the Horse

2008-08-22T20:30:00.000-07:00

A young boy with twisted legs. An old horse with a twisted
pelvis. Neither was expected to walk again. But their story has a twist of its own.

From James:

I was riding my horse Bob when I came to Gwame's house. Bob was an old horse who had been slightly handicapped by trying to jump over a six-foot-high fence. He didn't make it but hit the top of the chain link and flipped over. His knee popped out of joint and his pelvis was twisted. Somehow, he recovered enough to not only walk, but trot and gallop. The accident also made him gentler. Every once in a while, though, Bob still thinks he's a young stallion and he wants to race.

Today was one of those days.

I'd finished work early at the hospital and took Bob out to the river. We rode across the African plain at a slow gallop. There are no giraffes, elephants, zebras or lions. The local villagers hunted them all down years ago. The only dangerous animals are snakes and hippos.

After arriving at the river, I carefully looked up and down to make sure there were no hippos and then took a long swim. The day was hot and the water felt cool. I got out and got back on Bob. Bob had just eaten the only green grass to be found in the dry season here in Chad so he had a lot of energy. He took off at a mad pace. The wind was whipping in my hair and I was holding on for dear life.

We finally slowed down as we entered the village of Béré. Gwame's house is just on the outskirts. His house is made of mud bricks with long bundles of straw tied together for a roof. Around the house is a mud brick wall surrounding a courtyard. In the courtyard a bunch of chickens run around. There are also a few goats, two cows and a horse tied up to a pole. The horse stares at Bob wondering what it must be like to be free. There is also a round mud brick storage bin with what looks like a chimney coming out the top. It has been placed three feet off the ground on piles of sticks. That's so the rats can't eat the grain stored inside.

As I ride up, I see Gwame run out to meet me. I remember the first time I saw Gwame. He could barely walk, much less run. It was a year ago and I was with my friend, Troy. We went to Gwame's house to visit his family. Gwame was carried in by his older sister. His skin was covered with parasite bites. He was skinny and his eyes were dull and hollow. Both legs were angled towards the left at the knees as if something had hit them from the right side. It left him a cripple, unable to walk. His twin brother was also there reminding us of what Gwame should be like. When we said "hi," he didn't look up and barely said "lapia " in reply.

Troy wanted to help. So he found some friends back home in the USA who gave money for Gwame. We took him to N'Djamena, the capital of Chad, and got him a passport. Then, we sent him to Kenya to the CURE hospital to be treated. The CURE hospital does surgery on kids who have bone problems or who are crippled.

There they cut one of Gwame's bones in each leg and twisted his legs back into the right position. Then they put both legs in a heavy plaster cast for two months. Gwame came back after one month. He had eaten a lot of food in Kenya and now was a chubby little dude.

Six weeks after he came back, we took off his casts. He was scared and cried a lot. We tried to get him to walk but he was weak and frightened. He wobbled a few steps and then had to be carried home by his mom. Maybe the surgery didn’t work.

But today, a few months later, as I ride up to Gwame's house on my horse, Bob, Gwame comes running out to meet me with a huge smile on his face. There is no limp. His eyes are bright. He holds his arm high above his head with anticipation all over his face. I lean down holding my hand out and he slaps it a big "five".

"Gwame, ma gei ere lemga ga?" I ask if he wants to ride the horse. He nods solemnly. I lean way over and grab his still skinny, but healthy arm and haul his five-year-old healed body onto the saddle. He sits in front of me and squeals in delight as we trot off towards the hospital.

FUTBOL

2008-08-19T13:53:00.000-07:00

From James:

Why did I choose to wear shoes? I thought it would protect my ankle which had been smashed by Jason last week forming a superficial blood clot leaving my left inner ankle and foot swollen and different shades of purple and green.

Now as I send the ball skimming back across the grass, in the general direction of where I want it to go, I feel some burning pains on the sides of both small toes.

As Bond, Gabriel, Klevin and Stephan continue to play with some of the neighbor hood kids I step behind the two broken bricks marking the goal posts and take off my shoes. Sure enough, blisters have already burst leaving raw flesh where the side of the toes should be. I jump back up from the ground and join back in the game. As I look up past the other goal defended so well by Bond things sort of go into movie mode as four well muscled, lean teenage Chadians stroll up slowly from past the end of the fence. I almost feel like things should go in slow motion with sinister music from some gang flick plays in the background. The brief moment is burst, however, as they flash large smiles and I recognize Koumakoy and Frederick's "little" brother along with some of the normal neighborhood soccer thugs.

We quickly divide into "us" versus "them" as they are intent on preserving the national Chadian football honor on this warm, Friday afternoon. In fact, warm is an understatement as the humidity from last nights downpour hangs like a suffocating blanket over the ratty field as a cloudless sky lets a merciless African sun slowly broil us alive.

Needless to say, a few minutes into the match and my scrub bottoms are already soaking with sweat from the waist down and the top has long since been discarded. Along with our great Brazilian hope, Klevin, we are the only barefoot ones on our team. Stephan is our version of a gangbanger with his recently shaved-head-except-for-monstrous-sideburns look intimidating the opposition almost as much as his bare bear chest and cleats. Gabriel and Bond also are wearing scrubs and tennis shoes. Our opposition is lean and mean wearing only shirts and the occasional t-shirt along with bare feet and/or flip flops of various sorts.

We score first, a beautiful pass from Klevin after some footwork only a Brazilian could imagine setting up Stephan for a nifty tap in. Second blood is a breakdown in passing on my part setting up an easily intercepted ball across the middle and an easy angle shot off the bricks. From there on out it's back-and-forth with the Chadians controlling the ball the majority of the time before losing it through too much dribbling and not enough passing. We on the other hand make the most of our few opportunities and are soon up 3 to 1.

A loud thunder from the East makes me look up to see angry clouds forming quickly casting a slight shadow over the millet jungle that Bere has become and sending a cool breeze across our sweaty bodies. A perfect rainbow encircles the encroaching storm and as brilliant footwork and sometimes stellar passes continue beneath the now menacing sky, small pellets of water began to drop into the dry dust of the road making up the Western part of our playing field.

I quickly run over and put my Bible and songbook into the open doors of the church just to the Southeast, then grab my shoes and barely get them in before the downpour starts. We have not yet begun to play.

The game goes on.

We are drenched within minutes and passes start to get sloppy and slow down as the earth turns boggy. The rainbow has dissappeared but there is still clear sky to the West where the sun is almost changing color into sunset. The rain is coming down almost parallel to the ground drilling into our welcoming flesh from the East.

The western part of the field (formerly the road) is now almost unplayable as any pass hazarding into its slimy clutches is instantly stopped in a puddle of water and muddy sand. The chadians with flip flops are starting to slip and slide dangerously while the barefooted ones continue with no loss of traction. A huge grin splays across my face as Bond looks on from the eaves of the church having retreated there with the first of the downpour.

I haven't had this much fun in a long time.

Eventually, the Chadians say they are done. Down now 5 to 1 I don't blame them. They rub their tummies and give mournful looks as they say they haven't eaten since the morning...no strength. I mock them comparing our sagging bodies to their chiseled frames but they just laugh and insist. We finally agree to meet again sunday, slap hands all around and I head back over to the church as the torrent continues.

The noise inside the tin-roofed church is deafening. The only people who've made it for Friday evening prayer meeting are Lazare and a few kids who come around me as I sit in front of Lazare and say we should sing or something.

Shouting out loudly as we belt out songs in Nangjere I can tell that the kids are loving it, especially one-armed-boy. Finally after a few rounds of "Ka Ama Kouma Kwani Teri" and "Kela ka dane ma ei kera...dul kang ddi, Jesus, Jesus-Christi". I tell them the story of David and Goliath using Lazare to translate from French into Nangjere.

