Wedding Weekend

This weekend we headed up to Quito to celebrate the wedding of our friends, Jen and Harrison, who we met while in language school at the Nazarene seminary. Jael and Caleb had the honor of being the Flower Girl and Bubble Blower (Jen wanted Caleb to be involved too :)

 

It's hard to believe it's been over nine years for us!

A family pic before the wedding

"No petals!  What do I do?"

Notice the concentration.

The kids did a great job, although Jael took quite awhile to proceed as she made sure to drop a petal on each stair she stepped down, and the entire congregation heard her exasperated cry of, “Mommy, I’m out of petals.” 

Celebrating after the ceremony

I thought I'd better add a new pic of Anna, too!

We’ve been blessed with many new American and Ecuadorian friends during our almost two years here. As we prepare to head back to the states in November we look forward to reuniting with old friends, but we will have to say goodbye to many amazing people here, too.  We're so thankful that God has provided us fellowship not only for us, but for our children as well while we've been here.

Buggin' Out

A few more bug stories from Ecuador to share with you. Lately we’ve had a large influx of shield bugs on a specific tree near our home. We’ll pass and see many congregated in piles on top of each other. (I think it’s mating season.) Yesterday I heard the kids laughing and yelling about the bugs outside. I went outside to see what Caleb and Jael were up to and was greeting by my children covered in bugs and an awful stench. They had decided it would be cool to see how many bugs they could get in Caleb’s bug box, but in the process were “sprayed” as they attempted to catch them. I stripped the kids clothes and washed them up but couldn’t totally get rid of the smell. A few minutes later we discovered that the spray also left a strange yellow coloring on the kids’ hands. We’ve washed them numerous times, but it seems as though the coloring is just getting darker with time instead of going away. Hopefully it isn’t toxic and the kids will remember to ask before going bug collecting next time.

Caleb with a few of the bugs on his elbow and shirt.

Their collection!

Caleb's hands a day (and many washes) later.

A few hours later the kids were playing outside when we noticed a loud drone and looked up to see a huge swarm of bees. We rushed the kids inside for awhile but didn’t hear anything so thought they had flown away. We looked around and discovered a huge “bee ball” in the tree outside our kitchen window. There was nothing in the middle of them except more bees and they didn’t make a sound as they sat there. Our neighbors had had the same thing occur last week, but their “ball” was larger, the size of a basketball. We found someone who had bug spray (and could run quickly) and got rid of our bee problem.

Our bee ball.

Little Carlos; Kristina's Run

Carlos is a little 9-month-old who presented to us a few days ago.  His mother gave me permission to publish his picture and story on our blog.  He had been having fevers, and, as you can see in the picture, a bad infection of some sort that seemed to be eating his nose.  Even more worrisome was his extreme malnutrition.  This little guy weighed in at about 9 pounds on his admission, which is about half of what he should have weighed.  It was difficult and sad to see his tiny little arms and legs, which consisted of nothing but bone covered with a bit of skin.

Carlos had already seen a couple of docs here in Ecuador, but had not gotten any better.  We were thinking that his nose problem was a result of a bacterial infection or a parasitic infection called Leishmaniasis.  We sent a tiny biopsy to look for the parasite, and in the meantime, his nose did seem to get a little better with antibiotics.  He also gained 2 pounds in his first week on a high calorie diet (the picture above is his "after" picture).

Carlos has a few tests pending to help us to know more about his condition.  He still has a long way to go before he's out of the woods.  In the meantime, he would appreciate your prayers as he tries to gain some weight and fight off this difficult infection.

You may or may not know that Kristina has developed into quite the runner.  I have to try to keep running some as well, primarily so that I'll be able to catch my wife.  While out on a 4-mile tempo run a couple of days ago, Kristina was met by an unexpected visitor who left a nice souvenir on her calf.  As you might have guessed by the picture below, the visitor was a pretty good-sized dog who was surprised at seeing such a fast runner going by.

We washed the fang marks out really well, and Kristina began antibiotics to prevent infection.  She's also had to get some shots to make sure that she's properly protected against rabies, though I've not heard of a case of rabies here outside of the deep jungle.  Kristina's had a great attitude about the whole thing, but she says that she'll make sure to run on the other side of the road when she passes that house the next time.

We're Still Here

In the midst of travels and company we’ve gotten quite behind on our blogs lately.

