The Unabridged Version

I was told before I left for Africa in the summer of 1999, that Africa gets in your blood. I had no idea how true that statement was, nor how much it would change my life. Blood is spoken of in scripture in such vivid imagery – it is the symbol of all life. It is through God’s own blood that we are redeemed. Blood transforms. In every way, whether through its destruction or transfusion, it changes everything.

I have spent 5 summers in this enchanted land now. Each time has brought something different, and changed me in new ways. The first time I set foot on African soil I was 17. I remember looking out the window of the airplane as we landed in Harare at sunset and having an overwhelming sense of anticipation and excitement - like this first step could never be taken back or ignored. No matter what pain or pleasure was found in this foreign land, I would never again be the same. In many ways, I lost my innocence that first summer. I saw things I could not have imagined, and became a part of a people who were different than anything I had previously experienced. They were poor on an entirely different level. They had nothing - no running water, no electricity, no coats or shoes. Their clothes were rags that they cared for meticulously. Somehow, despite the dusty land, shirts were always white and clean. But the thing that impressed me the most were their smiles - the stark white teeth against contrastingly ebony skin. I had seen black people in the states, but the Shona dark skin looked different - from years of toil in the sun it became tough and leathery as they worked their land. They ate the same thing for every meal, sadza. The idea of complaining about this was beyond their comprehension. They were simply thankful to have something to fill their stomachs. I was inspired that summer to become a physician, and my life in the states since then has been dedicated to this dream: to one day return with something tangible to give. For, I realized that though they had nothing in the way of material things, the only thing that really mattered in a country so destitute was life.

I returned the next year with Papa and Terah. Elections had just occurred and the political unrest that would define the country in so many ways for the next ten years had begun. As we drove to Karanda through the Zimbabwe bush, we witnessed the squatters in the fields of the white farmers. There were road blocks and stories of beatings, rape and murder. Though I was white, I was never afraid after I got there. My only fear came before I left the States, having no idea what we would find there or if we would return. But going didn’t seem to be optional.

The country had changed in the time I had been gone. Yet still the people smiled. Terah and I spent hours and hours hiking around Karanda. The children laughed and followed us everywhere from a distance, equally enchanted by the strange white girls with long hair, as we were by them. Ultimately, I felt helpless. I had nothing to give. I had no skills or money to impart. The only thing I did have- hope in a better life after the assured death that awaited them I could not convey as I didn’t speak the language. That summer I vowed not to return until I had something to give.

Despite my promise, I returned in the summer of 2004. I had just finished college and been accepted to medical school. Maybe partly I needed to remember why I was making so many sacrifices to become a doctor. But mostly I think I went because I was drawn back to a place I had grown to love, a place that had become a part of my identity. This trip was a turning point in my love affair with Africa. It was then that I truly got to know the people there not as a foreign, captivating people, but as individuals. I came to understand that the reasons they didn’t do things the way I assumed they ought to, was not a lack of understanding, or education but because their world view was different than mine. And I began to develop an appreciation for how they viewed the world.

In December of 2006 my little brother died. I had witnessed death on what I thought was a personal level in Africa. I had no idea what death was, not the evil that it entails, not the desolation it leaves. My world was shattered the day Tyler died. Though I did my best to seek God’s comfort, I found none. I begged God to show me somehow that he still cared. I didn’t want a burning bush or a pillar of smoke in the sky, just some sort of reassurance that everything I had believed my entire life, of His character and love, wasn’t a lie. God was silent. Or maybe in retrospect I was so overwhelmed by pain that I could feel nothing else. At least I could feel. I think in some ways I held on to the pain because it meant I was still alive. As I forced myself to go through the motions of life, I felt like I had died that day in December. That I was only an empty shell of my former self. Even more than I hated the pain that I experienced through Tyler's death, I hated the pain that it made apparent in the world to me. When people would learn of Tyler's death, they inevitably would have their own story of pain to share. Rather than make me feel better about Tyler dying, it only made me question more why God didn’t return now. What he was waiting for. Why he didn’t take us home

I returned to Africa that summer. I’m not sure a lot of thought went into the decision to go, but I had set up a rotation there during medical school and everything kind of fell into place. Maybe partly I went to find out how they had so much joy despite all of the tragedy they experienced. To try to get myself to feel again. To stop feeling sorry for myself and realize how good I had it. When I got there, however, I didn’t find people who told me how much worse they had it, or about all the loved ones they had lost. They simply loved me. Unconditionally. There were no lectures on how God was in control or how we’ll all be together again in heaven. In fact, looking back on it, I don’t think they said much of anything. They listened. They understood. And I knew the reason they smiled was not because of anything in this life, but because of their own awareness of their proximity to the next.

The country was worse this year than any before. Four years of extreme civil unrest was taking it’s toll. The electricity was out more than it was on and petrol was in short supply so we couldn’t run the generators. We did surgery by candlelight with headlamps perched over our surgical hats. One night as we were about to sit down to eat dinner we got a knock on the door saying to come to the pediatric ward. There was a girl who was about 6 years old who had become unresponsive. We rushed down to the hospital as the rest of the people ran to haul the portable generator from the other side of the hospital compound to the ward so that we would have suction during the code. We coded the child for some time, but as the suction hadn’t arrived yet, our intubation attempts were unsuccessful. She never regained a pulse.

This past summer, I found myself drawn once again to this majestic land I have come to love. Timing was not ideal as I had just married six months before and had only a week prior to leaving for Africa finally moved into the same house with him. I had a sick feeling about this trip and to be honest, didn't want to go. Not only was Chris not going with me, but I felt that I was stepping into the front line of a spiritual battlefield. I didn’t know how or in what form Satan would attack, but I felt in my heart that I was walking into darkness. The night before I left I sat in Papa’s truck with my laptop, having wondered around until I found wireless signal to skype Chris. I cried, which isn’t all that unusual for me, and asked him to pray, and ask our friends to pray specifically for God to protect me from this attack. I had no idea how vital these prayers would be to the events in the days to come.

