Life in a box of chocolates

A little story about how practically and impractically God provides for me. This is from the last few minutes of my life.

I’ve been helping to care for my Grandma in the hospital since she just had a big surgery.  That isn’t really what the story is about, its just background. Well, my Grandma is a simple lady – easy to please, difficult to anger, a pleasure to care for. She doesn’t require much. But over the past many years, we’ve come to a little “tradition” of me getting her Godiva chocolate for special occasions. The tradition goes that I buy some at a discount store (I don’t tell her that part, because part of the fun is that it seems like expensive, fancy chocolate), and then she takes it from my hand saying things like “you’re trying to make me as big as a cow” and acting like I shouldn’t have gotten it. And then she keeps it on the counter at her house and rations it out one piece every day or two, until its gone.

Well, I’ve been planning to go get her those chocolates each day that she’s been in the hospital. And each day I’ve been too tired, or too busy. So, when I come back to the hospital, it’s been empty-handed with regard to my planned gift. Plus, though I’ve determined to do it because it is something special, I’ve thought many times about how I shouldn’t really buy things that aren’t necessary. I’m not completely broke, but it’s the principle that if there’s no income, there shouldn’t be any purchases apart from necessity. But a few minutes ago I just thought to myself that I needed to be sure to take care of getting it done today, especially cause Grandma’s appetite is starting to come back.

So, I just stopped by the house to find a package addressed to me. No joke, “Godiva Chocolate” is printed on the outside, and inside is a box of chocolates with a gold bow tied around. I smiled as I picked it up, seeing my name on the front. Immediately, I told Him thank you for His provision. I mean, I could tell you a thousand times when “coincidence” provided exactly what I needed. Time, and paper, would limit me if I started to name the ridiculous things - ranging from the right color socks to thousands of dollars- that have appeared at exactly the right time. I’m no fool, that’s no coincidence. By no means do I mean that God is some genie who grants my foolish wishes when I rub the side of my Bible in just the right way. Nope, He isn’t like that. And His gifts aren’t like that either. They are usually more like this.  Unexpected, undeserved, and just right.  Now sometimes He seems like He hasn’t heard, or hasn’t seen, or once in a while, like He doesn’t even care. But I’ve learned to trust that He always does, regardless of whether it is really clear to me. But sometimes, He really does do this kind of practical provision. And I love it cause maybe it is something tangible that someone else could actually see and understand.

And then I’m reminded of the impractical. One story always leads to another it seems. Like even Christmas. That was a totally impractical, destined to fail kind of plan. I wouldn’t have wrapped up God in flesh. And I sure can’t understand why the hope of the world was stuck in a little podunk town with average parents. Nor do I really grasp the life He lived and how His righteousness gets to cover my unrighteousness.  And then there’s the cross, and blood, and death, and resurrection – none of those sound reasonable regarding options for saving the world. Sounds kind of impractical for a God who just spoke and the world came into being. Why such an elaborate plan? Why didn’t He just speak again? But as I read the story I am reminded of how lavish this impractical love was. That Somebody chose to give their son to save me. I can’t understand that. I’d like to think that I’d give my life for lots of different people. But not my kids (the theoretical ones, how much less willing if they were actually real onesJ ). And not for a kind of wobbly plan. Or messed up, selfish people.

I think about the crazy extremes of His love. Wishing I could see Him smile as I opened up that box on the porch, understanding His care and provision through chocolate that will bring joy only for a moment. And then a minute later considering the kind of love that bought my life, at a much greater cost than it was even worth.  

Small things and great things

The cell phone sings out its tone, indicating a message has been left. Fingers quickly go to pushing the numbers and letters on the screen, communication activated. Minutes pass and no one realizes that all around the dinner table the scene from each seat is the same. A small screen held between two hands, a slight glow of blue light reflecting up to each face. After a little more lingering with occasional pauses to slip the fork again into the mouth, deeply engaged in private conversation, dinner is finished and the people turn their separate ways and return to their respective individual lives. Though, in fact, they never left their own insulated worlds to engage with anyone else, not even to break bread and give thanks.

Christmas shopping done with no lines, only a few clicks, and a charge through some unseen, yet not imagined network. No reason to brave the cold, plan with friends. I mean, the only friends one really needs can be found on Facebook. There one can live a life imagined. Whoever they desire to be can be the presentation they give. Wild and free, perpetually beautiful in 1000 “duckface” selfies, happy family, happy pets, mom of pets, mom of six, healthy, sexy, with someone who is sexy. In fact, why would one even need flesh and bone friends. Fewer “off screen” friends just limit the amount of shopping that must be done. And, anyways, they distract from the games on the computer. So little time. So many computer games. Interacting with society just limits the ability to fully connect with your Mac or PC.

And it is all so quick. So many things done with just a click. What did we ever do before we had devices like this. Cords. We did corded telephones. Cords were so binding. And before that it was the dark ages, and I wasn’t alive, so I don’t know what those poor souls did.

What is really amazing is how we get so much done, but still don’t have enough time. So many friends, but few real friends. So efficient, and yet still not completing life as we had hoped. How does that work? We don’t even have to wait for a pause for a breath between words like we did in the old days, we just read the rapid fire texts to keep up with friends. But there is something lost when you laugh alone at a friend’s post online, and can’t laugh together. There is something that feeds a friendship about a good snort, breathing warm life into the both of you. And you miss them when you close the door to part ways. All that is lost when all your friends are online, make believe friends. You never really miss them. They sometimes catch your thoughts, but rarely really steal your heart.

And then there are the families, texting one from upstairs to the one a level down. The kids see the list of things to do, but they don’t feel the love of the parent. There is communication, but it is unintentional – squished in between sports games, trips to the refrigerator, and a quick rush of gifts on Christmas morning. Not enough time or energy for discipline, at least not the consistent kind. But kids are resilient, they’ll probably grow up fine, right?

And the worst is that we think that because all of the rest of life is a fast food, right now mentality in which the only relationships which are often maintained are superficial, we believe that God will find that acceptable too. So, we say a quick prayer here and there, mostly in a genie like manner when we need a parking place, or when our team is down a few points. And then expect that such, combined with fulfilling the obligation of church (when we have time enough to fit it in) entitles us to good graces with the Father. We make God small, because we have only a few crevices left in life in which to fit Him into. And then we know Him shallowly, call on him superficially during times of need, and expect Him then to be a God who makes all our dreams come true. We have confused the short lived pleasures of visiting Disney, with the everlasting delight of living relationally connected with the Father.

But He has a bigger, more costly, more fulfilling agenda than we usually like to acknowledge. And He invites the weary, broken, tired, and scarred into it. He offers rest, but not a 10 minute cat nap. Rather a soul at rest in both hurricane force winds and sunny, pleasant days. He welcomes into relationship. But there is nothing superficial in this offer. It is a bit unfair, I will admit, for He enters the relationship with complete knowledge of our deepest parts and we begin with only glimpses of His character. Most interestingly, as we grow closer, we only see more and more how big He is, and though we know Him better and better, He only feels bigger and bigger, and we always smaller.  Though we try to hide our faults and failures, He knows them all. He is not interested in mere trivialities found in acquaintance-ship. He is always a strange mix of bruising and healing, ease and tension, work and rest, play and seriousness, comfort and a sandpaper rub. But never is He coldness, never careless, never unloving. And with Him, we are always part ourselves - plain, ordinary, sometimes dirty and much less than we would wish -  and part the best of who we could ever hope to be. In fact, He wants the best for us, and the best from us. He is strange that way, always wanting to better us, sharpen us, strengthen us. Indeed, one of His dear qualities is that He is not one to leave well enough alone. No, if He welcomes us, it will change us. Delightful, yet painful is His love. But I suppose all real love is. His relationship will test and try, as He has done from the very beginning. Not a kind of twisting such as a desire to break into pieces, but more of a process of refining, like obtaining pure metal by putting it through the terrible heat of fire.