I end with teaching them "Only a Boy Named David" in Nangjere (Kware kusi ne David) by holding the songbook up to the last rays of light coming in the slit that serves as a window on the church. Then, one of the boys prays, Lazare locks up and I walk back slowly home through the mud and the mist.

Ahhhhh, The Weekend

2008-08-15T21:14:00.000-07:00

You would think that I had completed a sewing project of mammoth proportions this week instead of just a size 4 children's dress...I just no energy to do anything else.

Finally drug myself over to DD's classroom to help her rehang her Cowboy wall of pictures that fell down while we were up north this past weekend. It was a nightmare of tape, paper and pictures that took up a wall that measured about 10' x 10' - what a mess. We were able to get it back on the wall and the pictures don't look too bad from a distance.

Then somewhere I got the wonderful idea that I needed to bake bread yesterday - after an absence of 10 or so years of doing it. The good part is that I used my Bosch so it wasn't too bad a deal to do. The not so good part is that I used too much flour and if you dropped a loaf on your foot it could do some serious damage. Oh, well, I will know next time that I need to stop adding the flour even when the dough isn't cleaning the sides of the bowl.

In a couple of weeks we need to go back north for a centennial celebration and another wedding so I thought that I should get busy figuring out what to wear for the weekend. I like to peruse the clothes on NM's website for ideas and when I saw this outfit it reminded me of a vogue pattern that I had purchased at the last pattern sale.

Do you think that this pattern will work? September is such a confusing time of the year to dress for...it is usually still warm but can be cool in the morning and evening so I am not sure what type of fabric would be the best for this look.

Well, that is the plan that will hopefully be started next week...we'll see how adjusting the pattern goes!

The Dress is Finished - Finally

2008-08-12T22:40:00.000-07:00

Even though I thought I would be finished with DGD's dress last week, life happened and it was only today (Tuesday) that I was able to have enough time to work on it and actually complete it. It was a fun little "frock" to make, although it turned out to include more handwork that I had anticipated. So I just rev'd up the laptop, tuned in to Project Runway Australia, and watched the latest episode while I did handwork. My DIL is really good about sending pictures so when I receive one of DGD in the dress I will let you see if it really did fit.

FRACTURE

2008-08-12T09:05:00.001-07:00

I feel like an idiot. What was I thinking! Of course, the wound would get infected. I was too optimistic when I wrote that the wound looked great three days later and maybe a miracle would happen. The fracture got infected the next day. I tried to clean it out again and cover the bone with some muscle. That got infected. I tried to cast it in various ways, the bone didn't stay in place and kept pushing out through the wound, seeking the outside air like a drowning man. Nothing seemed to work. I thought maybe we'd have to amputate. Finally, we just left the whole thing open and let diluted bleach dressings do their trick. Slowly the wound cleaned up and granulation tissue formed. We kept asking if anyone could send us an external fixator, no one could find one. Finally, the wound was clean but the fracture was still only partially stabilized and the bone was still exposed.

Luckily, I am temporarily not alone. Dr. Bond and Dr. Jason Shives are with me in Bere. We talk about the open tibia fracture and what to do. Finally, we come up with a brilliant plan straight out of the MacGyver archives. Abel and Simeon prepare the patient while I head over to the house. I find a long piece of two and a half inch pipe that seems pretty strong. I grab a saw from the tool box and we cut two pieces off, roughly the length of a certain man's tibia.

Meanwhile, Jason and Abel have brought out the small generator and the cast saw and have been spewing plaster powder all over the ward in an attempt to take of the full leg cast.

We rejoin Bond in the OR where we try out Bond's regional spinal anesthetic technique by having our patient lie on his left side, the side of the fracture, while we put in the spinal lidocaine and let him sit on that side so only his left leg will be numb. When it's settled in, we turn him back onto his back and I hand the leg off to Gabriel to hold while Abel preps the leg with Betadine.

Jason and I scrub while Bond directs and advises. I first pull out some pieces of infected sequestrum and chip off some of the bone sticking too far out with a rongeur. We twist the leg into a more anatomical position and Gabriel holds it steady. I follow Bond's suggestion and make four tiny incisions, two above the wound and two below. Then I take a regular, unsterile cordless drill with my right hand and insert a sterile, threaded Steinman pin into the drill with my still clean left hand. I insert the still sterile end of the pin in one of the incisions and push it against the bone. I then squeeze the trigger and thread the pin in and through the tibia till it pokes the skin on the other side. Jason makes a small cut with the scalpel over the pin and I drill it the rest of the way through till it's sticking out the same amount on both sides. I repeat the processes for the remaining three pins.

Then, while Jason holds the PVC pipe steady against the pins, I mark where they should go through and then drill holes through the pipe. I then force the pipe over the pins till the pins hit the other side of the pipe. I then try to estimate where I should drill the second holes and mark the pipe again. I drill again and this time get each pin to go through it's second hole with the help of a little hammering. I repeat the process on the other side.

Gabriel lets go his stabilizing hold on the leg and we confirm that the fracture is now stabilized. Jason wraps gauze with Betadine around the pins while I dress the fracture wound with diluted bleach and we take him back out to the ward. It's once again in God's hands.

MacGyver Surgery 1

MacGyver Surgery 2

Fires in Paradise

2008-08-11T22:57:00.000-07:00

It was the wedding of another one of our kids from the church youth group of several years ago that took us back up to Paradise this past weekend. We hadn't been back since the devastating fires that closed down the only hospital in town, destroyed homes and had the fire continued up the canyon wall destroyed the whole town. All of the motels in town were full so we ended up staying in Chico. This is what the parking lot looked like when we arrived as there were still other fires in Oroville and at Shasta. These are young guys that have been working so hard to save towns neighborhoods and agriculture in the area. Signs thanking the firefighters were posted all over the town of Paradise - on almost every corner and in between - very touching.

As we drove up the Skyway into Paradise here are the sights that greeted us...

Hope the fall rains will be gentle enough to encourage new growth and return it to "Paradise" soon.

Eclampsia

2008-08-11T06:20:00.001-07:00

From James:

Boom! Boom! Boom! The pounding on our cheap, metal front door jolts me out of a deep sleep. I glance quickly at my watch. 4:13am.

"James! Are you awake?!" I hear Dr. Bond's son, Gabriel, calling me, out of breath.

I pull on some shorts and fumble my way through the darkness out the bedroom door, past the bookshelf on the left, through the curtains covering the exit, out the living room door and onto the porch.

"What's up?" I mumble, trying to clear the cobwebs.

"Doudjé's wife just came in with seizures and we need some Magnesium from the pharmacy." I notice the shadowy form of Dr. Bond behind Gabriel in the moonless night.

"I'm coming," I reply and head back in to pull on some scrubs, grab my keys and a head lamp and back outside where I hear the voices of Gabriel and Bond fading around the corner of the container across the yard.

I push through the wet leaves of the bushes forming a hedge between our house and Lazare's little hut just outside the main house and stumble over his wire cooking "gounan". I make my way over to the fence, unlock the gate and head towards the dim light coming from the ER. I hear screams and wails and the sounds of a struggle coming from within that grow louder as I approach at a fast walk.

I push aside the bright green and yellow flowered curtain blocking the entrance to the ER and my eyes are instantly drawn to a group of 8-10 people surrounding on of the beds. Cries and moans are coming from inside the circle of bodies, a bottle of IV fluids hangs from a wooden IV pole and a tube descends into the crowd. Arms and legs shoot out here and there and are instantly seized by several hands and pushed back inside.

I push the people aside and get my first look. It is certainly Doudjés wife (and Koumakoy and Frederic's sister) but she is barely recognizable. I nod to Frederic and his mom who are part of the crowd.

"Lapia ei?"