We landed in Harare at night, the sun already below the horizon and the last bits of light quickly fading from the sky. We went straight to the guest house with plans to leave for Karanda early the following morning. I was too excited to sleep. We arrived in the afternoon and went straight to the hospital to help Roland Dr. Stephens in the operating theatre.

Two days into the trip, still trying to recover from jet lag, I left after rounds to help get lunch ready. Papa went back to theatre to help Roland finish the skin graft he was working on. He was late for lunch. When he sat down across from me, I saw the cut on his hand. As he told me he cut himself during the surgery, a wave of nausea swept over me. It was all I could do to sit through the remaining few minutes of lunch. Knowing that he wouldn’t want me to worry everyone else, I tried not to let my fear show. As we walked back to the hospital, despite his reluctance because of their notorious reputation for making one feel sick, I convinced him to take the prophylaxis. By the time we were able find the ARVs - not an easy task at Karanda - every second was crucial. The three-hour window during which the first dose is to be taken was closing. I rushed to the theatre where Papa was working, and gave him his first dose, along with a considerable amount of anti-nausea medication. By dinner Papa was violently ill.

We got called to a STAT section that night. As we delivered the baby, my heart sank as I saw it’s premature size. To my surprise, however, it gasped and let out a strong cry with obviously healthy lungs. At the same time I looked down only to see another sac protruding out of the uterus – a second baby! Both twins were alive and healthy. I’m sure one can imagine my surprise. However, I don’t think it is possible to imagine the mother’s surprise! By the time we were closing Papa was flushed and diaphoretic. He kept closing his eyes, I could tell he was trying to will himself to concentrate and not pass out. He left the OR taking Collin’s keys to the only bathroom at the hospital. I placed the dressing and was rolling out of the theatre when the midwife asked me to check another patient. She had just arrived at the hospital in labor. I had never felt such pronounced caput. As I was finishing my exam she started seizing. When Papa returned to finish orders she was still seizing. We tried to vacuum extract the baby, but where she had been incoherent and uncooperative before the seizure, she was now simply post-ictal. We cut an episiotomy, but still the baby was stuck. It was so wedged in the birth canal that it wasn’t even possible to place foreceps between the pelvic bones and the baby’s head. She started seizing again as we rolled her to the OR. As I stood next to Papa scrubbing, I could hear his labored breathing as he struggled to keep from vomiting yet again. We prepped and cut straight down to the uterus. Purulent, foul smelling fluid came gushing out. We delivered the baby and attempted to resuscitate it, but it was clear that the baby had been dead for quite some time. We later learned that the woman was part of the Apostale cult and her cult leaders forbid them from seeking medical attention. She had been laboring for 3 days before coming to the hospital and was extremely septic by the time she arrived.

Papa was severely orthostatic by the time we finished. He leaned on the counter to keep his balance as successive waves of dizziness passed. The rest of the trip was just as exhausting as this first night. We took care of everything from cervical tears to skull fractures to ilial perferations from Typhoid to the head nurse of the hospital developing organophosphate poisoning. We took call every night – after all, the reason we were there was to give Roland a break. And Roland was so exhausted that even knowing that Papa was sick, he didn’t even object once when we offered to take call. I worried about Papa, but what else could I do? The medicine is supposed to make you sick. He was confused, diaphoretic, weak, orthostatic, and dehydrated. Nausea, vomiting, and severe abdominal pain defined the remainder of the trip. Yet he still pushed himself and worked long hours day and night at the hospital.

We left Karanda, exhausted, but as usual overwhelmed once again by the faith and strength of the people who do this not once a year, but day in and day out. It was Monday morning and we got up early to finish packing before heading to the hospital to help round before leaving. Roland was already busy in theatre, and though I missed Chris terribly, I still had trouble saying goodbye to Karanda, which in so many indescribable ways had become such an integral part of my life.

We had been on the road about 45 minutes when Papa asked if he was sunburned. I had either been taking pictures of the countryside or shielding my face from the dust blowing in the open windows until now, but as I looked over at Papa, his face was swollen and a purple shade of red. I lifted his shirt only to find the same thing on his back and chest. It looked like hives that were so severe and raised that they had all coalesced until the hives were unrecognizable as such and simply looked like one large burn. There was nothing I could do. If we turned around, there was hardly anything Karanda could offer other than the precious little supply of IV fluid that it used so sparingly. I tried unsuccessfully to convince Papa to let me drive as he continued to worsen.

After dropping our luggage off at the guest house, we went to the bon marche to eat. I now began to admit to myself what my real fear was – that it wasn’t just the medicine that had made Papa sick – it was acute HIV. It was already noon, and I borrowed a phone to text Chris. I asked him to look up the symptoms of an acute infection and they all fit. I motioned for Mom to come to the bathroom with me… she needed to know how serious I thought this was. I told her that Papa needed to be on the next flight to the States. I could hardly breathe. My chest tightened into the same knot that had become so familiar after Tyler died. I left to find a pharmacy hoping to at least find some zofran to alleviate the vomiting and lessen the dehydration. The first three pharmacies I found were closed since it was a national holiday. I found the only one in the area that was open. It didn’t carry zofran. I asked the man behind the counter if he has a PDA or any drug refrence book. I could only remember the name of one of the combination pills he was taking, and we had left them at the guest house when we unloaded everything. Seeing the desperation in my eyes, and most certainly hearing it in my cracking voice, he walked to his house to bring me his personal copy.

