jim’s pharmacy has come in handy

I’m sick. I have enough cipro on-board to clear external bacteria from my skin. My head is fried. This is how I imagine myself on chemo. Except the rapid weight loss is probably from the bug I injested yesterday, or the day before…hard to know.

Somehow today zipped by without me knowing what I did. I think I laid in bed most of the day, and hoped the student nurses next door would entertain Rachel and Zach–they did, even gave them a mango and let them watch videos on their phone. I’m not sure what Hannah and Madelyn did: sew, read, and make food. Come to think of it, this is what they often do in their spare time now. Madelyn gets sulky when Edna, the cook, comes to visit. Madelyn wants to cook. She’s only watched her MP3 cooking shows seventy three times, quote unquote. She can describe creme fraiche, chocolate ganache and pate de choux. These were not in my vocabulary at nine. And I’ve still only eaten two out of three of them. Since Madelyn’s ingredient list is limited, her cooking repetoire is limited, but an awful more sophisticated than mine was at her age. She’s made coconut pie a half dozen times, brownie pudding a few times, bread and cinammon buns, and anything else with flour and yeast.

Hannah brought me breakfast: eggs and toast with coffee. She made lunch: ground beef and corn soup, nothing fancy, but it is protein. And supper was leftover fried spaghetti, toast and eggsagain. Slim pickins, as we’re on a countdown to home now. We have a five hundred shilling deposit on the next eggs the hens lay down the street. The egg vendor makes direct trips to our home, cause he knows I’ll buy him out.

Might it come as no surprise that we’re all losing a few pounds? Edna says that most people leave smaller than they came. And since I’ve been fantasizing about chocolate milk, potatoe chips, and ice cream (foods I don’t allow myself to fantasize about anymore), it’s a sure sign my body is looking for some grub. Since I had an extra five on board before we came, I am in no fear of malnutrition. Madelyn’s skirts are sagging, Hannah’s belt needs to be tightened to the bitter end, so I’m thinking we’ll be doing some hand me ups when we get home. Hannah can use Madelyn’s clothes, Madelyn uses Rachel’s, Rachel uses Zach’s….

I was asked if I liked Africa today. Bad day. Yes, I like it. No, it’s not quite what I thought. I like how Janie Schumacher described it, when I said that it seems so surreal that we’re almost there…when you touch down, it’ll be very real! Yup. If we come back, likely when we come back, I’ll just approach it differently. I’ll tell myself that we’re going camping. Might not have electricity or water. Definitely can search for firewood. Bring lots of bug spray. Won’t have typical pantry accoutrements. Will bring smores fixings…graham crackers, marshmallows and dark chocolate. And potatoe chips, chocolate pudding and cheese…can I bring cheese over the border? Thankfully our flight back home includes a visit to Paris on Rachel’s birthday, so will have her cake and eat brie too!

The Bangles

‘Manic Monday’ Teresa says in her post today.  Well, I remember where I was in the 1986 listening to “…it’s six o’clock already, I was just in the middle of a dream”  Good times.

Hey speaking of good times…I  am in the middle of a wild and wooly five day stretch of anesthesia call/duty.  Friday was full with with a thyroidectomy, cleft lip repair, open reduction internal fixation, 2 c-sections and an iv sedation.  Saturday we ran concurrent anesthetics again with an ortho case and a c section.  Sunday we rested….until this am.

The kids came to the door of the Rhodes house just as morning devotion was finishing to say “somebody has called the house and wants you at the hospital Dad”.  Ok.  Let’s walk quick as the text message comes through the mobile phone that there are two csections for anesthesia.  First one is a breech presentation in a first time mom.  Check.  Second case is twins with polyhydramnios (too much fluid) and a transverse lie.  Tougher and hey the other surgery room sures wishes you would hurry up and get over there to start their cases.  They have to wait.  I need to concentrate on patient safety here.  “Hey, Kimosop” (one of the Kenyan medical officers) I say, “you making up for lost time yesterday with two c-sections today?”  Smiles.   Five minutes later not as smiley as one of the babes is clearly syndromic and stillborn.  Aaarggh – nothing could be done – tough case.