"Lapie, Jamsuh," responds the mom.

"Ca va" is the reply from Frederic.

Doudjé hasn't arrived yet but his wife is swollen up like a balloon with edema everywhere and is alternately thrashing and lying moaning on the exam table. Just then she makes a violent effort and pulls out her IV causing blood to splatter all over the bed and floor as a nursing student rushes to stop the bleeding with a cotton ball.

She seems to vaguely recognize me as she looks at me, or more like through me, and mumbles "Jamsuh, jamsuh, jamsuh" over and over.

Augustin, the night nurse, informs me that she came in convulsing and with a blood pressure of 140/90. No question about it, it's eclampsia. I had just done an ultrasound on her a few weeks ago and discovered she had twins. There is definitely no time to lose.

"I found both fetal heartbeats" reassures Dr. Bond as I start to bark out orders.

"Augustin, call Simeon and Abel! Gabriel, you and the nursing student go get the gurney and take her to the OR! David, go call Sarah, tell her we need her immediately! Bond, I'll go get the Magnesium from the pharmacy, here's the keys to the OR."

We all split as the family continues to hold her down.

I pull out 6 ampoules of Magnesium and meet the gurney in the OR just in time to see the next seizure.

As she rolls through the door her body stiffens, her eyes roll back in her head and then she starts shaking violently with her teeth clenched. She starts bleeding again from the old IV site. Then, after a few seconds, the seizure stops and she falls unconscious.

"Now's our chance since she's unconscious. Let's get her clothes off, get her in the OR, start an IV and get her ready for surgery."

Sarah and Abel have both arrived now so an IV, a foley catheter and antibiotics are quickly done and she is transferred to the OR table.

I sidle up to Bond and ask him quietly if he minds if I do the surgery. Since I've been following her during her pregnancy and it's a friend of mine and I myself was a twin born by c-section, I request the privilege of doing the life-saving surgery on her. Bond is generous and concedes me the case. We scrub together.

By this time Simeon has arrived and I tell him to prepare one millilter of Ketamine. Doudjé's wife is still somnolent. Bond and I scrub and don gowns and gloves. Abel has prepared the surgical field and we drape the lower abdomen.

We pause for prayer and then I take up the scalpel. Two slices later and I see the uterus. Bond stretches the peritoneal opening wider as I insert the bladder retractor. I make a small transverse incision and poke through with a hemostat. I then insert the index finger of both hands and pull out and up opening the uterine wound. There is the upper back and neck of a tiny baby. I insert my hand down into the uterus till I find the head and lift it up and into the uterine wound. Bond pushes the top of the uterus and the baby slides into the world with a gasp and a scream.

Here's where things go temporarily wrong. Bond has grabbed the clamps for the ombilical cord and tells me to go for the next baby. I see the bulging amniotic sac and try to break it with my fingers with no success. Then, for some strange reason, I do something I never do, I reach again for the scalpel and as I bring it up to the surgical wound, Bond reaches down to grap some scissors to cut the cord and the scalpel collides with his finger. I'm horrified but Bond signals me to keep going as he finishes cutting the cord and handing off the baby. I put the scalpel down, burst the sac with another instrument and deliver the second baby who also comes out with great tone and grimacing and crying. Bond calls for another glove and we suture closed the uterus, the fascia and the skin with no further complications.

By the end of the surgery, her blood pressure has already normalized. Bond goes off to wash out his wound. We call in the lab to do an HIV test which is negative and Bond starts on post-exposure prophylaxis. By the next day, the edemas have started to go down, the twins are breastfeeding and Doudjé is the happiest, proudest man in town giving praise to God for his blessings

LET THE SEWING BEGIN

2008-08-05T11:39:00.000-07:00

As my energy begins to return I thought I should make myself do some sewing. Being able to fit myself (the nightmare that it is) didn't fit into the present energy scenario so I decided to make the DGD a little dress. The dress straight off of the pattern fits her just great which makes it such a pleasure to sew for her.

I chose fabric that I already had in my fabric closet (would you believe it once served as table cloths for a bridal shower YEARS ago!) and thought that the blue would be a great color for her. The pattern is Butterick 4680

As you can see, I just made the sleeveless version without a cape. The dress is turning out cuter that I expected. I was just drawn to the dress because it had a purse to go with it and DGD LOVES purses so I always try to include a matching purse with each dress.

This is the state of the dress as of today - needs a zipper, hemming both the dress and lining, button and botton hole for the belt on the back and fine tune the bow.

The dress seemed a little plain and I was wondering what I could do to spruce it up a bit. I remembered a thread on SG that talked about appleannie and her wonderful piping and thought I might give it a try. Although not perfect, I was pleased with how it turned out. I had never basted the cord inside the bias tape before sewing it before, but I must admit that taking the time was well worth it.

This was a kind fun dress because of the lining with netting ruffle that makes the dress stand out from the body. Do you think it just brings back memories of the crinoline era?
Despite what the pictures shows - it is even! Hopefully I will have it completed by tonight and can show you the completed version.

Just a few pictures of outfits on the internet that I think have some great style.

This is an outfit from Neiman Marcus - I love the jacket.

A jacket from Burda 7764 that is really classy.

This is an Oscar de la Renta that is shown on Neiman Marcus. An interesting combination of fabrics for sure but I was drawn to it after seeing the yellow beauty knitted by Ann Rowley on SG.

This is another Neiman's suit that has a great use of trimmings. I am such a sucker for black and white that there was an immediate bond when I saw this pic.

Well, before I can sew I need to help DD get her classroom finished as she reports for duty on Monday. I always look forward to the first weeks of August and spending the fun time with her getting ready for the students. It's a great way to be creative - if you can get the out-of-the-box ideas past the principal.

THE COWBOYS

2008-08-01T17:58:00.000-07:00

On Wednesday my husband, daughter and I went to Oxnard to visit the Dallas Cowboy Training Camp. The daughter had been in touch with someone in the organization who arranged for VIP passes so a couple of her students could interview some players for the new Service Learning dept at her school this coming year.

Well, the students were not able to come at the last minute so in the afternoon the three of us plus one of DD's friends were invited to the corporate space to view the practice. (They had no corporate sponsors for the day!) Just letting you know that they couldn't have been more gracious and accommodating. What was cool was to watch the employees of the organization do their job and represent the DC's.

Now I have never been a great fan of Jerry Jones, but after hearing how his employees spoke about him and specifically how much of a man of his word he is I thought I might have to reconsider. I was especially impressed with his player education program that takes troubled players under their wings and work with them for 6 weeks to help education them in all walks of life.
It was a fun afternoon and we couldn't have been treated any nicer...Thanks Bryan and Megan

EARTHQUAKE!!!!! 5.4 or 5.8?

2008-07-29T13:38:00.000-07:00

I had just left the house to drive to check on our rental house. As I pulled up to the stoplight and waited for the red light my SUV started rocking back and forth. I looked around and at the car next to me thinking that it might be a souped up car that rattles everything within 50 yards of it when at a stoplight but it didn't seem to be that problem. My car rocked and rolled for the entire length of the red light and I was relieved to get going.

After crossing the intersection I pulled to the curb to use my cell phone (you know we have a new law that we can only talk on hands free phones while driving now! and I haven't gotten a headpiece yet - does anyone making the laws know what mothers do when driving their kids around?) and when I stopped my car was still rocking from side to side. This had to have lasted for 30-40 seconds. I tried calling my daughter for another matter and the call would not go through. Only when I finally reached her did I find out that the problem had been an earthquake. We are very happy that the dishes are still in the hutch, mirrors, clocks, and pictures are still attached to the walls and all of the food is still in the cabinets and most of all we are all safe.

Life is back to normal, well, sorta, because every movement that you're not expecting stops your heart for just a moment until you confirm that it's an okay movement and not the dreaded earthquake movement. We're going to be okay.