Papa had gone to the van to rest, and the others had gone to the market to buy souvenirs. I had already contacted Terah to have her start working on changing our flights. Everyone had gathered early at the van and drove over to find me at pharmacy. Papa and I waited for the man to get back with his book, and he started reading the side effects I had written down – of course, the nausea, vomiting, malaise, and dehydration were expected, but then the list continued – Stevens Johnsons syndrome, rhabdomyolysis, acute liver failure, arrhythmias, heart attacks - all life threatening conditions. I felt the inevitability of every terrible reaction, and while 20 minutes before sitting at lunch I had convinced myself it was acute HIV, I now convinced myself it was a drug reaction. I felt completely inadequate and impotent. The weight of responsibility settled on my shoulders; I was the doctor who would make decisions in the next 48 hours that would determine whether Papa lived or died. Though I had so many times before made these decisions for someone else with such confidence and clarity, I was too close to be objective and I knew it. This is why doctors don’t treat family members. We got back to the guest house and settled in to wait. There was nothing else to do. Papa had perked up a little, but his skin still looked like it would start peeling off at any moment, and I knew it was simply a matter of time before the pendulum swung back the other way and he started to deteriorate again.

Terah called and said she could change two tickets and that one of our friends in Dallas had an Infectious Disease doctor that he knew who would see Papa as soon as we landed. I gave her a list of the individual medications he had been taking and asked her to call the ID doctor and ask him if we should continue the ARVs. Papa had decided by this time that he didn’t want to go home early. I had other plans. I was walking a fine line, but though his mental state had cleared some, I didn’t feel comfortable leaving decisions such as this one to him at the moment. Thankfully, Mom and I persuaded him that he needed to go, if not for his sake then for ours. Terah had said that she could change Mom’s ticket as well, but Mom wouldn’t leave Cori alone. She told me that I should go with Papa as that was his best chance if anything happened. I’m not sure Mom and I ever really discussed with words the gravity of the situation or what might happen, but it was understood. She knew how serious it was and yet, selflessly, as she has been my whole life, chose to send one daughter to care for her husband, and stay in Africa with the other. I cannot grasp the strength it took to do this.

Our flight left at four in the morning. Everything is harder in Africa, and even more so for those of us who don’t know how to work the system. Everyone in the Harare office was gone. We had no phone numbers to reach them or to call Karanda and talk to Roland or Kiersten. Thankfully the groundskeeper was around and had a phone number for the driver. It was late by the time we called, but we were able to reach him and tell him we needed a ride to the airport in the morning. We were already packed, all we could do was wait. The cards game we had started as a welcome distraction had dwindled, and Papa, experiencing another wave of sickness, had gone to bed. I showered as the electricity had been on long enough for the water to heat up, and stayed up for a while longer waiting on Terah to text back with the doctor’s recommendation on whether Papa should continue the ARVs or not. Mom came in and we all prayed for Papa. Finally, dreading that the next 40 hours would bring, I crawled into Cori’s twin bed with her and tried to sleep.

It was still dark outside only a few hours later when Mom came in to say that Terah had texted and the recommendation was to stop one of the combination pills and keep taking the other. The driver was already there and we loaded our bags. I watched as Papa hugged Cori, and then Mom – each knowing that it might be the last time.

Papa didn’t want to continue any of the ARVs, and I felt the same way to a great extent, but we both knew the dangers of self-treating – of thinking that since I’m a doctor I know better than the expert in this field who is giving me advice. So against our better judgment, I gave Papa another dose as we left the guest house. He got worse after that. By the time we reached the airport he was violently ill again. We settled into our seats on the airplane and I tucked the blanket I carried with me around him as he began to shake with fever. By the time we landed in South Africa, he didn’t argue with me when I insisted he let me get him a wheel chair. I had prepared myself for a battle on this issue, and when none came, it only increased my concern. We found a little cafe with a tiny love seat and settled in for the 12 hour lay over. It was 17 degrees outside the airport and inside, the air conditioner was on. I have no idea what the temperature was, but all the airport staff had their heavy winter coats on inside the airport. I scoured the airport shops until I found a fleece for Papa and a power adapter so I could use the computer in case he passed out or became unresponsive.

Despite my efforts he still shook uncontrollably. By the time I got a thermometer, his temperature was already over 104.5 F. (Papa took it out and refused to let me continue taking it at point.) All I could do was pray. I paced the floor trying to stay warm. I alternated looking up symptoms online and holding Papa’s wrist to count the number of PVC’s/min and the increase in his respiratory rate as his pulmonary edema worsened. By this time he was impressively encephalopathic, his liver was enlarged and tender, and his eyes became jaundiced. - further confirmation that his liver was failing. His skin was still worsening, and now on top of the rash he already had he developed petechiae over his legs - signs that his blood was no longer clotting appropriately. He was still himself at the core. He told me to send all the kids a message that he loved them, told me to find out how Ben’s surgery went. But most of his sentences were disjointed and hardly made sense. He told me he felt like he was dying. I told him I thought he was right. As any physician will tell you, most of the time when patients say they are dying, they are. Somehow they just know. I’m not sure if the 12 hours in the airport watching him deteriorate were worse, or the next 17 on the flight across the atlantic. Papa hadn’t wanted anyone to worry, but by the time we were getting ready to board the plane I was at my breaking point. I knew that letting him see my fear would only worsen his condition, and telling the rest of the family would only mean they would experience the same excruciating misery that I did. Neither would accomplish anything. One thing I did know, I had never felt more helpless, and had never doubted myself as a physician as much as I did at this moment. I had already told people to pray, but I sent one final plea to Chris - to tell him to call Kendall and Amy and Geoff and Candy, and anyone else he knew to be prayer warriors and have them on their knees. As I had when Tyler died, I lost all sense of pride. I couldn't care less if I looked like a raving lunatic. I simply wanted to have no doubt in my mind that I did all I could.

