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. 

Disheartened

Like the dust filling the air this dry season, troubles and difficulties hover in this place. Almost  every breath breathes them in, breathes them out. You think that maybe the dust has settled, but then a passerby or a rolling tire comes and poofs it back up to fill the air. Even when you haven’t noticed it as much, its still there. You go to blow your nose and there’s half dust, half snot. Just like even the decent days are filled with struggle mixed in, constant dirt in what otherwise could be a nice scene.

Effort has been significant, difference made has been minimal. I will qualify “minimal” by saying that for individuals served by the physician- patient relationship, lives have been changed, spirits lifted, maybe even hearts opened. But in the systemic plagues that define medicine in the developing world, little to no change. Pages could be written about culture, or departmental issues, or education, or mission hospitals, or accountability, or sustainability, but the words would only describe, they couldn’t in themselves actually bring resolution. I have spoken them over and over, and am weary of speaking to issues beyond my strength to change. I have fought hard, a good fight with worthy goals, but winning is not possible. My encouragement is that disappointment now is often looked back on with gratitude for what we have learned in the process.

For now, there are hard, jagged days that I wonder multiple times “how much longer?” Where I check the calendar on the phone attached to my hip to see if the time is drawing near. The constancy of the struggle turns my gaze away from the here and now to something that may someday be. To faces that I love, people that I miss, the gentle blanket of familiarity. For those moments the wonder is gone for distant places and things, and returns to the place where my roots hold fast. The romance in my imagination returns to home. Beauty, and warmth, and acceptance, snuggled alongside those I love most, tucked in between mountains and streams, familiar places, delightful people. And when I think of it, I remember that there is an even better home waiting, an eternal home. One filled with ultimate purpose and pleasure and love. A home where He is. A home that I am one day meant for.

Home. There is no comfort in that word, no heart connection for millions who roam the earth. I do not speak of here in Cameroon specifically, not for the moment. But in nations not too far to the north or east or west or south, and then further countries spotted all over the globe, they are there wandering, wallowing in despair. Daily struggles for survival and basic necessities are considered normal for many. Hopelessness sets in, trying to overtake any other emotion. Children dying untimely deaths, men and women with no semblance of honor left, disease, war, and decay ruining what could be a beautiful world. Yet there are those with a glimpse of hope, not for here and now, but for somewhere and forever. They stop in the midst of the struggle to imagine what it will be like “in a little while”. They long for a better world. The desperate spirit inside calls out to the God above, yearning to be freed from all the horrors that have come to make up life. Longing for the time to come.  

And yet, amazement will always be ignited within me when I recall the reality of the God who hears. I can’t understand even the worst days that come and go in my own life. How much less the much worse horrors in the most desperate of places. I can’t give you the right answer for why bad things exist, sometimes even thrive. But God does hear and is at work from the broken-hearted wealthy, residing in penthouses, to the hungry refugee within the barbed-wire encircled camp. And the rest of those who read this, who are somewhere in between.

I lie down sometimes in my bed at the end of a disheartening day, and in the darkness remember that on the wall just above my head is written “I will both lie down and sleep in peace, for You, O Lord, make me to dwell in safety”. I am reminded of His presence. Even when the night comes on thick in its darkness I can take cover, give a little grin and think “in a little while”. Better things are yet to come.