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. 

Born Broken

“Some people are born with these kinds of problems…”, that is how the explanation started. I had the luxury of reviewing the patient’s booklet the day before, and realized that her problem was genetic. However, it is the sort of problem that doesn’t display itself until puberty. All the other girls had started to wear bras, grown mature patterns of hair, filled out their curves. But she didn’t. In the states, the parents would have brought her in at 13 or 14, realizing that something was wrong. But not here. Here, she presents in her mid-twenties with the chest of a child, no hair under her arms (or anywhere else that may signal maturity), never having seen a cyclic pattern declaring womanhood, dark eyes filled with insecurity and disgrace.

It is a rare problem, where the initial genetic material is wrong. People presenting like this can either have female or male genetic makeup, but they look, and have always thought, that they were a girl. We don’t have the tools to properly work up the genetics. Recommendations are out the window for proper care. I told her of the possibility of surgery, to reduce the risk of a rare type cancer that can sometimes come with this disorder. She didn’t want that. I counseled her on her options for making her develop breasts. Her head shook quickly, confirming her desires. She longed for woman-breasts instead of the little child chest she had worn all her life. This was the most outward, obvious sign that she was not like the other girls. She wanted some hope that she could fit in, and this was the way that had filled her dreams. She didn’t even try to hide her excitement, when she realized that the option was available. I told her that it is a process, not a quick fix. Hope of normalcy sustained the possibility, even if it were going to take a long while.

Next was the hardest part. It is a subject that none of us would want to broach. The uncomfortable nature even made me squirm. I began gently by telling her that she had great worth as a person. That God made her and thought she was valuable. But then came the sad reality. That is God’s way, but not the way of the visible world around her. Her culture gives no value to a woman who cannot bear children. Over and over I see women set aside by their husbands because they are infertile. Three husbands later, they are often still coming in looking for something that may help, some magic chance to have a baby.  This girl didn’t stand a chance. I told her that because the probability for a husband was low, she should really try to stay in school and get a good education so that she could learn to support herself. She had thought of this already, and told me that she was working hard to finish her education. The cultural truths were hard and mean and ugly. She might be good enough to be used or enjoyed by a man, but she would likely never be able to depend on any commitment from one. She would never be accepted as a wife, and would certainly never be accepted by any in-laws. But in the midst of such bitter reality, the eternal truth was sweet, that she was valuable as a human being, and strongly loved by the God who made her.

Sometimes we see that life is just not kind. It is sharp and harsh. Our struggles are each different. Some can be seen from the outside, like this patients. Others lie hidden from the watchful eyes, deep in the broken parts within. But they all still bring pain. Being a Christian doesn’t make life a constant spring bouquet of fragrant pleasures. It doesn’t make every sadness better, every wrong right, at least not for now. But no matter what the road brings, or how defective we feel as we walk down it, there is a deep, abiding pleasure when we stop for a moment and remember that even in our brokenness and incompleteness, we are highly valued and deeply loved.

A funny, likely distorted sense of humor

Hats. People wear some funny ones, mostly passed down from a holiday. But they aren't wearing them for a holiday, they are actually wearing them for a hat. 

Thanks America for the costume!

I don't even know what caption to write. Go get em tiger.

Well, I thought this lady had on a hat, then I realized that it wasn't. 

Baby Santa. Thanks again America!

The old, distinguished man hats aren't like ours.

Santa Motorcycle Taxi. No extra charge. 

Okay, enough with the hats. Though they never cease to make me laugh. 

Next is hospital scenes.

Sometimes you just need a good soft place to rest. 

The taxi just at the hospital gate. Poor fellow in the trunk, as if it hasn't been a hard enough day. 

So, maybe you can't see this, but even though balancing a  huge mass of junk on the head and in the hand, she still has the skill to use her cell. And you thought you had talent. 

Never saw this in the sterilizing room in the US.

Wheres Waldo? I mean, where in the world is my scrub tech?

This isn't funny to me. It's a darn plague of flying insects - everywhere around the hospital.

And this is the kind of plague they like. Grasshoppers everywhere. They catch and eat. This is the storekeeper at the hospital showing me her bag of the ones she caught in the store. Including the ones that just came off of the toilet paper rolls that I bought. I told her she could have them. 

And then for road scenes.

These are a combo, the two are always found together. They know that nobody is going to pay attention to a silly "caution, sharp turn" or "low shoulder", so instead, they quantify how many people have died at this particular location. (Ici 10 morts=here 10 dead). I'll admit that this is dark humor, but I think these signs are funny cause they would never be culturally appropriate in the US. 