It’s ironic looking back on it... we are always at the mercy of God, but at times like these, it is so undeniably apparent that we are helpless. I knew as we boarded that the coming hours would be the most difficult of my life. As we took our seats, the flight attendant motioned for me to come to the back. She asked what was wrong with Papa, as it was overly apparent at this point that he was not well. I tried to hold back the flood of tears that threatened to burst forth and told her as little as possible. A few moments later I was told that the pilots wanted to speak to me and was taken to the cockpit. I stood there desperate to make them understand that he had to be on this flight. I told them that I was a doctor, and that he was in acute fulminate hepatic failure, and that his only chance for survival if his liver didn’t handle the insult was a transplant in the next few days. He would never get a transplant in South Africa - he had to get to Atlanta. I told him that I was aware that he might die on the flight, but that if he did worsen, his only chance was to be in the States.Finally, I told them that regardless of what happened, even if he died, they were not to turn the plane around. After a little more coaxing, they seemed satisfied with this. They told me they would cut as much time off the trip as they could, and to let them know if I wanted an ambulance waiting at the airport. I returned to my seat and wedged myself in between Papa and the 600 pound man that sat to my right. Armed with my stethescope and a vial of epinepherine I had with me in case of an anaphylactic reaction, I tried to plan out how I could drag Papa the 6 feet to the cabin area so that I would have room to do chest compressions if he coded.

While in Johanesburg, we had decided that even if it was an acute HIV infection, it was too late for the ARV’s to help much. However, with how violently ill he was after taking the medication, and how much he had deteriorated after the morning dose, if it was a drug reaction he probably wouldn’t survive another dose. All we could do was wait. I woke Papa up every thirty minutes as I had since leaving Zimbabwe to drink water. I had reached a new low, checking the magnesium content on the mineral water and calculating how much water he would have to drink to consume the equivalent to a treatment dose for torsades - an arrhythmia that can be caused by the meds.

He finally drifted off to sleep, and I crawled over him and made it to the bathroom just in time to vomit the water I had forced myself to drink. I slumped over on the floor of the tiny stall, not caring how disgusting it was that I was curled up in a fetal position on the floor of an airplane bathroom. I wept. Through my sobs, I told God that I would never understand why he didn’t save Tyler, and that I knew Papa wouldn’t live forever, but Cori was only 14, and she and Ben and Shelley needed him. And selfishly, I begged that if he did die from this... “not on this flight.” I’m not sure how long I stayed there and prayed. When someone finally knocked, I realized that I should go check on Papa. I left the bathroom and saw him still sleeping. I stood, trying to clean my face before returning to my seat when one of the four men standing in the galley started trying to ask if I was sick and offered me Tylox. I refused and he began trying to explain in broken English what Tylox was. Trying to blow him off, I assured him that I was ok and knew what it was, and told him, “I am a doctor.” His face brightened, and he explained that he and his three friends were doctors too, as were 96 other passengers. They were the top physicians from the University Hospital in Monterrey, Mexico. I began to tell them the real reason I was sick and they quickly brought their friend who is one of the top Infectious Disease doctors in Mexico to meet me. They all agreed that it was more likely a drug reaction and that there was nothing else could be done. I asked them, as I had almost every person on the airplane, to pray. They did. And they told me they would watch him while I slept. I squished back into my seat, placed my fingers on Papa’s wrist so I could feel his pulse, and closed my eyes for the first time since leaving Karanda.

It was as if God was laughing at me, asking how I could be so lacking in faith to think that just because we were on an airplane over the middle of the Atlantic ocean, that the situation was beyond His control. When I awoke Papa was standing a few feet away talking to one of the Mexican doctors. I was shocked. He still looked terrible, but the fact that he was able to stand and complete a sentence was a huge improvement. He was still sick enough to be in an ICU by any standards, even without knowing lab values, but his liver had obviously started to metabolize the drug, which meant he would likely continue to improve. His skin was still swollen and purple, but his breathing had slowed and his heart rate was more regular. Though he was not himself by any stretch of the imagination, I knew he would make it to Atlanta. By the time we landed he had improved enough that I felt safe flying to Dallas where doctors would see him immediately. When we met with the doctors, they were amazed. Not only did Papa miraculously recover from the drug reaction in record time, there was not a trace of HIV in his blood work.

The strangest thing is this: when confronted by death itself, my thought was not, “why did we come to Africa?” but, “why didn’t we come more often?” For all the difficulties that a trip to Karanda poses, it exemplifies the very thing that gives life meaning. I never once considered that this event was caused by Africa. In fact, there is a much higher chance that I could die on my way to work tomorrow than from an HIV exposure such as this.

In this season during which we remember Jesus’ birth, I am humbled by the privilege of sharing His love for others by loving the people of Africa. And I am awestruck that in the process, I witnessed a miracle. I witnessed first hand the power of prayer. If you have ever felt as I often have, that your contribution is too small, your prayers too inarticulate, your sacrifice not weighty enough to matter, I hope this story inspires you. Your prayers do not fall on deaf ears, and they are not to a God who is distant and uninvolved. I cannot explain why God doesn’t always answer in the ways we expect. I cannot tell you why God didn't choose to intervene and save Tyler. But I can tell you that our LORD is alive and well, He loves us deeply, and He saved Papa. And in this season, when we remember the “Christmas Miracle,” I want to personally thank you for your prayers and remind you that miracles still happen.

