Albertine

A heart too hardened...?

With the local satellite down since last Thursday I've been without internet for almost a week!

As written last Friday:

Dear friend,

Another Friday has come and gone for what has been quite an eventful week. Monday was the worst day of my time so far in regards to the work. With the consultant, Dr J, back on the wards we did a full round of all the inpatients under my care (i.e. women’s ward). We went through each of our patients with a fine-tooth comb, especially a few tricky medical patients we have had for a while, which was satisfying but made for a very long morning.

Having heard that Dr J was back from South Africa after three weeks away there were a hoard of patients milling around outside the ward office hoping to get a chance to see him and get his review – a few previously arrange, but mostly “self-referrals.” As Dr J is still recovering from his illness he is trying to limit himself to half-days, so this flood of unexpected, unplanned, unfiltered patients was frustrating to say the least.

I don’t know how he does it, really. The day turned out to be so chaotic. Patients (literally) pushing their way to you, giving you no space, with a complete lack of a system or any kind of order. And it wasn’t even me specifically that they were clamoring for. 

The work here is never-ending, the resources scare and prevention nonexistent.

As I was walking home at the end of the day I was so frustrated. That frustration combined with exhaustion led to anger… and anger to blame. “Why can’t you just sort yourselves out?!” I thought in silence. Immediately I felt horrible and ashamed. When did my heart become so hardened? After one bad day I had lost sight of why I was here. Who am I to point fingers? Who am I to boast in my own situation? Can I take any credit for the fact that I was born into a land of the plentiful while the people here were not? No. I cannot boast in anything but Christ.

Since then I’ve been considering whether my heart has become too hardened. Have I lost empathy? Compassion? Are empathy and compassion feelings and emotions? Are they thoughts? Are they actions stemming from all of the above? Or all of the above?!

I’m a bit dumbfounded because daily I have seen all kinds of poverty yet I haven’t felt… sad. At all. I have thought to myself, “This is sad,” but I haven’t felt anything. I am working hard with what I have and to the best of my abilities; I have come here to contribute, recognizing the injustice of it all. Yet I don’t feel outrage about the injustice.

It is a quiet act, changing the world -- one rectal exam at a time.

Yet through it all I continue to feel very little, if anything at all. Maybe it’s because I have yet to make a connection with any of the patients or staff. Back home I thrive off of building rapport and relationships with patients and colleagues, but here not only are the people a bit stand off-ish, but there is the huge barrier in communication (building rapport via an interpreter is near impossible).

Love is an action, embodied by sacrifice, so I’m here, but has my heart become hardened beyond the point of what is normal for this job?

Day 12, Case 4

(A glimmer of hope for my potentially hardened heart)

We currently have a woman in her early thirties who was admitted with a couple months history of worsening upper back pain. A pleasant woman with a sweet smile, she had no other warning signs or symptoms. X-rays has since shown a dangerous collapse of T4 and T5 vertebrae (= two back bones relatively high up in the spine), most likely due to untreated tuberculosis. Now on bed rest she has been started on TB treatment and we are waiting for a specialist consult on her X-rays from an orthopaedic surgeon overseas. The bottom line is, however, there is virtually no chance she will be able to get that kind of surgery here.

Constantly at her side is her baby daughter, Albertine. She is about a year and half old and quiet easily the most adorable baby I have ever seen. Very aware of the (very important) life lesson of “stranger danger,” it has taken these past two weeks for her to warm up to me. Then on Wednesday for the first time ever she locked eyes with me then slowly began to grin. As I excitedly waved back, her smile exploded and she laughed. My heart melted in an instant and I fell in love.

Today on my ward round the mum complained of numbness of her legs. On examination she has lost normal sensation all the way down from her mid-trunk – a very bad sign. With Albertine staring up at me with her big brown eyes all I could think as I was examining her mum was, “Beautiful girl, please don’t become an orphan.”

I am daily astounded with how sick people are here. In ways you just don’t see back home. I am astounded by how physically small the people are here – women older than me who look like they belong in the children’s ward. Reading the scale, when you see “60” it is not 60 kgs but pounds. Skeletal eighteen year olds with severe HIV who must have acquired the infection in their early teens. Placing your stethoscope on the chest of a patient who is so malnourished -- ribs so prominent -- that drum of your stethoscope is unable to lie flat as it should...

