Six Week Follow-up

Tomorrow marks 7 weeks since my stroke! In some senses, the time has flown by, but when I think about my life pre-stoke, it feels like a long time ago.

Since my last update, I have been continuing to do really well. I did get approved to drive right before Thanksgiving! That has obviously been a huge blessing. My right hand is basically 99%. Most of the time I can't tell that anything ever happened. I continue to go to physical therapy for my equilibrium, but that has improved so much, that I'm assuming that she will graduate me soon. Most of the time, I can't feel any problems with my equilibrium. At this point, we are working more on getting my endurance up since I was sedentary for about a month. I also am able to do more with my days, which is nice. I still need to make sure that I get a full night's sleep, but overall my energy level is improving. My only complaint these days seems to be some soreness and stiffness in my neck. Still trying to sort out what that is and how to best treat it. Please be praying for complete healing of my neck.

This week I had my six week follow-up MRI and my follow-up neurosurgery appointment. My follow-up  MRI was harder to sit through than the one I had originally. I think because I was so exhausted the night of my stroke that I slept through the first one. It is really hard to lay completely still for an hour when you are wide awake! I definitely inherited some of my dad's restlessness! At my neurosurgeon appointment, he told me that everything looked good, specifically that the dissection (tear) in my vertebral artery is healing well!! I am so thankful! He doesn't need to see me again until my next MRI which will be at the six month mark (end of April-ish). Nothing really changed as far as my restrictions/treatment. I will continue on a full Aspirin every day to keep the dissection from clotting and still cannot lift more than 10 lbs to keep the dissection from getting worse while it heals. He is confident that my six month MRI will look great and that my lifting restriction can be "lifted" at that time.

In the meantime, I am looking forward to spending some extended (compared to normal years) time at home in Memphis over Christmas. When I get back, though, I will be looking for something concrete to fill my time. I have found as my energy level comes back, that it is very unmotivating and even somewhat depressing to not be working. At times I feel very unproductive with my time, I think because I have "unlimited" time and nothing putting me on a schedule. I have been busy with traveling for Thanksgiving, my grandfather's funeral, and my brother's graduation, and thankful that I was able to have the time off to do all those things. However, I can tell that I miss my job and that sense of having a "purpose". It's amazing how much we place our identity in what we "do". I do know that there is a purpose in these "days that were formed for me" surrounding my dissection and stroke, and that ultimately my purpose is actually not mine at all, but God's purpose. Please pray with me that God will continually remind me of his purposes and direct me day by day with how he would have me to use this time away from my job.

"And we know that in all things God works for the good of those who love Him, who have been called according to His purpose." Romans 8:28

Thanks again to you all who have been so supportive through prayer and encouragement during my recovery!! Hope you have a very Merry Christmas and a blessed New Year!!

So Much To Be Thankful For

It's Thanksgiving Week, and in these days I have so much to be thankful for!! I have continued to improve day by day, and I definitely credit my quick recovery to all of my amazing family and friends continual prayers for me. God has been so faithful to me, and I give him the glory for where I am now!

Here are some updated praises and prayer requests in the different areas of my life that have been affected by the vertebral artery dissection (tear) and stroke. I again apologize for the length, but God has been doing a lot of great things! Thank you again for all your prayers and support. They have meant the world to me during this time!

Headaches:

• At the time of my last blog entry, I had started taking Aleve each night to see if that would help me not wake up with headaches each morning. That was definitely a great suggestion by my primary care doctor, and since starting that medication at night, I am no longer waking up with headaches!!
• Thankfully, also, I am rarely having headaches at all any time of the day!
• A few days after being headache free on the Aleve, I gradually moved from the recliner (which was helping my headaches too) into my bed with no increase in my headaches. I am now sleeping well in my bed every night!
• I am now taking Aleve every other night and hope to wean off of it soon! Thankfully, I have not seen any adverse effects from being on a full Aspirin everyday and one Aleve at night, but I don't want to continue that for an extended period of time because that can cause problems.