Time to get started on the scheduled list.  Two tougher cases, one a horrible looking lower limb needing recurrent debridement.  Lunch.  Ten minutes into lunch break.  Emergency c-section.  “Hey, Kimosop” I say,”what’s your record for sections in one day?”.  Six is the answer – all on a rainy night.  Okey dokey.  Next is the 84 year old needing orthopedic fix of broken tibia and fibula.  Her IV doesn’t work.  Much effort to find two tiny IV sites.  Case starts.  None of the monitors are working.  Usually only 50% of the monitoring equipment does not work.  No, we are flying on visual flight rules only.  Not a happy spot.  I prefer some instruments in my twin engine otter.  Now the other surgeon wants me to get an IV and sedate a 6 year old for an Achilles tendon repair.  What and leave my plane flying without instruments to the first year medical student?  Well ya, come on, work to be done.  This does not feel comfy.  The nurse visiting from northwest Iraq takes over feeling the carotid and radial pulses and estimating blood pressures by their presence or absence.  We sedate the kid.  Before the surgery starts – maternity calls a cord prolapse c-section.  Oh for the love of….this mandates a crash general anesthetic induction.  The sedated kid is hauled out of the room.  I scurry for supplies.  The patient arrives and the news has changed – arm is the presenting part, not umbilical cord so we have time for a spinal (safer approach).  OK, I am running out of spinal needles so the bigger ones (the ones with a higher incidence of headache afterwards) will have to do.  Baby is very hard to extract.  Not active at cord clamp.  The nurse repeatedly suctions the baby but it is obvious to me he needs to be manual assisted with an ambu bag to breath.  “Start bagging” I say.  “Now”.  Stares.  I walk over and bag the baby but no one is helping do pulse checks etc. I check the pulse — none.  Needs to be intubated so I grab the laryngoscope and ask for a neonatal sized ett which is surely in one of the 3 drawers of the neonatal resuscitation table we are using.   Stares.  No tube.  I rush to my machine and look.  One that is a size too big but nothing else close.  Oh for the love of… I try using the too large tube cause I have nothing else to try.  Will not fit…look around for the small sized tubes.  None.  Inside I am not happy and feel very empty.  Baby now has no chance (maybe never did but…..).  Aarggh.  Why have a resus table and zero supplies in it.  (I was not aware of this or would have spent the time to fix it — took me two hours or so on Thurs/Fri to organize my emerg supplies for anesthetics for bigger people so that I could have a comfort level.  Never thought to fix the neonatal table).  Kimosop says he thinks the baby was gone from the get go — nothing we could do…only God knows but I am not feeling right about the whole scene.  One more c-section to go he says as a Vaginal birth after cesarean is not progressing.  Of course, one more — only had a total of two stillbirths, today already — twice my career total.  Ortho case is still going on — without me.  Rachel the Iraq nurse  says the plane is coping on autopilot without me.  Good spinal topped up with epinephrine and opioid — normally last about 3 hours (case is now longer than advertised and approaching 3 hours).  Do the next c-section – live baby 🙂 after enormously difficult extraction again.

Ok.  Ortho case still going with Rachel the RN.  Achilles tendon needs to be sedated the second time – ok.  Teresa drops off supper halfway through. By the way, the spinal is wearing off — case is taking 2x predicted length.  Oh, dear, let’s give her sedation and cross fingers it is done soon. Breast abscess needs sedation and an IV.  L breast twice normal.  Huge amounts of pus — did not accumulate overnight.  Haven’t had monitors for either of the last cases.  The cleaning and autoclaving department is running out of stuff.  Monitor with my eyes and hands.

Still on-call — hoping not to break Kimosop’s record.  I’ve got interesting days in my life story books from Canada but this one might take the cake.

“These are the days when you wish your bed was already made”  It’s a line from the Manic Monday 80’s tune.  Not sure if it applies but it’s closer than “kissing Valentino by a crystal blue Italian stream”.

monday

It’s our Monday morning. You are likely sleeping, or getting ready for bed. Hannah, Madelyn and I might walk to the local orphanage in the early afternoon. That’s if Agnes is willing to babysit Rachel and Zach. The two steep inclines are not favourable for them. I’m not sure they are for us either, but I’m willing to risk it. If the orphanage doesn’t happen, I am invited to the operating room with Jim, where he’ll be all day and evening. I am to wear a big, baggy pair of green scrubs and a scarf covering all my hair. Haven’t been in surgery since nursing school, and didn’t particularly enjoy watching the c-sections or thoracotomy. But I’m intrigued at watching my husband hovering over his patient, ensuring the patient continues sleeping comfortably and pain-free with healthy oxygen saturations. I’ve heard that he anaesthetizes people; I have not actually seen it before. I have seen him in scrubs–it brings back romantic remembrances of how we met.

