My blog as a ministry tool?

It has been brought to my attention that my readership has shifted slightly. Last year I had about 4,000 hits. Last month I had more than 2,500. Tim and Mandy, I blame this on you. Anyway, regardless of who's fault it is, it has challenged me to censor what I write. Don't worry though. It has only challenged me to do it. I still have not started actually censoring. I still tend to write exactly what is on my mind. And post the majority of it.
But that being said I know that some of you newer readers don't know me. Often what I write is what I'm struggling with and from time to time I heap on the sarcasm. Journaling has, for a long time, been my medium to process, to understand what God is teaching me and unfortunately, mostly to vent. Occasionally life here can be stressful and well, I'm not always proud of what is going on in my head but I want to be honest and when I go back and read what I've written over time, if nothing else it reminds me that I'm far from having it all together.

So, I commit to remaining honest, at least in this forum. I want to continue to share what I'm struggling with disregarding what people may think of me. I know we all struggle with stuff and I hope that as I share God can use it.
One other thing, if you have questions after reading anything please just ask. I would rather answer questions than have something misunderstood. I continue to pray that God uses this blog as a ministry tool, maybe more so now that I have readers who don't know me. God, take it and use it as you will. Amen

Why?

Something that I'm possibly over thinking but still want to analyze... I shared that I've felt tired and burdened and frustrated and anxious and a whole range of feelings from ambivalent to furious with all that has been going on. I've gone to God both disappointed and pissed off. But why such strong emotions with all of this? I know illness is a fact of life. I've cared for sick patients before that take some time to recover. I know that we don't understand God's timing and what He allows into our lives but that He is still in control. I saw amazing things that God did and provided. One of the greatest was how the body of Christ around the world rose up in prayer, support and encouragement. So why has this thrown me for a loop? If you think I'm going to be able to answer this tonight, sorry. I'm still pondering....

Things God has been teaching me

Journal excerpts from the past few days...

9/24 Its been dry but rain always eventually follows the drought. Reminded today that my faith doesn't have anything to do with how I “feel”. I've felt tired and alone and frustrated and anxious and a whole range from ambivalent to furious. I've gone to God both disappointed and pissed off. But none of our circumstances change what is true of God. Reading through promises that I know to be true I'm reminded now that I don't understand the whole picture but I don't have to and I'm just here to be obedient.

Eph 2 I am his workmanship. He knew from the beginning that I would be doing this, struggling with these things. And even in this HE IS MY PEACE! Not things of this world, not my own strength or resources here. But He creates peace in me.

Phil 4:19 He will meet all of my needs, not my wants, but he knows, understands and WILL supply my needs.

II Thess 2&3 God is making me complete, sanctifying me. Somehow this means I'm blessed and set apart for a special purpose. (All believers are sanctified!) God is faithful. He will strengthen and protect me. None of this EVER changes.

There are so many of these promises. They go on and on. Yet, I'm stopped by how overwhelmed I feel. No matter what I experience God's truths are still well, true.



9/25  He emptied my hands of my treasure store,
And his covenant love revealed.
There was not a wound in my aching heart
The balm of his breath has not healed.
Oh, tender and true was his discipline sore,
In wisdom that taught & tried.
Till the soul that he sought was trusting in Him
And nothing on earth beside.
                -O.T. Deevers



9/27  Sitting on top of the falls. Look to the right, Karamoja spread as far as I can see in the early light. Can't help but wonder what the horizon holds. Time to start looking ahead again. Where do I begin?

I'm excited to think about the work that can be down out there. I know it is a hard place but I want the challenge. I want to see what God is going to do. How to begin? If I've learned nothing else in the last few weeks it is that I don't want to, nor can I, rely on myself. So Lord, lead the way. Show me the next step.

Home sweet home

After several days of travel we are finally back in Soroti.

In the airport, Tim with his daughter, heading back into Uganda

How are we doing?  Honestly, I'm exhausted so this will be a quick post just because I haven't in too long. So, on our way back through Mbale we had Tim's follow up labs drawn. Two different laboratories and several hours later we know his kidneys are doing a little better and his liver enzymes are slowly going back down. The values aren't as close to normal as I'd like but the doctor we discussed with in the states is content to continue to wait and watch. Tim is having a little more pain than before and lots more pain than I would like to see but again the doctor reminded us he has a bad infection and it will take time and rest. You hear that Tim?! REST! So we will continue to wait and watch and pray and trust God for healing.
Angie looked really drained tonight and she is pretty much now is a single parent with four kids to take care of so please be praying for her. Tim can be just a little stubborn.
I was reminded when we arrived back with our team how amazing this group is and how much I love working with these guys. It is good to be back with them. And back with Beckie in our home.  So, now tonight we go to bed and sleep. Tomorrow is a new day.