I want to be better. To be known. To be accepted. To be made right. And yet, all this takes time, and process. It is not something rapid. But it is something that, in its finality, shapes well. It is enduring. The problem, though, is that He only offers it as a long walk, through all of life. Not only when we are aware of our need, but at all times. No, it doesn’t really work to order Him around as if in the drive thru on the way to work. In fact, He never has seemed the sort to take orders at all. But He has said that He hears the humble, and that if a man draws near, seeking beyond all else to know Him, then indeed he is welcome into relationship. He offers that man may engage Him in conversation. And yet, it isn’t the kind of conversation that we often desire. Answers are not immediate, nor always are they clear. Sometimes he answers with a story, or parable. And often we only see that He answered as we look back behind us. It seems once in a while that He wasn’t paying attention at all while we were talking to Him – but of course I guess He could say that sometimes it doesn’t appear that we were paying any attention to Him while He was talking to us either. And in truth, the latter has been indeed true many a time, though the aforementioned never once has been. And besides the guidance that we’ve specifically asked for, He has given us page after page of lessons, counsel, warnings, promises, direction, and command. But, turning page after page to see what His thoughts are takes…time.

So, too many of us don’t want what He offers, at least not on His terms. But, alas, the only way that relationship comes is on the eternally assigned conditions, set up by Him.  It isn’t a quick fix. No, that it isn’t. Not duct tape on the pipe. It is a real fix. In the long haul, it requires effort, and diligence, and persistence. But really all of relationship with Him is founded on faith. Believing the unseen. It can be so hard to believe what is not seen, so many desire no part of that. Unless they are out in the cold snow, heavily bundled in coat, hat, and gloves. Then, it is all too desirous to see the exhaled air lifted from their nose and mouth in a funny little white puff. Something unseen, yet quite obviously going in and out with every deep breath. But now away from silly things and back to the matter at hand. Faith. It is too much for so many.

And then there is time. It takes too much time to really seek Him. Many a night I would rather fall asleep under the covers than truly take the time to talk with Him seriously. And after a few weeks of relatively little deep conversation, I have wondered, “why does it feel a bit distant here recently?” And then I remember, that I pushed Him away a little as I put the phone on the bedside table (to be sure I was available if any important text came through) and pulled the covers up. At first He didn’t mind much cause He knew that I was oh so tired. But honestly many of those nights I was just too lazy. Too lazy to talk, too lazy to listen. He saw that I seemed to want some space, so He gave it to me. That is how we are, not willing to invest time. Pulled away by small connections, small warmth and small hopes of just a little rest. When He is offering us better connections, better warmth, and complete rest.

There are many things in life are so useful, and can be so distracting. In their own realms, it is difficult enough to maintain boundaries to keep the important things important. Family, and friends, and loves should be pursued, for they are worth it. How much more is our relationship with God worth? Whatever it is that holds us back from full devotion and pursuit are just small things through the view of an eternal lens. How greatly He has loved us. Endless writing couldn’t contain even the love shown in the life of Christ. And then, far less, yet still infinite are His provision, care, and love shown a thousand times over each day that we live. He is worthy of continually being our first affection, first desire, and first priority.

Return

I could barely control my excitement as I sat on the plane. Realization of longings to be near those I love, to feel the fulfillment that they bring – it was so close. The thousands of miles I traveled over the days comprising the journey was made shorter and more delightful by the anticipation of joys to come.

My family awaited me at the airport. The familiar burden of the clinging weight of my nieces and nephews hanging off of me almost immediately returned me to a feeling of normalcy. I felt my heart beating with an old, deeply soothing rhythm of pleasure and wondered at the sudden return of its song. Perhaps its pulse had missed beats here and there since I had been gone, and I hadn’t really noticed until the sudden restoration. Whatever it was, it was good, and right, and pleasant.

Conversations were again simple. “Will you be here until Christmas?” “Can you hold me?” “Did you see any lizards?” “How big were the lizards?” The important things were just small things. And I was glad for the feather-light weight of them.

They have, however, begun to have a significant interest in finding me a husband. Even in the airport my oldest niece was picking out men, suggesting which ones looked like nice ones. She has apparently determinedly been searching on my behalf. There have been some issues though, as she doesn’t consider age or marital status in her assessment. My nephew is the only one with significant insight and clarity on the issue. He says that he hopes that I only meet grumpy, old men, since that way I can just live with their family forever (or at least until he’s 20, he says).

The pleasures have been deep. Deep enough to swim in. And they have been shallow. Shallow enough to miss if not attuned. I’ve sat around the dinner table, passing bowls of home cooked food to the hands of those who share branches in my family tree. I’ve picked handfuls of blueberries off of the bushes out back of the house, remembering when we planted those little sprigs that now are high above me. I’ve tasted the freedom that comes from being able to get in the car and drive (something that I have greatly missed), to feel the wind blowing in the windows as I sing Motown off-key at the top of my lungs. I’ve had four children’s bodies strewn all over my bed, clinging to my words as I read them the stories of Narnia. I’ve seen glimmers in the eyes of old friends. I’ve given long awaited, strong hugs, filled with gratitude and love, to those who have prayed with me and for me.

What comes next, I do not know. But I am thankful for this season now of simplicity and restoration. Of seeing small things as great things. And enjoying Him through winding foothills of life in Travelers Rest. Like a promise, it resonates with me. Rest for the weary traveler. Rest in Him. 

The Barrenness of Seventeen

This all started over a month ago. She was pregnant at seventeen. Scared and unprepared, she looked for a way out. Traditional medicines were taken for a month trying to provoke an abortion. Finally, she had gone to another facility and gotten a D&C procedure to scrape out the little life. And for reasons unknown to me, a second D&C was done the next day. Unfortunately the results of those procedures included complications all too common in the developing world.

All of that happened before she came to me. She moaned and then gasped as I touched her abdomen. It wasn’t just tender along the uterus, it was tender everywhere. I knew that the prior procedure had likely caused a hole in the uterus. And I knew that there was likely infection taking hold inside. I counseled her that there was a true possibility that I could even have to take out her uterus, leaving her barren. But she was in such pain, she just nodded. I counseled the family as well.

During the operation I sent word out to the father and mother that indeed, the majority of the uterus was rotten. It had to be removed. They understood. “Clamp”, “tie”, “suture”, “cut”, again and again until the malodorous, dead organ was out. I closed her up and continued antibiotics.

The next day I sat on the edge of the bed and counseled her again. She nodded, eyes glazed over, barely listening. I told her that we would talk more specifically when she came to see me in the clinic. I counseled the family again. Each day she made progress, and finally I sent her home with follow up a few days later.

She was doing amazingly well on her return. Too well. There was no somber spirit, no sense of sadness. I needed to counsel her again. She was either in denial, or she hadn’t listened at all.

This time she started to weep. Her head bowed low. Her tears ran down her cheeks. Everything changed in that instant. She finally understood. She hadn’t before, and though her family had known, they didn’t tell her. The fact that she otherwise would have died was no consolation. Her life changed in those fleeting moments as she sat in that straight backed wooden chair. The carefree youthfulness of her seventeen years became shackled by the adult understanding of a barren life. She realized then that huge parts of her adulthood and womanhood, had been taken away. Her moans were heard in the adjacent rooms as she heaved, rocking forward and back.

Finally her breathing slowed toward normal and her tears dropped to only one by one rather than the prior river’s flow. I told her that her pain was real, and there was loss, but that her value had not changed. A conversation too often repeated with patients struggling with infertility of all types, women stuck in a culture that says they no longer have any value. It didn’t make it all okay. It didn’t make her leave with a smile. It didn’t take the pain away. She was overwhelmed by the thoughts of what her life would and would not be. New fears and insecurities were already taking hold. The depths of her tear-filled eyes laid her soul bare before me.