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e I left for Africa in the summer of 1999, that Africa gets in your blood. I had no idea how true that statement was, nor how much it would change my life. Blood is spoken of in scripture in such vivid imagery – it is the symbol of all life. It is through God’s own blood that we are redeemed. Blood transforms. In every way, whether through its destruction or transfusion, it changes everything.
I have spent 5 summers in this enchanted land now. Each time has brought something different, and changed me in new ways. The first time I set foot on African soil I was 17. I remember looking out the window of the airplane as we landed in Harare at sunset and having an overwhelming sense of anticipation and excitement - like this first step could never be taken back or ignored. No matter what pain or pleasure was found in this foreign land, I would never again be the same. In many ways, I lost my innocence that first summer. I saw things I could not have imagined, and became a part of a people who were different than anything I had previously experienced. They were poor on an entirely different level. They had nothing - no running water, no electricity, no coats or shoes. Their clothes were rags that they cared for meticulously. Somehow, despite the dusty land, shirts were always white and clean. But the thing that impressed me the most were their smiles - the stark white teeth against contrastingly ebony skin. I had seen black people in the states, but the Shona dark skin looked different - from years of toil in the sun it became tough and leathery as they worked their land. They ate the same thing for every meal, sadza. The idea of complaining about this was beyond their comprehension. They were simply thankful to have something to fill their stomachs. I was inspired that summer to become a physician, and my life in the states since then has been dedicated to this dream: to one day return with something tangible to give. For, I realized that though they had nothing in the way of material things, the only thing that really mattered in a country so destitute was life.

I returned the next year with Papa and Terah. Elections had just occurred and the political unrest that would define the country in so many ways for the next ten years had begun. As we drove to Karanda through the Zimbabwe bush, we witnessed the squatters in the fields of the white farmers. There were road blocks and stories of beatings, rape and murder. Though I was white, I was never afraid after I got there. My only fear came before I left the States, having no idea what we would find there or if we would return. But going didn’t seem to be optional.

The country had changed in the time I had been gone. Yet still the people smiled. Terah and I spent hours and hours hiking around Karanda. The children laughed and followed us everywhere from a distance, equally enchanted by the strange white girls with long hair, as we were by them. Ultimately, I felt helpless. I had nothing to give. I had no skills or money to impart. The only thing I did have- hope in a better life after the assured death that awaited them I could not convey as I didn’t speak the language. That summer I vowed not to return until I had something to give.

Despite my promise, I returned in the summer of 2004. I had just finished college and been accepted to medical school. Maybe partly I needed to remember why I was making so many sacrifices to become a doctor. But mostly I think I went because I was drawn back to a place I had grown to love, a place that had become a part of my identity. This trip was a turning point in my love affair with Africa. It was then that I truly got to know the people there not as a foreign, captivating people, but as individuals. I came to understand that the reasons they didn’t do things the way I assumed they ought to, was not a lack of understanding, or education but because their world view was different than mine. And I began to develop an appreciation for how they viewed the world.

In December of 2006 my little brother died. I had witnessed death on what I thought was a personal level in Africa. I had no idea what death was, not the evil that it entails, not the desolation it leaves. My world was shattered the day Tyler died. Though I did my best to seek God’s comfort, I found none. I begged God to show me somehow that he still cared. I didn’t want a burning bush or a pillar of smoke in the sky, just some sort of reassurance that everything I had believed my entire life, of His character and love, wasn’t a lie. God was silent. Or maybe in retrospect I was so overwhelmed by pain that I could feel nothing else. At least I could feel. I think in some ways I held on to the pain because it meant I was still alive. As I forced myself to go through the motions of life, I felt like I had died that day in December. That I was only an empty shell of my former self. Even more than I hated the pain that I experienced through Tylers death, I hated the pain that it made apearant in the world to me. When people would learn of Tylers death, they inevitably would have their own story of pain to share. Rather than make me feel beter about Tyler dying, it only made me question more why God didn’t return now. What he was waiting for. Why he didn’t take us home.

I returned to Africa that summer. I’m not sure a lot of thought went into the decision to go, but I had set up a rotation there during medical school and everything kind of fell into place. Maybe partly I went to find out how they had so much joy despite all of the tragedy they experienced. To try to get myself to feel again. To stop feeling sorry for myself and realize how good I had it. When I got there, however, I didn’t find people who told me how much worse they had it, or about all the loved ones they had lost. They simply loved me. Unconditionally. There were no lectures on how God was in control or how we’ll all be together again in heaven. In fact, looking back on it, I don’t think they said much of anything. They listened. They understood. And I knew the reason they smiled was not because of anything in this life, but because of their own awareness of their proximity to the next.

The country was worse this year than any before. Four years of extreme civil unrest was taking it’s toll. The electricity was out more than it was on and petrol was in short supply so we couldn’t run the generators. We did surgery by candlelight with headlamps perched over our surgical hats. One night as we were about to sit down to eat dinner we got a knock on the door saying to come to the pediatric ward. There was a girl who was about 6 years old who had become unresponsive. We rushed down to the hospital as the rest of the people ran to haul the portable generator from the other side of the hospital compound to the ward so that we would have suction during the code. We coded the child for some time, but as the suction hadn’t arrived yet, our intubation attempts were unsuccessful. She never regained a pulse.

This past summer, I found myself drawn once again to this majestic land I have come to love. Timing was not ideal as I had just married six months before and had only a week prior to leaving for Africa finally moved into the same house with him. I had a sick feeling about this trip and to be honest, didn't want to go. Not only was Chris not going with me, but I felt that I was stepping into the front line of a spiritual battlefield. I didn’t know how or in what form Satan would attack, but I felt in my heart that I was walking into darkness. The night before I left I sat in Papa’s truck with my laptop, having wondered around until I found wireless signal to skype Chris. I cried, which isn’t all that unusual for me, and asked him to pray, and ask our friends to pray specifically for God to protect me from this attack. I had no idea how vital these prayers would be to the events in the days to come.

