Life in the Bush House

Thursday, March 29, 2012

Jenny, Steph, and Ali got here yesterday evening so we are now all settled into our new bunks in the appropriately named “Bush House”, as it sits at the back edge of the property in “the bush”.

After dinner we came back to the house to settle in for the night. We noticed before dinner, however that the water wasn’t working properly for the showers. Everything else was fine, but we’d just flushed a toilet so we thought it was related to that and decided just to give it more time. So tonight when Ali went to take her shower, the water still wasn’t working. We had been using water in all the other rooms so we decided to again wait to see if time made any difference.

We sat around chatting while waitng on the water to miraculously start working when all of a sudden we hear this loud beeping sound as if from a smoke detector. We search around and decide it is coming from the battery that runs all the lights in the house. We quickly turn it off as Jenny runs to get the flashlights. Steph and I are now sitting in the dark living room for about 2 minutes while I call Dr. Tom to see if he can help. Just as he answers the phone, something in the dining room makes a loud scurrying noise right behind me. Steph and I both scream and run to the other end of the hall as I try to calm down enough to apologize to Dr. Tom and convince him that we are not crazy. He explains that there are screeching owls that live in our ceiling, that our battery is dying and that our water tank is drained and he will have to come turn on a valve to pump water into it in the morning since it’s already so late.

I thanked him for the explanation and hung up the phone relaying the news. Jenny walks me to my room with the flashlight and just as she exits the door I hear someone whisper through my window…”hello?” I let out a very high-pitched squeal as Dr. Tom again says “hello?” Jenny and Steph come running back in, hearing nothing but the squeal. “Dr. Tom?” I ask. “I decided just to fix your tank now,” he explains through my dark window.

We invite him inside and he agrees to come look at our battery situation as well. We bring out our flashlights and walk over to the closet; still hesitant from the loud clanking sound we’d heard earlier in the dining room. Just as we lean in to watch what buttons he’s pushing and what plugs go where, a flyswatter that had been hanging on the wall falls and brushes against Jenny’s arm. She screams and jumps scaring all of us and again we are left trying to explain our sanity… I’m not sure of our success.

The “Bush House” can be a scary place after dark.

Possessed

Wednesday, March 28, 2012

Last night Phillip got called back to the OR for a c-section. Apparently Dr. Tom had to call him three times to wake him up. I felt bad but I guess Dr. Tom could tell by how I fell asleep on Judy’s couch after dinner that I was very tired. They told me that they were in surgery until 3:30am. I did not even hear the generator turn on.

Needless to say, it was a slow day because of it. I’m happy to say that everyone in the women’s ward is doing well under my watch this week. I did have a strange case come in on Monday. She’d had an exploratory laprotomy (open abdominal surgery) for primary infertility at the beginning of the month and she presented to the hospital at post-operative day #20 with restlessness, insomnia, headache and altered mental status. When I went to see her she was moaning and flailing around with a blank stare in her eyes, but complaining of nothing more than a headache. I prescribed her medications for pain and something to help her sleep while I waited on her laboratory studies. When I went back to check on her yesterday I was informed that she began having seizures during the night. On exam, she was not actively seizing, but she was foaming at the mouth and very incoherent. Her speech was muffled and broken and she could not maintain eye contact. Her eyes kept rolling back in her head and then she’d open them wide and stare into space. It was very bizarre bit she did have a pain response to flexion of her neck so I started her on antibiotics for encephalitis (a brain infection that could be caused from malaria or some other type of infection).

As I was leaving her room, I passed Pastor Jarr on the way out. I said hello and she greeted me as she entered to see the lady.

I found out from Judy today that Pastor Jarr spent some time with the lady praying for healing. Apparently it worked, because today when I went to check on her eshe was sitting up and talking- completely oriented! She knew her name and where she was and could answer any question I asked.

As Judy informed me, Pastor Jarr seemed to think that the lady had been cursed and was possessed by an evil spirit. When I told Emily this story today, she agreed saying that there is definitely an evil presence here and that many of the people greatly fear it. I’m not sure what I believe in this specific case, but I don’t think that just a few doses of an antibiotic can heal someone that quickly. I also think that you can’t believe in the presence of the Holy Spirit if you don’t believe in the presence of evil. I also think that if you believe in anything enough, then it does become real to you.

Either way I’m just grateful she is on the road to healing now, whether it be physical or spiritual.