Right Hand Dexterity/Strength:

• Even before going to my hand PT appointment last Monday, I had seen a significant improvement in the dexterity and strength in my right hand. I take notes every Sunday at church and in just one week there was a significant visual improvement in my handwriting!! (I was able to write after the stroke, but it was harder to write and my handwriting was not my own.) It was so encouraging to have a visual example of the quick work the Lord was doing with my recovery.
• When I went to my hand PT appointment, she evaluated me and determined that while my fine motor skills weren't perfect, my overall strength was were it should be and I would not need any further physical therapy for my hand!! She told me to take up a hobby that would exercise my fine motor skills, so my friend is going to teach me to crochet and let me borrow her crochet materials and some beading materials that she has!! 
• I have noticed since meeting with her that when I am more tired or do too much with my right arm/hand that my right arm/hand gets more tired and feels fatigued easily. The hand PT said that I could follow-up with her if I needed to and so I plan to talk to her this week as well as my doctor. Please pray that this is normal and that I will figure out the best way to not overdo it while also exercising my hand appropriately.

Equilibrium:

• The first big praise for my equilibrium issues is that I was able to get into physical therapy for this 5 days sooner than I had expected! I originally didn't have this appointment until today, but the office manager at the physical therapy office I am going to remembered that I had wanted to get in sooner and called me when they had a cancellation last Wednesday!!
• As with my hand, I have noticed a spontaneous improvement in my equilibrium issues. From not being able to walk without help during the stroke, to being able to walk alone with the feeling of "motion sickness" when I was discharged from the hospital, when I went to PT for my equilibrium I was only feeling the "motion sickness" with specific head movements or trying to move around too fast while walking. 
• The physical therapist evaluated me and does want to continue to see me once a week until I get closer to 100%. She sent me home with some daily exercises. 
• Physical therapy for equilibrium is tricky because the exercises are not that straight forward and my improvement and how I am doing is subjective to how I describe that I am feeling. Since my symptoms are so slight, I have a hard time explaining them. Pray that I will be disciplined with doing the exercises even if I can't tell how they are helping and that I can communicate well with my physical therapist about how I am doing. 

Driving:

• I was hoping to be cleared to drive last week after seeing the equilibrium physical therapist, and while she did feel that I am ready to drive, my primary care doctor doesn't want me driving until I see him tomorrow. I am hopeful that there won't be any reason why he can't clear me tomorrow.
• In the mean time, I have been so blessed to have so many friends and coworkers that have gone out of their way to pick me up for appointments and just to get me out of the house. Thank you to everyone who has given me a ride and been on call for giving me rides!!
• I will never cease to be amazed at how God uses every little detail in our lives to teach us and to prepare us for what is ahead of us (James 1:2-4). I went 4 weeks in Cambodia with not having as much to do as I am used to and also not having my own transportation, and I knew while I was there that He was teaching me something, I just didn't realize that "something" would happen so soon! 

Overall Energy Level:

• While I have definitely been feeling better day by day, I have noticed that my energy level and ability to "go" like I used to is not the same as it used to be. Unfortunately, as the headaches went away and my deficits were spontaneously improved, I think that I got the false sense that since those things were better that I must be almost back to my normal self. 
• I am realizing that I can't do as much with my days as I am used to, and that is a struggle for me. The other evening I had to cancel going to a friend's birthday celebration, and for those that know me well, you know that is a very big deal to me. 
• Again, this goes back to the lessons that God is teaching me about being still and not as busy. Please pray that I will be good about pacing myself and not pushing too hard, but also that my energy will increase day by day so that I will be back to "myself" as soon as God provides. 