To be with family after my grandma passed away I attempted a trip to the states with the three kids while Dan stayed in Shell to continue working at the hospital.  At some points along the way I felt really confident, and then several minutes later I’d be humbled and realize I was out of my mind to attempt such a feat.  (Have you ever tried to go to the bathroom in a public place with three kids four and under?)  Truthfully, though, the kids did great and we made it safe and sound to Washington.

The kids had a great time on the swing Papa set up in the old barn.

We had lots of help on our return trip with my mom, Aunt Donna, cousin Kaylan, and friend Sam.  It is always such a blessing to have visitors and makes the reality of being far from family and living in a different culture easier.  A week after their visit Dan’s folks were here to love on us.

Dan and his dad exploring some caves not too far from Shell.

After much prayer and discernment we’ve made the decision to head back to the States after our contract ends in September.  We plan to be there sometime mid-November.  Thank you to all who prayed and offered words of wisdom as we made this decision.  We’ve been blessed during our time in Shell and are confident this is where we were to be for these 2+ years; we’re excited to see where the Lord leads next.  We’re still not sure where we’ll be, but we'd like to be close to family in the Northwest.  We’re also anxious to get involved in Hispanic ministries wherever we end up.

The kids are getting ever bigger, especially Anna, who has just started solid foods.  She’s our little laid back Ecuadorian child and is very content to just sit back and let her big brother and sister entertain her.  Caleb is our engineer.  He spends lots of his time drawing plans for and then setting up blanket forts and playing with  lego sets.  Jael is a little firecracker.  The other day we were sitting on the couch together as she quietly contemplated something.  When I asked her what she was thinking about, she replied, "Boys."  I think we're going to be in trouble :)

Caleb has been learning to ride his bike without training wheels and always needs a congratulatory headbutt from Daddy after a good ride.

Playing in the hammock with Grandpa and Grandma.

Anna is quite the "drooler"; she can soak a shirt in a few minutes flat.

Life-Giving Blood

It was Saturday around noon, and I was busy seeing patients in my AM clinic and juggling some issues from the ER. I received word from the family medicine resident that a patient had arrived who was suffering from an apparent intestinal bleed, with the source likely being in the stomach or the duodenum (the first part of the intestines after the stomach). We started him on some medicine in his IV for a suspected bleeding ulcer and admitted him to a hospital bed. The next step was to perform an upper endoscopy procedure to try to diagnose the cause and severity of the bleeding. However, before doing so, the patient would have to be hemodynamically stable. That’s a fancy way of saying that he would have to have a relatively normal blood pressure and pulse, and that he would appear to have a decent blood supply to all of his vital organs. Unfortunately our patient did not meet these criteria. His pulse was high, his blood pressure was low, and he appeared very sleepy (which was a result of not getting sufficient blood flow to his brain).

How do you “stabilize” a patient who has lost copious amounts of blood? By giving him loads of blood and IV fluid, of course! We began this process. After getting the equivalent of two 2-liter bottles of IV fluid pumped in, he had not stabilized. Simultaneously, he was receiving red blood cells as fast as we could give them (not fast—when they come from the lab they are packed into a very compressed state, and they run into the patient’s veins over a span of about 3 hours). After receiving the only three units of packed red cells that we had in our hospital, plus two units of fresh plasma, he STILL had not stabilized, and his symptoms told us that his intestines were still actively bleeding. There is a Red Cross in the next town over, but our lab informed me that there was no way to contact them during the night. Could we transfer the patient to another province? The patient elected to stay in our hospital, even though two important facts had become clear:
1) We had run out of blood
2) Our patient was bleeding to death.

Now it’s time to crunch the data a bit. These numbers are estimates, but they will give us some ideas of this patient’s condition. A human male about the size of my patient typically has approximately 5 liters of blood volume. We measure red blood cells, the part that carries the oxygen, by “the hemoglobin”.  A unit of whole blood contains about 450 milliliters of volume, and is expected to raise the hemoglobin by about 1.5 grams/deciliter. Our patient, before he started bleeding, probably had a hemoglobin value of around 14, which is normal. When he arrived at our hospital, his hemoglobin was 11. The next morning, after receiving the above-mentioned transfusions, his hemoglobin was 4. It was clear that our patient had essentially bled out his entire blood volume, and was now just hanging on for dear life with the little bit of blood that he had received from our lab upon his admission. At that point he looked worse than ever. He was as white as a ghost and barely responsive, and we still had no blood to offer him.