White Girl in the OR

Tuesday, March 27, 2012

Every day I see things that amaze me more than the last. Today was my first day to go into the OR to actually perform a procedure and I realized first hand the shortage of materials and limitations to what we can offer. It was quite surprising yet still very fulfilling.

A 14 yo girl came hobbling in on one leg. They got her onto an OR table and called Dr. Tom. I’m sitting on the couch not even changed from work yet when I hear through the window “Angela?”

At first it startled me a little. I still haven’t completely gotten used to the open slatted windows yet. “Yes?” I reply, recognizing Dr. Tom’s voice. “There is a new case in the OR. A girl came in from a motorbike accident with a laceration on her leg. I want you and Phillip to repair it.” We quickly gather our things and head down to the hospital to meet him.

When I walked in, there was a very frightened girl atop the table. My attention immediately turned to her leg. There was an open wound starting from behind her left knee and making a jagged turn down the inside of her leg. Impressively, she was crying on a little. The wound was covered in dirt and debris and the edges of her skin were torn very unevenly.

We quickly get to work. Dr. Tom leaves to go get supplies and the nurse starts to work on her IV. Soon she is sleeping peacefully as if she didn’t even know how badly her leg was injured and how lucky she was that she could still walk. WE irrigated the wound and dug out dirt and debris for over an hour until finally Dr. Tom brought in suture. Phillip started suturing on her left side. The needle was not a cutting edge needle (the kind you typically use at home) so it was VERY difficult to penetrate the skin. The wound edges barely matched up as they were and there were several time that Phillip had to pull so hard on her skin to get the needle through that I was most certain he would tear the skin more. But, thankfully, he did not. After several sutures on the top of the knee he rolled her leg outwards so that I could try to suture the inside of her leg. It was getting dark and we have no electricity. My eyes were beginning to hurt from all the straining. The dark blue suture was nearly impossible to see against her dark skin. Finally Dr. Tom agreed that we needed the lights to continue further.

I look over at Phillip and he has been concentrating so hard in the hot stuffy room that he hasn’t even realized that there is sweat dripping down his nose. I quickly motion for the nurse to get a napkin. He wipes Phillip’s head and face just before the sweat drips into the wound. My scrubs are soaked and I feel faint so we take a short break while we wait for the generator.

Eventually it cuts on and Dr. Tom returns. While we were waiting I noticed that the wound started bleeding again. I turn to Dr. Tom and ask if we have any gauze to dry the area for better viewing. “We don’t have any,” he replies. So, without gauze or a clear picture of what we had already sutured and what exactly was left, we continued on in perseverance.

After over 24 wide spaced sutures (we had to conserve) and 2 hours of working on a wound that should have taken less than one hour anywhere else, I again look at Dr. Tom and ask, “Do we have anything to clean her with before we bandage her leg?” “No,” he says “but here, try this.” He hands me a large paper like material that is normally used as a drape to cover areas where you aren’t working to keep them clean. I glance at her leg, now covered with dried blood and sitting in a pool of blood/iodine/sterile water mix that was also slowly dripping onto the floor. Reluctantly I scrubbed her legs with the tough scratchy paper until I got it a little cleaner…not clean by any means.

As she was becoming aroused, we began to pick up the drapes and instruments. I asked if I could bandage her leg (still bleeding somewhat) and was handed a roll of Kurlex- a loosely woven stretchy gauze type material that normally is used to only hold a bandage in place. It is non-absorbent, but it’s all we have. I know she will bleed through it in a matter of minutes but I wrap her up and send her back to the ward where she will stay for a long recovery. I hope she knows how lucky she is to have her leg and most especially to still have full function of her leg. I’m certain she will have much suffering during her stay at KWH but I’m also very hopeful she will walk again with no complications. I praise God for that.

They bring in the mobile bed and begin to roll her from the room. I offer to hold the door for them and after such a long period of time in the hot, stuffy, sweat-box of a room, when the hot night air hits my face I let out a big sigh. “Ahhhh, AIR!!!” I yell and they laugh at me. Silly white girl…

Whatever You Do For the Least of These

Monday, March 26, 2012  Day 17

“For I was hungry and you gave me food…”             Matthew 25:35

I have so many many thoughts racing through my mind right now that I feel like I should’ve been jotting things down all day.