This afternoon I scrubbed up to assist Dr J with a hand amputation of a patient whose right hand has slowly rotted away after severe burns earlier this year to the point that it was now mummified. (I’ll refrained from posting pictures as it is actually quite frightening, but I have some if you’d like to see.) As we were starting the procedure, I said to Dr J, “It’s so tragic,” to which he simply replied, “Here, tragedy is life.”

Here, tragedy is life.

Photos from the Big 2-5!

As promised, a quick photo chronicle of my birthday Tuesday:

Awake at 0640hrs for my morning run…

The view from the usual route from my run, along the road leading out of the mission compound (just before sunrise).

A full day in theatre! With John Paul, the super experienced scrub nurse – he has the hands-on skills of a surgical registrar.

Hayley making delicious pizza for my birthday dinner…

The cake Hayley made for me, which we took to share at the weekly Tuesday prayer meeting.

Nothing spectacular but a good day from start to finish!

Heat + creamy cheesy discharge = not good

Dear friend,

Today marks the end of my first full work week here at Kalene. It’s hard to believe I have only been here a week, as the memories of home already feel far and foreign while my life here feels like the norm.

Physically it has been taking its toll on me. Don’t worry, I’m not sick, it’s just that I have found it harder than expected, adjusting to full-time work in this heat! Even on days when I may not work as many hours compared to back home, I feel absolutely shattered here.

All of which culminated in my near fainting episode in surgery on Thursday. I have never fainted in my life but twice I have come very close, both times as a medical student when I scrubbed up for surgeries after skipping a meal. Since then I make it a point to have a decent breakfast on days when I know I will be in theatre…

Day 5, Case 3

On Thursday, knowing it was our theatre day, I had a good breakfast before heading to the hospital. We had two relatively straightforward cases listed, one of which was an excision of what we thought was a lipoma (=small fatty mass) in a young, otherwise well woman. The mass was quite large, at least 15cm wide, at the bottom of the neck on the left hand side. The history given was that the patient had had a similar mass as a child, which someone back in the Congo had excised but that over her adult lifetime it had slowly recurred.

On feeling the mass it felt like a typical lipoma albeit ever so slightly more fluid-like than fat. Having limited imaging available the decision was made to proceed to surgery for excision. 


Unbeknownst to me the air conditioning had not been turned on in theatre that morning. (You can see where this is heading.)

Initially only Dr M and I were scrubbed. Our every experienced scrub nurse, JP, remained unscrubbed and manned the anaesthetic side of things (which these nurses also do…?). Most surgical procedures here are done under ketamine.

Slowly dissecting around the mass there was quite a lot of bleeding, unusual for lipomas, and it had grown into the tissues around it, again unusual for lipomas. With these unexpected difficulties JP decided to scrub in to lend an extra pair of hands.

At this point we would have been about forty minutes into the procedure and it was at around this time that the patient started to groan and move and struggle while being under ketamine. Of course she was given some more, etc, but I am told that generally this is not too uncommon (for all the procedures they do under ketamine here) and that the patients don’t remember any of it once the anaesthetic has worn off.

Yet being a newbie I found it seriously unnerving.

Then, all of a sudden, Dr M let out a frustrated moan as he inadvertently nicked the mass and out of nowhere this creamy cheese-y fluid began to gush out. It was obvious this was not a simple fat mass -- it gushed and it gushed and it gushed.

With the surgical drapes usually not being taped down onto the skin here, the creamy fluid managed to gush down the patient’s neck. This combined with the patient’s intermittent groaning and moving under the ketamine meant some of it was getting on her face and mouth.

It looked like vomitus.

I don’t get queasy easily but this was not a pleasant sight.

In the next few minutes I started to feel increasingly hot and… not right. Hoping to “fight” it off I tried ignoring it, shifting my weight, changing position as much as I could whilst assisting, etc, etc. And then that inevitable point came at which I knew I would faint if I didn’t do something soon. I felt a deluge of cold sweats, nausea, and weakness so I set down my instruments, moved away from the operating table and took a seat across the room.

It’s always hard when this happens as it feels like a failing. Especially as a female doctor pursuing a surgical career it’s hard not to take it personally and to admit, to accept, that this has happened. Much like the Swiss cheese model of multiple circumstances lining up just right to result in an error, all the events of the day lined up to get me to that point – sitting on the ground, gloves off but scrubs still on, feeling horrid.