Now it was Sunday morning, and we began to ask everyone, “What can we do!!??” Our lab technician mentioned that if there were people present who wanted to give blood to our patient, the necessary tests could be performed to make that happen. Of course the donor would need to have blood type either O+ or O-, since our patient had O+ blood. The first person to step up and donate was one of our surgeons, Dr. Mattias Egberth. He was followed closely by one of our medical students, David Garcia. At about that time, approximately 20 of the patient’s relatives arrived to visit and to wish him well. They began to ask, “Can we donate as well?” Within just a few hours, we had rounded up SIX units of whole blood, which the patient gladly received. Now he was waking up, and for the first time since his admission, he was hemodynamically stable. We performed the endoscopy procedure and found a large ulcer in his duodenum. It was no longer bleeding! Thank you, God!

In all, we calculated that our patient had lost his entire blood supply and then some. By day number three, essentially none of his circulating blood was his own. He had received three units of packed red cells, six units of whole blood, and five units of fresh plasma, all because of donations by fourteen different people who were willing to give their own blood. The patient and his family were extremely grateful and humbled to know that he was alive through the sacrifice of fourteen other people, many of whom did not even know him.

Blood is an amazing creation of God, and it has long symbolized “sacrifice.” In Moses’ time, the blood of an animal was poured out on an altar in a petition for the forgiveness of sins. This was only a temporary, imperfect solution for man’s sin problem. But God made a perfect way, the only way, to salvation through the sacrificial blood of His perfect Son, Jesus Christ. “He personally carried our sins in his body on the cross so that we can be dead to sin and live for what is right. By his wounds you are healed.” (1 Peter 2:24, New Living Translation) We are alive today, and we can live in Heaven forever, because of the blood of Another, because of the blood of Jesus Christ.  And the power of Jesus’ blood does not stop when we pray to accept Him as our Rescuer. Instead, our sinful nature dies, and His perfect, righteous nature goes on living. In the same way that my patient received a completely new supply of circulating blood, we are continually filled with Christ’s perfection.

The patient gladly gave permission to share his picture and story on our blog.

Keep the Door Shut

Ever since we arrived home from our trip to the states we’ve had a little problem: jungle critters. I’ve always prided myself that our house was pretty cockroach free, but they’ve made a comeback. However, they are the least of our worries. Several nights ago Dan and I were sitting on the couch and in walks a tarantula, even with the screen door closed. He wasn’t too big but several nights later his larger cousin came to join him right in the middle of our marriage class.

An even bigger problem has been Mr. Rat. I’d never had an encounter with one until a few weeks ago. Dan was on call at the hospital and I kept hearing rustling in the laundry room. I called Dan to come home to find the culprit and after investigating he said he couldn’t find anything. As he was walking out of the laundry room he kicked the washer and out ran an enormous rat (well at least I thought it was enormous). I’m usually a pretty calm person when it comes to creepy-crawlies, but I went running for my life . Over the next week and a half the rat became Dan’s biggest nemesis as he tried multiple ways to get rid of it. The first night the rat ate all the poison we left out for him and we thought our troubles were over. However we knew he was back the next night when he go into some “sacred” cereal we’d bought in the states. Now we knew our rat had a strong stomach. Next Dan tried a homemade bucket trap in hopes of drowning the rat, but our visitor was pretty smart and only would eat the food at the front of the plank leading up to the water. After that Dan moved to a spring trap. Dan set it up several nights in a row so sensitive that it took him quite a while to get it to set without snapping back on Dan. Somehow our rat was able to get the food every time without setting it on himself. Now we knew our rat wasn’t just smart, but a genius. After several more days I was preparing lunch and looked over and there sat Mr. Rat in the laundry room right in the middle of the day. Now he’d gotten way too arrogant. I climbed on the counter and told Dan to get over there. Dan grabbed a broom and used his baseball skills to stun him. As Dan brushed him outside to finish him off he kept making these sad little squeaks and we almost felt sorry for him. Maybe he’d visited us so many nights we felt partial to our unwanted pest.
Last night was the scariest of all. As we were sitting in the living room I looked into the kitchen and there was a snake slithering around. His coloring was black, red, and yellow, and both Dan and I thought coral snake. He was a little guy, but our adrenaline was running as Dan brushed him out of the house and killed him with the broom handle. Thankfully we didn’t have Anna on her floor mat. We investigated on the computer and are hopeful his markings tell us it’s a harmless black ground snake, which mimic the coloring of a poisonous coral snake…we sure hope so.
Though it rains almost every day here, it is the rainy season and maybe our unwanted guests are trying to escape the rain. Almost all the critters have come at night when we’ve had the screen doors closed but the main doors open. Hopefully by keeping the doors closed we can keep them away; at least that’s what I keep telling myself.
AUGH…as I write this Jael is yelling that there’s a frog in the house!