Mistakes made, consequences realized, naivety lost – all of it too real. Bitter truths. “Valuable, God says that you have worth and value, and none of that has changed”, it was the one truth that had the ability to resonate deep in the darkness of her soul. It is the one truth that can carry her now and through a lifetime. 

A little Bible study for a Sunday post

Amos. One may ask, why in the world read in the obscure book of Amos??? But I love to read the old words, see the way God has worked from times past. No one can pin Him down as to what He will do next, or presume that because once He acted in such a way, He always must. For He is God, infinitely greater in imagination, wisdom, and knowledge. But sometimes I like to see the things He does over and over, the themes that always seem to return. Through those age old texts, He still guides and instructs.

Amos was just a normal shepherd. He had no social standing, or religious authority. He was just a simple guy, doing a simple job, living a simple life. Until God gave him words to say, elevating normal flesh to the mouth of God. His prophecies were hard for the nations surrounding Israel, they had been evil, and judgment was coming. And come it eventually would. But more interesting, and pertinent to the church today, seem to be his words toward Israel.

Specifically he addressed neglect of the poor, direct abuse of the poor, and the pursuit of injustice. The Israel that he addressed was then a wealthy, place, full of people reclining at ease. Satisfied in their religious practice, they sought God only partially, and with an impure heart. He was not their everything, but had become small to them. Amos reminded them of His greatness “He who made the Pleiades and Orion and changes deep darkness into morning, who also darkens day into night, who calls for the waters of the sea and pours them out on the surface of the earth, the Lord is His name…” The simpleness and greatness of morning and evening, the steady stars, the seasonal rains – all made and changed by Him. But they had forgotten. Their lips spoke of Him, but life showed that their hearts were far from Him. “You impose heavy rent on the poor and exact a tribute of grain from them…For I know that your transgressions are many and your sins are great, you who distress the righteous and accept bribes and turn aside the poor in the gate…”

Their perceived themselves as dressed in robes, but really they were dressed in rags. They self-righteously envisioned how good they would look when they would one day stand before the Lord, as if He should be so glad to have the honor of meeting them. But harsh words awaited them. “Alas, you who are longing for the day of the Lord, for what purpose will the day of the Lord be to you? It will be darkness and not light; as when a man flees from a lion and a bear meets him, or goes home, leans his hand against the wall and a snake bites him. Will not the day of the Lord be darkness instead of light, even gloom with no brightness in it?” He goes on to say that he has come to despise and reject their sacrifices and offerings, for their hearts are wicked when they offer such things to Him. Instead, He desires that “justice roll down like waters and righteousness like an ever-flowing stream”. Real faith wasn’t going to live turning a blind eye. He didn’t want vain words, or monotonous service, He wanted hearts devoted, lives changed.

The people were like mahogany veneer, overlying pressed board. External service looked good, but beneath was cheap, self-centered religion. I wonder how much of religion today fits that same analogy. Filling the visible roles necessary to find acceptance within the church, and yet really being all about our own wants, desires, and pleasures. We cast away thoughts of the poor, walk a shady line of righteousness that appears acceptable, and turn a blind eye to injustice. Faith is spoken of, but lives never show the change that real faith inevitably brings. We say that we care about what God cares about, but our lives are quite revealing otherwise. What a sad delusion to say to ourselves, “Oh, we long for the day of the Lord…” only to realize that justice on that day will surprisingly be unfavorable to many.

The book of Amos goes on to tell that even though justice would come and would be painful, God was eventually going to purify and draw people closer to Him. Restoration and redemption would be accomplished, and would be amazing. It is a common theme through the scriptures. The world is messed up, it will feel the repercussions of the paths chosen, but there is yet a plan for something better to come. God will not stop pursuing His children, even through the brokenness they have created.

Another theme found here, and recurring through so many other parts of scripture, is how God over and over again directly correlates the honest and transparency of our relationship with Him to the way that we care for those in need among us. If our eyes are blind to the orphans, widows, poor, suffering, etc, it could be that we are really blind to the desires of God. Just as later when asked, what are the greatest commandments, Christ would answer “Love the Lord your God with all your heart and with all your soul and with all your mind. This is the great and foremost commandment. The second is like it, you shall love your neighbor as yourself. On these two commandments depend the whole Law and the Prophets.” This even includes the prophet Amos, speaking so long before Christ about the truths of loving those around us. For Gods people, to be made right with God would mean also to be made right with others. To just turn away from the needs of people around us is an indicator that our hearts have probably not been truly inclined toward God.

It is incredible to me to know more of the story. How often the themes repeat, the same story and lessons at different times in history. Things veiled and seen only dimly by the prophets of old, now made much clearer by Christ. Redemption has been completed. And yet the gracious character of God is still made known again and again, even as His people fail time after time. As the church, may we have eyes to look on the accounts of old and have a clearer view of the God we serve. I hope that we can learn the hard lessons through the lives of others, have our eyes opened through their stories. Too sad it is to waste the years, only to look back and realize that our affections were wrongly placed, our energies thrown into foolish pursuits, our lives poured out for things that don’t matter. May our hearts be always inclined toward Him. And as we serve Him, may others see the greatness of His love and compassion, even in the midst of a broken world.  

Fighting for health, and knowing God's hand in the midst of it all

I knew that something wasn’t right when I heard her story. She had been taking malaria treatment at home, and the sickness should have been better. The treatment she had gotten was almost always effective. But still, she was sick. We put her in the hospital and put her on IV medicines to make sure that she received all that she needed.

But she got worse. She started vomiting, and contractions started. Labs were drawn as she was prepared for a repeat C-section. Her twins were delivered safely. But her labs came back, showing that something was terribly wrong. But what it was didn’t seem to fit in any typical specific diagnosis. She was destroying her own blood cells, and her kidneys and liver weren’t working well. This type of pregnancy-induced disease can always be dangerous, but her type was worse than normal because it was much different and more complicated. I drew more labs to rule out rare disorders, hoping to find a medical diagnosis that she could fully fit.

The day after surgery, she started having trouble breathing. People like her are at risk for this. Suddenly they go from feeling relatively okay to drowning from the water filling their lungs – we call it “flash pulmonary edema”. I had already restricted her IV fluids to less than what is normal to avoid something like this. But she was so sick, and even minimal fluid went straight to her lungs and tipped her over into respiratory distress. If the fluid got any worse, she wouldn’t be able to breathe. No breathing, no living. I knew what to do, and I quickly and urgently gave orders. Sweat pooled in the notch at the bottom of her neck. She leaned forward, muscles straining for every breath. There was only one way to help, I had to get the fluid out. The only way for that to happen was to make her urinate. Her kidneys were going to have to make urine, make a lot of it, and make it quickly. But they were damaged already by her disease process. I wasn’t sure if they would be able to do what I was going to ask them for. I pushed medicines into the IV line, knowing that the next several minutes would tell me if her kidneys were still functioning enough to get the fluid out. I watched her urine bag. The kidneys rose to the occasion and began filling the bag with clear, beautiful urine. I delighted to see it coming. An hour later, there were only a few beads of sweat on her brow. A victory won, but the war ravaging her body was far from over.

There were fevers starting too. This seemed like a separate problem. Fevers should mean infection, but it seemed there was no infection to be found. I knew that they weren’t from her recent malaria after a day or two of continued treatment. But blood tests, urine tests, x-rays, ultrasounds – nothing was showing where the infection was coming from. Antibiotics were started. Fevers continued. Finally, the only thing left was to assume that she had an infected blood clot within her pelvis somewhere. I couldn’t see it on ultrasound, but I knew it must be there. It is sort of a last-ditch diagnosis, when everything else has been considered. So, I started her on blood thinners as treatment to break up the clot.