CT Scan

And because I have not perpetrated enough HIPPA violations yet tonight here are some CT images of the elbow also.

Bone Scan

Just for grins and because I can here is the bone scan. Notice the left elbow. An increase in absorption of the radioactive dye indicates a problem. You can see the left is much darker than the right.

Discharged!

So we are getting the heck out of here! The doctors seem to think he is fine. They would like a follow up visit tuesday with a recheck of Tim's labs at that time. After making some phone calls though we are thinking we can get reasonable follow up labs in Mbale next week. That means we can leave Kenya! So we will take today slowly and see if Tim feels up for the flight tomorrow. We will watch closely for an increase or change in pain of either joint or any signs of fever. But I really feel like we are headed in the right direction.... thanks so much to all of you for your prayers! I know that they are the biggest reason that Tim has been "too well" for the doctors to see how sick he initially was and also the reason that they didn't manage to come up with a clear diagnosis.

Waiting for the entorage to round.....

Update time....


Tim seems to be doing much better in most ways. He has a crutch that he uses to get around and seems in better spirits. (Well, is demanding to leave better spirits?) However his liver enzymes are still high enough to make me concerned and his kidney function isn't normal but values are trending down. No fevers in a few days and his blood pressure is within normal range (at least I think. They always tell us it is above 70 diastolic but they aren't very good at taking it. And hypertensive seems ridiculous so I'm not fighting them about it.) So, we are expecting to be discharged today!!

Maybe it is just because we have been back and forth and up and down so much but I'm not as excited about this as I'd like to be. I'm really afraid that we are under medicating a still septic joint and that in two weeks he'll be sick again. I'd also really like us to be in a place where we can still get good lab results for follow up but as soon as we head back to Uganda that just isn't a possibility. So, I think at this point we go and trust God.

Fruit market (AKA today's mental diversion)

There is a great outdoor market within walking distance of the hospital. We got a great variety of fruit that we can't get in Uganda and some pictures that make me laugh.


changing abx again....

Ahhhhhhhh!!! Just when I think I'm getting the frustration under control! Just 12 hours ago Angie and I were brave enough to say aloud maybe we could be back in Soroti by friday. Quick post:

Bone scan scheduled for this morning. Angie and I came in a little later than usual because this test takes several hours and we didn't expect Tim back to his room until late morning. Tim called us at the guest house to tell us that the doctors came around early and are concerned about elevated LFT's (liver enzymes) which are most likely rising due to the antibiotics. That explains why he has been increasingly nauseated and sicker since sunday.

When we arrived here I bullied today's nurse into letting me see the labs- renal function is also off but he didn't let me see anything else. We are really unsure of what the plan is (Tim isn't back to his room so we haven't seen him yet), which meds we will be changing too, what this means for the longer run and if we will just wait and watch (what I'm expecting) or if we will be a little more aggressive with hydration for his kidneys (what I'd like). I just don't know what to do. I'd like to talk with his physician in the states again but as it is 4am there that seems like a bad idea. I'm making enough enemies here I don't need to do it there also.

Anyway, we were reminded again this morning about how real, tangible and concrete spiritual warfare can be and I'm feeling convicted that we need to be more aggressive in standing against it. But what does that even mean? Back to praying for wisdom....

Psalm

Spending some reasurring time in psalms 139 this morning.....

O LORD, you have searched me and you know me. (you know better than I do what we need today)
You know when I sit and when I rise; you perceive my thoughts from afar.
You discern my going out and my lying down; you are familiar with all my ways (back and forth to the hospital)

Before a word is on my tongue you know it completely, O LORD. (Help me to keep my tongue with the doctors)
You hem me in—behind and before; you have laid your hand upon me...

If I rise on the wings of the dawn, if I settle on the far side of the sea,
even there your hand will guide me, your right hand will hold me fast. (I have felt your guiding hand please keep directing us)

Search me, O God, and know my heart; test me and know my anxious thoughts. (I'm anxious but I WILL TRUST YOU)
See if there is any offensive way in me, and lead me in the way everlasting. (Please continue to refine me and lead me in your way. Amen)

