April 14th, 2012

I have been asked by many about the details of why we left Kenya urgently and what exactly happened. I am finally sitting down to write this story, and I have no idea how it is going to come out or how my emotions will be by the end, but here it goes…

We had just had an amazing two days in the Masai Mara, Kenya. We had stayed at an incredible resort called Ngerende Lodge, and as the only guests during their slow season; we were treated remarkably well and given the honeymoon suite to enjoy. About 7 months pregnant with our son, it was a wonderful time of relaxing, dreaming, talking, celebrating Jason's birthday, and experiencing more of the warm Kenyan culture. On the game drives we got to see all kinds of exotic and wild animals, along with the beauty of the land.

Our experience of Kenya’s beauty continued as we travelled through the countryside and tea plantations. I had made reservations at a motel in a small town for a couple of nights as Jason was going to run a marathon the following morning. He had been training for months for this marathon, as it would be his first to complete. Much of his training had been done in Kenya so he was adjusted to the altitude and hilly landscape of many parts of the country. We arrived in town on Friday afternoon and after driving the running route with a taxi driver, we ate dinner and then headed to bed early. Jason was up a couple times in the night, as the food didn’t settle well with him, but by morning he was feeling much better and seemed excited and ready to go.

Saturday morning was absolutely beautiful as the sun rose over the hills of tea plantations and other small farms. We were under the impression that there would be a variety of types of people running this marathon, but when we arrived at the start / finish line, we realized that we were the only foreigners present. In addition, it appeared to be a race of all elite Kenyan runners. For you Americans, you can imagine how extremely intimidating this was. Kudos to all the Kenyan runners out there – you are our inspiration as you win nearly all the races here in the US. Jason took it all in stride though as he went up to several of the runners and joked with them that he was looking for the “short and fat Kenyans” that he could keep up with. They seemed delighted that Jason was taking part in the race and wished him well. We heard later that they were announcing on the radio about their “guest runner” of the day.

When the gun sounded, the pack of runners took off. Despite the temptation to try and keep up, Jason did an awesome job at settling in at his own pace and running the race that he had trained for. The taxi driver from the day before had agreed to stay with me and take me around to various locations on the route to greet Jason and cheer him on. It greatly surprised me when just a few miles in, I started seeing Kenyan runners dropping out. It turns out that unlike the American culture of just running to finish a race, the culture there was much more about winning and being in the top group. Many runners would quit the race if they were out of the money bracket, realized they weren’t going to finish well, or just got tired of running. This became disheartening for Jason and others who were planning to finish, but at a much slower pace than the rest (a majority of the runners who finished were able to complete the marathon within 2.5 hours, Jason had trained at around a 4 hour finish pace). Jason was able to pass several runners, but many of them dropped out by about the halfway point.

One thing that became quickly apparent was that there was no Gatorade or any other type of electrolyte replacement along the route. Although there were several water stations, by the time Jason was about ¾ of the way completed the stations had all either closed or run out of water. Throughout Jason’s training, he would often just drink water during a run, but he would also stop and eat bananas and/or mandazis (a type of pastry) along the way. I tried to get him some bananas for the halfway point, but by the time the taxi driver and I could find them and get them to Jason, he was already around kilometer 32 I think. By this point, he wasn’t able to eat much and only took a couple of bites of a small banana. Within a few more kilometers, there was only Jason and two other runners who were still in the race. The taxi driver, his friend who was riding along, and I would meet them every little while to cheer them on to finish the race and to give them water. With only a few kilometers left, Jason asked if he could have some cold milk at the finish line. I told him I would go find some and meet him there. He looked tired but seemed to be doing well. I encouraged him and the other two men that they were almost there! I went to buy the milk and in hindsight wish I had given it to him right then…

When I arrived at the finish line, I was appalled to realize that they had already taken it down! I quickly found an official and told them there were still three runners out there and that they needed to put the finish line back up for them. While arguing with the official over why my husband and the two Kenyans needed a finish line, I heard someone say, “Jason is already here”. I turned around with extreme disappointment as I realized that I must have missed him finishing while out buying the milk. My disappointment quickly turned to fear as I saw Jason lying on the ground in the medic tent.