Sometimes you just know someone is a nice, warm person. Other times, they probably aren't. Bumper stickers state "Beware of BAD friends" and "SHUT UP, are you God?" x 2. Makes me want to beware of him.

And around the village

"Mbingo - Upper Old Peoples Club"
You are looking at the old peoples gardening spot just behind the sign, inside the "fence". I have no idea if there is actually a clubhouse.

And around town about an hour away

This gang of 4 or 5 police women are streetside high heel shoe shopping on their shift. Machine gun in tow on shoulder. I can't take authority seriously when they are buying stilletos. Really???

Health Care

Every 9 or 10 days I run out. Hand sanitizer is supposed to be provided by the hospital, so I go to get some more. For decades we have had evidence that clean hands by health providers saves lives, but most of the nurses and staff never clean their hands between patients. I must say this is probably partially due to the painful waste of time that acquisition of necessary cleaners can be. I stick my head in the pharmacy window, explaining that I need some more. “It is finished”, is the response. At first, I assume the obvious truth that such a statement means that there isn’t anymore. But during those extra few delayed moments, she adds a statement indicating that maybe there is more, but it isn’t in the pharmacy. So I ask, “where would it be?” The answer is “in the store”. The store is only 2 small cement buildings away, maybe 50 steps needed to get there. I can clearly see it from the window which I am looking in and from which she is looking out. However, in spite of the fact that multiple employees have come for a refill, no one has found it important to go see if there’s any in that building. So, I turn and head for it. There are three doors, I step in the only open one. “Is there any hand cleaner? The pharmacy says they are out.” “You’ll have to check next door”, is the response. I move toward the next door, but it is closed. I return to the other man stating that the door is closed, asking if I should go ahead in. He never looks toward me or acknowledges me, though he is aware that I am there and speaking to him. So, I leave and go back to the second door, push it open. I look over each of the shelves, seeing many items, but no hand cleaner. I return to the man, asking more loudly and in such a way to encourage a response, “do you know where it would be, I am not seeing it”. He finally looks at me and eases up from his seated position. He walks to the second door. Less than a second of glance inside the door brings a response, “I am sure, it must be finished”. I respond, “are you sure, or are you guessing?” He again says the same statement “I am sure, it must be finished”,  never looking within the room again, zero effort to try to find the item that I am seeking. I again respond, “Are you sure, or are you guessing?” Finally he realizes that I am not leaving until some effort is made to actually assess if the hand gel is there or not. He yells, in an obviously bothered tone, to a man walking on the sidewalk, “Is the hand gel finished?” The reply is that there is plenty. Within a few seconds, the new face is walking over carrying a whole box full of the gel. I take a whole large bottle, hoping to avoid this same scenario for at least a month. My tongue gently, yet untamed for the moment again speaks as I turn to the first man, “So, are you sure, or just guessing?”

It’s a foolish example intentionally. There are other examples within every area which are not so foolish and have direct patient effects. Stat labs still unresulted after 12 hours, no staff has checked on them but they are “not back”. Necessary medications were not given, arguments blame nursing staff, no pharmacy, no nursing staff again. None of it is charted, so who could know? Medical records “have not been found”, but it turns out they were never looked for. The patient was admitted, but no one looked at her all night, so they never noticed the complication or notified a doctor. No area that affects medical care is exempt. It is sort of depressing.

But I was riding down the road the other day and saw something interesting. The previously battered road was being repaved. Now, the typical way for road repair is to have some dusty man in torn pants, and an oversized, dirty shirt filling in the hole with dirt or gravel. As the drivers pass by the area where he has obviously been working and sweating during that day, they may give him a coin as his pay. But, this particular road repair was a world apart from that. It was the developed world apart. A French company had been hired to repair a large section of road. The employees working were all Cameroonian. The sight was not anything like a normal process in Africa though. Traffic was stopped in an orderly manner, giving me a good time to watch. Dumptruck after dumptruck of gravel came and went in an orderly fashion. As they dumped the rocks, immediately they were leveled out by the workers on the ground. No one was standing around, there were no extra people. On the other side of the road, an orderly system for grading the land was occurring. The whole process was like watching the inside of a watch – all of the parts were working together to make the clock tick. I had never seen anything so systematic and successful in my travels in West Africa. I wondered, how did they make this work so well? The existing systems did not support such effort, response, or effect. But what had been brought in as the standard within this company was working. The workers wanted work. If they didn’t want to do it within the standard put forth, there were hundreds more standing behind them who would be glad to. Hmm.