I waited, and doctored, and prayed, and hoped. By this point she had required five units of blood (since her body was killing off her own blood cells, we had to replace them with transfusions). The blood would drip in, but by the next day, the blood level would have fallen again. Finally, the blood level remained steady overnight. Her other labs also began to move in the right direction, indicating that the multiple organ systems which previously were struggling were heading toward normal functioning again. And lastly, the fevers finally stopped. We turned the corner.

She held her babies in her arms today as I signed her discharge paperwork. I realized that every day that I had come to sit on the edge of her bed I had come to like her more. I had become more invested. I had been the one in charge, working to save her life. I had been the one trying every morning to figure out how to manage her to restore health. But I wasn’t the one who could actually make her better. Sometimes women just like her don’t turn the corner. No matter what we do - not with the best care, not in America, and certainly not in Africa. I don’t know why one and not another. I only know to ask for wisdom and guidance as I practice medicine, and know that He is able to be trusted with the outcomes. So as she left and I said “Thank the Lord for two healthy babies and a healthy mom”, I didn’t say it lightly. He holds it all together, and I see that is His hand doing so. Mine are too small, too human. I am grateful for the work that they have been given to do, but alone they are not enough. Indeed, thank the Lord for two healthy babies and a healthy mom. He has again provided. 

Normal Patient, Extraordinary Moments

It was the most normal of surgeries for me. An abdominal hysterectomy. Big fibroids distorting the uterus and causing heavy bleeding. Her story was all too common, not at all thrilling. She had lost significant amounts of blood from the menstrual flow, and her blood level was one third or one fourth the amount of normal. Each time she stood up, the dizziness came because she had lost too much to really sustain herself anymore. She had already received one bag of blood replacement, and two more were on the way. So, I gave her the options of medicines versus surgery, and she desired a hysterectomy to remove the offending uterus and permanently stop the bothersome flow of blood. The bleeding was too much to send her away, so I put her on the schedule for the next morning.

The case went well, no complications, no excitement. And just as I was closing up, I heard her crying, almost weeping. I leaned over the curtain that separates the body from the face, usually keeping the humanity veiled away from the surgical field. I asked, “Is she okay?”, wondering if she was feeling pain from the surgery. The response was rewarding. She was weeping for joy. She had just asked the anesthetist if the bleeding would ever return (which I did cover in my counseling, but she must have not completely understood). When he told her that she would never again have this problem, the tears began to flow. She heaved her chest as she gasped air in between sobs. And then she began to sing praises to the Lord. A sweet, sweet moment breaking through the ordinary clamps, knots, scissors, scalpel of routine surgery.

Just a half hour before, while I had my hands buried in her abdomen assessing the size and mobility of the distorted uterus, I had thought about how blessed I am to be able to operate. Blessed that people would trust me inside their bodies. Blessed that I’ve had training to provide good surgical skills. Blessed that God cares for my patients long after my hands have finished their work.

My contentment in my calling, and her delight in newly found relief from the heavy burden she bore mixed together in that operating room – swirling around in worship to the God who gives good gifts, and allows us to do the same. I’m grateful to be able to pour energy and life into another. And I’m grateful that He is the One who she praised and glorified. 

Afraid of the Weeping

Been in the room too many times when the cancer is diagnosed, when the baby is lost, when the marriage is over. Tears and snot running down faces too beautiful to be puffy from hopeless weeping. Daughters and sons, husbands, friends – the awkward moments leave silence and space between relationships. Who knows what to say?

Most often everyone steps back. The pain is uneasy, tense. Our comfort is at risk. This is a time for the pastor to step in. The family to step in. The doctor to step in. The counselor to step in. Someone else. Not us. We aren’t trained or prepared. They write whole books on how to deal with this stuff. We feel foolish. Can’t fix it, and that is what we want to be able to do.

I remember times of pain, some near, others long ago and forgotten by others.Sitting in a purple plaid chair in the hospital lobby, alone, tears streaming down my face. That day as he died, I knew what loss felt like. Another time, fear and pain consumed me. I was just a child, lying in the hospital bed alone. The medications given into my arm were supposed to make me better, but also had side effects of making me hallucinate, the terror was so real. Such confusion in the midst of hurting so badly. And then again, when their marriage broke down, so lonely, such despair. Whose was I? Not theirs, so hers? Or his? In heartbreak. In despair. A thousand times I have had reason to cry.

David cries out to God in the midst of his distress – “Reproach has broken my heart and I am so sick. And I looked for sympathy, but there was none, and for comforters, but I found none.” So sad to cry out, and hear no one answer.

Who hasn’t bled, who hasn’t cried, who hasn’t lost. Each member of the body of Christ has been through circumstances that have pain us, shaped us, sometimes scarred us. Each has some compassion to share, a shoulder to lend. But we don’t want to share or lend. When the uncomfortable times of grief, or pain, or confusion come we want to draw away. But maybe God has been training us just for that moment, to step in. To try, knowing we may fail. To offer silence, or words. Provision, or even only presence.

The Word says “Rejoice with those who rejoice, and weep with those who weep”, and later regarding the body of Christ, “And if one member suffers, all the members suffer with it; if one member is honored, all the members rejoice with it”. We were meant for this. It is part of our life together.

Christ left the example for us. He didn’t just find Himself in the midst of the needy, He went out to be among them. He stepped into the world of dust and filth. He saw the Samaritan woman at the well, thirsty and tired. But he met her not exalted as He deserved, but dirty, thirsty, and tired Himself. He multiplied bread for the multitudes, knowing hunger Himself. He took Judas’s foul kiss, feeling the knife in His back, stabbed by betrayal. He watched His mother weep, as her heart was broken. He cried out to the Father for relief on that dreadful day, feeling His abandonment for the first time. He looked in Peter’s eyes as the rooster crowed, knowing that his best friend had been too ashamed to claim Him. He bled. He cried. He lost. And because of this He understands our trials and our pain. He also understands our weaknesses, sympathizes with us, and provides mercy and grace for our times of need. We are to be His, imaging Him into the broken places and broken lives, not just the easy, comfortable situations. May we have boldness and compassion to walk toward those in pain rather than walk away. He has trained us through our own trials, for times such as these.

The Search For Aisha Kelly

The story began long before I arrived. A young couple looked at their premature newborn, 28 weeks of gestational age (way too early). The village elders, several old Fulani men, came and told the doctor, Dr Kelly, that they were just going to take the baby home. They had no hope for it. Against all cultural norms, she stood against them. She told them that no, they weren’t going to take the baby girl out of the hospital. She would not relent. Cultures collided – Muslim Fulanis and the Christian medical doctor were at odds. The doctor won, believing that there was hope for the small, frail life.

The child was eventually discharged from the hospital, healthy and normal. And she bore the name Aisha Kelly, the latter obviously in honor of the pediatrician who cared for her. Relationships were not only restored, but flourished. The whole village came to know of the tiny baby, and the strong-willed doctor.

Now, a year later, Dr Kelly was going to the village to see the child. This seems like a simple concept, but the practicalities were more involved. It is best to travel with a second person, especially as a single woman in the developing world. So, she needed somebody to accompany her. I didn’t know the language, or the location, but I was somebody. So, the plan was made, and off we went.

We walked half an hour to the edge of the nearest town. Two motos (mopeds) were arranged as she bargained on the price. The ideal moto driver is a bit older and a bit fatter, as this generally indicates a lower testosterone level and safer ride. The last key is to pick one with a helmet on, since at least he appears to have some concern for safety. Mine had no helmet, was young, and skinny. But, such it was, so I just prayed as I put on the helmet I had brought and jumped on. As light raindrops fell, we were off. Further and further from town, down dusty dirt roads, out into the bush we went. Dust particles covered us, even grinding between my teeth.

