(please especially don't forward this post onto anyone without my permission, political content ahead)
Back in Nelspruit today. This week will be working in Rob Ferriera Hospital, a fairly urban public hospital here, as compared to the rural clinic we were in last week.
Last night before we left the unincorporated township where the rural clinic is, we had dinner at the home of Dr Ian Proudfoot and his wife Joan. With the luxury of sitting over a lovely dinner in a warm room (I don;t believe there was another warm spot in all of the township. As soon as we got "home" every night, I had to go to bed because I was too cold to be anywhere else), I was able to hear more of Ian's story about how he ended up in this rural area, and it was so extraordinary and touching, I had to share it.
So as I mentioned before, Ian had spent his whole life (up until 18 months ago) in Cape Town, and had spent the first 20 years of his practice there in the private sector. In South Africa there is a public system and a private system. The private system is for well-off people with insurance and money. It is a high quality system, indistinguishable from what you would find in a good US hospital. The public system is government run and known to be overtaxed, underresourced, etc. 80% of physicians work in the private sector, 20% of people in the country can afford private insurance. So the other 20% of physicians are taking care of 80% of the patients, with lesser salaries. Can you do the math and see why the public system is over-taxed?
Anyhow, Ian was working in the private sector, was feeling like he wanted to move to the public sector the more he heard and understood the need. He was exploring different options, and concurrently he and his wife traveled to the eastern part of the country to visit their favorite spot, Kruger national Park, for a weekend holiday. In looking for accomodations during their trip, they found that this clinic, ACTS, had very cheap accomodations close to the park, so they decided to stay there. While checking in there, they found out Ian was a dr and started trying to sell him on working in the clinic, as they were looking for another dr. He was skeptical at first, but he and his wife started discussing it as he had been looking for options in the public sector.
So they are driving through the park, and see 3 people sitting on the edge of the road. For those of you who haven't been to Kruger, you DON'T get out of the car. There are wild animals everywhere, and they walk in and out of the roads, and it is seriously dangerous to not follow the rules. Getting out is dangerous, sitting on the side of the road more so. They assumed the people were refugees from one of the countries northward. Apparently many refugees cross through the park, as it is not gated very well on it's northern border, but it is VERY VERY dangerous and many are killed in the process.
They drive a kilometer further down the road, and see a pride of Lions, close to the road, staring back in the direction they had come, where the refugees were. They had a very intent stare. They continued driving, and Joan became more and more uneasy, and said, "we have to go back and get those refugees, I have a bad feeling." So they went back to the refugees. They tried to talk with them, the refugees did not understand their language. So they gestured into the car. Meanwhile, they can see the lions in the distance, stalking closer and closer. The refugees refused to get in the car, likely nervous because of their "illegal" status. Finally, Joan and Ian pulled out their game book and showed a picture of a lion, pointed to the road where the lions were in the distance, and the refugees got in the car. They then weren't sure what to do with the refugees, but found a ranger to take them out of the park.
Later, while they were getting ready for bed, both of them felt simultaneously like it was meant to be for them to move to the Mpumalanga province and for Ian to work at the ACTS clinic. And as they put this out in the open, and realized they were on the same wavelength, Joan remembered a dream that a friend had shared with them. She had told them that she had had a dream about Ian and Joan recently, and that the imagery of the dream was abstract, but the way she had understood the dream was "once you save someone's life, the path of your life will change." And this further solidified their decision to stay.
And 18 months later, they are at total peace with the decision. Even with daily drives down an unpaved, muddy road, car getting stuck often, black mamba snakes (the most deadly snake in the world) on their front porch, etc.
I just thought that story was so touching and beautiful, I had to share it.
More later on my thoughts about being back in Rob Ferriera and an urban setting, tired now and must go to bed.
Monday, July 19, 2010
Week 1 in Africa
Just finished my first week in South Africa, and my first week of clinical mentoring.
Initially had some computer trouble, and wrote like 10 pages in my journal about how I felt the first couple of days…I will spare you all the details. But basically, I was alternatingly excited and nervous about being here. As I watched the “moving map” on the plane, I got more and more nervous as I saw us approaching Johannesburg. Who was I to be doing this? I am a resident, practically the lowest on the totem pole. And I am here to teach?! Humbling…
So I arrive in Jo-burg on Saturday night. A nice man named Hetmen picked me up from the airport and took me to Pretoria. We chatted on our way to Pretoria. I was struck as we talked at how clearly non-American he was (bear with me, I don’t expect people in other countries to be “American.” In my head I was just comparing things). It wasn’t just his accent, but also the way he carried himself. There was a bit more joy in him than I see in America, generally…And I think also a bit less anxiety. He dropped me at the hotel I was staying in for the night, and said “and now you are home.” I found that so comforting. At first I thought it was just his English translation (but nonetheless found it endearing), but I have subsequently realized that that is a common expression here. Somehow makes things feel more hospitable. And the actions to back up this piece of warm fuzzy dialog. When I arrived at the hotel, the clerk made me a pot of tea before I could even check in, and my experience with service and hospitality has been the same since.