Our snake after Dan got through finishing him off.

Run for It!

It was Fall 1992.  I was getting ready to start my freshman year at Vallivue High School.  I was a bit too skinny to do well at organized football, and our school didn't have a soccer team.  My dad said, "Why don't you give Cross Country a try?  You'll be able to get in shape to play baseball."  Well, I had no idea what I was getting into, but that's when I visited Coach Gary Ward's office and became a runner for the rest of my life.

I'm pretty sure that the Apostle Paul was also a runner.  He had all the characteristics that are needed to be a good runner: discipline, dedication, and lack of fear.  He learned to press on whatever the circumstances, and he knew where his strength came from.  "I know what it is to be in need, and I know what it is to have plenty. I have learned the secret of being content in any and every situation, whether well fed or hungry, whether living in plenty or in want.  I can do all this through him who gives me strength." (Philippians 4:12-13)  Whether he was doing a difficult hill workout or witnessing to people in prison, this determined mindset kept Paul going, even when it would have been easier to give up!

When we were in the USA this past month, my family bought me a gift certificate to buy some running gear.  Anyone who runs knows that, when you go out, you want to make sure that you only carry exactly what you need.  Running companies are always developing shoes, shorts, jackets, etc. that are ounces lighter than the models before.  It's also a good idea to minimize the ounces that I'm carrying around my belly by eating a smart diet.  The writer of Hebrews knew about getting rid of dead weight.  We're not 100% sure about whether or not Paul wrote the book of Hebrews, but I think it must have been either Paul or his running partner. "Therefore, since we are surrounded by such a great cloud of witnesses, let us throw off everything that hinders and the sin that so easily entangles. And let us run with perseverance the race marked out for us,  fixing our eyes on Jesus, the pioneer and perfecter of faith. For the joy set before him he endured the cross, scorning its shame, and sat down at the right hand of the throne of God." (Hebrews 12:1-2)  Not only did he cut out all extra weights, the author had his sights set on the Prize!

God has taught me many great lessons through many years of tough running.  Every runner who ran cross country while Coach Ward was at the helm knows of the famous Airport Hill workout.  Every year, Coach would take his runners there one time for a super-tough workout, the most difficult practice of the season.  It's steep, it's dusty, and it's hot.  I experienced pure jubilation when I finished that workout during my senior year, knowing that I would never have to torture myself on the hill's ridiculous grade ever again.  Thankfully, I had a smart coach who knew better.  I couldn't believe it when our bus turned onto the road to Airport Hill again a couple of weeks later in the season for a second workout on the dreaded mountain!  What was our coach trying to do to us?  Coach knew that the state meet would be held at Farragut State Park, and that it included a gigantic hill in the third mile.  The wisdom of our coach was proven a few weeks later when we walked away from the state meet hoisting the championship trophy!

As a doc practicing in a busy rural hospital, I'm constantly faced with grief and loss.  Last week we had some tough times.  I lost a sick 3-month old to severe pneumonia.  One of our Ecuadorian friends' 7-year-old son was playing with dynamite and literally exploded off both of his hands.  These events are devastating for the whole community, and we are blessed that we get to pray with the patients and families during the tough times.  I tend to be a pretty emotionally involved guy, so these cases are also very difficult for me as the doc.  It's time like these that I'm glad to be a runner.  I know that with Christ's strength, I can stick with it.  God has a bigger purpose, and He will work all things together for good.  He's a good God, and we know He will do it.  Sometimes we feel like we're approaching "Airport Hill" for another tough workout, but we know that God is the wisest Coach ever.  We need to trust that He knows what He's doing, and in that trust, we will live in the peace and strength that only He can give.

Kristina is also a runner.  We are sad to report that her grandmother passed away last night.  We will surely miss her.  At the same time, we rejoice at the wonderful life and example that we've been able to witness and be a part of.  Marjorie Mills lived in such a way that she could say, "I have fought the good fight, I have finished the race, I have kept the faith." (2 Tim. 4:7)  We are filled with happiness to know that Marjorie is in Heaven today!