This morning was a normal hospital day, except that before we stared rounding we said goodbye to a very tearful Lorena. She and Dr. Karen left for Freetown today to pick up Jenny, Steph and Ali, and even though it was sad to say goodbye, I’m still very excited to see the girls!

Today we decided to switch things up a bit so Phillip covered the ped’s ward and I took the women’s. I am happy to report that the lady who received Phillip’s blood donation was stable and doing very well. I sent a lady with ascites for her second paracentesis- I’m unsure if it will really help with anything other than making her symptoms more bearable, but we have no treatment for hepatitis so I have to continue with what we can do. The surgical patient that I spoke of earlier from Freetown that has the open wound in her pelvis is worsening. I do not think her strength will last much longer, but her daughter seems to be very hopeful.

On the ped’s ward, all my patients from the weekend are still stable! Thank goodness. Phillip did get a new patient who was temporarily placed in a private room in the back of the ward. When we entered the room, I noticed a small radio propped up on the edge of the bed. Over the noisy cries that are the peds ward, I could hear the voice of Josh Groban singing “You raise me up”. I sat on the edge of the bed and held out my arm towards the small 6 year old. Most of the time, they don’t shake my hand, but instead stare at my strange white skin or scream out in tears because the last “white” stuck them with a needle. To my great surprise the child sprang up and wrapped her tiny arms around my waist in a big hug! It absolutely made the rest of my hospital work totally worth it!

Before leaving the wards for lunch, I decided to make a stop to check in on the Alpha children. The last time I was there, a proud “Mami”came rushing up to me showing me her “pitkins”. There were two older children, each of who were holding an infant- a tiny set of twins!! They were absolutely adorable. Both were being treated for malnourishment, but it was obvious one was flourishing more than the other (which I’m told is also typical of twins here.) As we were visiting with Tira yesterday, she made mention of a cousin of hers who had twins in the alpha ward. She said she went to visit them, but that one of the twins had died. I thought it must have been a mistake. She couldn’t have been talking of the same set of twins. I’d just seen them. I didn’t want to believe it, so to be certain I decided to check for myself.

I greet the nurse. “Where are the twins?” I ask. She looks at me and points to a child alone in a bed. “Here is the one. WE lost the other on Saturday,” she responds. My heart dropped. I must have heard wrong. It cannot be. I look over at the Mami and with only the look in her eyes, I could tell it was true. I recalled the wailing Saturday night. My heart broke. I watched the woman as she collected her things. The second twin was now strong enough to go home, she had just been waiting on her sister to get well enough to join her. The whole atmosphere of the ward seemed to have transformed. On previous visits the mothers were very happy- all smiling and showing their pitkins as if saying, “Look at mine! Look at mine!” But not today. Today things were much darker.

I wished them well and then walked away to go eat my lunch while I tried to forget about the news.

I have a group of about 4-5 girls that have learned my lunch routine. Every day for the last week or so, they have visited me. They come to Bud and Judy’s front porch and climb on the bench to press their faces to the screen window as the stretch their necks to see if anyone is inside. We can hear their whispers followed by snickering giggles. Eventually a “helloooo” and “where is An-gel-a?” I go outside “Where is Phil-lip?” they ask. “Phil-lip is sleeping,” I tell them. They giggle and think it is funny that he and Bud nap on the couches during the hot day. Soon the questions begin and they either decided to count my freckles or plant my hair. They are amazed with our hair and it sometimes becomes a game to them to just pat my head. My watch beeps and they ask what time it is. “2:00, “ I tell them “Time to go to work. We will meet tomorrow.” “Tomorrow!” they respond as they run down the hill.

I join Dr. Tom in clinic while Phillip goes to teach the nursing students about genetics and when he is done, we switch. The students seem so eager to learn and to my surprise they actually understood the blood groups by the time I left. I think they really loved the clay models. We ended up making a game of it- one person was the donor, one the recipient and each had to express their “antigen” while a third “antibody” person decided whether the recipient could accept the donation. I was a lot of fun. I may have enjoyed it more than them in fact!!

After dinner tonight, we went for our usual slow stroll back to Bud and Judy’s. We were sitting in the living room in silence each engulfed in our own work. In the distance I hear the leaves rustle and then the scattering of little feet followed by an “An-gel-a”. I close my laptop and walk to the door. “Where is Phil-lip?” The familiar voices always ask. “He’s scared of the dark, “ I reply. As usual they snicker and I can hear Phillip laughing through the window as well. “We have come to see if you have for us any mango? We have no chop (dinner). Do you have for us a mango?”