NO SEWING

2008-07-25T14:38:00.000-07:00

There has been no sewing in our house for the last couple of weeks...sad to say. We have had store issues to deal with and have spent many, many hours working on solutions to some of the recent problems. It is always a fun time to get together with my husband and search for the best answers for a retail business. (of which we have absolutely no experience!)

It seemed like week after week I just couldn't get myself together to do anything, that all I wanted to do was just sit and vege. One day I happened to pay particular attention to my medicine bottle that contained my prescription of thyroid medicine and thought to myself that the dosage didn't look quite right. I finally called my physicians office to check what strength he had written the Rx for to compare with what the bottle said. Well, my bottle said .05 mg and the Rx was for .15 mg.

With that information I called my pharmacy and told them that there was a discrepancy in my dosage and would they please check the Rx against what was dispensed. They put me on hold and were gone quite a while before coming back and telling me that it should indeed have been the .15 mg dosage and they would call the doctor and have a new Rx of the right dosage waiting for me. AND I would have to have new blood tests run and it would take about 6 weeks to get back to feeling normal. I have been taking the wrong dosage for at least 6 months and you wouldn't believe how sad my poor body is!

So, it may take a few weeks for me to get enough energy to get up off the couch, but I am looking forward to getting back in the swing of sewing things as soon as possible. Until that time I will live vicariously through all of you others sewers who are just churning out wonderful garments.

MORTALITY

2008-07-16T00:27:00.000-07:00

From James:

The strong young man's body is covered with goose bumps. His eyes are rolled up in his head staring blankly into nowhere. The mourning wails will begin shortly. It's hard to believe that just 15 minutes ago I was standing by his bedside and he was looking at me. Although I shouldn't be surprised considering ever since he came last night and we opened up his abdoment to suck out liter of stool and inflammatory fluid from a perforated small bowel from Typhoid Fever, ever since then he's been hanging on despite being in septic shock. What's sort of weird is to look over at the bed next to him and see a young woman who just 10 days ago was operated on for the same thing and just 8 days ago also stopped breathing but miraculously came back to life.

I can still remember it clearly...

It was while my cousins, John and Jenny, were visiting Bere along with my sister, Chelsey, and a radiology tech named Brian.

It was a Sunday and I was rounding late. About 1:30pm I find myself at the bedside of a 25 year old woman operated on Friday for intestinal perforation secondary to Typhoid Fever. We'd taken out a small section of her small intestine and sutured to bowel back together.

She looks weak and shaky but is looking at us as we ask how she's doing and examine her. There is no bowel function yet and we are keeping her NPO (nothing by mouth) and on IV fluids. She has a quinine perfusion running in slowly. John and Brian are with me as is Abel and two nursing students. It turns out to be the perfectly assembled team for what quickly transpires next.

I am in the midst of talking to the nursing students about Typhoid Fever and its complications when I glance down at the woman and see that she has stopped breathing and her eyes are rolled back in her head. I check her pulse, nothing. My first instinct is to do nothing since I've tried to resuscitate patients here before without success, but something makes me decide to try one more time. I start doing chest compressions and call John over to take over. As he continues CPR, I stop the quinine perfusion and switch to a bottle of 5% Glucose solution that is there at bedside. I think that maybe the Quinine has caused hypoglycemia. I send Abel to the OR to get some Adrenaline. I send Brian to get a pulse oximeter. John keeps pumping valiantly on her chest. I remember something else and send one of the nursing students to chase down Abel and make sure he brings some Atropine as well.

Andre has just shown up, attracted by normally dignified nurses tearing up and down the halls at full speed. I thought about sending for the bag-valve-mask to breath for the dead patient but remember just hearing from my friend, Erling Oksenholt, that chest compressions not only pump blood from the heart but serve to move air in and out of the lungs as well.

I ask Andre if we have any more 10% glucose bottles, He says he thinks we do and runs of to look for them in the pharmacy. Meanwhile, Abel has returned with the Adrenaline and Atropine and Brian has come back with the pulse ox which he attaches to the woman's finger before taking over CPR from John.

Her oxygen saturation is in the low 80's and her pulse is present only with chest compressions. I push Adrenaline and Atropine one right after the other. Still nothing. We continue CPR with John and Brian taking turns. Andre comes back with the 10% glucose which we let run in full bore. Her O2 sats come up to the 90's.

Amazingly, after 20 minutes she has a faint pulse and is taking occasional gasping breaths. We continue to help her with CPR. Finally, after 30 minutes, although her breaths are shallow and labored, she is breathing on her own. Her eyes are closed and her pulse is thready. Without intubation, without oxygen, withous labs, with minimal monitoring and only a couple of medications she came back to life.

All this rushes in upon me as I glance back and forth between the two patients post-op from exploratory surgeries and bowel repair for Typhoid perforations and think about the thin thread that separates life and death. Miraculously for one, all the elements came together so that we were at her side when she stopped breathing (even though I almost never do rounds at that hour) and all the staff necessary were there (Abel is usually in surgery, he only is on the wards occasionally on Sunday but he knew where all the meds were and had the key for the OR where they are kept) and Andre is never on the wards, much less on a Sunday but he is the only one who knew where we had 10% glucose, plus usually we don't have visitors who are familiar with emergencies and CPR like my cousin (worked years in an ER) and enough students to run back and forth to help send messages and find things. So why did it all come together for her and not for the strong young man in the bed next to her?

As I walk away I hear wails and cries of grief pierce the air and my heart as the goosebumps rise on my arms as well.

Finally Catching Up

2008-07-04T23:35:00.000-07:00

It was a push to finish the JCC by the Monday midnight deadline but how fun to get past the hump and complete it. It has taken the rest of the week to get caught up on all that I let go in order to have my capsule finished so I haven't posted any of the pics.

I discovered that even after doing my fitting and making changes to the pattern that after the garments were sewn (the top and blouse/jacket) a few fitting problems still remained. This week I think I will see what I can do to refine the fit some more.

How thankful I am for the many sewers that are willing to post how they do different sewing applications and then take pictures to show you exactly what they're talking about. Shannon's blog gave me the courage to WASH the dupioni. I was scared to death I would ruin it but plowed ahead just based on her recommendations. I need not have worried as following her instructions proved the good thing to do and I won't have to think about the cleaning bill.

The next thing that Shannon explained was sewing the underlining to the fashion fabric right sides together and the turning them right-side out to produce beautifully finished seams.

Fitting info and other techniques were from reading blogs by Debbie, Gigi, Ann, Paco, Tany, Carolyn, Cidel, Summerset, Liana and others . Thanks to all who have given of their information - I promise not to hold you responsible for the outcome!

This is the final storyboard for my capsule -

Even though the are neutral they are so peaceful for me and will go with quite a few other garments in my wardrobe. I have enough of the dupioni to make pants so I might think up something else and continue on with the July projects. That is after I make a dress for the granddaughter and teepee for the grandson.....

Jugular Vein

2008-07-04T21:46:00.000-07:00

From James:

The dark blood suddenly gushes out of the neck wound like a hot spring bubbling up from the ground. I had hardly slept the night before anticipating the complexities of operating on this man's neck. He had a mass bulging out under his right mandible which looked like a bunch of large grapes with bearded skin stretched tightly over them. The mass was smooth and lumpy and about the size of a large grapefruit.

He'd been to many other hospitals who'd told him there's nothing that can be done.

The surgery started off bad with a difficult intubation. I put the laryngoscope into his mouth only to find myself faced with a looming open esophagus and no vocal cords in sight. I pulled up with all my strength, tried repositioning the head, had someone try and push his voice box down, all to no avail. Finally, I blindly inserted the tube above where I could see the esophagus and pulled out the guide wire. As my cousin Jenny filled up the cuff with air and my cousin John attached the ambu-bag I looked for the telltale signs of vapor on the tube. Then, Jenny verified that there were breath sounds.