The other theatre assistant brought a fan over to where I was sitting on the ground; Dr M and JP asked if I were okay, but they remained focused on the operation (as they should). Luckily I had some food in my bag next to me, which I started to munch on slowly. When I was feeling a bit better about five minutes later I headed home. Hayley immediately knew something was wrong when she saw me – apparently all colour had left my face. After a good lunch I went back to the hospital for another hour to tie up some loose ends on the wards, then came straight back and took a nap (which I never do normally!) and that night I went to bed before nine, for ten hours straight.

The heat with the work has needed some adjustment. I’m getting there slowly, I think. The most important thing is to cut myself some slack while I adjust. 

On the plus side, I am definitely getting more confident with the medical side of things and by the end of the week Dr M and I seemed to have found our groove. I even had my first full day of Outpatients Clinic (=primary care/Accidents & Emergencies) yesterday, seeing patients for myself with the help of an interpreter.

The kiwi surgeon, Dr J, (de factor clinical head of the hospital) returned yesterday from South Africa and is on the mend. Still recovering from his illness he will most likely leave the day-to-day running of the wards to Dr M and I, reserving his time for surgical opinions and theatre days.

We had our first proper team ward round this morning, reviewing all the patients who have been awaiting Dr J’s surgical opinion. It was clear everyone was very happy to have him back.

With a Saturday Clinic after the ward round I didn’t get home until 2pm, so a full day off tomorrow will be most welcomed.

‘Till next time,

-A

Medical P.S. For the medics, that mass we excised was most likely a lymphangioma (aka: cystic hygroma) and that creamy cheesy fluid lymphatic fluid! Take a few minutes to read about it on Medscape, it’s quite interesting.

The Big 2-5

Tuesday 10 July 2012
2210hrs local time

Dear friend,

Two days into the week and I am officially fully immersed in the clinical work here. There is now just myself and the other (new) Zambian doctor, Dr M, covering the hospital with the help of our lovely medical student (also my flatmate) and the nursing staff. We have decided to split up the hospital so that I oversee the ~40bed women’s ward, while Dr M covers mens and chlidrens. Mondays, Wednesdays and Fridays are ward round mornings, followed by Clinic in the afternoons (primary care), while Tuesdays and Thursdays are set aside for operating.

Not knowing any of the patients, it took me four and a half hours to do a ward round yesterday. For those of you who have journeyed with me through medical school, you would know I am not a “medical” person. My buzz is from getting things done – hands on – so a four-hour ward round is generally something to be avoided as much as possible. Yet when you are the lead clinician, doing the examinations, making the decisions, time seems to go by remarkably quick!

Tuberculosis, HIV, malaria, syphyllis, malnutrition – the Big Five and all their sequelae. I felt so out of my depth on the ward round. The last time I gave any thought to HIV was in a lecture theatre back in third year of medical school. Sexual health education is almost nonexistent here and it is so sad to see such rampant pathology from diseases that are otherwise preventable with sound knowledge and safe behavior. There are also the cultural issues: women unempowered, the fears of stigmatization and male polygamy still in existence in certain tribal communities. 

Day 2, Case 2

A women in her twenties was admitted with abdominal pain and maybe some discharge. A bit vague in history she came forward for a PV exam. On examination there seemed to be hard, matted stuff all around the cervix, green and brown in colour, with no discharge or bleeding. Closer examination of this material revealed grass and sticks and dirt… most likely a trial (?self, ?witch doctor, ?other) remedy which was now causing her harm.

Which brings it all back to education. Empowerment through knowledge, knowledge through education. It never fails to astound me, how much of health has so little to do with medicine!

On another note I turned the big 2-5 today. Yup, I am celebrating this -- what on paper seems like a momentous -- milestone in Mama Afrika and it has been a great day! It was my first full day in theatre with a mix of arranged acute and elective surgeries. With just myself, Dr M and a very experienced theatre nurse present, it is a completely safe learning environment where I don’t have to be anxious about being drilled or looking stupid and where I can ask all the “silly” questions I dare not ask back home! They were all Obstetrics & Gynaecology cases, but I didn’t mind because regardless of the procedure itself, it is always a feast of suturing practice. Plus, I love being in theatre. The world around you dissolves away, leaving just the task in front of you.

I won’t go on about it anymore except to say, I am looking forward to all the Tuesdays and Thursdays ahead.

I don’t even mind the ward rounds on the other days of the week.