The cell phone for the family we were visiting wasn’t working, nor had we actual directions to where they lived, and lastly, the family name couldn’t be recalled. We only knew the name of the nearest village. But we were determined. The family is from a aforementioned tribe called the Fulani, cow herders who previously were completely nomadic. The group that we were going to see has two camps, hours apart. We were hoping that they would be at the one near the village that we were heading toward.

We arrived at the village market. Most of the villagers didn’t speak French, so we wandered around until we found a man who did. Then the three of us wandered around more, initially in what appeared to be an aimless fashion. Within an hour, though, we had found an elder from the Fulani tribe, who spoke neither French, nor the predominant local language. He was one of the men who had come to the hospital, demanding the child a year ago. Immediately upon seeing Dr Kelly, he smiled and laughed as he rushed to greet her. She had won his respect over the intervening time. There were four languages that were being translated amidst all the people in order to figure out where to go to find the husband, wife, and little girl. Finally, after much ado and the formation of an entourage of translators mixed with moto drivers, we were again off.

A few miles down the road, and off the path, to where the path narrowed. I could tell we were getting close. There were several women bearing large loads atop their heads, with fewer clothes, more skin, and dense brightly colored beads. The decorations seemed to grow heavier and heavier with each subsequent woman, signs of beauty and prosperity, shiny glimmers covering necks, chests, ears, wrists, and ankles. Their appearance showed that they were obviously Fulani. Finally, the motos stopped, though there was no trail, or obvious camp. We began walking through the bush until we saw the small domed houses, covered in plastic tarping. These structures even have the appearance of the nomadic, temporal lifestyle, easily picked up and carried off to whatever place is next necessary for the grazing of the cattle.

Finally, we had found them. The grandmother came out, with little Aisha Kelly wrapped on her back. Another family’s child also peered out at us, obviously stricken with some condition limiting his mobility, nearly crippling him. Then came the young father and mother. I watched the mutual delight of Dr Kelly and the family. The little girl locked my eyes, at first scared of the white skin, but intrigued as well. Again translation ensued through many people, the long task of communication.

It turned out that the wife was pregnant again, which allowed for encouraging her to come to the clinic for care. Any woman who has had a prior preterm baby is at risk for having a similar outcome, and needs to be watched carefully and given some special medicines to try to prevent a repeat of the prior early delivery. So, Dr Kelly pushed me forward, indicating that I was the mom-baby doctor, and she needed to see me. I was glad that I was there, as she would be much more likely to actually come for and accept care within an established relationship.

We enjoyed the time, took some photos, and eventually said goodbye, mounting the motos again and heading back out the path to eat more dust. Furthering relationships here almost always requires a bit of adventure, stepping out into the unknown, risking something. But I suppose that life worth living requires those things. Life lived today. 

A typical fulani house

They are taught not to smile in pictures, it isn't that they were scared to death of Kelly

Mom and little Kelly

Worth Running For

I finished with the lady in clinic. Her problem list included high blood pressure, thyroid disease, obesity, and medication exposures that can cause damage to a developing baby. Ugghh. High risk pregnancies are difficult to manage even in the developed world with fancy tests and monitoring. Here, “high risk” just brings a sigh and a sense of helplessness. Too weighty for limited resource settings. I headed off to the house to grab some lunch, glad to have closed her chart for the moment.

I was about 2/3 finished with my bowl of macaroni noodles when I heard the noise. Like a circus clown horn, with a high pitched honk-honk. I had heard rumors of such a horn, and was sad that I hadn’t ever heard it here. So, I jumped up from the table, leaving my fork in my lunch bowl, and ran for it. The only problem was that the hospital compound is on a circle. As I approached the road it hit me that if I went the wrong way, I may miss it all together. So, I just started yelling “Fan Milk? Fan Milk? Fan Milk?” There was no reply, sadly.

I saw one of the missionaries heading across the grass. “Mr Teusink! Have you seen the Fan Milk man?” To my delight, he directed me in the way. A few moments later, I rounded the corner of a house, and found him. There he was, looking glorious, the ice cream man. He rides his bicycle around tooting the little horn on the handlebar, selling ice cream in little sachets. I put in my order. “Five?”, he questioned. My reply “I’m hungry” as I smiled and rubbed my belly for emphasis. I smiled as I walked away, carrying my bag of goodies.

Finishing my bowl of room temperature noodles, I grasped one of the cold plastic bags, tore the corner off with my teeth, and squished all the ice cream up through the little hole. Delightful. A new, and wonderful addition to my life. The ice cream man might become one of the more important men in my life. He definitely brought joy to my day. In those few moments, I went from sigh of helplessness in the face of medical problems, to sigh of satisfaction and happiness. Ice cream makes my heart beat fast in delight.

Phone rings, it’s a retained placenta. So, I’m off. But I’ve been refreshed, ready for the next thing. Thank God for life’s small pleasures amidst normal needs and tasks of life. 

Looking in the rear view

It’s a Toyota hatchback. Always a hatchback it seems. Me and seven others. Seven “healthy” others (aka obese). Children don’t count, so more can fit if kids are piled inside. Thick hips and thighs crush together, one sits forward and three sit back. Armpit at my head, one arm thrown behind the next passenger too. No one needs to know anatomy to realize that there is a nerve on the outside of the calf. Pressed firmly against the door, or the neighbor’s leg, every time the one leg is numb when we finally arrive. Today is no exception to the norms.

The driver hangs out the window to allow one more passenger (or obtain one more fare). He swerves around potholes and people, beeps his horn. Oftentimes, though not today, he is obviously inebriated, as the odor of alcohol wafts toward us through the wind blowing through the open window. We pass police check, one after the next. He gives them a coin so they turn their eyes from the long list of obvious illegalities. And then we pass on through.

He drops us at the taxi area, where we scatter, each into another hatchback or mini-bus. It is the same routine. Finally, I get dropped at the bus station. My ticket says “VIP, 8:30am”. But VIP may be misleading. It means you have an assigned seat, and the bus should leave on time. “On time” is sometime before 9am, and it is much better than the non-VIP bus, which only leaves after every single crevice and crack is filled with human cargo.

I’m in seat 3. Seat 2 has a skinny guy, but yet he leans halfway over into my seat. My thigh, my shoulder, they each touch his. I lean deeply into the window. “Thank You God for the window”. Seat 2 only shifts more, making himself more comfortable. I am the only passenger who recognizes the idea of personal space. So, I silence any complaint, knowing that the culture here currently rules over my own preferences. I’ve come to find that the inner thigh is really the only place that one can call their own on public transport. Every other place is public. Buttocks are shifted, one person on the next, babies are halfway on your lap, pushing against your breasts. Feet are entangled. Yep, the only part that I get to keep is my inner thigh. But thank God I get at least one part.

The bus moves slowly, up the winding hills. In spite of the uncomfortable seating, the driver is safe and cautious, partially because the bus’s steady, slow limit of acceleration. I listen to music, singing out the window, finding opportunity to worship with the engine muffling the sound of my words. Deep, thick black smoke blows on us from the unmaintained semi-truck, painfully pulling its load in front of us. The bellows out of the engine rush into the window, and I cease my song for a moment.

After a while, we come to a stop. Suddenly swarms of hands shove bananas, plantains, roasted corn, coke bottles (filled with something that is not any official coke product), bush meat creatures – resembling armadillos, furry rats with long tails, and sometimes a small deer or monkey. The sellers envelop the bus, each passenger buys the desired items, and the bus begins to move. As the tires roll dangerously close, the sellers are forced to retreat from the hope of a day’s wages. I smell the curled, dried fish that some passenger bought, and it pushes me further out the window.