Unfortunately, at this time his oxygen saturation started to fall as his pulse jumped up to 172 beats per minute. I listened to his lungs and they were clamped down like a severe asthma attack. I quickly asked Simeon to give him some IV steroids and Chelsey to run to the pharmacy for some bronchodilators. It was about this time he started to grunt and clench his jaw and hands while straining like he was going to burst through some invisible barrier like the Incredible Hulk transforming himself into the Green Monster. I shouted at Simeon who quickly gave him more Diazepam on top of the Ketamine.

Finally, after about 30 minutes, we had him sedated enough, airways open enough and heart rate down enough to start the hard part of the case.

I had dissected the skin off the mass and was working my way around the lateral side underneath the tumor when I got into the jugular vein.

As the blood gurgles into the wound I quickly put my finger over it with a gauze pad between me and the large vein carrying most of the blood from the head. I pause for a moment. What do I do now? I'm definitely in uncharted territory. I calmly ask Johnny to put on some sterile gloves and hold pressure on the wound. As he holds the man's lifeblood from escaping under his finger I continue to methodically and painstakingly dissect the rest of the mass off the mandible, the voice box, the trachea and the carotid artery and other deep muscular neck structures. An hour later, the mass is out.

Johnny's fingers are paralyzed in position and totally numb.

I ask him to gently take off pressure. Blood surges into the surgical field. He quickly presses back down.

It's then I remember my old friend, Erling Oksenholt pulling me into his office in Oregon in May and showing me a short video. In the video, a gloved hand is poised over a pig's groin. A sharp scalpel suddenly lunges down slicing through the porker's femoral artery. As blood spews from the wound the gloved hand quickly piles on gauze and holds down fiercely. Then, just as quickly, the gauze is withdrawn and a white powder is poured into the wound and the gauze and pressure is quickly reapplied. A note on the bottom of the screen says "five minutes later" as the scene shifts slightly. The gloved hand releases pressure and gently pulls up the gauze. There is no bleeding.

I also remember that Erling gave me some packets of this miracle powder (Celox) that I had left with my cousin John to bring with him when he came three days ago.

I yell to Brian to run over and check the bags that he and John brought and see if he couldn't find any. Meanwhile, John and I continue to wait and hold pressure. Brian comes back at first to say he didn't find any. Jenny and Chelsey go to help him look. Finally, Brian comes back with a small, white plastic bag with Celox in big red letters. Brian opens the sack and I say, "ready" and lift off the gauze as he quickly pours in the powder and I reapply pressure. Five minutes later I lift off the guaze and see white powder in the wound but no bleeding.

Johnny has been reading the instructions and says that now I should irrigate the powder out of the wound which I do. At the end I am trying to wipe out the last fragments and the blood gushes forth again. We repeat the process and the second time I'm a little gentler.

It holds and I close the muscles and skin, wrap his head and neck in a loose ace wrap and then send him off to ICU attached to a ventilator (whoops, dreaming again). Instead, I take out his endotracheal tube and send him out to the hot, sticky wards where his family will fan him with homemade woven fans and we'll hope he wakes up and his throat doesn't swell up too much so that he can't breathe.

Two days later he's complaining of a sore throat but sitting up, breathing normally and taking liquids. His neck has virtually no swelling at all.

Storyboard

2008-07-01T22:01:00.000-07:00

Well, this is how my JCC actually turned out. I know that the white pants look goofy on this board, but I really like it together with the champagne colored dupioni. There is no way I can take credit for this, I just took my cue from the picture already posted from Bloomingdale's with the yellow dupioni top and white pants. To be honest, I had enough fabric to make the pants but just ran out of time and decided to make the pants my purchased item. Pictures of the garments coming tomorrow

I'm Done!!!!!!!!!!!1

2008-07-01T01:23:00.000-07:00

I finished my JCC about 11:30 tonight and tried to go online and let Elizabeth know I had made the deadline. My camera is not wanting to cooperate right now and so there are not pictures yet of the finished garments.

I'll quickly try again, but then I am off to bed.............rest is sweet when you finish the project....

Bloomingdale's Tank and Shirt

2008-06-29T01:03:00.000-07:00

I was searching the internet for a more simple pattern for the jacket/shirt I had planned for my JCC when I stumbled upon this picture of a dupioni tank and big shirt. I love it and have been searching for some type of pattern that would give me a similar look. Tomorrow I will be off to JoAnn's or Hancocks to see what there might be.

TWO DOWN

2008-06-27T20:30:00.001-07:00

I can hardly believe it myself, but I have finished my dress for the JCC. It has a total of 8 darts that I've discovered are worth the pain (I'm not thrilled to do darts) because they have a slimming effect. It is a very easy pattern and shouldn't take very long to do. Because the poly I used was so light I had to line it with some batiste. Even that wasn't bad. My challenge always ends up making all of the adjustments I need to and then making everything match up. I can't complain because it is way better than it used to be when I tried to make adjustments and make sure that I had changed everything that that adjustment affected...but I have quite a bit of room for improvement. Good...I look forward to it.

Three days and three garments...hmmmmmmm.....

Here is the dress with my accessory scarf.

Guess I should have used a clothes pin on the back to give it more shape and have it look like a smaller size. ;-]

Next up are the pants -

and the top
This top is similar to the one with the pants, the only difference is that I have made this one before, with adjustments, and it halfway fit so why at this late date should I start with a new one.

JCC - Some Progress?

2008-06-26T22:15:00.000-07:00

Well, well...after having to take care of some unexpected store business I was able to spend some time sewing today. I had wanted to finish the dress but my daughter says that everything I sew after 10 p.m. I end up ripping out the next morning so I will wait until tomorrow morning to sew the lining to the back zipper and hem. At least that only leaves 3 more garments to finish by Monday. Fun times. Will get a picture of the dress tomorrow.

The above mentioned daughter went to a noon Dodger game today (in the crazy heat) with her teacher friends. Before the game started I received this phone picture from her
Larry King was nice enough to take a picture with her even though it was his day off.

Human Resource Development Projects

2008-06-24T18:31:00.000-07:00

From James:

Training of Nurses:

Samedi Deying Michel has been working the Bere Adventist Hospital since 1979 and started out as a janitor working his way up to nurse, surgical assistant and finally performing operations himself. Two years ago, we decided to send him off to nursing school to add some theoretical knowledge to his already vast experience.

Mbayambo Patchanne Andre is our administrator who we are sending to Kenya one month out of the year for 4 years to get his master's in International Development. This year will be his third session. He finishes is 2009.

Iaknone Hortence is a nurse's aide who we have sent off to become a midwife. The hospital currently has no midwives. She finishes in October 2008.

Djekourboa Anatole is one of our long term workers of almost 30 years service at the hospital as head of the laboratory. We are sending him to Valley View University in Ghana 2 months every year to be trained in medical equipment repair and maintenance. The program is put on by International Aid and last for three years. Anatole will finish this August, 2008.

It Was to Be a Simple Scarf!

2008-06-19T23:16:00.000-07:00

The electric company promised to turn on the electricity to one of the temporarily vacant rentals so we could keep the lawn watered in this 100+ heat but they couldn't give an exact time, just some time between 8 a.m and 5 p.m. Sounds like a fun day of just waiting?!?!?! but I wasn't realy bothered because I thought that I would just whip out my scarf accessory for the JCC over at SG. Well, that was yesterday and it is now 11:15 p.m. the next day and I am just now finishing the hand rolled hem on a 36 x 36+ scarf.

I love hand work for some insane reason and was looking forward to a relaxing time. By noon yesterday I was kicking myself for not signing up for Susan Khalje's hand stitches class at PR. It was always something that I was "gonna" do.