Thanks for your birthday well wishes and thoughts, warmly received from the remote bushes of Zambia. I was going to finish with a photo chronicle to mark the day but, alas, the internt connection just doesn't seem good enough. Next time. :)

Fifty-six to go

Saturday 7 July 2012

Location: Kalene Hill, Northwestern Province, Zambia

1315hrs local time

Dear friend,

It’s been two days since my arrival into Kalene -- and what a full-on two days it’s been! I’ve been having real issues accessing the wireless internet on my Mac so have had to lump quite a lot of excitement into one entry and use my flatmate's laptop to upload. Cup of tea in hand advised (i.e. very long entry ahead!).

I spent my second day in Lusaka visiting Immigration and spending 1.6million kwacha (=local currency) at the grocery store, buying enough to last the entirety of my two months at Kalene. Lusaka is surprisingly developed. They have shopping centres and strip malls reminiscent of home, with even a Subways, KFC and a café with a pretty decent Hazelnut Latte.

The next day (Thursday) I met up with a few missionaries returning to Kalene after a furlough home to Canada. The group of us headed out to the airport together to meet up with the missionary pilot. It’s an incredible work they do here, having developed a small independent flight service in the early 90s for transporting staff, supplies, visitors to the relatively inaccessible rural missionary sites. It would otherwise have been a two to three day journey by (undeveloped) road! We embarked on the three-hour flight in our tiny five-seater plane. Before we took off the pilot asked if I was prone to motion sickness – which I wasn’t – but told me there were sickness bags next to my seat, “just in case.” And boy, did I get close to needing it!

Looking over the landscape I realized I had never been completely landlocked before. Growing up in New Zealand, Korea, Seattle, there has always been a body of water if not in direct view then just a drive away. With that, being here kind of feels… suffocating, like geographical claustrophobia. Maybe this is why I don’t like the idea of being on a cruise with nothing but endless ocean in view.

Dry, red-brown earth dominates the landscape here and the horizon is dusted with a haze of dirt – stark contrast to the deep blues and greens of home. Taking in the view as we made our ascent I couldn’t help but wonder, is it possible to have beauty in barrenness? … yes.

Upon landing at the dirt airstrip at Kalene Hill I was greeted by some of the missionaries, as well as two UK medical students I would be living with. The mission compound is made up of the hospital, a nursing school and various small houses/flats for staff and visitors. The small two-bedroom flat we are in is exactly what one might expect in rural Africa – concrete slab floors, small screened windows, a bathroom and kitchen that has just survived the test of time, and furnishings you might see in a museum about life in the early 1900s. But it has everything one might need, even a breadmaker (the only way of being able to have bread out here in the whops).

The hospital is currently at a transition period with one long-term doctor (kiwi surgeon) currently sick in South Africa, leaving the other senior (Zambian) doctor managing the hospital on his own. Yesterday (Friday) saw the arrival of not just myself but also a new Zambian medical doctor who is here for at least one year. No one was quite sure who would be there that day, if they would even have one doctor, and at the end there were three!

There is no need to go on about the amount of disease and pathology I have already seen in just a day and a half, because that is (sadly) what you’d expect. Having made my peace last time around with the complexity of the issues regarding access and quality of healthcare in Africa, I came out this time to do what I can, when I can, acknowledging that so much of “it” is beyond my control.

But it still breaks your heart.

Day 1, Case 1

A small boy (?age, maybe two) was brought to hospital last week with vomiting and bloody diarrhea. The impression at that stage was dysentery so supportive management was started. A few days later his abdomen started to distend and rather than diarrhea he developed constipation. On the morning of my first day at work he was clinically obstructed, his abdomen so distended it looked like it was just about to burst open and having passed no bowel motions or flatus for days. He was sick. 

Most Zambian doctors have some basic surgical knowledge and experience, including Caesareans, hernia repairs, simple grafts, appendectomies and laparotomies.  With the kiwi surgeon for the hospital out of action, the operating doctor was the senior Zambian doctor covering the hospital. There is currently no specialist anaesthetist, only a local whom the hospital has trained in-house to do some basic procedures.

It is in this context this very sick little boy went for a major paediatric operation. As soon as the incision was made and the abdominal cavity opened, loops of small bowel filled with gas tumbled out under the pressure of the obstruction. It didn’t turn out to be worms, but rather, the results of typhoid – something I have been vaccinated against without a second’s thought. 