It made me wonder. Health care is certainly different. It requires more training and skill than basic manual labor. Developing a good system could not just be “dropped in”. However, how can one make a system that actually is effective within this setting. Is there a way to change the present system? Each missionary doctor comes with that expectation, that some part of the system will be improved as we pour our lives into it. But every one of us would say that the change we have made is much less than we had hoped. I am not foolish enough to believe that there is a place on earth where all frustrations cease and all problems are solved. But I must continue to believe that there is a better way, a more supportive system, for such change. I long to learn more about such a method. I want to see, is there a way to pour out a life where more is left when we finish than just our sweat which has dried invisibly into the ground we have toiled? I believe that whatever work we do should be done well, and that in doing so is a part of how God is glorified through His people. That we should implement systems that are sustainable within our communities and areas of influence. And that the people we serve with should be trained and empowered to carry on after we are gone. But all of that takes a better system than I have seen. Practically I don’t know how to do it. Yet, there is something inside me, determined and stubborn, that refuses to settle for less. I don’t want to see my patients unnecessarily at risk for generation after generation. I want to see life-change, and system-change, and method-change. Ultimately I want the health care that I provide to glorify God both in the present, and long after I’m gone. And that requires some plan for better care of patients and communities.

On the other side of the world, in the land that I would proudly call my home, there is a whole different battle for health care. One of which, as a doctor, I admit that I still do not understand well. It is also true, that I do not have some magic answer that would straighten out the whole, messy system. My world is much simpler, the baseline needs are much greater, and the resources to meet those needs are much less. Of all of the problems that the US has, the developing world has piles more. And there are fewer people committed to solving them. One isn’t more important than the other – I want my family cared for well there, just as I want someone else’s family cared for well here. We all certainly need wisdom in these times. Better systems are needed all over the world. How do we keep the patient a priority, while building an effective system to serve them? It turns out I am not the only one who doesn’t know. A whole army of healthcare thinkers can’t figure it out. There is no easy, obvious answer. May God grant us wisdom as we attempt to care for the people around us. We certainly need it.

The small physician degraded, the Great Physician at work

I was called after liters of blood were already on the floor. Besides a dead baby being delivered and now lying in the baby warmer, now another complication with massive blood loss. I went through all the possibilities of how to treat her, and none slowed the bleeding. The only option left was to go to the operating room. It was a quick surgery without complications. Unfortunately, her uterus had to be removed in order to save her life. I thought that we were out of the woods. I was a little bit proud of myself, that now these complications don’t really get me too excited, not like when I first came out to work here. I’ve had an awful lot of “opportunities” and experiences of big cases for this one to get me flushed.

I went home for lunch. I hate to miss a meal. Just as I finished my soup the call came. Her incision was bleeding heavily. A moment later the phone rang again, now she was bleeding profusely from the vagina too. I knew it wasn’t a surgical issue, all the areas had been repaired well and were not having any bleeding issues only a short time before. I also was aware that such bleeding is much worse than something that can be stopped by surgery. See, sometimes when someone bleeds excessively, they run out of the particles in their blood that actually make the blood clot (yes, DIC for you medical folks). I knew that this was the case with her. Some blood had already been given, but she needed something more. She needed fresh blood to get her the substances that would make the bleeding stop. Really fresh blood. I asked the type, and of course mine would do.

So, off I went to the lab. I sat upright and squeezed my arm, watching the life-blood drain out of my arm. Finally the bag was filled. I knew that if I didn’t take it directly to her that delivery would be much slower. And I knew that every minute counted,  she really needed it immediately. I thought I could do it. I grabbed the blood and walked toward the ward.

The surgery ward lies uphill from the other walkways. In order to get up to it, there’s a sidewalk with a grade. Usually it’s no big deal. But there are times, like when you are emergently pushing a patient, that you realize it definitely has an incline. When you’re pushing that stretcher, you can feel the back of the thighs and butt really having to work to get up the hill. Well, that day, there was no stretcher, and no pushing. But by the time I reached the top I knew that something bad was about to happen. That incline got me. I hadn’t had anything to drink all day. And my body screamed at me that it wasn’t going to take dehydration, followed by the blood loss in the lab, followed by a brisk walk. It was over. Things started spinning and flashing. I saw one of the anesthesia students who is a friend walking by. I reached out a hand with the blood and said “take it to the ward”. Then I sat down, put my head between my knees, and tried to recover. At this point my autonomic nervous system decided to continue the craziness – was it passing out that was coming? No, vomiting…wait, diarrhea… one wave of possibilities followed the next. Even in my current status of degradation and confusion, I could imagine things getting worse and more de-humanizing. I hoped it would just be vomiting. One of the staff saw me and came by to see if I was okay. I could only say, “Get Doctor Keith”. He is the anesthesiologist, and a friend of mine, who I knew was there because he was also watching my bleeding patient. I never lifted my head, just said, “take me home”. He came and shuffled me into a wheelchair. I looked like I was dead. Normally I am one of the palest ones at the hospital (ha ha, like my joke?), but today was especially pale. As well, I was doubled over with my head between my knees, slumped in the wheelchair. Anytime I lifted my head things would start spinning again.