We landed in Harare at night, the sun already below the horizon and the last bits of light quickly fading from the sky. We went straight to the guest house with plans to leave for Karanda early the following morning. I was too excited to sleep. We arrived in the afternoon and went straight to the hospital to help Roland Dr. Stephens in the operating theatre.

Two days into the trip, still trying to recover from jet lag, I left after rounds to help get lunch ready. Papa went back to theatre to help Roland finish the skin graft he was working on. He was late for lunch. When he sat down across from me, I saw the cut on his hand. As he told me he cut himself during the surgery, a wave of nausea swept over me. It was all I could do to sit through the remaining few minutes of lunch. Knowing that he wouldn’t want me to worry everyone else, I tried not to let my fear show. As we walked back to the hospital, despite his reluctance because of their notorious reputation for making one feel sick, I convinced him to take the prophylaxis. By the time we were able find the ARVs - not an easy task at Karanda - every second was crucial. The three-hour window during which the first dose is to be taken was closing. I rushed to the theatre where Papa was working, and gave him his first dose, along with a considerable amount of anti-nausea medication. By dinner Papa was violently ill.

We got called to a STAT section that night. As we delivered the baby, my heart sank as I saw it’s premature size. To my surprise, however, it gasped and let out a strong cry with obviously healthy lungs. At the same time I looked down only to see another sac protruding out of the uterus – a second baby! Both twins were alive and healthy. I’m sure one can imagine my surprise. However, I don’t think it is possible to imagine the mother’s surprise! By the time we were closing Papa was flushed and diaphoretic. He kept closing his eyes, I could tell he was trying to will himself to concentrate and not pass out. He left the OR taking Collin’s keys to the only bathroom at the hospital. I placed the dressing and was rolling out of the theatre when the midwife asked me to check another patient. She had just arrived at the hospital in labor. I had never felt such pronounced caput. As I was finishing my exam she started seizing. When Papa returned to finish orders she was still seizing. We tried to vacuum extract the baby, but where she had been incoherent and uncooperative before the seizure, she was now simply post-ictal. We cut an episiotomy, but still the baby was stuck. It was so wedged in the birth canal that it wasn’t even possible to place foreceps between the pelvic bones and the baby’s head. She started seizing again as we rolled her to the OR. As I stood next to Papa scrubbing, I could hear his labored breathing as he struggled to keep from vomiting yet again. We prepped and cut straight down to the uterus. Purulent, foul smelling fluid came gushing out. We delivered the baby and attempted to resuscitate it, but it was clear that the baby had been dead for quite some time. We later learned that the woman was part of the Apostale cult and her cult leaders forbid them from seeking medical attention. She had been laboring for 3 days before coming to the hospital and was extremely septic by the time she arrived.

Papa was severly orthostatic by the time we finished. He leaned on the counter to keep his balance as successive waves of dizziness passed. The rest of the trip was just as exhausting as this first night. We took care of everything from cervical tears to skull fractures to illeal perferations from Typhoid to the head nurse of the hospital developing organophosphate poisoning. We took call every night – after all, the reason we were there was to give Roland a break. And Roland was so exhausted that even knowing that Papa was sick, he didn’t even object once when we offered to take call. I worried about Papa, but what else could I do? The medicine is supposed to make you sick. He was confused, diaphoretic, weak, orthostatic, and dehydrated. Nausea, vomiting, and severe abdominal pain defined the remainder of the trip. Yet he still pushed himself and worked long hours day and night at the hospital.

We left Karanda, exhausted, but as usual overwhelmed once again by the faith and strength of the people who do this not once a year, but day in and day out. It was Monday morning and we got up early to finish packing before heading to the hospital to help round before leaving. Roland was already busy in Theatre, and though I missed Chris terribly, I still had trouble saying goodbye to Karanda, which in so many indescribable ways had become such an integral part of my life.

We had been on the road about 45 minutes when Papa asked if he was sunburned. I had either been taking pictures of the countryside or shielding my face from the dust blowing in the open windows untill now, but as I looked over at Papa, his face was swollen and a purple shade of red. I lifted his shirt only to find the same thing on his back and chest. It looked like hives that were so severe and raised that they had all coalesced until the hives were unrecognizable as such and simply looked like one large burn. There was nothing I could do. If we turned around, there was hardly anything Karanda could offer other than the precious little supply of IV fluid that it used so sparingly. I tried unsuccessfully to convince Papa to let me drive as he continued to worsen.

After dropping our luggage off at the guest house, we went to the bon marche to eat. I now began to admit to myself what my real fear was – that it wasn’t just the medicine that had made Papa sick – it was acute HIV. It was already noon, and I borrowed a phone to text Chris. I asked him to look up the symptoms of an acute infection and they all fit. I motioned for Mom to come to the bathroom with me… she needed to know how serious I thought this was. I told her that Papa needed to be on the next flight to the States. I could hardly breathe. My chest tightened into the same knot that had become so familiar after Tyler died. I left to find a pharmacy hoping to at least find some zofran to alleviate the vomiting and lessen the dehydration. The first three pharmacies I found were closed since it was a national holiday. I found the only one in the area that was open. It didn’t carry zofran. I asked the man behind the counter if he has a PDA or any drug refrence book. I could only remember the name of one of the combination pills he was taking, and we had left them at the guest house when we unloaded everything. Seeing the desperation in my eyes, and most certainly hearing it in my cracking voice, he walked to his house to bring me his personal copy.