But no matter. I smile, grateful for the chance to ride. The smoke and fish, the drawn out slow pull up the hills, the uncomfortable skin on skin – they are all noticed but not concerning. My eyes are set ahead, looking forward to the hope of coming things. Glad to see the rearview mirror looking at the past, things truly behind. Last time I took this one-way trip with a paid hospital car, I received a bill for $450. That was on the day that I arrived. Today, I return for a $10 charge. Lessons learned along the way (many important ones - one just practical one was how to save about $450). Eyes now wide open to realities, some of which were much more romantic while hidden. And yet, also opened to the graciousness and provision of God seen both personally and through my patients.

I praised Him through the difficult days on those beautiful, hard mountains with the hospital nestled between them. I praise Him now on this windy road, uncomfortable, but hopeful. And I am learning to praise Him at all times, though perfection of that may be beyond sight, far off in the distant haze. I am reminded of the constancy of God in the midst of varying circumstances, of time and place. He calls for heart worship through them all. And the worthiness of the One who calls is constant and unchanging. 

Goodbyes and Hellos

I knew that it was time to walk away. The moment I turned my mind toward leaving, it was as if a big cement block was removed from my shoulders. I physically felt some sort of strange freedom.

But I do hate goodbyes. I had several good friends, and knew it would be hard. But I wouldn’t cry. I knew it. My missionary friends from the next city down were sad, just as I was to be leaving them. But we always knew it wouldn’t be for the long term. They had seen my through some hard times, heavy laden, and dark. And we had enjoyed many times of fellowship together. As we drove down the road for the last time, my friend noted the mood simply with “this sucks”. When he stopped and stepped out to get gas, I was left only with Kindle, one fittingly named for the fire and warmth she provides. She has been a  bright spot of laughter and joy that I had the privilege of walking these roads with. We often found ourselves reveling in giddy drunkenness, brought merely from the intoxicating humors of life. She only said, “I don’t do goodbyes well, you already know I’ll miss you. Lets keep it at that”. I replied, “You already know how much you mean to me”. That was it. Short, sweet, the way I like it.

But then came Anna. I knew she could bring me to tears in a moment. She worked in my house 2 half days per week. Plucking chickens and grinding flour, and other such things that I wouldn’t ever get time to do without her. But it wasn’t like she really worked for me. When we were together, we just fooled around, laughed, cooked, ate. Life was brighter on her days. Literally, she always opened the curtains. But more than that, she left my heart more alive. She was the only Cameroonian who really knew me inside. She didn’t require cultural sensitivity, or a fake smile, or a special greeting. I’d smack her on the butt as I left for the hospital, retreating quickly before she had the chance to swat me back. She was the closest thing I had to family during that time and in that place. “Bye ma”, I’d laugh as I fled. She would smile, “bye daughter”. I stopped to pray for her just before I put my bags on my shoulder. She just stood there. And I knew that this would be the one time for me, the first time in many, many hard months, that the tears would flow. She grabbed me and just held on. Her sobs heaved into my chest as she said, “I’ll never see you again”. I felt the weight of her soul leaning into me. I could only hold her, and tell her the best of truths. I would see her again, if only on the other side. And it would be wonderful. I spoke of the thing that I knew for sure, and whispered instruction “Love the Lord with all of your heart, mind, soul, and strength – in this He will be pleased”. I told her that I loved her. She finally let go and lifted her head from my chest. I put my bags on, and she watched as I walked away to the road.

My current season is full of comings and goings. “Hello” and “goodbye”. I am thankful for those who have passed through life, stayed a while, had a seat. We’ve shared joys and pain. Let’s not forget those who have made our paths brighter, those who have provided shelter in the storms. And let’s not forget to do the same for others who walk along through our lives. 

Moving Along

After a year and a half, I knew for sure that the hospital where I had initially been assigned was not a place that I would call home. Trustworthy people who had walked these paths before I came advised me some time ago to consider another place. I lingered, wanting to make sure that I had done my part and tried to honor my commitment. It has become clear that I have fulfilled my obligations to the best of my ability, and am able to move on to something else.

As my two year term is drawing nearer and nearer to a close, I've decided that it is time to volunteer at another location to see what differences may be found in another mission hospital setting. The organization that I work for (Samaritan's Purse) has been constantly supportive and gracious, and has agreed that I am able to explore other options for the last months of my service.

So, bags are packed and I'm heading off on another journey. I am going to a hospital in Togo, West Africa (a few centimeters up on the globe, but pretty far away in reality). There I will be on a team with some other doctors who are trained in obstetrics. I'm excited to see differences within practice patterns and medical care between hospitals. I'm also looking forward to working within the community of believers there (of whom I already know a few people).

I'm refreshed and encouraged as I step into a new place and new phase. I'm looking ahead to see what God has in store. And I am thankful that it is He who holds my hand and leads through it all. Thanks for your prayers as I transition. I'll try to keep the stories coming. 

A Good Laugh

I found myself laughing a big, deep, belly laugh all by myself while lying in bed. I’d gotten a phone call and had been rolling in laughter until tears were squeezed out from my eyes. This story is not for the easily disgusted, it is indeed far too much information to put out there on a blog. But since folks sometimes accuse my blog of being a downer, I figured I’d share the twisted humor that delighted my soul.

Two background ideas were running in parallel. The first is that times are often very difficult at the hospital where I have worked for the past 1.5 years. Stress can be unimaginably high. In the midst of such, I have a few friends who live a little ways away who make it a point to care for my soul. There’s always a top bunk available, a fridge with food in it, and a house full of fellowship.

The second running storyline is that I have had terrible gastrointestinal upset for over two months. It must be some Africa-induced misery. I’ve taken all the antibiotics, antiparasitics, probiotics, etc that have been recommended in multiple courses, yet to no avail. Still I am rushing out of the OR for the nearest toilet all too regularly.

Earlier today I called to ask my friends what days they would be leaving to go out of town (as I know they are travelling soon). I was in a rush, so I got off the phone after just a couple of questions, finished what I was doing, and headed back to care for my patients. I never thought of it again. But they did. For hours they wondered if I was alright, if the day had been something awful, if I needed their support. That is just the kind of genuine, caring people that they are. Finally, hours later as I lay in bed, I got the call. “Do you need anything? The door is always open. We are here for you and can come get you if there is something wrong. You can come out of town with us if you need a break.”

I responded that today was actually a surprisingly good day, with excellent patient care and multiple episodes of encouragement. The person on the other end of the phone line was a friend of rare quality, who immediately brings a sense of comfort and familiarity beyond what most could in years of knowing them.  So, I just bluntly told her the real reason that I had called earlier. In the midst of one of my GI moments, I realized that I really needed to do something about all of this terrible diarrhea. The situation had gone on too long, and suddenly I realized my desperation. Enough was enough. This was ridiculous. I needed labs, and blood tests, and evaluations only available in the big city which was many hours away. Since I knew that they were travelling to an area where there was a major lab, I was considering getting them to take down a stool sample in a coffee can and a vial of blood for me so I could get a real diagnosis.  It had initially seemed like a brilliant idea. It didn’t seem awkward until I said it out loud.

The contrast of her concern for my well-being (now completely alleviated) and my true intentions was too much. I got totally tickled. We both began laughter too great to continue the conversation. It was the rolling type of laughter that could make one pee their pants, the type with risk of losing control, the type I usually only dare engage in with my sister. Well, during the intervening time since I had come up with this great idea and made that initial phone call, my doctor from home had recommended another regimen of antibiotics, so I had decided to hold off on the stool sample. Through my choking laughter I told her that she was relieved of the wierdness of poop transport duty. I was laughing too hard, we had to hang up the phone. And so then I just laid there in bed with alternating giggles, then full on obnoxious loud laughing bursts. Tears rolled, cheeks tired, abdominal muscles became sore. It was wonderful. I was reminded of how good God is to give moments of delight. As well as how good He is to give friends and fellowship of such caliber that could encourage and protect my heart, as well as be considered close enough for intimate requests of a much more embarrassing nature.