I immediately ran over to the medic tent and my fear increased at what I saw. Jason was starring straight ahead with his eyes open but glazed over, he was breathing hard and irregularly, and was paler than I had ever seen him. I started saying his name and trying to get him to look at me, but all he could do was moan and stare. When I realized that he was not conscious, I started looking around for help. Trying to gather what had happened, all anyone knew is that he had “fallen” just a few yards away. When I asked if anyone had IV equipment or oxygen, my only answer was blank stares. I am still unsure if anyone had any sort of medical training that was in that tent, but they all seemed to think that he was just too hot and needed to cool down and would be fine. They kept trying to re-assure me. I knew that things were more serious than that as Jason still could not respond at all, so the tone and volume of my voice quickly picked up and I stated that he needed more help now. I think that everyone thought I was some crazy, pregnant, little white woman who was freaking out because her husband had fallen. I tried to tell them that I am a nurse in the states and that I could start the IV myself if needed but there still didn’t seem to be any equipment available. Someone mentioned that we could take him to the local hospital, to which I agreed while stating strongly that we must hurry. Several men loaded him into an ambulance and helped me in.

As we arrived to the ER of the small district hospital, Jason started having a grand mal seizure. He had never had seizures before in his life, so I now knew that either his electrolytes were too low or he had a stroke or brain injury. I started asking if he had hit his head but no one seemed sure. His already pale color worsened as he started turning shades of blue during the seizure and I quickly asked for an oxygen mask, along with IV equipment. I was handed a nasal cannula (a thin tubing that goes in your nose to give oxygen). When I asked again if there was a mask available, I was redirected by the medical staff to the nasal cannula. Realizing that is all they had, I turned it up as much as I could and prayed for it to be enough to keep Jason’s brain from (further?) injury from lack of oxygen. At the same time I begged again for IV equipment. Someone stepped up and started an IV while Jason began to have his second seizure. When I asked for fluids to be given immediately, a small bottle of normal saline (water and sodium) was started with it slowly dripping into his veins. When a third seizure started within a half an hour of the first, I knew that we were in trouble and that we had to get him more help and fast. I opened the clamp on the IV tubing so that the fluid was running as quickly as possible and asked for another IV to be started and more fluid to be brought. I then picked up Jason’s phone and started calling anyone I could think of that could get us more help. The first several numbers of friends in various parts of Kenya didn’t answer and I started to get frantic. “Lord, please help us” and “Jesus please help him” was all I could pray over and over again. I finally got ahold of a pediatric surgeon’s wife at a mission hospital about 3 hours away. I quickly told her what was going on and she said she would try to get ahold of a doctor for me and would be praying. Just moments later, a missionary doctor from the same hospital called me back. When I told him Jason had just had his third seizure, he asked to speak to the doctor. I didn’t know who the doctor was but when I asked, several people pointed to a young man standing not far from Jason’s hospital bed. At the instruction of the missionary doctor, the nurse gave Jason glucose (sugar) through the IV in his left hand. A minute later, someone checked Jason’s blood sugar in one of the fingers of his left hand. They received a very high blood sugar reading and said they wanted to give him some insulin to bring his sugar level down.

For those of you reading this who are non medical, forgive me if this next part is confusing. I knew from being an ICU nurse that there were several things wrong with this plan. 1. The blood sugar level drawn was inaccurate. They had just given glucose in the same hand so the reading was falsely high. 2. Too low blood sugar can cause seizures, coma, and death. Too high blood sugar for a moment in time probably won’t hurt much of anything anyway 3. Most importantly, Jason’s potassium level was probably already extremely low from running the marathon without electrolyte replacement. Giving insulin lowers your potassium level in the blood. If Jason’s potassium dropped any lower he would most likely go into cardiac arrest from heart arrhythmias.

For all of the above reasons (especially number 3!), I told the nurses and doctor that they could not give Jason any insulin. I tried to explain why. Although most of the medical personnel spoke English, they didn’t seem to understand my reasoning. Their focus was three-fold 1. His body temperature was too high (they gave Tylenol) 2. He might be in pain from the seizures (they wanted to give pain medicine which I denied) 3. They needed to give medicine to stop the seizures.