 

The little boy was under for more than three hours and likely had a few apneic episodes while they were trying to intubate as well as during the surgery itself.

One hour post-op he spiked a fever to 40degrees Celcius. Everyone watched, metaphorically holding our breath, and waited.

My flatmate, the medical student, takes shifts as being the senior nurse on-call (there is a senior nurse on-call and a doctor on-call after hours). At ten that evening she was called to certify the little boy. As she had never walked over to the hospital in the dark alone we decided to go together; as she had never certified a dead body before (senior nurses can do this in Zambia), we decided I would this time around.

I’ve written about this before, on my FirstYear blog about intern year, but the part about certification that really gets to me, the part that is so unsettling, is staring into their huge, dilated pupils that seem to have a streaky haze of white, like you’re staring out at the universe that just goes on… and on.

Back home after a death in hospital one must examine the events leading up to it, to try to figure out why it occurred and whether or not it could have been prevented.

Simply said, this death would not have occurred had this precious little boy had been born in many other parts of the world. Is there someone or something to blame? It would be misguided and ignorant to think it’s that simple. Was it the surgery? The post-op care? Could this have been picked up earlier, before the boy became so acutely unwell and there was no other option but to operate? Could the typhoid have been prevented? Why wasn’t he, and all those other children, vaccinated? Something so accessible to those in other parts of the world.

There are no simple answers…

So that was my first day of work. My flatmate was again called around midnight. As she is a very sound sleeper, I ended up answering the phone in our flat. 

“I am calling from Mens’ Ward. Is this nurse on-call?”

“No, but I am a doctor and I live with her. What’s the problem?”

“There is a man here who has amputated middle finger. Human. Human bite.”

[Pause]

“Okay, we’re on our way.”

All that, in one day. Fifty-six to go.

23degrees! Not that I'm rubbing it in or anything...

Location: Lusaka, Zambia

2100hrs local time 

Dear friend, 

Greetings from Lusaka, the capital of Zambia, where it is a balmy 23degrees... without humidity. Talk about perfect weather, a welcomed escape from the particularly cold Auckland winter. 

The last leg of my trip was again uneventful, though I started to really struggle to keep my head upright, bobbing up and down for the duration of the two hour flight. Coincidentally there were two groups of Korean tourists on the flight which always provides good entertainment. One of the women randomly came up to me, asked me if I was Korean, and then very kindly offered me a special bandage for the bleeding blister on the back of my ankle (the inevitable result of breaking into new hiking sandals!).

After an incredibly long wait in Immigration (hello again, African time!) I was finally cleared, and despite being one of the last people through the taxi driver who was arranged to pick me up was thankfully still waiting for me.

Stepping out of the airport was... bliss. The temperature, the lack of humidity, the warmth, the magnificent and commanding sun, the clear blue sky... just perfect. And, for the first time in my thirty two hour journey, I couldn't help but smile.

The driver brought me to my arranged accommodation, a guest house used by various missionaries going through Lusaka. I had a quick chat with a lovely couple who live here long term and provide logistical and transport support to the peripheral rural sites around the country. Midnight in New Zealand, I crashed into bed soon thereafter, completely out of action for the rest of the afternoon. This evening they kindly invited me out to dinner with them and another visiting Anaesthetist from Ireland, the latter of whom is heading home after a two-week stint.

Now it's early evening local time and I am wide awake. I keep trying to not think about the time in New Zealand where it is seven in the morning -- a futile attempt at forcing my body into ignorance. Sadly it doesn't seem to be working...

A quick South African hello!

Location: Johannesburg, South Africa

0830hrs local time

Wandering around Johannesburg airport I am taken aback by the stark contrast of this trip compared to my trip two years ago.

Two years ago I spent a fortnight holidaying around the US before flying from Washington DC to Dakar, Senegal. One of only ten people who stepped off a South African Airlines flight continuing on to Johannesburg, I walked into French-speaking Dakar at five in the morning alone. Little did I know the day that was to follow would turn out to be one of the toughest experiences of my life, psychologically, physically, and emotionally. The airport, I had been warned by my travel agent back home, was one of the most run down despite being the major port of call for West Africa. That combined with the plethora of machine-gun welding French-speaking Senegalese soldiers and the hords of grown men waiting to "help you" with anything and everything (for a price, of course) made the visual something straight out of the movies. Over the next ten hours I sat on a hard metal bench unable to close my eyes or rest my head, rationing the two snack bars my friend in Boston had insisted I take, unsure of whether my flight would ever board.