It’s 9:45 and we’ve been awake for a couple hours now, having lounged in bed reading David Copperfield on the Kobo to my early morning risers, Zach and Madelyn. Hannah fried eggs, Madelyn prepared the yoghurt and muesli (a surgeon had a visit to El Doret yesterday—yay, carrots, chickpeas, and yoghurt!) The beds are made, the floors tidied–how do we make such a mess with so few things from home? The kitchen counter is still filled with dirty dishes, the floors filthy, the garbages full, the laundry overwhelmed by fabrics–but I am supposed to leave this for Agnes, when she arrives at 10:30.

I’ve filled the water filter with six plastic bottles of sun filtered water (it sat in the equatorial sun all day and overnight, which apparently kills all the microorganisms…I’ve read about its validity, but we still boil). The kids are playing hospital, Hannah gave Madelyn a greenstick fracture of the radius, and Rachel is nursing her to health. Zach found another location than the toilet to pee in, his recent preoccupation. And we will soon pull out the devotional book, Aesop’s fables, and African study books.  I’d like to say, it’s just another manic Monday, cause it sounds conventionally clever, but these days are anything but manic. More like Scarlett O’Hara in a foreign country. What to do, what to do…

orange is the colour of connection and warmth

I’m alive. Our orange internet stick has not been. The continuity has been, well, not continuous. The price: exorbitant. The kids and I walked to the center for an orange top-up card and came back with flour, oil, cocoa, twenty eggs and material for a tablecloth…but no internet top-up card. It was in my left pocket. Can I help you carry your things, someone asked. No, I’m fine. Then Rachel comes running up to me, and whispers mom, someone is RIGHT behind you. It didn’t dawn on my until much later that Rachel thought this person was suspiciously close to me, not until I couldn’t find my internet top-up card.

Edna, the cook, shares with me that when she was a child, she had chai and bread for breakfast and ugali, vegetables and sometimes mutton for dinner. No occasional trips to a restaurant to break up the monotony. No Kraft Dinner, hot dogs or ice cream. I’m probably wrong in that scarcity isn’t really an issue for me here, it’s food availability. And when we return, I wonder how long I’ll be standing inside the Superstore doors staring…in awe, in excitement at the possibilities, and in shock that so many people can’t afford any of this.

Agnes told me about her visit to mamaTeresa. She walked into her home and asked if Teresa was preparing chai for the kids. Oh no, not chai today. Agnes says, yes, chai today…and hands her two pounds of flour, a pound of sugar and tea leaves. She cried. Five dollars worth of groceries, and she cried. Somehow flour, sugar, and tea leaves don’t qualify as extras to me. Madelyn’s convinced me to celebrate North America’s abundance with fries from McDonald’s, sandwiches from Arby’s, frosties from Wendy’s and root beer from A+W. We might do this before we make it home.

We started our African studies at the same time the wandering neighbourhood preschoolers came out to play. So I found some pencil crayons and paper and let them doodle while we sat and read and wrote. Then the rain started. So we moved to the verandah. And then sheets of rain came so hard we had to move inside. We were already baking banana bread, then decided to boil some eggs and chai to warm us all. I asked Agnes if their mothers wouldn’t be worried if they weren’t back home. Oh no, not worried. Is it okay that they’re in my home? Oh, that will just be the fun adventure for the day to share with their mamas.

In desperate need of a haircut, Jim asked me to snip away. This is a first. Good thing I paid attention when Zach was getting snipped before we left. I told Jim I’d wave the fee, this time. Next time I’ll get cutting shears and a flowbee. Do they still sell those late in the night?

With increased admissions to peds for pneumonia, and my own increasing sniffles with the cooler climes, I am now convinced, antithetical to current medical theory, that a cold can indeed be encouraged by the cold. I know, a cold is a virus transmitted from mucosal secretions. I’ve got the theory firmly implanted in my nursing school trained mind. But the wet cold was making me feel more ill. I now understand why little ones here are dressed in winter jackets in twenty degrees celsius. I asked for dry firewood to intiate the fireplace two nights ago, and sitting in front of the dry heat for five hours, I felt so much better…watching the orange flames dancing in their fierce warpaths.

blinded by passion

I’d like to write a clever story of an interesting adventure today, but I spent most of my time shushing the kids so daddy could sleep in the morning hours (he got home at dawn…his ICU patient died), part of the day I ran around the backyard with Jim for exercise and the other part I spent on the phone to North America or preparing food and cleaning dishes. This I can experience on my home continent. But with fewer activities, much opportunity for contemplation.