This seems like I've written this before... we had such high hopes for today. We thought we were scheduled to have a bone scan that would tell us if the infection had progressed to osteomylitis or not. But the orthopedic surgeon stopped by last night and said he still didn't really think it could be infection and he didn't think that the scan was warranted. So then what are we doing here?! If it isn't infection what does he think it is? He isn't really sure but some physical therapy and NSAIDS should help. Right! We have been at this for two weeks! Why didn't I think of motrin? Well, after he left the room and I had my temper under control again we all reassured each other that he had no idea what he was talking about. We were frustrated to hear that the bone scan wasn't even ordered and just don't even know what more to say to these doctors but headed back to the guest house to wait for a new day. This morning the whole entourage rounded (5 different physicians- most of whom I have no idea what they do) and said that they still don't understand Tim's labs and they are so happy that he has stopped having fevers. They talk of decreasing his antibiotics and doing some therapy and that he is fine now. It makes me just want to cry. I've lost track of the ways that I've mentioned that HE CANT WALK and that no matter what the labs say now HE WAS SICK. I've been on the phone with two different physicians in the states who both say that it really sounds like it was septic arthritis and now is possibly osteomylitis and don't decrease the antibiotics. If it is a bone infection we really need 6 to 8 WEEKS of treatment. As much as I hate the idea of continuing the IV, I hate more the idea that we could head back and in two weeks have Tim be sick again and possibly lose function in one or both joints. But to continue treatment a PICC line would be ideal (so that I don't have to start and IV new every few days) when we head back to Soroti.


Things did look up a little this afternoon when the surgeon came around again and admitted that even though he disagreed, that the radiologist believed, after looking at the MRI of the elbow, that there was infection in there. He is now willing to order the bone scan and it will be done tomorrow sometime. I talked again with Tim's doctor from the states who will call the doctors here and see if he can... well, if he can do anything. 
I'm sure that there are other things that I could include like how I still have to talk to the nurses about meds that Tim has been on for days now. I had a discussion with today's nurse about what his actual dose of levaquin was and how it seemed he was about 30 cc short when I did the math and she responded that it looked like she gave about half the bottle and I rendered speechless.

Quiet sunday afternoon

I have several other things that I should be working on but my mind is tired and scattered so I'll use the need for an update as an excuse. So where are we at? Sunday afternoon, just hanging out in Tim's hospital room. I'm not sure I've ever seen Tim this discouraged. I'm pretty sure he won't like that I wrote that and he is possibly the single harderst to read patient I've ever had so I could be wrong but I'm sure he's pretty disheartened and sick of this. I know you are all praying for his healing but I really believe we need to be praying for his mental well being also. I personally would have lost it days ago with all of this up and down and back and forth but he is still hanging in there and I'm impressed.


Today we took him out of the hospital to church with some friends this morning and initially the knee didn't seem too bad. But he got really pale during the service and said he was nauseated (I would have given anything to have a BP cuff- I'm sure he was low) and then after church he was back to being unable to bear weight at all and looked very tired. We are just waiting for a bone scan tomorrow that will hopefully give us some answers..... Oh, and I continue to harass the nurses and we are still receiving shoddy care. I lost it with today's nurse when I was questioning his levaquin dose and she told me she just gave the second half of yesterday's dose (out of an already spiked IV piggyback?!!?) I also found out his other antibiotic is scheduled at 6am and 6pm. I don't think he has gotten a morning dose before 9 and he tells us they wake him up to give the night dose. Great. Don't worry those schedules are just suggestions. It makes me want to be out of this african culture so badly.

Ride for Refuge!!

So if I was not in Kenya right now with a sick team mate I'd be doing things to promote Ride for Refuge. This is a great fundraiser for the work we are a part of in Soroti. The money raised goes toward former child soldiers abducted by the LRA, unreached people in northern Uganda (people I really want to work with more!) and vulnerable and exploited kids around Soroti. This is a bike ride but not just for bike riders. If you like to ride or can only do 20 minutes this is the day for you!
I have created a team and will be riding in Soroti. If you are interested I'd love for you to join my team- Soroti Cyclists. Check it out : Grand Rapids- Ride I'll ride here and you'll ride there.
If you can't ride but can still give that would be great too! Grand Rapids- Give Just enter my name. 
Questions?  Let me know. (I'm just sitting around in this hospital room....)

So for a little change of pace I'm posting pictures today. The first few are of the guest house we are staying at. When we drove in late wednesday night, after dark, exhausted from traveling and being at hospitals I felt like I was 7 again. We had stayed in the this same guest house when I lived here with my family 20 years ago. We would arrive after LONG days of travel, after dark, exhausted. The place looks exactly the same as it did as a child. It felt like the weirdest deja vu ever. It is a really nice guest house and I'm glad we are staying there.

The other two pictures are Tim and Angie in their usual places. Hanging in there....

Dessert Song

I've been listening to this song frequently and it has be come one of my favorites during this period of time. (By Hillsong).