Johannesburg couldn’t be more different. Designer clothing, restaurants, tourist shops -- it could be any major airport in any Western city. The only things giving it away are the wealthy African businessmen speeding past and, the diamonds! Wow, what a place to find a ring if ever you felt so inclined. (Good thing I’m not much of a jewelry person or this would be a very "dangerous" port of call.)

The aim of my trip back then was just to survive. Having never been much of an outdoorsy person, no one -- myself included -- was sure I could make it. I held no grandiose fantasies of delivering babies or running my own clinics as a final year medical student. The name of that game was to come home in one piece. Anything more than that would be a bonus.

My time in The Gambia was… incredible. For those who followed my blog while I was over there you would have some sense of the impact it had on me personally. It was a different adventure than the one I had been expecting. An urban setting permeating with Muslim culture, I spend more time with young British ex-pats on the beach and watching football than doing anything remotely doctor-y. Yet above all else it made me fall in love with Mama Afrika and I left knowing I would be back again soon.

This time I am heading to East Africa Southern Africa, to a missionary hospital in rural Zambia, to do as much doctor-ing as I can fit into eight weeks. More specifically, my hope for this trip is to get as much surgical experience as possible as I work alongside some New Zealand trained general surgeons.

In saying that I learnt last time that as a visitor it is not my place to force any sort of agenda. I have to take things as they come (sometimes unbearably slowly) and make the most of what I can, when I can. Respect must be given to the rhythm and beat of the culture here -- a respect that leads to adaptation, and adaptation to growth.

So far so good – only one more flight to go until I touchdown in Lusaka, the capital of Zambia. Having been trapped inside Johannesburg airport waiting in transit, I have been limited to admiring the vast clear blue sky through the windows. It's official, I'm excited now. Yay!

‘Till next time,

Always,

-A

Blog resurrected...!

Location: Perth, Australia

2030hrs local time

Dear friend, 

Eight years ago I went on my first overseas adventure, aged sixteen. With nothing to lose and without any idea of what to expect I left New Zealand for two months in Boston, a pivotal experience that culminated in my making the decision to become a doctor. 

Two years ago I went on my first adventure to Africa, aged 22. With nothing to lose and without any idea of what to expect I left New Zealand for three months in The Gambia, a surreal adventure that helped me overcome my fear of insects, dirt and heat, but more significantly, grew me into the woman I am today.

Today I find myself heading back to the warm embrace of Mama Afrika, aged 24. This time however I leave with a sense of having too much to lose. For the first time in my life I feel scared of losing what I am leaving behind. Is it a sign that I've lost my sense of adventure? Is it a symptom of aging, of becoming an adult, with ties and roots and a home and someone I love? Or, as I fear most, is it the result of being so far from God for so long?

I've really struggled in my walk with Christ since moving to Auckland a year and a half ago. The experience of transitioning into doctor-hood was hard for me, my "natural" reserve of discipline just enough to see me through work and little else. Yet even with first year of work behind me and life being pretty wonderful this second year out, I have struggled to reconnect with God. I know my heart has walked further and further away, excuse after excuse, into a real spiritual desert. And I have struggled to find my way back.

In spite of all that, beyond understanding, God has continued to bless me abundantly. I have seen success in my job, things continue to fall into place for my eventual application for the Plastic Surgery training program (=Residency) and, most significantly, I have met an incredible guy who is just right for me, a literal answer to prayer. 

Every good story starts with setting the scene, and this is where I find myself as I leave for two months in Zambia -- a deep-seated feeling of being lost, while life around me continues to steam full-power ahead. 

For the first time in my life I do not underestimate the dangers fraught in volunteering overseas and, for the first time in my life, I think I am scared. This weekend however was a reminder of the many incredible, loving, strong Christ-followers and co-journeyers I have been blessed with in this life. It got me thinking of St Augustine's Confessions, in which he acknowledged that if it hadn't been for the prayers and the Faith of his grandmother and mother during his (wayward) young adulthood, he would not be where he was. 

I have no idea what God has in store for me these next two months, but please keep me in your thoughts and prayers -- for me to have a peace in God's beautiful promise made in Jeremiah, "For I know the plans I have for you, plans to give you hope and a future."

'Till next time,

Always,

-A