I’m silenced. I can’t get the words to come out. Finally I stutter, “I have no mango.” They ask again. My heart sinks into my stomach, but I literally have nothing to give them. I look back at the door half expecting Judy or Phillip or Bud to come running out to help me whisk the children in the house so that we can properly feed them, but I am left with nothing- no words and a dumb look on my face. My jaw won’t move. I can’t even find words to tell them I’m sorry. Finally, I again disappointedly say, “I have no mango.” The tears are building up and I find it hard to swallow, but the children just flash a big bright smile and say, “Okay we see you tomorrow,” and again off they go- as if nothing ever happened. As if they were just so used to going to bed hungry. That thought made me even sadder.

My heart is still breaking. All I can think of is the scripture that keeps repeating in my head:

“Whatever you do for the least of these, you have done for me…”           

Sleep will not come easy tonight.

What A Weekend

Sunday morning, March 25, 2012  Day 16

Last night I was awoken three times. Once at 4am by the wails of a woman from the hospital. I could hear her screams piercing the silence of the still night like glass shattering from a brick. I drifted back off to sleep listening to her cry. Again, at 5am the Muslim chants began. I rolled over slightly trying to ignore them and pretend they didn’t exist. Although I love how faithful and devout the chanting its, I was determined not to let it ruin my sleep. A second scream broke out through the early morning again at 6am. I awoke and listened for a while. Was I dreaming? No, the chants were still there too. The wailing continued. Was it the same woman? Was it more family just now finding out? Did a different patient expire? It’s hard to sleep with so many thoughts running through my mind. The remainder of my sleep was restless at best. I sincerely hope and pray that Phillip’s blood donation was not in vain.

Sunday night, March 25, 2012 Day 16

What a way to spend a weekend! It absolutely did NOT last long enough! I guess with working half the day on Saturday, I feel like we try to cram a whole weekend in on Sunday. Which, by the way, is a pretty impressive feat considering we attend two church services and a typical African service last at least 2 hours.

There is a medical student that is visiting Kamakwie from San Francisco. Her father was from here so she still has a lot of family in Kamakwie. Dr. Asher even knows some of her relatives, so she attended rounds with us in the hospital on Friday. We recognized her with her brother this morning in church where they invited us to their aunt’s home for a family lunch with traditional African food. So…we actually had lunch with the Ashers’ around noon and then a “mid-afternoon snack” around 2pm. It was very interesting too because they served kasava leaves (a spinach type vegetable served over rice), which we’ve had before with the Ashers and Bud and Judy’s, but this time it was very different. I was informed that it’s always the same ingredients, which I’ve learned is most often the case with any meal. (Dr. Tom even tells a story of how he once got in trouble with the cook for suggesting she put fish in a dish that is traditionally cooked with chicken.) But some how, each person manages to make it taste a little differently. The food here is amazing though.

We spent a couple of hours conversing with Tira and her brother and meeting their family. She has an uncle who is in the government in SL. He was very instrumental in getting the Catholic church in Kamakwie (which I’m told is a fairly new development), and his dad (Tira’s grandfather) actually donated the land for the Catholic school! Her uncle was very nice and spoke very good English. He even taught us a few Krio phrases! He also invited us to go and visit him when we go to Freetown.

Our afternoon gathering ended with a rendezvous with Lorena and Meredith for a trip to visit our friend Mansu, the tailor. Yesterday I dropped off 2 lapas (precut yards of fabric)- one for me a dress and one for Phillip a shirt. I actually got a dress and a skirt out of the fabric, and Phillip’s shirt looks great on him. He looks like he’s ready for the beach- a natural tourist! I think he will definitely be able to wear it back home. Once Meredith and Lorena had collected their items, we began the walk back.

Along the way, a couple of the children called me by my name!! It’s very exciting because I usually get called “white”, “white woman”, or “Lorena”. As Tira explained to me, the children don’t see enough white people here to learn how to distinguish between our facial features- and I thought I was having the reverse problem, turns out I’m not the only one!!

Upon returning home, we cleaned up and had an African dinner at Judy’s house- Jalif Rice- my favorite so far! It’s a stew of chopped onions cooked in a tomato sauce with other spices and served over rice. (Like everything else African!)The onions make it taste sweet so it is very good!