Long Term Restrictions/Working:

• Most of the above issues have to do with the minor stroke that I had, and they will hopefully be completely resolved quickly (I don't want to put a time on it, but at the rate things are going I would hope within the end of the year).
• However, the vertebral artery dissection (tear) that clotted and caused the stroke will be healing over the next six months. As long as the headaches stay away and the aspirin does its job in preventing the tear from clotting again, I shouldn't have any physical issues with the tear as it heals, but I am under a strict lifting restriction while it heals (as well as a restriction on crazy sports like skiing and roller coasters and such). 
• No matter how well I am doing otherwise, my neurosurgeon will not clear me to lift more than 10 lbs until May 1. This means that I will be on disability from my job at CHOP until then. Thankfully, I have disability pay and my manager is committed to bringing me back into a position as soon as she can in May. 
• Over the last 3 weeks, I have been reminded of what I have always known. I am an extreme extrovert and need interaction with people for energy and general well-being. While it is nice to have a break from my job at the craziest time of year for us and take some time be a little quieter with life, I have realized that I am definitely going to have to find either consistent volunteer work or some type of part-time job (which would help with finances) once the holidays are over and I am back to myself energy wise. Please be praying that God will lead me to what he wants me to be doing with my time and finances while I am on disability.

Because God has ultimately provided for me through sending his Son, Jesus, to die the death that I should die, and to make a way for me, a sinner, to become a child of God, I know that he will provide for me during these days that he has formed for me.

"What, then, shall we say in response to this? If God is for us, who can be against us? He who did not spare his own Son, but gave him up for us all—how will he not also, along with him, graciously give us all things?" Romans 8:31-32

So, I had a stroke...

When I started this blog, "the days that were formed for me" included a 4-week trip to Cambodia to do medical missions. The title came from wanting to possibly continue the blog past my trip but not knowing what I would ultimately blog about because only the Lord knows what lies ahead for each one of us. Little did I know that the next season of "days" would include recovering from a vertebral artery dissection and a minor stroke. Below is the (long) story of how this all unfolded, how God has protected me, and what lies before me in recovery.

On Friday, October 28th, I had a very minor headache that I didn't think much of. I took Tylenol and Motrin for it and went about my day as normal, working and volunteering at my church's Autumn Fest. The next morning, I woke up with the headache and decided that it was probably the start of a sinus thing and took some Tylenol and Sudafed. I was going to be taking my friends, Amanda and Keith, to the airport, so I drove to their house to pick them up. I had the headache as I was driving, but felt totally fine. After getting out of the car at their house, I immediately got very dizzy and had some visual disturbances in my left eye. It was unlike any dizziness that I had ever experienced in my life. It definitely concerned me, and I told Amanda that I was really sorry but I didn't think I would be able to drive them to the airport. That was a big deal for me because I knew that I was making them miss their flight. They were very gracious and drove me home. On our way home, I had a moment when I thought I should go to the ER, but I talked with a medical friend and we decide that it was probably just an intense sinus headache and I should give it some time.

By the time I got home, I was having a hard time focusing on things and was feeling a lot of pressure in my head. Because of the focusing issue, it was hard for me to walk on my own. Looking back on it now, I probably should have gone to the ER then, but as an ER nurse, you never want to go to the ER prematurely or for something that ends up being nothing. Oh yeah, I was also having numbness in my right hand (I wasn't focusing on that, yet it should have been the most concerning factor!). Finally, a couple hours later, after calling my on-call primary doctor, we decided it was time to go the the ER. At this point, I knew it probably was something that would keep me in the ER for a while, so I had my roommate and good friend, Tiffany, pack up all the things I knew I would need to survive an ER visit!

Around 4pm on Saturday, Tiffany drove me, through the SNOW, to Bryn Mawr's (a local hospital) ER. The whole thing was the most surreal experience I've had in a while. It's snowing, in October, and I'm the one presenting to an ER. The whole time I was being triaged, I kept thinking, "I'm the one that's supposed to be asking these questions!" The anticipation of knowing exactly what they were going to do and then them doing it (because of the severity of my symptoms) was too much for me to handle emotionally (on top of not being able to see straight or walk without help), and so I pretty much cried with each new doctor or nurse that I met. I'm pretty sure I wouldn't have appreciated having me as a patient! But, I knew that something was wrong, and so crying was my way of dealing with it.