Being a doctor-patient with all the hospital watching was embarrassing. On and on we went, over speed bumps and gravel. I could hear people talking, but couldn’t see anyone with my head tucked down. Even without vision, I could feel them all watching me. Keith kept saying “She’s fine, I’ve just gotta get her home”. Finally I saw the grass passing beneath the wheelchair, and I knew that we were almost there. I heard Anna’s voice from inside the house. (She is one of my best friends here and works at my house one day a week, helping to prepare stuff to cook cause everything is really from scratch – like grind your own corn kind of scratch). I could tell she was a bit scared. I told her I was okay as I wobbled to the bedroom. Within four minutes, I could hear voices in my house. My initial thought was, “Why are their voices in my house? Intruders, and I am not even able to fend them off!” Then heads peaked around my bedroom door frame, and I saw that it was the clinic and maternity staff. They had let themselves in so they could catch any action. When they realized it was just me laying in the bed, unable to get up, they lost interest, said they hoped I felt better, and went back to the hospital. Forty-five minutes later after a good bit of water and a coke, I was pretty much back to normal. I headed to the hospital to check on the patient.

She stopped bleeding when my blood got into her. I’d like to say it was cause my blood was exceptional, however, it was really just God’s grace. She was even starting to make a little urine, which is a great sign that someone is having enough blood in their vascular system. I was cautiously delighted, at least she didn’t look like she was walking straight for death’s door anymore. She had turned the first corner.

I got the call at dinner that her condition was again deteriorating. The hope from earlier quickly began to dissipate. Now she was vomiting blood, and her belly was distending out. When I saw her, I knew that her condition was not just deterioration, she was standing at death’s door again. And this time there wasn’t really anything more I could do. All over the world, her condition would have a high mortality rate. Anywhere in the world, the doctors would have done the same thing and would be hoping that somehow she would turn around. But hope was dwindling. I talked with the family, letting them know that there was nothing that I could do to intervene. I told them that we would watch her, but that likely she would not make it. They understood. I left her there to die.

I thought of her each time I awakened in the night. Finally in the five o’clock hour I woke and reached for the phone. I wanted to see what time she had died. I asked about her, and they said that she had not died - she was still alive! I hung up the phone, praised the Lord, and jumped out of bed to do a little dance. It was no attractive, choreographed dance, but a soul thrilled, wild expression of delight. I was like a little kid jumping around. It was so exciting to hear, so beyond medical expectation, I couldn’t help it. The doctor turned into a four year old jumping and spinning around, giggling laughter and praise. Death was grabbing hold of her by big handfuls, in such a way that no medical intervention could help, and yet now ALIVE!!! I got it under control a bit, dressed and went to see her. From a beyond-treatment, miracle-hoping condition, to talking to me and asking if she could eat. I was so thrilled but cautious – I laughed and like an overbearing mother, then cautioned her - “no eating, no drinking, no moving, no nothing, just lie there and breathe”.

And she did. She kept breathing, and kept doing better and better and better. Day after day she improved. I did eventually even allow her to move and perform all other bodily functions. And then this afternoon I wrote on her chart, “D/C home”. I stepped over to the bed to tell her goodbye. Tapping her leg, I gently woke her up. I gave her the general instructions to call if there was fever or pus or worsening pain. And then I gave her a little glimpse from within my eyes. I told her that she had gotten so sick that I knew that there was nothing that I could do. Walking away from her was the first time that I just left a person in their bed to die. She had been beyond our medical capabilities. We gave her all we had, yet it was not enough. But God had been gracious, and had amazingly restored her health and life. She was the closest thing I’ve seen here to a medical miracle. Like God was just showing off His Great Physician skills. They were indeed great, beyond my capabilities and my mental grasp of possibilities. I am so thankful to watch Him move. I revel to know that He is indeed the one who controls all things, and that sometimes, beyond reason or expectation, He just chooses to save. Bless His name.