The Broken

Woman after woman comes into the exam room bringing her designated plastic sheet, folded neatly. She unfolds it, presses out the creases, and places it on the table. Then she follows the nurse’s instruction to sit atop the shiny plastic. The history takes a few minutes, telling her pattern of uncontrolled leaking. Sometimes stool, sometimes urine, sometimes both. Then the story takes fleshly, human form as we examine. By this point, often she is sitting in a pool of urine, it shifts and splatters on the plastic beneath her with every movement.

The line outside the door is filled with similar stories. One normal occurrence – getting pregnant and giving birth – and everything changed. Left life shattered, leaking, foul. Drip. Drip. Drip. Always cleaning but never able to be clean. Most have been left by husbands, rejected from society. The odor wafts strongly in and out with each patient. They knew that there was a problem, but never had the money to get it fixed. But thankfully, now they have heard of this opportunity for free treatment, and they have made the trip. Some from near, some from far. All ages – young, embarrassed teenagers with recent births sitting beside old, wrinkled women who have borne their shame for decades. Each with desperation, and each with hope.

Days later that hope is mixed with fear as she walks to the operating room door. Her longing for continence, for normalcy stirs within to overcome the anxiety as she lifts herself onto the operative bed. Spinal is placed for anesthesia, legs flexed back into the gynecology stirrups. And the repair is begun.

My surgery skills are enough for the easier ones. On those, I operate while an experienced fistula surgeon assists. But many are beyond me. Those are scarred, fibrotic fistulae, in difficult to reach places, with much higher risk for failure after the procedure. On these patients I assist while an extensively experienced surgeon operates. I watch their hands perform from the creativity of their imagination, combined with years of training and experience. For a moment, I occasionally am jealous, wishing that I had the same level of skill. But after a second passes I return to the reality that life doesn’t work that way. We all start novice, and time brings us expertise as our hair grays. I focus again to learn from the experts, watching their thoughts work themselves out with the throw of each stitch. Some time later, she rolls on the stretcher back to the fistula ward, with hopes of being a new woman, a restored woman.

The next morning we pass by to see each woman. “Dry” is translated by the nurse, though often the patient’s smile needs no translation. Sometimes there is disappointment, but most often cautious joy. Sometimes overwhelming, unrestrained joy. It is amazing to see the soul stirring in a woman whose body has been restored to what it was meant to be.

A picture of renewal. We all need renewal, restoration. We all need Something beyond us to make us who we were meant to be. For most of us, we hide behind our own strengths, masking our weaknesses, insecurities, and failures. We feign wholeness, pushing brokenness out of sight into the recesses of our minds and flesh. Sometimes we even buy into the idea that we are okay. We are good. We have forced self-discipline, we’ve grasped success, we’ve made something of ourselves. But all it takes is one phone call, one doctor’s visit, one screech of metal on metal, and our fragility is exposed fully, laid bare and open. A deep cut from the normal occurrences of life, and we are left hemorrhaging, empty. Suddenly our awareness of our lack of sufficiency becomes acute. Sometimes that is what it takes to break our façade. To realize that our deepest needs are beyond our ability to supply. We all need restoration deeply in our souls. And thankfully, God offers us that. Through Christ, He has made a way to be renewed, made right. What we could not be with all our effort, He has made us – sufficient and whole.

These women, with brokenness unable to be hidden from the harsh eyes of the world, are finding healing. They have called out for help, and help has come. We delight to see their once known, then lost, now restored body with all its function. Theirs is easy to see. How I long for the rest of us to have eyes opened to know our brokenness, to realize our desperation, to call out for the One who offers help. The tears of the saints for generation after generation have been for restoration of the brokenness around us. A restoration better than intact flesh or function, rather one of the individual man to the God who made him. I praise Him for being a God who restores. And I am thankful that He allows us to be instruments of restoration in His hand. 

Another Airplane

Since the first time I heard of it, obstetric fistula had peaked my interest and stirred my heart. The condition occurs after a long, difficult labor which causes damage to the urinary system or bowels. Women then leak urine or stool from the damage incurred during labor and delivery. It is crippling for a woman and affects every area of her life. I've tried time and time again to get involved in more training during my time in Africa. And at last it worked out for me to go to a fistula camp.

I got on the plane and was off to Uganda. I arrived at the Catholic hospital which was the site for the fistula work. It's nice to work with a bunch of nuns, mostly because names aren't an issue - you can just call everyone "Sister" and it works. For someone like me, who is terribly bad with remembering names and faces (basically just can't remember people), it was a great perk. I was definitely the trainee among the physicians there. Other well established fistula surgeons had come from Great Britain and other parts of Africa to take part.

Word had been spread for weeks over the radio, and women had responded from hours and hours away to come for help. It was a good time for me professionally as I was able to learn techniques and get feedback from other doctors. I have been working alone for a good while now, and I really miss having other people within my field to bounce ideas off or or to get advice from. It was also refreshing to be in a different environment than usual and to see how other hospitals work.

On the way back out of the country I got to stay over for a bit in the big city. I have become much more easily entertained over the time I've spent in Africa, and was delighted to get to just go to the grocery store and look through all the merchandise. So many options. I love to gaze down all the bright, shiny aisles. Next, I had the luxury of going to a swimming pool where I swam until my fingers and toes were all shriveled up and water was stuck way down deep in my ears. And lastly, one of the greatest and most treasured opportunities was getting to spend some time with other Christians who I met along the way. What a delight to meet people who love the Lord and are willing to follow after Him wherever He leads. They are dotted across nations, tribes, and tongues spanning the globe. All with one great affection and purpose, Christ and His glorification.

Thanks to those of you who have given financially, you've made it possible for me to take this trip and begin learning more techniques that can help the women who I serve. And thanks of course to each who prays for me in my work here. I couldn't make it without you. 

House Call

I walked the rocky path up that steep hill. My lungs restrained me, as my feet tried to hurry. I wondered if this was wise. I had my emergency supplies tucked in the bag on my shoulder, along with my lunch (hate skipping meals). It was something I hadn’t done before, so I was a little nervous, and a little excited.

She had said she desired to deliver at home. She knew the risks, and she knew what she wanted. I reluctantly told her that if I wasn’t in another operation or busy in clinic that I would come and deliver her there. So, I finished up two hysterectomies just before the phone rang. The contractions were getting stronger.

I arrived up the big hill, short of breath, and was grateful to find that she was already well into labor. I balanced in my mind the ease and carefree doula approach and the well drilled medical training. If everything went well it was going to be awesome. If things didn’t, it had potential to be awful. I listened for the baby’s heart beat from time to time. Again, a bit awkwardly, I told her that if she wanted anything specific, to just let me know. I would be checking in on her and the baby, and if she wanted me to help any other way, or if anything changed, she would need to tell me. Thankfully, she was content to labor quietly, no drama, no overly specific plan.

I waited. Ate my lunch. Listened to the heart beat. Waited some more. Prayed for mom and baby. Waited. Listened. Small talk. Waited.

After a couple of hours, the forces inside culminated into the deep urge to push. She was completely in control. I guided the head out, then the body. The baby’s lungs filled with air and she strong cries began. She was beautiful (besides slippery and a bit bloody, of course - the norm for all newborns). I breathed a sigh of relief, all had gone well.

I was glad it hadn’t been a long labor. Patience isn’t my strong point. All of obstetrics, of course, has a lot of waiting involved, but the constancy of midwifery-type one on one care is different. I have always appreciated and respected it. A doctor is often more pointedly intentional about the times and interactions with patients. We always are there when the patient needs us, we enter in and bring a trustworthy set of values and skills. But a midwife is there regardless of distinct need, she is a provider, but more relational as a companion and friend. I felt like a strange mix of both, sitting in another person’s home, my tools spread out on the sterile towel beside the bed.