They immediately ordered blood work and a head CT. I knew that the waiting process would then begin. I waited to be transported to CT, waited at CT as a "STAT" patient got their CT in front of me, and waited for the results...always anticipating each of these waiting periods. I would have been shocked if it had happened any faster. Knowing what to expect in an ER is a blessing and a curse. About when I expected, the ER attending physician came in with my CT results. My CT was negative, but he was very concerned about my neurological symptoms and wanted to transfer me to Jefferson University Hospital (a big hospital in Philly) to figure out was was causing them. It was the first time anyone used any scary words (the ones I was trying not to think about the whole day) like stroke, aneurysm, or tumor. Another waiting period began...waiting on transport...again, not surprising to me. Thankfully, at that point, my ER room was filled with some of the closest members of my "Philly" fam (longtime friends from my church), who were a great emotional support, and also an entertaining distraction from the gravity of the situation. When I was being loaded onto the gurney to be transferred via ambulance to Jefferson, I found out that I wasn't being transferred to their ER like I had assumed, but I was being directly admitted to their Neuro ICU. I assumed this would be a good thing, since I wouldn't have to sit through all the waiting games at another ER. I was proved wrong.

After arriving in the ICU around 10:30pm, the nurses quickly admitted me and threw in another (very large and uncomfortable) IV. My nurse then told me that I would be getting another head CT. This didn't surprise me, but I really didn't think that I needed another CT. I knew that it probably wouldn't show anything and that what I really needed was a MRI. I refused the CT until I could talk to a doctor. "Ok, but that might be a while, we have a lot of sick patients here tonight." Ughh...I know that line all too well...not sure how many hundreds of times I've said it to my patients. I was glad not to be their sickest patient, but I knew that something was definitely wrong with me and I was getting quite tired of not knowing what it was. I was also very stressed out on behalf of my parents who were 1000 miles away and very worried about me to say the least. I was quite surprised to find out that the Neuro ICU I had been transferred to, in order to get a much needed MRI, only had one neurosurgeon resident (who was spread way too thin) covering the unit and no MRI tech currently in the hospital. I had a few moments of wishing I had asked more questions before I was transferred, and also a moment of wishing I was a child and could be at my own hospital where I knew there would be people who would advocate for me to get what I needed right away. But, I was where I was, and so after giving the resident a pretty good earful about what I knew I needed and basically making my nurse put a smaller IV in a more comfortable spot on my forearm, I settled into a night of waiting on the MRI. I was so, so thankful to have my close friend, Liz, stay with me, in a very uncomfortable straight backed chair, that whole night.

I finally went down to MRI about 6 hours after arriving at Jefferson. The MRI actually wasn't that bad to sit through, and by 6:30am, I was back in the ICU and a neurosurgeon resident immediately came in and told me that I had suffered two small strokes in the pons of my brainstem and one small stoke near my cerebellum. With that diagnosis, the worst of my emotional stress was over. I had been mainly praying that it wasn't cancer or an aneurysm, so I was actually thankful for that diagnosis. I was thankfully able to catch my mom on the phone before she took off to fly to Philly, and I know she was also thankful to finally have the results. Very soon after, I was also told that they had found a left vertebral artery dissection (VAD), a tear in an artery in my neck. This was the cause of my stroke. It had clotted off and then the clot blew off and caused the small strokes. They grilled me on the common causes of VADs...have you been skydiving...had chiropractic manipulation of your neck...do you play the trumpet...have you been sneezing a lot...lifting weights? I couldn't think of anything weird involving my neck that had happened recently. After all the grilling, they said that many times they never pinpoint the cause. Arterial dissections are the most common cause of strokes in young people, so even though it was obviously crazy for this to happen to me, it's not unheard of. They also said that this had nothing to do with my travel to Cambodia. Because it seemed to happen basically randomly, I am so, so thankful that I was in this country when it happened. If it had happened just 2 weeks prior, I would have had an experience with the Cambodian healthcare system that I hadn't gone there looking for!