After completing one side and was started on the next I decided to look on the internet once again to see if there were any more instructions that would make this process go faster. I think it was seeing a tutorial with pictures at Pins and Needles on hand stitches that showed me that I was most likely trying to sew these tiny little stiches backwards and upside down. So.....

I stopped mid stream and turned it all around and started going the other way and would you believe that it started to actually work. Being a silk fabric it was still slippery to work with and the process took longer. It is hard to see in these pics but the fabric has something like burnout areas in the fabric where you can see right through and when that part is turned under to hem there are fuzzy edges to that burnout area that were hard to make sure they were caught in the hemming.

So I'm happy that I learned another skill and thrilled that I now have completed one piece of my capsule!

This is a rather washed out picture of a sample of wonderful silk that I got on my trek to LA on Tuesday from ISW. It looks great with the scarf but I'm really not a great brown person.

Think I will start the dress for the capsule tomorrow. Only four more garments. ;-]

Fabrics

2008-06-18T09:56:00.001-07:00

Well, yesterday I needed a fabric field trip and so I headed into LA to finally visit at least one of the fabric stores that I keep reading about, F & S on W. Pico. I don't know if it is the gas prices or just what, but I made it to LA in just over an hour and with no traffic, well, except minor slowing on the 10 to Santa Monica. Unheard of.

I have a piece of silk dupioni that I have been trying to find a coordinating fabric for for the June Capsule Contest and thought I would have no problem in LA. The dear little lady at F & S was so helpful and we scoured the store looking for just the right piece of fabric. They all seemed too pink or too yellow with nothing seeming "just right". She suggested that I go over to International Silk and Woolens to see if they might have a fabric that would work.

It had been over a year ago that I was at this store and even then was just there to buy a notion and not fabric. I did remember looking at some beautiful shirt fabric and thinking I would get back to get some. That didn't happen though. Anyway, upon entering the store there was a sales lady with a headscarf who asked if she could help me. I pulled my fabric out of the bag and told her what I was attempting to do and what I thought I needed. She went right over to some linen/silk blend and pulled out this gorgeous piece of fabric that matched perfectly. I was so impressed and loved it. After looking at a few more pieces of fabric I was at the point of making the decision to purchase when I thought I should see what this fabric looked like on me...good thing I did...it looked absolutely horrible on me! even the sales lady agreed so you know it was bad.

Window

2008-06-17T21:06:00.000-07:00

The thunder rolls. A cool breeze bursts through the window ruffling the papers on the table. I'm sitting, staring out my window at life in Bere as the sun goes down behind the house. The red sunset reflects off the mango tree leaves poking up like heads of broccoli above the pale tan of the mud brick walls of my neighbors lots. The thatch roofs of the huts add no color but rather texture and ruggedness. A gentle rain sprinkles down. The sky is a steel grey.

People pass by on the path that runs 20 feet from where I sit behind mosquito screen and iron bars. Finally, a little rest from a long 24 hours of hospital work.

It started yesterday evening after the lights came on with a simple testicular abscess that we drained in the OR by removing his testicle. Afterwards, I was reminded how often unusual things come in pairs.

The nurse calls me to see an old man with urinary retention who had gone to a health center where they tried to insert a catheter into his bladder but came up with blood instead and couldn't get it in. They referred him to us. I see him now with a huge round mass in his lower abdomen: a distended bladder holding a liter or two of pee. I try half-heartedly for a few minutes knowing that a false track has probably been created leaving me with no option except to drain his bladder through his abdominal wall.

Then, I remember an instrument I saw among the bag of weird, mostly useless instruments brought by one of our volunteers. I hurry home and come back with an instrument looking like a torture device from the dark ages. It's a metal tube with a tee at the end and perpindicular to the tee a spout curving out. on top is a round top on a piston connected to a four-sided razor sharp spearhead poking out the opposite end.

I inject some local anesthetic above the pubic bone of the old gentleman, make a small skin incision and then poke and twist the torture device straight in until I feel a "pop". I pull back the piston and bloody, foul-smelling urine jets out the spout all over the bed and partly in the basin we'd arranged for it to go in. I then slide a rubber tube down the spout into the bladder and pull the torture device out. I tie the tube in place and attach it to a drain bag and send him to the ward after examining his prostate with a gloved (duh) finger and confirming that it's monstrously enlarged.

Outside my window, a fat lady mosey's on by pushing a push cart. Chickens peck the ground looking for insects while trying to escape the amorous advances of a strutting, cocky rooster.

Last night at 11pm, the twin of old man with the large prostate and urinary retention comes in. Same story, went to health center, tried to put in catheter, got blood, sent to the hospital. This time I'm ready and quickly repeat the same suprapubic insertion of the drainage tube under local anesthetic with the severe-looking trocar.

The rain continues to fall outside as a woman walks her friend out the gate of her courtyard half way down her path to the main path. As the saying goes here in Tchad, if I accompany you out then my blessing goes with you. She stops and shakes hands and her tall lanky friend saunters away down the path glancing casually around and greeting the two boys bringing the cows back in from grazing. A sharp smack with a long stick ensures that the cows keep up a healthy trot and stay in line.

The morning brings a pair of hernias. Not too unusual except that both have associated hydroceles. We do them with the generator running, but since it's kind of a mutant, handicapped generator, it can only do a few things at a time so we operate without lights (except for sunlight through the opaque glass brick "windows") so we can run the a/c and keep from dying from heat stroke and falling into an open groin wound.

In between cases, a 10 year old boy comes in after being attacked by a bull on the outside of his upper arm. A superficial 10cm U-shaped wound looks like it was cut with a knife or razor blade. How he avoided massive injury with those big horns I'll never know. I suture him up under general anesthesia and then do the second hernia/hydrocele combo.

A few hours later, another 10 year old boy comes in with a wound to his armpit from another bull's horn. This one is also superficial having missed his blood vessels and lungs. Those bulls need to practice their goring, they're attempts are pathetic. I let Simeon suture this one up while I grab a bite to eat.

A large woman waddles by outside my house as I sit and take in the calm evening scene around my house. On her head are carefully balance an enormous pile of bound reeds. I'll never cease to be amazed...where this path joins the main road in front of the hospital a group of about six kids hops, skips and talks animatedly to each other as they head away from me. A tiny girl in a tattered pink dress does semi-cartwheels, her bare feet flailing in the air before tumbling over on her back.

As I'm about to go home a little after 3pm, one of the nurses comes to see me to say that one of the kids on pediatrics is pooping blood. I go over to see one of the kids we'd treated for meningitis and malaria as well as giving a blood transfusion for anemia. She was doing better this morning according to the family and had finished the treatment. She always looked a little drowsy to me, but I guess I just chocked it up to being worn out from all that's happened. For some reason, it did strike me, though, especially looking back.

She is 4 months old, very cute, and with devoted parents.

She is resting face down on her moms lap, her butt cheeks in the air, her legs hanging down and dark red, partially coagulated blood coming out of her anus. I've never seen what I'd learned about in medical school as red currant jelly stool but this looks like it. I refresh my mind with a quick look up in my ER book and am convinced it's what's called intusseception (when the small intestine gets swallowed up by the large instestine creating obstruction).

We take her to the OR. She looks so tiny on that large table. She only weighs a little over 10 lbs (5 kg). Abel finds an IV, Simeon administers the anesthetic and after prayer I open up the thin skin of her belly with much trepidation.

Some red inflammatory fluid bubbles out along with most of her small instestines. I search for where her small intestine joins her large bowel and don't find what I expect. Instead, I find a deep red, almost black gangrenous appendix that fortunately hasn't ruptured. I perform an appendectomy and close her tummy up.