I talked with the missionary doctor on the phone about the latter option. He told me the main treatment was to get fluids in him to replace his electrolytes – especially sodium. Low sodium can cause seizures and if it gets low enough it causes death. I was running fluids into both of his hands as fast as I could without IV pumps or fluid bags that could be squeezed in. Anyway, since we were treating the assumed underlying cause of the seizures (low sodium = hyponatremia), I decided it was ok to give some medicine to help stop the seizures as well. Since this is what the Kenyan doctor wanted to do after talking with the other doctor, I agreed to them giving him some Valium. What I didn’t know is how much they were giving him, nor did I remember what a normal IV adult dose is, having worked for several years in pediatrics. After they gave the medication, the seizures stopped and Jason seemed to be sleeping peacefully. However, although he had never regained consciousness since I found him in the medic tent, he now would not respond at all or even open his eyes.

A couple of minutes later, the missionary doctor called me back to see how things were going. When I told him they gave Valium he asked how much they had given. When I told him 40mg, his voice sounded almost panicked “Meridith, that is way to much!” he said. (I now know that a normal dose is 5-10mg max). “I’m sorry!” I immediately responded “I didn’t know”. I began to feel panicked as I quickly realized the possible repercussions of this. “What am I going to do if he stops breathing?!” I asked the doctor over the phone. “ I don’t have any equipment to support his airway”. All I had was a nasal cannula and an old dusty ambu bag that someone found with the wrong size mask and no ability to hook up to oxygen. That high of a dose of Valium should have taken away Jason’s ability to keep breathing and support his airway. “Here is what we are going to do” the voice on the other end of the phone now sounded calm and reassuring to me. “We are going to pray. I have an ambulance on the way from another mission hospital. It will take about 45 minutes for them to get there. They will have equipment and more people who can help. We will all just pray that he keeps breathing until then.” “Ok” I stated weakly. As I hung up the phone I felt myself having another strong contraction and the baby inside me started moving around. The contractions had been coming fairly frequently for the past hour or so. The wonderful taxi driver and his friend had stayed with me through this whole ordeal. I guess they could tell by the look on my face that I needed to sit down and drink some water. They offered me a seat by Jason’s bedside and brought me a bottle of cold water. I drank it down and thanked them. They continued to stay with me as I prayed over my amazing husband aloud, stroking his forehead, and holding his hand. I begged God to keep him breathing, for him to wake up and be ok, for him to be able to meet his baby in a couple months. I prayed briefly that I wouldn’t go into labor, that this baby would stay safe as well. I don’t know if these men were Christians, but they prayed with me. And somehow, in the midst of all of this, I had peace.

The strange part was that it wasn’t a peace that everything was going to turn out well. I didn’t feel like God answered “yes” to my prayer and promised to save Jason and keep our baby healthy. It was instead a strong realization that God was there. We weren’t alone. In the end, no matter what happened, God would continue to be there and all would be ok.

For the next 45 minutes, I continued to pray as I ran IV fluids, and began writing down Jason’s vital signs (blood pressure, heart rate, etc) and what time different things had happened. I knew I would never remember these details later, and the nurse in me knew that other doctors would want to know them. Going into “nurse mode” helped keep me calm and sane at this time (and throughout the following couple of weeks to come).

When the ambulance arrived from the nearby mission hospital, Jason finally began to wake up. It had been about 3.5 hours since I had found him unconscious and I had managed to get about 3 liters of fluid in him over that time. The first thing he said when he woke up in route is “What happened?” I was so relieved for his eyes to look at me and to hear his voice! I briefly re-counted the story. He asked me again a moment later what had happened. I told him again, not too worried at first about his memory due to all he had just been through. He immediately wanted to know if he had finished the marathon, to which I replied “I really don’t know” (and internally added “I really don’t care” :) ). His next question gripped my heart again with fear however. As I finished updating the missionary doctor over the phone and hung up, Jason asked me “Was that my wife on the phone?” My heart beating hard, I leaned over him and quietly said “Jason, who am I?” He looked at me as if sorry that he didn’t know the answer. For some reason my next response was “I am carrying your baby!” to which he quickly said “Oh, you’re my wife!” :) When he also didn’t know my name, I tried to reassure him and myself that this was probably all temporary memory loss. When I told him again about the seizures and the large dose of valium, he said “I do feel very post-ictal right now” (the medical term for after a seizure), along with “40mg!?!”. Both comments re-assured me that he definitely had parts of his memory intact.