Well, this "summary" has gotten really long, so I'm going to try to be more brief from here out. The rest of my hospital stay was filled with visits from doctors (not as many as you would think), lots and lots of visits from family, friends, and coworkers. My parents and my 2nd parents, The Bishops, made their way to me very quickly. I was discharged 3 days later. My stroke symptoms had resolved so much with each half day that I was there. We determined that my (thankfully, very minor) deficits include some right hand dexterity issues, very, very mild right leg weakness, and mild equilibrium issues with walking and looking around quickly. I will be getting PT/OT for these deficits and given how fast I have been moving back to baseline, the therapy shouldn't take too long. Thankfully to look at me, and even when the doctors examine me, you would never know I had a stroke. Also, I was told that I would probably have headaches for a "while". I didn't think much of this because my headaches in the hospital hadn't been that bad. Unfortunately, my first few days at home I had some pretty intense headaches that wouldn't go away with the meds they sent me home on. It has become clear that this will possibly be an ongoing issue for a least a few weeks. I tend to go to sleep fine, wake up with a headache that varies in intensity, and then as long as I push through it, it's gone by the afternoon. I have thankfully just started taking a med at night that has so far been improving how I feel in the morning.

There was one thing that I was told on discharge that will affect me for a longer period of time than any of the rest of these issues. The vertebral artery dissection is still there and will heal over the next six months. I have to be on a full aspirin daily to decrease the risk of it clotting again (and that is a risk...I could have another stroke). Also, because it is healing, I am not allowed to lift more than 10 lbs for six months. When I heard this, I no longer worried how long it would take me to retrain my hand to place IVs. I knew this meant that I would be out of my job as a nurse in the ER for those six months. I will thankfully have short-term and long-term disability to cover a percentage of my salary, but my position will be filled after 3 months. I have an amazing manager who is so supportive and will bring me back into my position as soon as my weight restriction is cleared and she has a position available.

I have been humbled and overwhelmed by the outpouring of thoughts, prayers, calls, visits, messages, cards, and flowers from my family and friends from every aspect of my life. Thank you so, so much for everything and continuing to follow up to see how I am doing. It is so encouraging and helpful for my recovery. I am so blessed that this was not more serious and am truly trusting God that these are "the days that were formed for me" (see Psalm 139:16) and that he knows what lies ahead of me during this time. Here is how you can be thanking the Lord and praying with me as I take this season day by day:

Praise:

• That I was not out of the country when this happened.
• That my vertebral artery dissection was not more severe.
• That the clots were small and the neurologic deficits are minor.
• That I had great doctors and nurses who were able to diagnose and care for me.
• That my stroke deficits have been fading fast and that I will have a full recovery.
• For my "Philly" fam, especially Tiffany and Liz, who stayed with me before my parents arrived.
• For my mom and dad and their support despite dealing with my ailing grandfather in Atlanta at the same time. Especially to my mom who hasn't been home for two weeks and has been doing more than I could have ever asked for me here at home.
• For all of my amazing family and friends who are supporting me during this time.

Prayer

• That I will continue to take things day by day and not be frustrated by "bad" days.
• That my Physical Therapists will be knowledgeable of my deficits and know the best plan to get me back to 100%.
• That I will be disciplined in my physical therapy.
• That while I can't drive, I will be patient and not get frustrated with feeling cooped up.
• That my morning headaches will continue to subside and that I will be able to sleep in my bed again (I've been sleeping in a recliner to keep my head more elevated).
• That my vertebral artery dissection will not clot again and cause another stroke.
• That the Lord will lead me with what to do with my time and finances during my six month leave from work.

Thanks again! Giving God the Glory!