I’d thought about writing about sharing…sharing our resources, sharing our skills, sharing ourselves to commune with one another. All good stuff. Especially in the context of the developing country I now reside, I feel compelled to consider what my part is in all this. What do I do with those hungry about me? Share. Do I share so much that I don’t have enough? Should I sell my home? Ask others to do the same? Live in a tent in the valley for the next forty years? Should I simply spend less? Be less consumed by consuming and materialism, give a few of the kids’ toys away and buy fewer lattes?

Then I have to ask if George W. Bush can give a few billion dollars to Africa, and that can’t change the tidal wave of poverty among the African masses, or if aid organizations or a few minor celebrities can’t put a major dent into the trouble, then what could possibly induce real change. Is the real solution political, having too much money in the hands of the corrupt and disorganized? And if it is, then how could I really help? My only conclusion is that I indeed don’t have an answer and there have been a  few people that thought about this before me, have spent their lives advocating for it, and still nothing of a profound tidal wave. So I have to ask, what do you think? The spotlight is on you.

the land of fortitude

This equatorial sun is doing a lot for the growth of our family. Hannah has grown a foot, Zach is nighttime potty trained, Madelyn’s medical knowledge is expanding, and Rachel comfortably introduces herself to others. The heartiness factor of our family has increased. We can eat local veggies without fuss, live without electricity and even last a few days without running water. The kids have even tried a squatting outhouse, nuff said.

And today, we hired a taxi driver to take us twenty five minutes out of Kapsowar and drop us off in a tiny village called Sisay. We stood, we photographed and we awed over the Great Rift Valley…misty green with miles of sky above. We stood atop the highest local point and looked way down to the purported beginning of civilization. Photography does not do this view justice.

We were followed by the kid-arazzi…can’t say paparazzi, because they don’t have cameras. Don’t always know what to say to these sweet little things, but I shake their hands and hold my hand to my chest and say mamaHannah (introducing myself) and ask Djena lanku? (what’s your name?) Then I learn if they know a little Swahili. And if they don’t speak Swahili, I’m stuck. And if they speak Swahili, I’m still stuck, cause my repetoire ends at the next phrase: nini gabbi? (how much is that?… which doesn’t apply to a nine year old). The flock grew the longer we walked. The shocked cackles of kids up on hills looking down at us, or running alongside us pointing, or mamas directing their little ones to look at the muzungus…this all in honour of the colour of our skin! Imagine the trouble we’d be in if we made that sort of show walking down Victoria Street!

When we’d had our share of the Valley view, we walked out of this tiny village, back to Kapsowar. The taxi driver didn’t believe that we’d want to be left way up here. We anticipated a two hour walk back home. Up, down, and around these hills, motorcycles passing at every turn, travelling with one, two, or three passengers and no helmets. Children herding sheep and goats. Lots of little ones packing water, firewood, or bottles of oil.

Lush green, but with sharp and immediately descending shoulders, and continuous ruts of rust-coloured dust or muck, not even flat roads for walking let alone driving. Zach panted for water, despite being on daddy’s shoulders. Rachel and Madelyn had the occasional piggy back, and Hannah trekked independantly. Promise of a lollipop at the one hour mark kept them going. Shambas speckled throughout the valley, grass thatched roofs, and wandering cows. Every couple minutes we yelled motorcycle and everyone shuffled left or right. I was nearly clipped by one that came only inches from me. I am driver, hear me roar!

As we climbed the last hill, we recognized a few more landmarks, and saw the hints of town, Zach tripped, and a young girl came running to help him. Many men and boys were peeping down into the Kapsowar valley to watch a soccer game playing at the girls high school. We were relieved to see familiar Kapsowar.

We were thankful to have a little weekend of reprieve for Jim to share in our journey to the Great Rift Valley. Almost as soon as we were home, though, he was called about a thirty three year old who’d been in an accident and had serious reactions to a blood transfusion. He’s been the emerg doc/pseudo-ICU nurse, watching and waiting for the fellow’s oxygen saturations to improve after intubation ever since. But that’s why we came.