Since this long story could become much longer, I will try to summarize the rest. By the time we arrived at the mission hospital, Jason’s electrolytes were normal when drawn. His memory quickly returned as his body re-stabilized. He stayed in the hospital overnight, got a CT scan to make sure nothing else was wrong, and by the next morning they discharged us. We decided to stay at the guesthouse for a day or two to re-coup before heading back “home” to our apartment in Nairobi. I had contacted our families in the States the night before and was updating them as able. We assumed that all would now be well, but the following day Jason became unable to eat or drink due to severe nausea and heartburn. When we went back to the hospital for tests, some of his blood work revealed that his kidney function was not doing well. He ended up going into renal failure.

For medical people: His creatinine was around 2.4 and eventually peaked at 5.7 by the time we were back in the States. While oliguric, he never became anuric. The assumed diagnosis is hyponatremia --> seizures --> marathon + seizures --> rhabdomyolisis --> acute renal failure.

For non-medical people: The sodium level in his blood dropped too low during the marathon because of only drinking water --> this caused the seizures --> both the marathon and seizures caused muscle and protein breakdown --> all of the breakdown of muscle and protein in his blood clogged up kidneys --> this caused him to go into kidney failure.

Another awesome part of this story though is that while almost all of the missionary doctors at this hospital were at a conference on the coast, there was a visiting Nephrologist (Kidney specialist) from the States. There is almost never a nephrologist at this hospital. What a blessing he was to us! He spoke over the phone with a Nephrologist from Vanderbilt and after a day of me giving Jason IV fluids in the guesthouse, without any improvement with his kidneys, they decided it was best for us to come back to the States. There was a decent chance that Jason could temporarily need dialysis within the next couple of days so we had about a two day window to fly commercially back to the States. We arrived back in Nairobi by taxi and the small group from our church there met us at our apartment to help us pack. We packed up the entire apartment in 3 hours, with this amazing group of Kenyans helping us sort and carry everything down the 6 floors of stairs and make it to the airport in time to catch our flight (the arrangement of all this is a whole other story…).

After a few long and uncomfortable flights (especially for Jason who was having back pain around his kidneys) we arrived in Nashville and were directly admitted to Vanderbilt. We stayed there for a couple days and were then discharged to wait for Jason’s kidneys to start functioning again. He never did need dialysis.

It took about a week and a half for anything that had happened to really hit me. When it did, I spent about 45 minutes sobbing in Jason’s arms one night. Through it all though, the Lord’s presence continued to be close and strong. He had performed so many miracles along the way to preserve Jason’s life and to give us all help and strength along the way. His grace and mercy leaves me continually overwhelmed and amazed.

Jason’s kidney function was back to normal within a month of returning to the States. By this time, our son was about to be born and it was almost time for Jason to re-start residency. We were forced to wrap up our part in the research we had been doing there through email and phone calls and then pass it on to other hands. We are looking forward to returning to Kenya in April for Jason to do a month of surgery training in one of the mission hospitals through a residency rotation they have developed with Vanderbilt. We are hoping to see many of the people we became friends with over our almost 6 months there last year. We can hardly wait to introduce our precious son to those friends and tell them about all God has done.

Many people have asked us if we want to return, and if we still plan to do long-term medical missions work, after all that happened. While there are many days that fear tries to take hold, this experience has actually re-enforced our hearts’ desire to teach and train medical professionals while offering teaching and mentoring from the Bible as well. There is an overwhelming need for medical and surgical education throughout the developing world. We want to help meet this need, while sharing Christ and His love and hope with anyone we can. This is why Christ came and this is why we are here. He wants us to know Him. Our hearts’ cry is to know Him more. Anything that draws us closer to God, and that He is able to use for His purposes and glory, is well worth it.

Thank you so much to everyone who prayed for us and helped us through all of this! God answers prayers. He uses His people to accomplish His purposes all along the way. This Thanksgiving week and always, we are so grateful for His hand, provision, and grace in our lives. Thank you Jesus!!