This is my prayer in the desert

And all that's within me feels dry

This is my prayer in the hunger in me

My God is a God who provides

And this is my prayer in the fire

In weakness or trial or pain
There is a faith proved

Of more worth than gold

So refine me Lord through the flames

And I will bring praise
I will bring praise

No weapon forged against me shall remain

I will rejoice

I will declare

God is my victory and He is here

And this is my prayer in the battle

And triumph is still on it's way

I am a conqueror and co-heir with Christ

So firm on His promise I'll stand

All of my life

In every season

You are still God

I have a reason to sing

I have a reason to worship

This is my prayer in the harvest

When favor and providence flow

I know I'm filled to be empited again

The seed I've recieved I will sow.

I'm not even sure what to write anymore. NOTHING has changed! We had such high hopes for yesterday but got no new information. We did manage to get the MRIs done but have not seen results yet. Labs also, they were drawn but no results. I wish I had a good relationship with the nurses but I spend so much time hounding them to do stuff and give meds on time and call doctors that they seem to not be able to stand me (for all you nurses out there that have had patient's family members like me I'm sorry!) They won't let me look at the chart and I've already had two conversations with the nurse manager (about meds being given more than 6 hours after they were ordered, labs not being collected and vitals not being taken when a patient is say he having trouble breathing).


Because of the LORD's great love we are not consumed, for his compassions never fail. They are new every morning; great is your faithfulness. I say to myself, "The LORD is my portion; therefore I will wait for him." - Lam3:22-24

I keep telling God that we are ready for something to change but I'm afraid he is just telling me to be patient. But this is really hard!! The CT is at 9:30 (Tim has to be taken to another hospital to have that done) and the doctors should round after that so hopefully we will hear something late morning or early afternoon. We head to the hospital soon....

The ongoing saga....

Lets see... I must be to at least part 17. I think I left off last time we were still in Uganda, at home...

Tim was still unable to bear weight standing at all. (I want to just point out again that he is an otherwise really healthy, active guy. It is really disheartening to see him unable to walk.) After talking with a doctor in the states (you know who you are- THANK YOU!!) and the doctor that saw us in Kampala we increased the abx and switched them back to IV. Q 6 hours until we could get him back to the International Hospital. So at dawn we packed up the car again, Angie drove this time (good work Angie!) and 5 hours later we finally got there and got him admitted. But we quickly became discouraged with the terrible care at the hospital in Kampala. (that will be it's own post in the near future- it will be titled something like “nursing as it never should be”) Late evening we decided that we couldn't stay. We discussed leaving right then but we had no where to get the IV abx that Tim needed so we would stay to allow them to provide the meds and I would continue to give them and hound them through the night to do things like vitals. We would begin arranging flights first thing in the morning. So by 10 am we were pushing the staff to get us our paperwork, another dose to go and get the bill paid. In true african fashion it was 1pm and we had to have the taxi racing towards Entebee to make the flight. (Funny story here: We were passed by a police car with lights/siren so the taxi driver hit his hazard lights on and jumped in behind him. We usually leave more than an hour when going to the airport and we did it in 25 minutes.) We managed security somehow. I had my fully stocked medical bag with everything from a high temp cautery and scalpels to prescription meds and narcotics but no where to leave it and I was thinking I was still going to need a few things from it. And we did. 2pm found us struggling though the airport with a bunch a bags, Tim and Angie's 6 month old, her car seat and Tim unable to walk. With meds due. So I'm a good american nurse. Meds can't be more than a hour late. At quarter to 3 we were sitting on a plane waiting for take off and I was reconstituting ampicillin and cloxacillin into a 500 cc NS bag to infuse over the next hour. Tim wondered out loud if the change in barometric pressure would change the rate of infusion. (BTW the answer seems to be that the elevation has little to no effect on the drip rate.) I was getting very frustrated when what should have been a really good line wouldn't flush and we were stuck in our seats as the seat belt light was on. Any way, we managed, arrived in Kenya. Got Tim through the airport, and found our taxi. 2 hours later we arrived at the hospital with Tim looking increasingly sick. But the doctor was standing outside the ED entrance waiting for us. I can't even begin to tell you how comforting it was walking into a well staffed, well stocked, honest to goodness ER where they took vitals and did a real assessment! They had a new line in and had drawn blood and two sets of cultures in a matter of about 30 minutes. Within two hours he had been to radiology and we were admitted to a room on a floor that actually looks like a hospital. The head of the bed goes up and there is a call light. I really felt like we were leaving him in good hands. The doctor came in and let us know that the labs were back. The results were good and bad. Good that there is practically nothing on them. BUN and creat normal. White count normal. (How can that even be?!!) The doctor really can't explain. But we knew they were going to start the antibiotics and keep an eye on him through the night. Angie and I were both so hungry and tired we packed up very shortly after that and headed out to find the guesthouse.