I can say I like both parts. In training, I used to enjoy slower nights on labor and delivery that would allow for more patient interaction than the usual rapid pace rushing from one room to another. Partnering with a patient in labor takes a soothing, calm spirit, only a bit of thrill after a long while of support. There’s something special about the delivery room provider’s relationship as they walk the patient through the pain. I’ve always liked near the end, when their eyes are searching, scared, wild – and then they meet with your eyes, settle there, and find a place to trust and focus.

But then there are the times when everything doesn’t go quite right. And then I’m glad that I’m a doctor in a hospital. All of the sudden, there is the rush of an emergent delivery. The call needing immediate help. The bed rolls quickly, the IV runs, the instruments fly into place. In a few minutes, it is all over. The emergency has been managed.

As enjoyable as a normal birth is, there is something trained up inside me that must prepare for those emergencies. I am not able to enjoy the tranquil, doula experience like many. My right hand is now meant to hold a blade, to cut in case of emergency. My mind is remembering where I have set the medications to treat hemorrhage – just in case. Lists of risk factors for numerous emergent possibilities run through my thoughts.  I am enjoying the awe of new life, but not lost in it. Making their moments special means that I protect them by preparing, even while they don’t know it.

But after the blood, and cries – when life is established and the baby’s lips are firmly latched onto mother’s breast. Then. Then, whether complicated or uncomplicated, I can embrace fully the amazement of what has happened. I can see that what God has made is indeed wonderful. I can protect life, but I can’t give it. What a wonder. I sure am glad that He lets me be part of it. 

One for V Day

I recently was spending time with some teenage girls. I glanced over to see one of them gently turning the pages in her magazine. I laughed a bit as I asked “Is there anything you aren’t telling me?” The magazine was a bridal catalog, filled with fancy gowns and ideal poses. She answered, “No, I just love to look at these, they are my favorite”. Dreams were being formed, shaped, trimmed, tucked with each turn of the page. She hadn’t ever even had a boyfriend, but the hope continued to grow for the fulfillment of plans for that special white-satin draped moment. Hours and days cumulatively spent pondering the specifics of some far off occasion. The delight in the thrill of love and excitement of marriage were captivating. “The one” as yet unknown, but known somehow to be completing and satisfying in the walk through life. She naively dreams of perfect beauty and love, a perfect life, a perfect day. How much she wants to give her life away. Can’t wait for it. Longs to say “yes”.

And yet there is a divide when God asks for a life. We shy away, a bit put off that He would think this a valid option. I mean, maybe its okay to ask if You can stop in from time to time for a visit, but all of it? The audacity and impudence of God for asking for our everything. Often He is greeted in an unwelcome manner, as if through the locked screen door. Suspiciously we may ask what He wants, but we are taken aback when He wants too much. Funny how we would question His motives, wonder if He’s worth it. But when some half-way handsome fellow with a smile walks in and sweeps our feet out from under us, we would gladly promise everything. On the one hand completely trustworthy, patient, loving, all knowing, all powerful – we find Him too scary. But on the other hand, the one marred by frequent failures, irrationality, fickleness, along with a few decent attributes hidden amongst all the defects – we find him delightful. Why can’t we see that God’s love infinitely greater, more secure, more sheltering?

I think of the young girl who sits dreaming, the future full of wishes. Somewhat worthy dreams, somewhat false reality. And I wonder, is what you dream of worth giving a life away for? Is it going to satisfy? Or will imaginations hit the rock hard ground of the earth we trod and the fleshly-ness of it disappoint? Maybe someone tall, dark, and handsome is coming. I do hope that sweet girl finds great love that makes her days brighter, her smile bigger. But I know for sure, Someone is going to ask for her life, all of it. But He is better than the perfect man she day-dreams about as she flips the pages of the magazine. And if she dares to say “yes”, He is going to be infinitely more amazing than what she has dreamt. He can take a woman and breathe life into her. She will only have thought that she lived, dreamed, was, before He came. 

May she, and many others, boldly welcome the One who does complete. May each find dreams bigger and fuller than imagination ever lent before. When He asks, let us not draw back and shy away, but instead respond with “Here’s all I’ve got, all that I am”. 

Dim Hope

She had been only on the earliest brink of the changes to womanhood. She had never even seen her menstrual flow, but the boy in the village wanted to have sex, so she agreed. He pushed his frame onto her childlike bony frame. That is what had started all the pains. Months later, at twelve years old she lay pushing in the darkness for days. Finally, after the seemingly endless labor, the family made it down the lengthy footpaths out of the bush to a distant health clinic. A clinician with minimal training cut open her belly and released the dead baby from the tiny pelvis which had become its prison. Her family’s dread turned to a bit of hope that maybe the girl would live.

And live she did. But life became much more complicated. Just after the surgery, urine and stool both leaked though the incision on her abdomen. Foul odor and discolored drainage from the urine-feces mix stained clothes day after day. She was sent back to her village, where it continued for a full year. Then, finally the wound on her belly healed, the dirty leaking through the incision stopped. Her bowel movements returned to normal. But the urine did not. Now, she began urinating constantly through the vagina. Whatever injury to the urinary tract that had been, managed to find a different method of exit. Still, it was better than the prior, at least the stool had stopped. Years went on, time continued. For seven years she stayed in the village, smelling of urine, and dripping all around.

Finally, she came to the hospital. I wish I could say that all got better, and she left with a smile. But that isn’t the way it went. Some initial blood work showed that she had HIV. Further tests and examination revealed that it wasn’t a new, mild case, but full-out AIDS. Her health was terrible. In a few moments, her world had once again worsened tremendously. She thought her world had fallen apart long ago, but now even the intact threads seemed to be shredding.

I got some initial tests for the urine problem. It was still her heaviest burden - the plague that she felt the most, and the trail of urine that others could see and judge. The HIV at least was not known as soon as she entered a room. She hoped for a cure for the chronic leak. I examined inside her pelvis, noting that its full development had been stunted by the pregnancy, now many years ago. My finger felt bones like that of a normal ten year old girl. She could barely endure the pain of the exam.

We sat down to talk, not of immediate satisfaction, but a lengthy process. First, she needed months on medications to fight the newly diagnosed virus that was ravaging her body. The chance of healing would be low if we decided to operate before her overall health was improved. However, even getting the medications was not an easy task to manage, since the closest place to obtain the necessary medications is a two day walk from her village. But determined, she agreed to make the journey monthly for the drugs. Then, we needed more imaging studies of the urinary tract to make sure we knew exactly where the defect was that was causing the urine loss. These costs were beyond her means, but thankfully the missionary who had brought her to the hospital agreed to help cover the hospital’s costs. Lastly, she had to understand that the repair would be difficult, and depending on what we found when all of the information was put together, I may need to wait for a specialist to come with more expertise than I have. She understood. Resolution to her condition wasn’t a magic tablet that could affect a quick fix, but it was a glimmer of hope.

But a glimmer is important when the rest of the world is caving in so awfully dark. In the midst of pain, filth, rejection, scars, odors, drips, disease, despair – a glimmer starts to grow. And maybe one day it will burst into flame with some beautiful light. Life has been too hard. At least now there is a little, tiny ray of light peaking through that days may get better, and wrongs may be right. Maybe one day she will shine like “a city on a hill”, or a “lamp on a lamp stand”, giving light even for others to see. But for now it is only the smallest little speck, the tiniest little ray buried inside her. I hope that her soul will begin to find rest and comfort as we begin to care for her body. I hope that her burdens are a bit lighter, as she begins to know that others do care and want to help. For now, it is our job to bring our lights to her, to bring hope into her darkness. It has been too hard for too long.