"Living" in Cambodia

(I am now back in the States. My last two weeks in Cambodia were a lot busier than the first two weeks, so I was unable to take time to blog. The next several posts will be back posts from that time)

While my last post highlighted snapshots of my transportation modes, this post highlights snapshots from my everyday life while "living" (I use that term loosely) in Cambodia for four weeks.

I stayed with an Australian couple, Chris and Rhiannon Foster, and their very cute 4 month old son, Liam. They are missionaries working at New Life Church. The group that I volunteered with is the healthcare ministry of that church. It was so nice to have a room with "air-con" and a home cooked meal on the nights that I stayed in. Chris is a great cook! They made me feel a part of their family for four weeks. Thanks again, Fosters!!

Chris, Rhi and Baby Liam

My adorable back-seatmate for many a drive to and from home.

My room

A sleeping must for me in humid Cambodia, "Air-con"!

New Life Church has three healthcare ministries: Community Enabling Health, The Healing Home and Patient Care Ministry. I spent most of my time working with Donnie, a missionary from Canada, from Patient Care Ministry. He was preparing for a short term medical team that arrived the last week that I was there. The project that I worked on for the majority of my days in the office was sorting through, organizing, and inventorying the medications that would available for the doctors to use during the medical mission. 

Donnie, his wife, Sophea, and their children, Nan and Isaac.

New Life Fellowship

The office that I worked in

Sorting and Labeling Meds

Preparing the Inventory/Formulary for the MDs on the medical team

Finally, here are some snapshots of life around Phnom Penh. I wish that I had captured more things, but I found that being on my own, I took less pictures (762 pics in 4 weeks) than I normally did on my team trips (avg of over 1000 pics in just 2 weeks).

Glass factory on the street that I stayed on. They had a habit of breaking up the discarded glass into tiny pieces...

Old Phnom Penh

New Phnom Penh

Sunset from the house I stayed at

One of my favorite parts of Cambodia is all the exotic fruits. This is Dragonfruit.

Walmart of Phnom Penh?

Found that many of the western restaurants put a Cambodian spin on western food.

Geckos are all over the place in Cambodia. Many a time these friends would be scurrying around my bathroom in the morning.

Always something interesting for sale on the streets in Phnom Penh

Phnom Penh has developed exponentially since I first visited in 2007. There were no tall buildings then.

Got to spend time with a missionary from our church, Mades, and his family. This is his daughter, Allison. Sopheary was pregnant with her when I first met them.

No need to search around for reception sites in Cambodia. You just block off the street in front of your house!

Exercising along the Mekong River

The Cambodian Transportation Food Chain

As I have been completely dependent on others or my own two feet for my transportation during my time in Cambodia, I have learned a lot about the Transportation Food Chain here and found myself a part of each level.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

At the top of the food chain are cars, trucks, vans and buses. Jeeps come in especially handy during flooding situations

You Don’t Expect to Take a Week Off on a Mission Trip

Quickly after I arrived in Cambodia, I was told that there was a holiday coming up the next week. Oh, ok, just a day or two off, right? That’s what we’re used to in the States. No, it’s a 3-day holiday, and because it falls on a Monday to Wednesday this year, it means that a lot of Cambodians will take the whole week off. Oh…ok…

When I heard this, it didn’t quite sink in for what it would mean for me. Even though I arrived a week before the holiday, the upcoming holiday was already affecting things that I thought I would be doing. Three days after I arrived, I met the couple that run the Healing Home, a ministry that I was told I would be helping out with. “When should I come visit your ministry and start helping out?” I asked. “Oh, well, our patients are all well enough to go home for the holiday, so we’re closing next week and most of our patients have already left,” they replied. Oh…ok…

I was also excited to get to know the missionaries that work with the church that I am working with, especially the young single women. However, most of them were leaving that first weekend to take advantage of the 5-day weekend, meaning I wouldn’t meet them until almost half of my time was over. Oh…ok…

Because I had been given very few details on what my time would look like while I was here, I prayed a lot about not having too many expectations on WHAT I would be doing. However, I realized that even with trying to prepare for the unexpected, I never thought the unexpected would be not working or serving for almost a week!!