I woke up feeling great (Angie too I think). Zulea slept through the night, the guest house was quiet and peaceful. Only to get a phone call from Tim first thing in the morning.  He had a miserable night and was feeling sicker than he had in a while. Just listening to Angie talk to him on the phone made me physically nauseated. We tried to get quickly to the hospital but had some trouble getting there quick...this is still a third world country. We arrived and the doctors were rounding right then. Listening to them discuss- none of the 4 of them have a clear idea what is going on. During the night the fever was back (101.6 ax) and he was shaking with chills. He was feeling palpations and chest pressure but the nurse never took vitals. She told Tim it was just due to the infection. She also didn't call the doctor so they didn't hear about it until am. So the plan for now is to change the abx again and add a CT and MRI. So now we are back to waiting.....

Today's fun fact...

We were talking about chills and fever and began to wonder why we shiver with a fever, especially  I when you don't feel cold.  I thought the explanation was kind of fun:

 Those suffering with a fever may also shiver and shake with chills. Although they may have a temperature above 98.6 degrees, the “set point” of the body’s temperature has been raised by the brain by the onset of a fever. This prompts the body to do things to make it warmer. Shivering when you have a fever creates more heat as it would in the cold, thus, elevating your body’s temperature even more.

Now you know. You're welcome.

Journal entries

Nairobi. Once again time to update. I was looking at my journal to get all the pieces in order and my entries give just a little glimps:
9/14 1:00am Trying to sleep in the guest house in Sorti (closer to Tim and Angie's place than my home because of the meds needed in the night). Feeling so frustrated. Wanting to badly to get Tim back to his “normal” self but feeling like we are running in circles. But we know the doc at international hospital now. Headed back to Kampala in a few short hours...

Then:

9/15 11pm Kenya. Trying to sleep in a guest house here in Nairobi. Feels unreal. So much has happened. Too tired to even process. I don't think I have slept more than 3 consequative hours.... Lord why can't I just trust you and relax?! While trying to mix and administer meds on the plane I just kept asking myself about this trust question. Am I relying on myself? At what point do we say God is going to take care and let our actions say that we believe it?

The list of things that has frustrated us since arriving again here at International Hospital just keeps growing. As I sit here in Tim's hospital room writing his abx are more than an hour late. When I asked about them she said the pharmacy is all out. Umm... so we drive out and get our own?! We were here more than 4 hours before his vitals were checked. This is a patient with a working diagnosis of septicemia!! The nurse gave meds IV push instead of piggyback. The doctor told us around 5pm when I pushed him as to why there have been no cultures done that he couldn't order them anymore tonight because the tech would be mad and not do them correctly- what?! When I asked about


11pm I can't get on the internet right now and that is probably a good thing right now anyway.  Angie went to the guest house to try to get some sleep. I stayed here at the hospital with Tim because we have only one treatment thing going on and they are getting it wrong. They seem completely unable to give these meds. The only thing they are doing for Tim here is the abx regimen and they are being given late (3 hours?! When I've asked for them 3 times already?!) or wrong. 1 gm amipclox IV push over 20 seconds is nothing like IV piggyback over 30 minutes ladies!  Thrombophlebitis 6 hours later- anyone suprised?!
The night physician came in to meet and we asked about RFT and electrolytes. (both drawn at 2pm) no electrolytes yet (lets face it they aren't coming) and the high BUN with a creat of .8 says to me we need to stop ignoring the hypotension. However, when questioned the dr didn't know the normal values and didn't want to do anything about them anyway. Thats fine. Thats why God gives us two kidneys.

When the surgon walked in early evening I asked him what he thought of the white count, and other CBC results and he in essence said the lab was usually wrong so he wasn't going to do anything about them. Ummmm...what?! I pushed him to do a needle aspiration of the joint (s) for culture but he pretty much said it wouldn't change our plan of care. It wouldn't?! How about a repeat ultrasound to see how much fluid is on the elbow or an initial one of the knee to assess the pain. Not necessary. Really?!

Father God- this all seems so surreal. What am I supposed to be thinking? Feeling? Praying? We are headed to Kenya in the morning. I should go? I want to just be still in your presence tonight. Help me quiet my thoughts. What do you need to say to me? My God will meet all of your needs according to His glorious riches in Christ Jesus. I pray for Tim tonight. I'd be a nut job by now. Draw him close to yourself. Remind him of your presence. We all need you to be our strength.

Currently sitting at International Hospital- Tim was admitted yesterday mid-day. Have been here less than 24 hours and the medical care is ridiculous and atrocious. (Is that redundant?) If I knew where to get the meds that he needs here in Kampala we would just leave because he was getting, if not better, than at least less life threatening care, before we got here. Josh and Mandy are arranging many of the details

So, how am I feeling? I don't even know. Sleep debt is becoming a real problem. I'm functioning with half my brain I think and this isn't good because we (I) need to question EVERYTHING the doctors say. Like my late night conversation with the night shift doc. He had the results of the RFTs and didn't know how to interperet the results. I haven't had to do that in months and so I asked him what were normal values and what Tim's indicated. The long and short of his answer was he didn't know the normal ranges and Tim didn't have anything to worry about. So, I've refreshed myself on the ranges and indications and I'm ready for you next time buddy....