As I hand her back to her parents, tubes coming out from all over, I can't help but hope that one day soon, she too will be attempting cartwheels down the streets of Bere...

Capsule Find

2008-06-16T12:01:00.000-07:00

The fires are under control and things are getting back to normal, now maybe I can get some sewing done on my June Capsule.

While looking for a sewing book I ran across these pamphlets that I remember ordering from Anne Klein probably sometime in the 80's, thought it was a great idea and then promptly forgot about them. Anyway thought the info was interesting.

Second muslin for my pants are just about complete. I tried them on and took another picture and was horrified at how my fit really pronounced a round tummy so I am working on camouflaging that unwelcome sight!

Flashlights

2008-06-15T12:38:00.001-07:00

I find myself bumping along the supposedly paved streets of N'Djamena in a Hilux pickup so thrashed that you wouldn't believe it could still be running unless you've lived in Chad and seen the miraculously still running majority of Chadian vehicules limping along the highways and byways of the African plain. Sitting next to me is Enock, a squat, heavily muscled slowly turning to fat nursing student flashing a toothy grin complete with gold glint.

Whatever the case, he has been reminded of an unbelievable story that he now shares with me.

Several years ago, his son became deathly ill with severe abdominal pain. He was rushed to the health center who appropriately referred him to the National Reference Hospital in the capital, N'Djamena. They were fortunately living there at the time and were able to get him there quickly.

It was the middle of the night.

Trying to manoeuvre through the crazy ER with people piled all over the place already cost him some "tea" and "soap" money but finally he was seen by a doctor who confirmed the diagnosis: acute appendicitis.

He was scheduled for surgery that very night.

As Enock and his wife huddled together praying, the surgery team wheeled their son away through the swinging doors on a gurney. All they could do was sit and wait...

Until a half hour later, when all the lights went out.

Of course, there was instant confusion and they heard an orderly fumbling through the halls and bursting through the doors of the operating room. In a frantic rush he bumped into Enock.

"Are you the father of the boy with appendicitis?" He demanded.

"Yes, what's going on?"

"We're in the middle of the case, your son's belly is open and we have no light."

"Yeah, I noticed...what..."

"Hurry out to the market and buy some flashlights...HURRY!"

Enock rushed out, down the stairs, out the door of the hospital, hailed a motorcycle taxi, raced to the market, luckily found someone open, bought two flashlights and hurried back.

The surgeons then continued their life saving procedure and a week later Enock's son was home safe and sound.

Only in Chad.

2008-06-14T21:16:00.000-07:00

Smoke looming over Neal Rd

Not much sewing going on for me these last couple of days. Our beloved town of Paradise, CA where we lived for 25+ years and raised our kids has been under severe fire attack since Wednesday night. As of Saturday afternoon 70+ homes have been destroyed and 20 more damaged. These include the homes of dear friends, families of our kids friends, physicians, and coworkers.

While living in Paradise, it was always a concern that something like this might happen, but whenever there was a threat to the town it was always avoided. There have been several 5:00 a.m. wake-up door knocks from the sheriff telling up to pack up the vehicles for evacuation but our homes were always saved. I had hoped that that would be the case this time too, but sadly, that wasn't going to happen.

The first time we packed up was the hardest because I didn't have a clue, other than pictures and important papers, of what to take. I finally was able to narrow my valuables down to, as already stated, pictures, and important papers, some clothes for the interim, computer, sewing machine and serger (in case I had to either provide clothes for the family or make an interim living). The final thing I always put in the car was my recipe box. My reasoning was that if everything that said to my kids "home" was lost, if when they walked in the door to unfamiliar sights and furniture at the least the familiar "smells" of their favorite foods would tell them that they were indeed home.

The wonderful thing about Paradise is that the community family will rally around those with losses great and small and help them rebuild, both materially and emotionally, and hold them close as they heal.

My heart is so sad tonight.

Shaun

2008-06-12T23:05:00.000-07:00

It has been a sad week in the Loma Linda community and the young adults lost one of their own. Shaun was an acquaintance of my daughter's and had dated her roommate briefly several years ago. The article below is informative but you have to go to his blog and look at his amazing pictures. You will not believe them and you will not be disappointed for sure. Our prayers are with his family, father Norm, mother Marge and sister Shelly as they grieve this horrible loss. How comforting to know that he had a heart for God.

His blog is at: shaunlunt.typepad.com

California pilot dies in crash

Sat, June 7, 2008
Posted in Alaska News, Top Stories

Shaun Lunt in Alaska, 2007. More photos at shaunlunt.typepad.com

Friday night at approximately 7:30 p.m. (ADT), Alaska State Troopers in Bethel were notified a Piper Super Cub aircraft had crashed approximately 17.3 miles south of the village of Quinhagak, near Jack Smiths Bay.

View Larger Map

The victim of the crash was identified as Shaun Lunt, 33, of Loma Linda, California. Lunt was flying one of two Piper Super Cubs traveling together at the time of the crash. The pilot of the other Super Cub, identified as Lon “Loni” Habersetzer of Washington, had successfully landed in the area at the time the crash was reported, but then disappeared.

Photo of crash site on Friday evening, June 6, 2008. Photo courtesy Alaska State Troopers.

Troopers arrived on the scene around 10:00 p.m. and confirmed the pilot of the downed aircraft had died. Officials from the National Transportation Safety Board (NTSB) and the FAA were scheduled to arrive in Bethel Saturday afternoon before traveling to the crash site to investigate its cause.

The two did not file a flight plan, but bought fuel in Dillingham before flying north to where the crash occurred. Their intended destination was unclear Saturday afternoon.

Photo of crash site on Friday evening, June 6, 2008. Photo courtesy Alaska State Troopers.

UPDATE: 06/07/2008: Habersetzer, the second pilot, spoke briefly with Alaska State Troopers in Bethel via satellite phone on Saturday evening. According to a press release from the Troopers, he will be cooperating with the NTSB investigation.

Photo of pilot and Super Cub trainer Loni Habersetzer, from cubdriver749er.com

UPDATE: 06/08/2008: Shaun Lunt, the deceased pilot, had a blog featuring photography from his flying exploits in Alaska. He also has another blog with more photos. You can also see a video testimonial Lunt gave for the bush pilot training he received from Loni Habersetzer’s training business, CUBDRIVER 749ER, LLC. Habersetzer’s company also has a collection of 9 more videos related to the Super Cub training program.

Additionally, Lunt was quoted and in a lengthy Habersetzer profile in the Smithsonian’s Air & Space Magazine. The article was published last m

2008-06-11T19:48:00.000-07:00

I spent part of my day today trying to get these pants to fit. I didn't think that they were too bad until I took a picture of the behind and then thought that maybe I had fitted them tooooo much. Here are a couple of pics that tell the fitting story...what do you think?

Flat Seat Adjustment

2008-06-11T01:46:00.000-07:00

Okay, just a quick note to say that my goal of ending today with a wearable muslin pant did not materialize. I was just a bit discouraged when, after taking much time to adjust the pant pattern, I tried on the muslin and they did not fit anywhere!

I remembered reading about a flat seat adjustment on SC by Ann Rowley so I scurried to find the instructions that she so graciously shared. What a save for me - at least for the one leg that I have completed and tried on it surely fit differently. Since I had already cut the pants out I just cut the fabric in the manner she described for paper pattern and sewed where I had cut back up again after making the adjustments.

So we'll see what tomorrow brings when I do the other leg and put them together...I'm crossing my fingers...

Ann's flat seat adjustment can be found here http://artisanssquare.com/sg/index.php/topic,2106.0.html and her great photos of making the adjustment here http://www.flickr.com/photos/7370831@N07/sets/72157600004811376/detail/

Kids - Africa

2008-06-09T09:14:00.000-07:00

This is an update that we get from a friend of our kids that is a physician in Bere, Chad, Africa. Three years ago we took a group to this village with no running water or electricity to help build for them a new church so the old one could be used for an outpatient clinic for the hospital. Wonderful people, severe third world poverty. We spent time just teaching them to wash their hands.