On Monday, Vivian (a woman who is here working for the program for a year), Rolando (a UCSD pediatrician/infectious disease specialist whose last week was my first week) and I drove to Nelspruit, about 4 hours due east from Pretoria, in the Mpumalanga province. Vivian soon returned to Pretoria, so she could fly to England for her vaca.
Rolando and I spent the week working in a clinic called the ACTS clinic. It is a faith-based clinic, whose vision is: “to provide quality care & support to all those infected & affected by HIV/AIDS & to model this in the Masoyi Tribal Area.” Our main contact at this clinic was a man named Ian Proudfoot (not native American, in case you were wondering, because I did). He is a lovely, welcoming, gentle, and inspiring physician. His training was in “general practice” and he had spent all his life and the first 20 years of his practice in Cape Town, in the private sector (essentially rich people). About 2 years ago, did some soul searching, decided he needed to address the AIDS crisis in his country, moved across the country and joined this public clinic. He had never done AIDS/HIV work before, and had rarely seen children. He also didn’t speak Swa-Zulu which is the predominant language in this region. He has proved to be a quick learner of all of the above, and his enthusiasm is inspiring.
The clinic was great. They took what used to be a tobacco farm, solicited funds (partly from Swedish churches, some from PEPFAR – the US government funding of African HIV work), and basically rose from the ashes. An old shipping container was recycled into an on-site lab. Timber buildings with corregated tin roofs house the clinics, a 12 bed inpatient facility, and a counseling center. They have an on-site pharmacy to dispense patients meds, as most patients are too poor to buy meds on the outside. And I can see, they are SAVING LIVES. Just a year or 2 ago, all of their patients would be knocking on death’s door. Despite that, I am struck how many resources we waste in the US, and how we take for granted the billions of tests we order with the click of a button. The providers here didn’t have access to a CT scanner with the exception of a hospital about an hour away. And even then, as I was told “one CT scan would blow our testing budget for the entire year.” So something we order without even thinking in the US is a COMPLETE luxury. And they make do with very basic labs and chest Xrays, and a limited supply of meds.
The children here are so stoic. I was looking at a tiny 8 year old’s anti-retrovirals. They were HUGE. Like, I would have trouble swallowing them. And that was just one pill of three, and she has to take 2 tabs twice a day. I asked her mother how she gave the pills, assuming that she crushed them in food or something. The mom looked at me, surprised, and said “well, she swallows them with water.” The children don’t complain, their parents are not thrown into anxiety about their symptoms. One boy I saw had a rash all over his chest and back. We decided it was either fungal or a complication of his HIV. In the US, he would have along the way been labeled as an “allergy to amoxicillin” (which all the kids here get at some point for their frequent pneumonias due to compromised immune systems). Here, nobody seems to be allergic to amoxicillin. In the US, it is all over the place – “rash” “GI upset,” etc. There, amoxicillin is almost the only antibiotic you can receive for pneumonia, not taking it can result in death at worst, lung damage at best, in many cases, lungs that have already had HIV complications and/or tuberculosis.
I don’t mean to bag on the US. I hope to be a parent some day, and know (esp with my medical knowledge), that I will freak out about every symptom my child has and probably make their doctors nuts. But my point is just that abundant resources allow us to be more picky, more demanding, and more whiny (myself included). I was struck this week how many of the children we saw were AIDS orphans. They were being raised by grandparents, older siblings, or themselves. You hear the statistics, and then you hear a 9 year old recite his own meds because there is nobody to be responsible for the meds except him. I was struck by the number of children who were “failure to thrive” – in other words malnourished. Their HIV is treated, they are screened for TB, treated for worms, and asked about their symtoms. If no obvious cause is then found, the children are watched, sometimes given a fortification powder. In the US, we admit these children to hospitals. I suspect, based on the town I subsequently drove through, more of these children don’t have enough to eat than their caretakers are willing to admit. In addition to there being extreme poverty, a child’s metabolism increases by 30% when they have HIV.