So much for a restful week....

I think that Tim decided that he rather likes all of the attention he gets when he is sick so he added another septic joint tonight. Sharp shooting pain, can't walk, fevers up, BP down. We are all learning the drill. Phone calls to doctors, finding pharmacies that have the right supplies. More IV fluids, intravenous meds every 6 hours and we are back on our way to Kampala as soon as the sun is up. 5 hours of driving to get back to the international hospital. Last week the whole team was here to support, pitch in and make it “easy”. This time the team is all either in Jinga or Kampala. Please pray for Angie. And for Tim's mental well being. He doesn't take well to being sick. And the new team mates moving here next week. It will be hard to come into this confusion. Tim and Angie want to be getting ready for them but can't. And Josh and Mandy have family here and we want them to be able to enjoy their time together. Medications due in two hours. I should be trying to sleep...

Ummm.... so I want to be honest in this post but occasionally have a hard time being vulnerable.  O.K, starting right off not being honest. I never like being vulnerable. Or admitting weakness. But I'm pretty weak right now. I felt pretty overwhelmed when we returned from Kampala Friday evening and walked into a house that looked like a tornado hit it. Almost literally. A tree down in our yard that took a couple sections of fence and demolished the garden. We'd left in a hurry so there was rotten fruit on the table and had been days with off and on power so bad food in the fridge. My room had been ransacked (by me, looking for medical supplies and trying to pack) and my bed buried too deeply sleep on. Rachel (a wonderful teammate) had us over for dinner but while walking home in the dark we found our kitten outside the gate too injured to move. We made her as comfortable as we could but I was up again a portion of the night with her. Early Saturday we put her down. That was really hard for me to do. I'd grown a little attached.

It is amazing to me how all those little things added up and I felt so overwhelmed. There is also real spiritual fatigue that I've never experienced before. I feel like I've been calling out to God since Monday night and waiting and listening for His reply and comfort and encouragement and just not feeling it. I would ask Him what I was supposed to be doing and about all of these decisions and then not hear anything. So I would just rely on what I know and "go with my gut" but then be hit with the guilt that I'm relying on myself.  In church yesterday I realized I was just there, not engaged. Going through the motions but worse than that I was OK with it. I didn't want to engage. On top of all of that I'm still not really sleeping at night (as evidenced by the fact that I'm processing at 4 in the morning).  So rarely has this been a problem for me I don't really know how to cope.  Anyway, enough being vulnerable.

My family will be online to skype in a few minutes and I'm really looking forward to it. I'm going to plant the garden today and try not to think too much. 

Time to update again. Thank you all for faithfully praying us through all of the last 4 days. I just wrote four and I can't believe that is all that it has been. We are back in Soroti tonight and glad to be here. At the end of my last post I think we were waiting to get through the night and off to the international hospital in the morning. We met with a good doctor shortly after 8am who took us very seriously and immediately said it sounded just like septic arthritis. He gave us a referral to an orthopedic surgeon who could see us at 10am. So we killed some time and were sitting outside his office waiting by 9:50.  Unfortunately this is still Africa, so we finally got in to see him just before 11. He heard the whole story and sent us to radiology for ultrasound to see where exactly the fluid was. We waited another hour but then had a great ultrasound tech who immediately identified the fluid as within the joint with debris and clear infectious process.   So with test results in hand we headed back to the surgeon. He said he was willing to operate but as Tim is doing tolerably well he could try a two week course of antibiotics and reassess.
So we crashed back at the guest house to rest and pack up. Then this morning (after sleeping in a little) we headed back to Soroti. Tim isn't feeling as well as I would like him to be but he is doing O.K. It has been a crazy couple of days and it is really time to call it a night. I'm looking forward to not being awake at 2:30am.  Thank you all again.