After dinner Meredith stopped by on her walk home and we sat on the porch with she and Judy making red blood cells out of clay until dark. Tomorrow Phillip and I are speaking to the nursing students. He is going to talk about genetics and I am going to teach them about ABO blood groups and donor compatibility. I really hope it goes well and I don’t confuse them more! We will see how much of a language barrier there is! We’re both really excited to have this opportunity. It makes me realize how much I’ve missed teaching. I guess I get it honestly.

Dr. Tom informed us earlier that Philip’s patient was still stable after receiving her transfusion, so I’m still not sure what the wailing was about. Tomorrow I will have to go and check on my malaria patient. Hopefully he is doing better after his transfusion too, but I still want to check him for Sickle Cell Disease even though Dr. Tom says it’s not as prevalent here. We’ll have to wait and find out…

The Ultimate Sacrifice

Saturday, March 24, 2012  Day 15

Another Saturday spent in the hot SL sunshine!

We arose early and made rounds after breakfast. Earlier in the week there were 3 patients that Phillip had been monitoring for an acute abdomen. Two of the cases went to surgery with which he assisted. The third patient he continued to monitor throughout the day on Wednesday and Thursday until she began to show signs of improvement at which time he called off surgery.

We did not round yesterday since we spent the day in Medina, so when we came into the hospital door this morning, we were met by the nursing staff who informed us that this non-surgical patient had expired.

I will never forget the look of shock, disbelief, and immediate guilt on Phillip’s face. “What happened? I don’t understand. She was getting better,” he mumbled quietly to me. I knew it wasn’t something he was going to let go of easily whether he admitted it or not. Dr. Asher and I both reassured him that there was nothing that could have been done but as I walked over to the peds ward I heard the wailing begin in the breeze way. I peered out the window feeling guilty for watching but too intrigued to turn away and not knowing any other way to show respect.

I saw her daughter drop to the ground shaking profusely on the hard concrete- her body limp as if she had lost all control of function. The pain was paralyzing for her. I continued to watch as family members came to comfort her and help her up from the ground.

I watched until a woman speaking something to me in Krio interrupted me. I recognized her as Foday’s mother, the child from one of Phillip’s surgeries. She came to inform me that her son was able to go to the bathroom- a great feat for a post-operative patient who’d just had an open abdominal surgery for a perforated bowel because of typhoid.

“We done send de sample,” she tells me. I look over to the child and notice he has a tube in his nose. Apparently he’d had some trouble through the night. Dr. Tom instructs me to keep careful watch for signs of improvement so that we can try to take the tube out as soon as possible. So after lunch I made a short trip down to see the tailor in the afternoon heat so that I could go check on Foday. He was doing well with no vomiting so I tell the nurse that she can remove it. “Ok but I have a new malaria patient with a hemoglobin of 2.3 and I have to start the IV for a transfusion so you’ll have to do it yourself,” she says a bit flustered as she runs past me with a bag of blood in hand.

“Great, “ I think. “ I don’t even know where to start. Hopefully I can just pull…”

I instruct the child on what I’m doing and he thankfully agrees. I tug firmly and gently and slowly it is freed. “Whew!” I hope he didn’t know I was just as scared as he was.

I leave to go check on the malaria patient and as I walk in the door I recognize the limp pale child. I ask for his chart. He had been admitted only 10 days prior for the same condition. His hair had not even grown back from where they shaved his head for his last transfusion. I have never seen a dark child so pale.

The nurse wiped the scalp clean as she began looking for venous access. She slowly advanced the needle, but with no success. I convince her to try for the arm, so she hands me the needle. I stick once. The sweat is just rolling down my back now. Missed. The child barely squirms or flinches. I try again…nothing. The nurse tries once more for scalp access. Finally- a flash of blood! But still no drip yet. We tried to adjust the needle with no success. A second nurse is called in and eventually after sticking almost every vein in the child’s body we get access and the transfusion was started.

After all the drama, I decided to rest until after dinner when Dr. Tom got called in to check on an employee who’d passed out. Phillip and I both go with him, and as we are finishing up, the nurse comes over to inform us that there’s a victim of a dog bite in the peds ward that we need to see. We walk over only to find out that there are actually two victims- the child and the father who tried to save the child. I let Philip and Dr. Tom talk to them while I go over to check on the malaria patient from earlier. He was still very pale and lethargic but I am hopeful that he will recover.