Two Girls, Two Days

It was different than any experience that I’d ever had in sports. I mean, it’s been a little while since I’ve broken out a volleyball, but I don’t remember all of that being part of the game. This game had kicking and hitting the ball, whichever was necessary to get it over the net. And within the players, it included hitting, kicking, wrestling, and biting. Thankfully, since it was my first time, they left me out of that part. The deaf kids were glad to have me there. We played and played. My arms were sore, but my heart was happy. Dinner time eventually came and the headmaster sent all the kids inside but one. She was a sweet-faced girl. Initially I had noticed that she was a bit less confident and a bit more shy. It seemed she wasn’t sure of her ability to hit the ball, and was a little embarrassed to try. She was the oldest girl out there. In fact, they told me that she was a graduate of the deaf school who had now integrated into mainstream school with a sign language translator. (As a side note, it is nice to be able to talk about someone right in front of them, and not be worried about if they can hear you.) I heard the headmaster brag on her, saying that she had found her courage to come out and play, as she was often too shy. Though she wanted to, she sometimes held back. After all the other kids had been sent away to dinner, it was only one teacher, the headmaster, and the two of us girls. I watched her confidence grow each time she successfully hit the ball into the air. She wasn’t scared anymore, she was accepted and having fun. At one point, the girl’s phone dropped to the ground as she ran. The headmaster picked it up and said, “Everyone’s got a phone now”, half-jokingly adding “even the deaf”. I said back to him that with texting the whole world is wide open to communicate,  whether or not you can hear. He added, that if they were taught to read and write, a whole other realm could be entered. “Empowerment!”- he reveled for a moment in the victory that he got to be a part of as the leader of the deaf school. I agreed, that it was a big victory, for each child a much wider world of possibilities. I didn’t think any more about it. Just kept hitting the ball back and forth til the darkness began to overtake us.

The next day I had three surgeries. The third was a girl just over 20 years of age. She was deaf and mute, and couldn’t read or write. She made some hand motions, but she didn’t know sign language, so no one understood. When she got excited and was really trying to make something known, she would make some vague noises. All the history came from her caregiver. The exam was not showing any real issues, but there had been a cyst on ultrasound. Based on the caregiver’s persistent claim of the patient’s pain, she had been set up for surgery. She came into the OR, obviously a bit nervous. I stayed by her side the whole time as we prepared for the surgery, intentionally giving her a face and hand that she could trust. The time came for the spinal to occur. I sort of got across through hand motions that someone was about to prick her in the back. My hands rested on her shoulder and leg, calming her, soothing her. She made it through, but tears were streaming down her face. The anesthesia had some issues, so we needed to test and see if she was numb. It became like torture for her. She was already scared. She couldn’t understand why we were pinching her. Her eyes became wild, scared, untrusting. Breathing increased. Sweat poured off of her skin. The medicine that was supposed to make her numb wasn’t working. Finally the anesthesia team agreed to put her to sleep, this was too much for her. She couldn’t understand or enter our world. My heart broke for her. The final tears dropped down her cheeks as the sleeping medicines took effect. This magic drug took away the need to trust, the need to understand, the need to communicate.

I thought of how different the two stories were. Both were born to the same kind of life. But the worlds have become very different. One had entered a world where she had gained confidence in herself little by little. She had integrated into a normal school, she had been willing to take one step in front of the other to slowly make her way in toward the volleyball net (even though a white stranger was on the other side of it). The other had no way to enter the world around her. Her value was no less, but the possibilities were drastically inferior. All the world was filled with unknown risk; fear and misunderstanding lurked everywhere. What set them apart now wasn’t some amazing healing or great medical advance. It was the persistent, day to day struggle that had occurred in a classroom, and in a deaf community. Someone had a vision to care and to make a difference in the lives of deaf children. Each girl represents what could have been. Different choices, different opportunities. Now very different lives.

May we, as God’s people learn to reach into the dark worlds, the quiet worlds, the shameful worlds. Those hauntedly isolated places where people dwell. For me, I need to learn to speak love and truth into lives which cannot hear. If only a hand could come along to lift someone out of a lonely place and draw them near. That is what has been done for us. He brought us out of the pit of sinking, miry clay. He brought us out of the sins and failures and weaknesses that were smothering our life, and He pulled us up and drew us close. He showed us a life of kindness, mercy, and grace. And it has made all the difference. May we look for opportunity to do the same. May we not pass by those who need us. Those who need Him.