A very frustrating day. The good things of the day were that Tim was feeling ok this morning and we (Tim's wife Angie, Beckie to drive and I) left Soroti at 6am.  Travel went very smoothly, putting us in Kampal in a fast 5 hours. We were able to get right in and be seen. But that is about where the positives seemed to end. The British doc didn't take us seriously at all. He talked of bursitis or gout. I told him again and again of the past few days and he responded Tim is a young guy so his low blood pressures are normal, fever is no big deal and pain is to be expected. He even went so far as to say I shouldn't have given the big antibiotics. He tried twice to do a needle aspiration and got nothing. Then sent us to ultrasound where they could see a big pocket of fluid but not in the joint, above it. (I would have sworn that the fluid drawn off in Soroti was from within the joint not above it but I have no proof).  He did culture the fluids- positive for pus but no organisms seen. So he sent us home (to the guest house) and said we could come back at 2pm the next day to make sure the fluid pocket hadn't reformed.  When pressed about abx he said Tim could stay on the Levaquin but all he needed was PO. So, tired and discouraged but trying to be happy that at least Tim wasn't so sick we headed out to find something to eat.  (I want clarify this point- Tim is better as we left but still not great.  Limited range of motion in the elbow, tired and still a little sick.) So we sat down to lunch and Tim laid down on the booth in the restaurant.  I wanted to cry.  Fever was coming back and he was again increasingly weak and tired.  The elbow was hot, swelling again and more painful to move. Now what?!  We headed to the guest house to unpack, rest and re-group. We called the British doc and were again blown completely off. But he did say we could come back to have the fluids drawn off again if we wanted to help with the swelling in the joint. Gee thanks. We worked on a contact at the international hospital that at least seemed to take me seriously on the phone and wants to see him first thing in the morning.
Now, I'm sitting here, 9:45 at night, Tim's pressures are back down below 90, fever back up over 100, pulse tachy.  I don't want to give IV fluids or abx because then he will feel better by morning again and they won't take us seriously. So we are pushing PO and trying to wait. (still with good output I think) And again I won't sleep because I know sepsis goes bad fast and every fiber of my inner IIU nurse is screaming that it is insane to not treat what I know shouldn't be ignored.  Ahhhhh!  There may very well be another 2am post tonight. Please keep praying.

updates

Mandy (one of my amazing team mates) is doing a good job with updates so here is her blog address as we travel. Shaarda News Hopefully she can keep you posted.
I keep going back and forth between trusting God and just wanting to ask Him why is he allowing this? I look at Tim and he looks like he's doing alright then I look at the vitals and the ER nurse in me wants to start running some ACLS protocols. Anyone know where I can get some dopamine around here?  
As much as I want to I shouldn't be waxing philosophical at 2 am after a long day and going on a couple of long nights so I'm just going to sign off here right now.

Too tired to update on what is going on so just going to repost the updates from other team mates- really long frustrating day with a sick friend. Weird to try to be a nurse to my team leader. Discouraging to try to get good and safe medical care here. Headed to Kampala as soon as there is enough light to drive.

From Josh and Mandy Shaarda 11 hours ago:

For those of you who don't know, Tim has poked by the thorn of a cactus about two months ago and has had a lot of pain since then. Last night it became much worse and Jennifer (our teammate and nurse) said it looked like there was an infection and now it went into the blood stream. Tim was in a lot of pain, he had a fever, and his blood pressure was low. This morning his pain and fever are better only because of pain killers (and everyones prayers I am sure) but he still needs strong antibiotics, IV fluids, and his elbow to be drained. Jennifer is helping Angie figure out what to do. They have talked to doctors in America and Kampala to make sure it is the right diagnosis. Right now they are trying to get the medicine in town. They thought they would have to go to Kampala to drain the elbow but through an expat doctor found a doctor in Soroti who is going to do it this morning.

Wow, how quickly life is through upside down and we are falling to our knees desperate for God's help. How we need Him. Last night as Josh and I prayed I was so thankful we have the Lord with us. Thank you for praying for Tim and Angie. We will try to keep you up to date. Be assured God is here taking care of Tim.

From Josh and Mandy now:

Please keep praying for Tim! Really nothing has happened today working with the clinic here. We saw some signs of improvement but now he is back to what he was again. I really want to see them in Kampala. It looks like they will go first thing in the morning and Jennifer will monitor him tonight. He is getting the meds he needs but he has a fever again and his blood pressure is down again and he is not urinating. He has had IV too. It is so hard to know what to do. We are praying!!!

Cancel that consult...

I had finally asked for some help about this sore on my foot...hence the last blog post.  Sunday, late evening, our team was fasting and praying for Karamoja and Beckie felt led to pray for my foot.  By the time we were done praying the pain was gone. By the next morning the redness, swelling and drainage was gone and mid-day it was mostly health pink scar tissue. Now it is just a little scab on the top of my foot.  In my western mind I was quick to say, oh the abx finally kicked it, or something but I have to just shake my head. Cellulitis from nasty and hot to gone in 7 hours because of abx that haven't worked for the past 5 days? This was an amazing gift from God. Thank you Lord for your healing!  He is amazing and I know that He did this miracle to remind me of His power and ability.
And even as I write this it is 1am and I'm wide awake and worried. I have a really sick team mate but no IV fluids, no IV abx, no hospital within hours and I don't know what to do. I hate this feeling. I follow doctors orders well but I don't like writing them myself. But decisions had to be made.  I feel so helpless and anxious. BUT WAIT, didn't God just remind me He is amazing?! It was like He was just waiting for me to ask Him for his help about this foot. So here I am, unable to sleep, sitting at my desk worrying.... ummmm, doesn't line up.  Lord, we are asking for another miracle tonight. Please show your power! I know that you are the great healer and we need you to do this thing because there is nothing I can do to help. I place this in your hands. Amen

Need a quick consult...