Being here has grown us, increased our fortitude, a fortitude that the Kenyans grow up learning. I’ll bet none of the kids we walked with along the way have sore feet and aching hips. In fact, they’d make no note of a two hour mountain walk, it’s their everyday.  Africa, the land of fortitude.

Medical registry

The world is made up of two kinds of people: those who will find the next few paragraphs engaging at best and unique at worst AND those who will glaze over and decide to come back tomorrow in hopes of more Teresa.  (Editor’s note: today’s authour is a male and Zach is asleep).

Medical work here as been varied and at times intense.  I am currently covering the male medical patients and pediatrics.  I see outpatients with many of these requiring admissions.  I teach medical students, I take some anesthesia call and likely it will all change next week…stay tuned.

Lots of fascinating cases:

*sick babies with congenital heart disease +/- pneumonias, Group B strep sepsis

*malaria

*TB with cavitations

*organophosphate poisonings

*methanol poisoning

*poststreptococcal glomerulonephritis

*adenovirus pneumonia

*machete injuries

*supracondylar fractures

*severe alcoholic cardiomyopathy

*pellagra

*normal pressure hydrocephalus

*third degree heart block

*delirium tremens

*bipolar disorder

*epilepsy

*burns

*rheumatic heart disease

*paralysis post traditional trephination (rural bush craniotomy)

*gestational hypertension with proteinuria

*multiple patients with profound anemia

*esophageal candidiasis in five year old = HIV +

*man attempting suicide after learning he is HIV +

Just the highlights there.  Many people come to the hospital a wee bit on the late side.  Sometimes staff are not as attentive as they should be at quick triage and notifying the doc on call.  I got called Sun at 0840 to come quick to a sick patient (had been on the ward after admission for 15 hours). Babe was very sick with congenital heart disease and superimposed pneumonia.  Appropriate treatment started.  2 nours later, a code was called on the same now pulseless and apneic patient.  None of the resus measures we used worked.  Babe had been sick at home for 2 weeks but money or the lack thereof probably prevented a faster attendance for care.  Sad.  Later that day a code was called on the patient next door but fortunately the babe was just mucus plugged and not truly apneic – excitement in a bad way.

When people have money they may head to Eldoret for higher level investigations such as CT scans and echocardiograms but this seems to be the exception.  Drive is 2.5 hours and most people struggle to pay their hospital bill here.  Some never get admitted who should because family choose not to for fiscal reasons.  Rest assured the hospital is not gouging. Care here is inexpensive relative to anything across the pond but as a foundation there are basic charges for all types of care.

The kids are welcome on the hospital grounds and currently the daughter a day program is in place for la famille Wiedrick.  Each gets to solo silent shadow papa on rounds to get a feel for what I am doing in my work.

Love the scenery.  Walk everywhere.  Great to jog at sunrise.  Talk more later.  Thanks for the read.

just say no to dementia

Guest Authour: Jim

I thank God for each day that my brain still works.  That allows me to create both new short and long term memories. Here are but two streams of thought:

1. Out for the morning exercise routine today at sunrise. The selection today  is the high altitude jog…not the same as the sea level jog…but my 7000+ft elevation stamina is increasing.  On one turn a 10 year old kid decides to jog alongside which is cool except I got the impression he thought I was going too slow and he could do better…so the competitive old man in me cranked it up a gear just to keep my pride intact.  Five minutes later, I hear footsteps from a runner behind me.  For a second I was on the lookout for a 10 year old kid but instead I get the loping grace of a 20+ year old dude in an official looking Kenya jacket torching me…can you say Olympic athlete in training?  I enjoyed my fleeting brush with celebrity.  Cranking it up one gear did not help in this scenario and I am a 3 gear machine.  Fare well muchacho.

So then my thoughts go to two books about the Olympics that I ate up (read and reread) when I was Hannah and Madelyn’s age.  Lots of stories about Kenyan runners and their success in the larger of the two anthologies…the second book was predominantly about the Lake Placid 1980 Winter Olympics, a big section of which was about the American Ice Hockey team that won the Gold that year in a major upset….and that is how I got to thinking about where I was when Mike Eruzione beat Vladimir Myshkin from the R face off circle about the 8th minute of the third period to put the USA ahead.  A warm memory from 1980.  Al Micheal’s “Do you believe in miracles?” ringing in my mind.

One jog, one stream of consciousness, one blush of warmth from my youth.