Papa had gone to the van to rest, and the others had gone to the market to buy souvineers. I had already contacted Terah to have her start working on changing our flights. Everyone had gathered early at the van and drove over to find me at pharmacy. Papa and I waited for the man to get back with his book, and he started reading the side effects I had written down – of course, the nausea, vomiting, malaise, and dehydration were expected, but then the list continued – Stevens Johnsons syndrome, rhabdomyolysis, acute liver failure, arrhythmias, heart attacks - all life threatening conditions. I felt the inevetibility of every terrible reaction, and while 20 minutes before sitting at lunch I had convinced myself it was acute HIV, I now convinced myself it was a drug reaction. I felt completely inadequate and impotent. The weight of responsibility settled on my shoulders; I was the doctor who would make decisions in the next 48 hours that would determine whether Papa lived or died. Though I had so many times before made these decisions for someone else with such confidence and clarity, I was too close to be objective and I knew it. This is why doctors don’t treat family members. We got back to the guest house and settled in to wait. There was nothing else to do. Papa had perked up a little, but his skin still looked like it would start peeling off at any moment, and I knew it was simply a matter of time before the pendulum swung back the other way and he started to deteriorate again.

Terah called and said she could change two tickets and that one of our friends in Dallas had an Infectious Disease doctor that he knew who would see Papa as soon as we landed. I gave her a list of the individual medications he had been taking and asked her to call the ID doctor and ask him if we should continue the ARVs. Papa had decided by this time that he didn’t want to go home early. I had other plans. I was walking a fine line, but though his mental state had cleared some, I didn’t feel comfortable leaving decisions such as this one to him at the moment. Thankfully, Mom and I persuaded him that he needed to go, if not for his sake then for ours. Terah had said that she could change Mom’s ticket as well, but Mom wouldn’t leave Cori alone. She told me that I should go with Papa as that was his best chance if anything happened. I’m not sure Mom and I ever really discussed with words the gravity of the situation or what might happen, but it was understood. She knew how serious it was and yet, selflessly, as she has been my whole life, chose to send one daughter to care for her husband, and stay in Africa with the other. I cannot grasp the strength it took to do this.

Our flight left at four in the morning. Everything is harder in Africa, and even more so for those of us who don’t know how to work the system. Everyone in the Harare office was gone. We had no phone numbers to reach them or to call Karanda and talk to Roland or Kiersten. Thankfully the groundskeeper was around and had a phone number for the driver. It was late by the time we called, but we were able to reach him and tell him we needed a ride to the airport in the morning. We were already packed, all we could do was wait. The cards game we had started as a welcome distraction had dwindled, and Papa, experiencing another wave of sickness, had gone to bed. I showered as the electricity had been on long enough for the water to heat up, and stayed up for a while longer waiting on Terah to text back with the doctor’s recommendation on whether Papa should continue the ARVs or not. Mom came in and we all prayed for Papa. Finally, dreading that the next 40 hours would bring, I crawled into Cori’s twin bed with her and tried to sleep.

It was still dark outside only a few hours later when Mom came in to say that Terah had texted and the recommendation was to stop one of the combination pills and keep taking the other. The driver was already there and we loaded our bags. I watched as Papa hugged Cori, and then Mom – each knowing that it might be the last time.

Papa didn’t want to continue any of the ARVs, and I felt the same way to a great extent, but we both knew the dangers of self-treating – of thinking that since I’m a doctor I know better than the expert in this field who is giving me advice. So against our better judgement, I gave Papa another dose as we left the guest house. He got worse after that. By the time we reached the airport he was violently ill again. We settled into our seats on the airplane and I tucked the blanket I carried with me around him as he began to shake with fever. By the time we landed in South Africa, he didn’t argue with me when I insisted he let me get him a wheel chair. I had prepared myself for a battle on this issue, and when none came, it only increased my concern. We found a little cafe with a tiny love seat and settled in for the 12 hour lay over. It was 17 degrees outside the airport and inside, the air conditioner was on. I have no idea what the temperature was, but all the airport staff had their heavy winter coats on inside the airport. I scoured the airport shops until I found a fleece for Papa and a power adapter so I could use the computer in case he passed out or became unresponsive.

Despite my efforts he still shook uncontrollably. By the time I got a thermometer, his temperature was already over 104.5 F. (Papa took it out and refused to let me continue taking it at point.) All I could do was pray. I paced the floor trying to stay warm. I alternated looking up symptoms online and holding Papa’s wrist to count the number of PVC’s/min and the increase in his respiratory rate as his pulmonary edema worsened. By this time he was impressively encephalopathic, his liver was enlarged and tender, and his eyes became jaundiced. - further confirmation that his liver was failing. His skin was still worsening, and now on top of the rash he already had he developed petechiae over his legs - signs that his blood was no longer clotting appropriately. He was still himself at the core. He told me to send all the kids a message that he loved them, told me to find out how Ben’s surgery went. But most of his sentences were disjointed and hardly made sense. He told me he felt like he was dying. I told him I thought he was right. As any physician will tell you, most of the time when patients say they are dying, they are. Somehow they just know. I’m not sure if the 12 hours in the airport watching him deteriorate were worse, or the next 17 on the flight across the atlantic. Papa hadn’t wanted anyone to worry, but by the time we were getting ready to board the plane I was at my breaking point. I knew that letting him see my fear would only worsen his condition, and telling the rest of the family would only mean they would experience the same excrutiating misery that I did. Neither would accomplish anything. One thing I did know, I had never felt more helpless, and had never doubted myself as a physician as much as I did at this moment. I had already told people to pray, but I sent one final plea to Chris - to tell him to call Kendall and Amy and Geoff and Candy, and anyone else he knew to be prayer warriors and have them on their knees. As I had when Tyler died, I lost all sense of pride. I couldn't care less if I looked like a raving lunatic. I simply wanted to have no doubt in my mind that I did all I could.