I am still processing what this has meant/means for my trip and time here, but I continue to trust in God’s timing and plan for me being here during this time. I know that I have been a big help to the director of the patient care ministry, who is preparing for a large medical team that gets here this weekend. I also have been learning a lot about being still and being on my own with God.

Even though it was a pretty quiet week (I read a book and a half - both of which I highly recommend), I did find some fun things to do. Here are some highlights:

Spent one day relaxing at a pool owned by…

The man, the myth, the legend...Steve of Steve’s Steakhouse!

Went on a mini-photo tour of Phnom Penh

Found where Sambo the Elephant spends the holiday

Saw Cambodia’s Disney World

Went food shopping in the markets with a Cambodian friend. Then she made amazing Pad Thai with the ingredients!

Things have thankfully picked back up this week, which I will update you on when I can! 

Everybody's Got a Water Buffalo

If you grew up in the Christian sub-culture, then you're probably familiar with the VeggieTales song “Everybody’s Got a Water Buffalo” . I found myself humming this tune yesterday on our way out to see patients in one of the farther out clinics because everyone did have a water buffalo!!

Water Buffalo at the church

Water Buffalo blocking the way

After a bit of a slow and discouraging start, my first week here ended on a much more positive note. A doctor from the States and a nurse from South Africa were visiting the ministry that I am working with for only two days, so the director of the patient care ministry took us out to several of the churches out in the provinces to assess people that had been referred by the pastor or church members as needing medical assistance. Most of the patients were thankfully not too sick, but we did see some that will need to be brought to Phnom Penh for further follow-up.

A lot of our time was spent educating the patients on basic nutrition and hydration to increase overall health. I learned much from the doctor that was with us, as he had been on multiple medical missions all over the world and had worked in Cambodia twice before. He has a very balanced view of the help but also limitations of medical missions in third world countries. He also seamlessly integrates the care of the patients physical needs with their spiritual needs which is something I don’t have much practice in having only worked in the hospital setting where boundaries are more strict.

Dr. Ryan, Candace and I at a pastor's house. As you can see, our two days included lots of adventure!

A little boy with prune belly syndrome that can hopefully get international aid

Dr. Ryan praying with a patient who had suffered a stroke 2 years ago. Unfortunately, there is not much we can do medically for him at this point...that's where the spiritual becomes so important

Flooded entrance to one of the churches

One of my frustrations leading up to and since I’ve been here has been lack of a pre planned out schedule. However, God knew from before any of the 3 of us planned to come here that he would bring us together to serve the Cambodian people and this ministry for the past two days. It was one of those things that you couldn’t have orchestrated if you tried. We got along great as a team, and I know that I learned a lot not just from the doctor and other nurse but also the director and Cambodians that joined us. It was a joy working with them, and while I still don’t have a super specific schedule for the days ahead, I know God has great things planned for me!!

Adjusting to Being Still

Even if you've been to a country 3 times before, adjusting to the new place is never easy. Some of my adjusting has to do with being here on my own when I'm used to being with a team. Some adjustments have been easier to adapt to than others. Some I will probably not completely adjust to the whole time I’m here. Here are the things that I’ve been adjusting to this past week:

• Waking up routinely in the middle of the night because your body hasn't adjusted to the new time zone
• Cold showers
• Cultural differences on plans and communication/Not knowing what you will be doing from day to day
• Being reliant on others for transportation/Only being able to walk to a few places and not being able to walk alone after dark (Feeling cooped up)
• Working and living with people you have only just met
• Limited access to the internet/Feeling disconnected from people at home

About mid week, all of these things added up to feeling pretty overwhelmed. However, I was encouraged by Psalm 46:10, “Be still and know that I am God.” I realized that I was being impatient with these adjustments and wanted to be used to being here immediately. I needed to just rest in where I was and know that things would sort out over time. It was ok to not have anywhere to go or things to do. Being still is a discipline that I could definitely learn how to do better, and God is giving me that opportunity.