2. This weekend I am doing medical rounds but also am on anesthesia call as I give relief to the main anesthesia nurse provider here, a skilled man named Thomas.  I got called for a man with some serious machete injuries to tendons in his L wrist — after some scrambling to get somebody to turn on the main switch that allows anesthetic gases to flow to the machines (who turns that one off anyway?) and some rummaging around to find the meds and supplies I need (a place for everything and everything in its place is not a dictum here), I am feeling safe and put Paul off to sleep for a 3 + hour journey through general anesthesia.  Half way thru a C-section comes calling and they are not waiting for the original case to end.  So Paul gets topped up on a few key ingredients and I switch on autopilot and off I go to the 2nd theatre to give a spinal for Cynthia.  Back and forth for the next 45 minutes as I experience for the first time concurrent anesthestics.  Not considered optimal to play dueling anesthetic banjos but you do what you do here.  Another first in my life.  Late tonight, peds nurses want me to restart IV’s on the ward on little ones who are complicated and fragile in health and cannot seem to keep IVs functional for more than a day – the tissues are so irritable.  Two of us try and fail initially but finally get an external jugular vein iv on the one youngster who truly needed a replacement — quite a day.

The memories are precious.

it’s raining, it’s pouring, the old man is not snoring

Dr. Adams left for Gabon this morning. He travels wherever Samaritan’s Purse needs him and has done so for more than a dozen years. He told me that I was right on track, not so shocking that I would be culture shocking at the two week mark. He said that when I get back I’ll purge my closets and belongings and talk exhuberantly about the excesses of our culture, the consumerism, the materialism, the absurdity of perceived needs when real need almost doesn’t exist in North America. He said I’ll do that for about two to four months, then I’ll blend in again, get familiar with my old comforts and resume my previous approach. And when we come back to Africa again, we’ll go through the same process again.

We were so thankful when Laura and her sons caught a ride with the ambulance to El Doret this morning. This is our grocery run–a five hour round trip. We are now in receipt of four small containers of yoghurt…aka gold in our home. We figure each person can have a spoonful a day for the next two weeks, when there might be another trip, might being the keyword. Laura even found Knorr’s mushroom soup…yay, a reprieve from beans or tuna for lunch. She also found a carton of whipping cream, so we’ll try our hand at mango ice cream! It’s a good thing I feel confident cooking, or I would be very worried. Our carbohydrate consumption has increased; curiously, our waistlines have been shrinking. Nothing fancy to snack on. Carbs have increased because I can bake bread, cinnamon buns, muffins or roll kuchen, or anything else that has white flour.

The temperatures have been dropping over the last few days, in preparation for winter. Winter not being snow, but rather about 20 or so degrees, and more rain. The rain begins around supper time and makes the soil mucky and difficult to run. Not that I am running as often as I’d like. I take the kids out to the basketball court and run laps, freeze tag, mushroom tag, even with Zach’s suggestion, toilet tag. Whatever we can to get our heart rate up. One of the house helpers remarked that I look like a nursery school teacher running around with the kids.We march and sing: I may never march in the military, ride in the calvary, shoot the artillery, I may never fly o’r the enemy, but I’m in the Lord’s army, yes ma’am! I have no shame.

With Dr. Adam’s leaving, there is an increased workload for Jim. Jim comes home from lunch and says, playtime is over!  He does have five medical students streaming in from the University of Georgia over the weekend, but they are relatively new, first year students, so the workload isn’t shared. Jim was intending to blog tonight, but got called away for a seizing two year old, who originally came in for a relatively minor burn. Then there’s the really sick six month old with mumps, or was it meningitis. Over the last week, Jim is aware of four suicide attempts, one that was successful. This twenty five year old had to be trekked here from a few hours away, and couldn’t be resuscitated. His mother wailed at the loss, and my heart poured in thoughts of pain for her. There was a young boy who played the suicide threatening game, drinking just enough pesticide to get himself pretty sick, but not enough to accomplish more than manipulation. A twenty something woman coded and was pronounced dead for reasons Jim didn’t come to understand (not suicide though)–the family was utterly astonished. The fact that Jim didn’t come home to read his Tropical Medicine book this afternoon was a sure sign to me that he had a few more things to do today. The rains are pelting like the hot shower that I’m longing to feel on my back in six weeks, and Jim still isn’t home. May the Lord bless and keep the little one he cares for. And may the Lord bless and keep you, making his face to shine upon you, be gracious unto you and give you peace.