O.K.- I need to ask the advice of you medical people that read my blog. Two weeks ago I developed some blisters from walking. Slowly they have become kind of nasty infected sores. I started myself on erythromycin (250 mg q6 hrs) a week ago as they were red, hot and draining. So... five days later the one on the top of my foot is an open, continually draining ulcer with cellulitis from my toes to the base of my ankle. I'm asking for advice now because the joint is so stiff I can hardly walk and the pain is really starting to get to me. The other two sores are looking much better, still can't wear any straps but the drainage has stopped and the swelling is nearly gone. I could post pictures but just reading the description seems gross enough. I'm open to any suggestions as the erythromycin doesn't seem to be cutting it....
(Just for fun the differential diagnosis seems to include amebic skin ulcers, cutaneous anthrax, diphtheria, buruli ulcer, myiasis, and leishmaniasis. But I managed to rule all of these out because the centers are not black, I don't have maggots in the wounds, don't have a fever anymore, they are strictly on my feet, I only really have one that is bad and it isn't spreading to new parts of the body which leaves me with only your standard, run of the mill, tropical ulcer. )

Football (soccer)

I went to the sports grounds today and watched some football this afternoon. It was good football made better as the team I was cheering for won the championship! They are a group of boys (younger than 14), some of whom live on the streets and struggle to care for themselves. Bobby (one of my fellow IT missionaries) has been coaching and the boys played really hard. Bobby does a good job telling a little about it andseeeing the humor in it on their blog. (link below)

 Kolb's Journey- Freedom Boys will win the Goat!

Look at all those bare feet....

More Karamoja Pictures

A few more pictures from the Karamoja trip. My camera battery died but Heidi just shared these with me. Thanks Heidi!!!

This is the truck the day that the roads were so bad coming back from Nabwal. The land rover was heavily loaded, but the last stretch they said we couldn't walk and the guards rode on top because of attacks in the area a few nights ago.

That was of course after we walked quite a bit of the way first. With our armed escort.

A little look at life around the villages

 

Boneless, skinless chicken breast

Had a conversation with Abella tonight. Beckie and I were so excited that we can now purchase chicken here in Soroti that has no feathers, no skin and not even any bones! (Very exciting- I can't even begin to tell you how much easier dinner will now be if I don't have to start from squawking. ) But back to our conversation. They love bones here so Abella was pretty incredulous when I explained that most of the meat I purchased in the states had little or no bone in it and we liked it that way. I went on to tell her that we really never purchase live chickens for dinner in America either. When she asked why I told her because it really wasn't accepted to kill things in our backyards. Where would we put the heads and feet and stuff? She asked why couldn't we just dig latrines and put it in there. I explained that we really didn't need to dig latrines as every house has at least one indoor toilet. Besides, we are not allowed really to just dig giant deep holes without getting permits. She didn't really get that but undeterred, she then asked why we couldn't just burn the waste like here. I explained that it really wasn't acceptable to have fires in your yard to burn trash either. That we just put all of our trash in a bag and every Monday we put the bag outside and early in the morning a truck comes and takes it away. She was quiet for a long time. She is very polite but I could kind of follow where her mind was going so I said- that's right, we are not allowed to kill things, dig holes or light fires in our yards in the states. Her response- life is hard in America isn't it? Yeah, I guess it is a little. So sorry to all of you guys stuck in America today.

Newsletter links

I sent out my newsletter and in it I talked about the travels in Karamoja. Here is the quick jump to those posts.

Karamoja 1
Karamoja 2
Karamoja 3
Karamoja 4
Karamoja 5

Just a bike ride!

Ride for Refuge... less than one month away!  Want to do something in Grand Rapids that will have a big impact here in Soroti?!

I need you to ride!

You can help the displaced, vulnerable and exploited in Uganda – to connect to the hurt and pain personally, and to do something about it by riding your bike and raising awareness and money. You don’t have to be a “bike rider” to ride in the Ride – with the choice to ride from 5 miles to 60 miles, young, old, children, families… practically everyone can ride!  

Please check out http://www.rideforrefuge.org/.