It’s ironic looking back on it... we are always at the mercy of God, but at times like these, it is so undeniably apparent that we are helpless. I knew as we boarded that the coming hours would be the most difficult of my life. As we took our seats, the flight attendant motioned for me to come to the back. She asked what was wrong with Papa, as it was overly apparent at this point that he was not well. I tried to hold back the flood of tears that threatened to burst forth and told her as little as possible. A few moments later I was told that the pilots wanted to speak to me and was taken to the cockpit. I stood there desperate to make them understand that he had to be on this flight. I told them that I was a doctor, and that he was in acute fulminant hepatic failure, and that his only chance for survival if his liver didn’t handle the insult was a transplant in the next few days. He would never get a transplant in South Africa - he had to get to Atlanta. I told him that I was aware that he might die on the flight, but that if he did worsen, his only chance was to be in the States.Finally, I told them that regardless of what happened, even if he died, they were not to turn the plane around. After a little more coaxing, they seemed satisfied with this. They told me they would cut as much time off the trip as they could, and to let them know if I wanted an ambulance waiting at the airport. I returned to my seat and wedged myself in between Papa and the 600 pound man that sat to my right. Armed with my stethescope and a vial of epinepherine I had with me in case of an anaphylactic reaction, I tried to plan out how I could drag Papa the 6 feet to the cabin area so that I would have room to do chest compressions if he coded.

While in Johanesburg, we had decided that even if it was an acute HIV infection, it was too late for the ARV’s to help much. However, with how violently ill he was after taking the medication, and how much he had deteriorated after the morning dose, if it was a drug reaction he probably wouldn’t survive another dose. All we could do was wait. I woke Papa up every thirty minutes as I had since leaving Zimbabwe to drink water. I had reached a new low, checking the magnesium content on the mineral water and calculating how much water he would have to drink to consume the equivalent to a treatment dose for torsades - an arrhythmia that can be caused by the meds.

He finally drifted off to sleep, and I crawled over him and made it to the bathroom just in time to vomit the water I had forced myself to drink. I slumped over on the floor of the tiny stall, not caring how disgusting it was that I was curled up in a fetal position on the floor of an airplane bathroom. I wept. Through my sobs, I told God that I would never understand why he didn’t save Tyler, and that I knew Papa wouldn’t live forever, but Cori was only 14, and she and Ben and Shelley needed him. And selfishly, I begged that if he did die from this... “not on this flight.” I’m not sure how long I stayed there and prayed. When someone finally knocked, I realized that I should go check on Papa. I left the bathroom and saw him still sleeping. I stood, trying to clean my face before returning to my seat when one of the four men standing in the galley started trying to ask if I was sick and offered me Tylox. I refused and he began trying to explain in broken english what Tylox was. Trying to blow him off, I assured him that I was ok and knew what it was, and told him, “I am a doctor.” His face brightened, and he explained that he and his three friends were doctors too, as were 96 other passengers. They were the top physicians from the University Hospital in Monterrey, Mexico. I began to tell them the real reason I was sick and they quickly brought their friend who is one of the top Infectious Disease doctors in Mexico to meet me. They all agreed that it was more likely a drug reaction and that there was nothing else could be done. I asked them, as I had almost every person on the airplane, to pray. They did. And they told me they would watch him while I slept. I squished back into my seat, placed my fingers on Papa’s wrist so I could feel his pulse, and closed my eyes for the first time since leaving Karanda.

It was as if God was laughing at me, asking how I could be so lacking in faith to think that just because we were on an airplane over the middle of the Atlantic ocean, that the situation was beyond His control. When I awoke Papa was standing a few feet away talking to one of the Mexican doctors. I was shocked. He still looked terrible, but the fact that he was able to stand and complete a sentence was a huge improvement. He was still sick enough to be in an ICU by any standards, even without knowing lab values, but his liver had obviously started to metabolize the drug, which meant he would likely continue to improve. His skin was still swollen and purple, but his breathing had slowed and his heart rate was more regular. Though he was not himself by any stretch of the imagination, I knew he would make it to Atlanta. By the time we landed he had improved enough that I felt safe flying to Dallas where doctors would see him immediately. When we met with the doctors, they were amazed. Not only did Papa miraculously recover from the drug reaction in record time, there was not a trace of HIV in his blood work.

The strangest thing is this: when confronted by death itself, my thought was not, “why did we come to Africa?” but, “why didn’t we come more often?” For all the difficulties that a trip to Karanda poses, it exemplifies the very thing that gives life meaning. I never once considered that this event was caused by Africa. In fact, there is a much higher chance that I could die on my way to work tomorrow than from an HIV exposure such as this.

In this season during which we remember Jesus’ birth, I am humbled by the privilege of sharing His love for others by loving the people of Africa. And I am awestruck that in the process, I witnessed a miracle. I witnessed first hand the power of prayer. If you have ever felt as I often have, that your contribution is too small, your prayers too inarticulate, your sacrifice not weighty enough to matter, I hope this story inspires you. Your prayers do not fall on deaf ears, and they are not to a God who is distant and uninvolved. I cannot explain why God doesn’t always answer in the ways we expect. I cannot tell you why God didn't choose to intervene and save Tyler. But I can tell you that our LORD is alive and well, He loves us deeply, and He saved Papa. And in this season, when we remember the “Christmas Miracle,” I want to personally thank you for your prayers and remind you that miracles still happen.

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