All the Small Things

I am so thankful that God cares even about the small details of our lives.

I left Saturday morning on my 30-hour journey to Cambodia. Over the past few days, I had become anxious about that part of my trip in general. It was a long time to be on my own, and I currently had a middle seat on the 14.5-hour flight from Atlanta to Seoul. I get quite antsy and a sore lower back from sitting for so long and wanted to be able to get up and walk around without disturbing a seatmate. I had been praying for good company and/or and aisle seat if it was in God’s will for my travels.

God answered big time! When I checked in Saturday morning in Philly, I had been assigned an aisle seat instead of a middle seat for the long flight without even having to request it! Such a huge blessing!

I also had another surprise in store for me in Atlanta. I had a 3-hour layover in Atlanta, which I wasn’t looking forward to. Mainly just because of the anticipation of getting on the really long flight. My one goal for that time was to get a Chick-fil-a chicken biscuit before 10:30a (when they stop serving breakfast). I landed at 10a and headed straight to a directory to find out which terminal the Chick-fil-a was at. I knew there was one there…I just couldn’t remember where. I scoured the directory and couldn’t find a listing for Chick-fil-a. WHAT?!?! No Chick-fil-a!! In the airport of the city where Chick-fil-a was founded!! This was an outrage. I continue to scour the directory to make sure I wasn’t mistaken. Finally, I gave up and turned to the person standing next to me to say something about this travesty. The person standing next to me turned out to by my mom!! My mom, dad and sister had surprised me by staying a day later in Atlanta on their trip to visit my grandparents!! However, instead of saying, “Wow, I can’t believe you’re here!”, I said, “Is there not a Chick-fil-a here anymore!?!?” My dad assured me that there was and off we went to get the chicken biscuit. Even though my initial response to them wasn’t one of surprise and thanks, I was so thankful that they had taken time to see me off in Atlanta. It was very special to have them be able to pray over me in person right before I took off for Seoul.

The rest of my trip was long and thankfully uneventful. I had very nice seatmates to Seoul that I was able to chat with a bit. I didn’t sleep very much on that 14.5 hours, but on the next 5 hour flight to Phnom Penh, I had a whole 3 seats to myself so I stretched out and slept for 2 hours straight!!

Because I was landing in Cambodia at night, there wasn’t too much to see, but even so, I sat at the window all during the approach thanking the Lord for bringing me back and praying that he will use me in his ways during this 4 weeks.

God provided for me in so many small but important ways in this initial phase and I know that he will continue to do so!!

Here we go...

Ok, so here we go...

This is my first post of my brand new blog. I really have no idea what I am doing and don't really have time to make it pretty at this point. Maybe while I'm in Cambodia or get back from Cambodia, or maybe it will look like this for the rest of my life...

Anyway, I thought for my first post I would share with you how this blog came to be. (sounds like interesting reading, huh?) Once I knew that I was definitely going to Cambodia, I thought, "Maybe I should start a blog for while I am there." Ok, so, I felt like I needed a theme for my blog, but I was only going to be in Cambodia for 4 weeks. Was the trip the theme for my blog, or should it be broader? Definitely needed to be broader than just a 4 week trip. So would my theme be travel? I love to travel, but my trip is definitely a lot more than just traveling.

After going around in these circles for a while, I decided I didn't necessarily need one theme for my blog and it would probably just end up being whatever my life ended up being, so now for a title. I wanted a title that could encompass whatever God has in store for me for as long as I maintain this blog. I went to my favorite passage from scripture regarding God's sovereign plan for our lives: Psalm 139 From verse 16, I gleaned the title for my blog.

So, what to expect when you read this blog? My experiences and insights from living out "the days were formed for me" by my sovereign God, through the grace of his son, Jesus.