The dust kicks up a small puff of powder with each tread of my foot. The clear blue, cloudless sky leaves no hint
of the massive showers soon to hit. Travis, Justin and I are hoofin' it to the river while Sarah and Chelsey ride on Bob and Pepper, our two horses. It has been exceptionally hot this year reaching into the 130's Fahrenheit and even higher in the A/C-less furnace we used to call our operating room. As the sun bakes my brain I try to desperately keep it alive with frequent sips from my camelback. After about 45 minutes we are in a groove but suddenly feel a cool gust. I look up and notice that out of nowhere behind us is now this gray, hazy area in the sky blotting out the trees and dusty terrain to the northeast.

Plip-plop. The first drops plump into the parched soil of the path. Soon we are almost shivering as a cold rain pelts us just as we arrive at the river with the pack of local boys we've picked up like groupies at a rock concert. We are famous. After all, we are "Nasara" the most interesting thing to happen in these parts in a long while for sure.

The river actually feels warm after the cold rain. The clean sandy bottom is just a couple feet under the surface and I have to lie down completely to get covered. I drift along with the surprisingly fast current till I hit a slightly deeper section. I grab a breath and dive. As all other sounds mute instantly I am made keenly aware of the gnashing of teeth sound of fish feeding and the soothing melody of raindrops on water. I wish I could stay under forever.

As I come up, I spot our groupies who have stripped down to their birthday suits and are splashing around in the shallow end. I decide to have some fun. I jump up and crash through the water chasing them as they flee in all directions, terrified of the white beast from the deep. For me it's just a game so I'm shocked when I actually catch one and he's crying and screaming his brains out with a petrified look on his deer in the headlights stare.

I grab him, throw him over my shoulder and run back to the river where I toss him in. He comes up unsure and when he realizes I'm not going to torture or eat him he hesitantly starts to smile as his comrades in arms hoot and holler from the shore.

Several minutes later, I repeat the same thing, sure this time they'll realize it's all just a game. I chase down the chaplain's son, a boy well known to me who seems to like me and has never been afraid of me before...until now. As I pound my barefeet up the bank and through the ruts leading down to the river I find myself gaining on him easily. Just as I'm about to catch him, he rounds a small bush and does a face plant as his feet slip on the wet clay. Before I can laugh I follow him in a crash landing slide into home reaching out at the last minute to tag the plate by grabbing his leg.

As I stand up I am shocked to hear him shrieking in terror. "Je ne veux pas!!! Je ne veus pas!!! I don't want to..." I'm shocked. I try to calm him down. I definitely let go of him and try to tell him I'm not going to do anything and to stop screaming. He completely ignores me. Anyone within a mile must be sure that someone is torturing and killing something as he squeals like a stuck pig.

He is clutching desperately to a clump of grass as I back away. He won't let go even as I return to the river to wash off.

It's another brutal reminder of the differences in culture as I can only reason that here boys aren't used to rough-housing or playing with adults. In fact, about the only contact they have with an adult is if he is going to beat them or punish them in some way. So even though I've never given him a reason not to trust me and he just saw that I was just playing with his friend, he was sure something horrible was about to happen to him.

I weep for the kids of this country who are so often abandoned and neglected and left to fend for themselves even for the food they eat and grow up learning not to trust and that fear is the only way to interact with others.

JCC

2008-06-05T14:45:00.000-07:00

I am still struggling with how to bring my ideas, patterns and reality together to make a decent capsule for the SC JCC. As of right now, this is what the storyboard looks like

What do you think?

I Have Not Been Tagged

2008-06-05T14:19:00.001-07:00

....but what the heck, thought I would just answer the questions anyway since it keeps me from actually cutting into the dupioni silk that I bought for the June Capsule Contest. It looks pretty all folded and neat hanging there from my bookshelf and I hate to disturb it. Excuses, excuses.

So for that diversion:

What was I doing 10 years ago?
I had negotiated purchasing a house for our daughter that needed major fixing up. She had just graduated from college and was in her first year of teaching and we thought it would be a good idea to buy something rather than just rent. The main house had a little 500 sq ft cottage behind it that we would use when we came to visit so as to not intrude on daughter and her roommates. I did all of the painting and sub-contractor duties for what needed to be fixed and remodeled. It has been a great investment but I am sooooooooooo glad to have all of the hard completed.

What are 5 things on my to-do list today?
1. Schedule a health talk for our store.
2. Mail the bill to the insurance company of the truck driver who rear-ended me going 70 mph.
3. Check references for potential renter.
4. Have Michael explain why we should use Joomla to create a website for missionary doctors in Bere, Chad, Africa.
5. Call Sarah to let her know that the house is already rented.
6. Cut out pants pattern for the JCC

Snacks I enjoy.
fruit
popcorn with brewers yeast - you should try it
just about any kind of cookie
nuts

Things I would do if I were a billionaire.
1. Buy a house in the country with its own water source.
2. Expand the store.
3. Expand health care, clean water sources, and agriculture for Chad, Africa.
4. Fund physicians for relief duty in these 3rd world countries.
5. Create a drop-in center for the homeless youth on the streets of LA where they would learn skills to work for their handouts and to provide for themselves.

Places I have lived.
How much time do you have....
Lincoln, NB
Jacksonville, FL
St. Petersburg, FL
Belle Glade, FL
Louisville, KY
Kansas City, MO
Centralia, MO
Memphis, TN
Orlando, FL
Takoma Park, MD
Loma Linda, CA
Berrien Springs, MI
Paradise, CA
Dallas, TX
Arlington, TX
Grand Prairie, TX
Baker, OR
Camarillo, CA
Suisun, CA

and I am only 39 years old.

What types of work have I done.
Secretary - Heart Team Cardiologist
Radiology Transcriptionist
Radiology Receptionist
Music Teacher
Sold Bernina and Passap
Office Mgr Chiropractic Office
Human Resources Asst. Mgr.
Store Owner
Rental Homes Mgr.

If you happen to read this and haven't answered these questions, please add your answers and let me know so I can know you better.

2008-05-31T23:00:00.000-07:00

This is a first for me. I much prefer just reading about what everyone else is doing and seeing the lovely garments and projects they turn out to saying much myself. But after reading all of the input and feedback and encouragement the sewing internet sewing community gives each other I decided I needed to actually be a part of it...so thus the attempt to blog.

I have more fabric, patterns, notions and yarn than I will probably ever use, but others, I just keep adding to the pile. In fact, this last weekend Hancock's had a wonderful sale on patterns and I went crazy once again. Then on Monday went back and bought some cream dupioni silk thinking that I would join the SC June Capsule Contest. Well, it would be wonderful if I could ever get the garments to fit like I would like. Usually I sew them, try them on and then give them away.

This red dress just still hangs in the closet waiting for a miracle. It was supposed to be the required red dress for my 86 year old fathers wedding in February. Just didn't like the fit so bought something else to wear. I know, pathetic.

So I decided to sew for the granddaughter and hope that the things fit her. She is in Tennessee and I have no way of fitting her - I just asked the DIL to give me a few measurements to make sure that I was at least in the ballpark of fitting. So far - so good with these, and they sure are a lot of fun to do. Here she is in the last one. She loves purses so I included a, what she calls "pocket purse", with the dress.

The first one that I made was the McCalls pattern M5569 but I don't have a picture of her wearing that one yet. BTW, can I use this image from the McCalls website - I tried to find out what the guidelines were for this sort of thing on the web, but haven't found any definitive answers yet.

Well, it's a start.......