We leave the ward only to again be stopped. A lady on the women’s ward with a history of vomiting blood is now passing blood in her stool. Phillip goes to check on the woman since he’d seen her earlier in the day. Her hemoglobin is 5.0 and she is very sick. Dr. Tom, realizing that our blood stores are low and that there is no family here in the middle of the night to donate for her, quickly volunteers to donate. Phillip without hesitation piped up and refused. He decided that it was easier for him to give and to save Dr. Tom’s donation for a time when there was no one else available. I was floored. How is this even okay? For a moment I thought they were joking, but then I realized there was no laughter, no smile, and no other donor. After a few minutes, the idea settled in and I realized once again I’m in Africa. Phillip graciously walked to the lab with Dr. Tom to get typed for his donation while the woman lay sleeping, too ill to even know what a sacrifice he was making. I was amazed. What a great way to end the day.

The Potter and The Clay

Friday  March 23, 2012  Day 14

Today we held clinic in Medina for about 5 hours. Phillip and I acted as the doctors with Dr. Tom running between the two of us as a translator of sorts while overseeing our work. It was CRAZY, but even more so exciting to be calling all the shots. At the same time though, it was very nerve racking and frustrating because the translators were so few and I didn’t want to miss anything. It wasn’t until after about the 5^th or 6^th patient, that I had to remind myself again T.I.A. !! Anything is better than nothing and nothing is EVERYWHERE.

One lady came in with “the boil” that “hot her leg and make it warm”. When I raised her skirt she had an abscess the size of a baseball that was necrotic and smelly. I told her to “wait small” while I went to ask Dr. Tom if we had any wound care supplies. He looked at me with a puzzled face that told me he clearly did not know. “Let me go check to see what we brought,” he replied. Soon enough he came back with a Ziploc bag full of 4x4 gauze and a roll of Kurlex with some tape and scissors. “Here you go,” he said “Do what you can.” 

For a moment I panicked. “No gloves?!” I thought. I’m sorry but this is not something that I will EVER be able to chalk up to T.I.A.! Again I tell the lady to “wait small” while I leave her to go search for gloves. I ask a couple of the nurses with no success. Finally I interrupt Phillip’s room to scavenge. In the corner, in front of an open window sat a dust-covered box of size large latex gloves. Thank goodness! I snatched up a pair and shook them off. As I placed them on my hands, I brushed them across my scrubs and noticed the dirt that they left behind. All I could think was “it can’t be worse than the dirt that’s under my fingernails”...

So now, on top of being limited on knowledge and supplies, the nurse asks if he can watch so he will know what to do next time. Seriously?! I am hardly qualified to be doing wound care myself much less instructing someone else on what to do! The thought that my actions could shape the type of care that many others receive from this nurse long after I’m gone crossed my mind briefly and then again I was reminded T.I.A., you take what you can get…and right now it was me, a dirty pair of gloves and a bag of 4x4’s or the mud encrusted leaves that the “country doctor” had put over her leg. I decided I would prefer the dirty gloves with clean gauze and inexperienced hands too.

It is so easy for me to get caught up in the every day responsibilities of my job that after a while I begin to feel responsible for the bad and want to take the glory for the good. More often than not though; it’s the responsibility issue that troubles me the most. I feel the weight of having to “save every life” or make every person better. We struggle a lot with it in the peds ward when at least a handful of kids every week don’t go home or it’s “just another day” when 2-3 infants expire. It’s not a mentality that I’m used to and it’s not one that I like to accept, but again I have to learn to be satisfied with knowing that it is beyond my control and just as it is for all other things, it’s better left to God.

I don’t know how that lady will come through with her leg ulcer, but I am certain that the road of healing will be long and painful and I suppose it may never have even begun if she hadn’t shown up today. I refuse to take glory for any outcome, though, because I know that my actions were not my own but were guided by someone much more powerful than myself. I pray that God guide all those in the clinics here who will continue to heal once we have left and most especially for all who use healthcare as a ministry of healing- that they may always remember that they are merely an instrument of His will.

"And now, O Lord, you are our Father, yet truly, we are clay. And you are our Maker, and we are all the works of your hands."

Isaiah 64:8