One story stands out to me this week. We saw a 22 month old girl who has HIV. She is the size of a 6 month old (6kg), and has the development of about the same (can only sit up, makes no cooing or babbling noises, poor social contact). Her mother is mentally retarded, and the social situation is complicated. It is unclear whether the child is receiving her antiretrovirals, and how well she is being fed. In addition, on exam, we are suspecting she has some other genetic problems. We talked later with the social worker about her. The social worker expressed her extreme concern about the child’s development. She stated that some members of the clinic wanted to take the child off ARVs and “let her die.” She felt they should do a big effort at advocacy for the child before resorting to this. I was struck by this. The whole situation is heartbreaking, however you look at it. And I guess you can look at “letting her die” in 2 ways. You can see it as compassionate, in a child who will likely not survive much longer, or you can see it as a tragedy in a setting where resources are limited. I am not sure where I stand. In the US, I would like to be able to work her up a bit more and try her in a different social situation (we are doing a bit more work-up here, but it is limited – there is no “organic acid” panel we can get). But after that, I think “letting her die” may be the most compassionate thing. In the US, she would get a G-tube, tube feeds, seizure meds, and would be in and out of the hospital all the time…Is this better? Isn’t it a bit of torture to continue to force medical procedures on a child who will never understand their benefit?
I was also struck by the story of a woman in their “inpatient” unit who had died of coughing up blood, while she had TB, and a superimposed pneumonia. All I could think of was imagining in the US her being whisked off to IR, to get her lung embolized…Here, they handed her a bucket as she coughed, and held her as she died. Would the ultimate outcome have been the same in the US? After an invasive procedure? Is it better to die in the arms of someone or on a cold operating table?
But I have been shocked at the ability of people in the US to rally after what should have been a life ending complication of disease. And they have more time, if even a month or so, to hold and be held in the arms of people they love. So I don’t think everything we do is futile, some of it is definitely life saving, and life-quality saving.
These are just questions I am wrestling with
Initially had some computer trouble, and wrote like 10 pages in my journal about how I felt the first couple of days…I will spare you all the details. But basically, I was alternatingly excited and nervous about being here. As I watched the “moving map” on the plane, I got more and more nervous as I saw us approaching Johannesburg. Who was I to be doing this? I am a resident, practically the lowest on the totem pole. And I am here to teach?! Humbling…
So I arrive in Jo-burg on Saturday night. A nice man named Hetmen picked me up from the airport and took me to Pretoria. We chatted on our way to Pretoria. I was struck as we talked at how clearly non-American he was (bear with me, I don’t expect people in other countries to be “American.” In my head I was just comparing things). It wasn’t just his accent, but also the way he carried himself. There was a bit more joy in him than I see in America, generally…And I think also a bit less anxiety. He dropped me at the hotel I was staying in for the night, and said “and now you are home.” I found that so comforting. At first I thought it was just his English translation (but nonetheless found it endearing), but I have subsequently realized that that is a common expression here. Somehow makes things feel more hospitable. And the actions to back up this piece of warm fuzzy dialog. When I arrived at the hotel, the clerk made me a pot of tea before I could even check in, and my experience with service and hospitality has been the same since.
On Monday, Vivian (a woman who is here working for the program for a year), Rolando (a UCSD pediatrician/infectious disease specialist whose last week was my first week) and I drove to Nelspruit, about 4 hours due east from Pretoria, in the Mpumalanga province. Vivian soon returned to Pretoria, so she could fly to England for her vaca.
Rolando and I spent the week working in a clinic called the ACTS clinic. It is a faith-based clinic, whose vision is: “to provide quality care & support to all those infected & affected by HIV/AIDS & to model this in the Masoyi Tribal Area.” Our main contact at this clinic was a man named Ian Proudfoot (not native American, in case you were wondering, because I did). He is a lovely, welcoming, gentle, and inspiring physician. His training was in “general practice” and he had spent all his life and the first 20 years of his practice in Cape Town, in the private sector (essentially rich people). About 2 years ago, did some soul searching, decided he needed to address the AIDS crisis in his country, moved across the country and joined this public clinic. He had never done AIDS/HIV work before, and had rarely seen children. He also didn’t speak Swa-Zulu which is the predominant language in this region. He has proved to be a quick learner of all of the above, and his enthusiasm is inspiring.
The clinic was great. They took what used to be a tobacco farm, solicited funds (partly from Swedish churches, some from PEPFAR – the US government funding of African HIV work), and basically rose from the ashes. An old shipping container was recycled into an on-site lab. Timber buildings with corregated tin roofs house the clinics, a 12 bed inpatient facility, and a counseling center. They have an on-site pharmacy to dispense patients meds, as most patients are too poor to buy meds on the outside. And I can see, they are SAVING LIVES. Just a year or 2 ago, all of their patients would be knocking on death’s door. Despite that, I am struck how many resources we waste in the US, and how we take for granted the billions of tests we order with the click of a button. The providers here didn’t have access to a CT scanner with the exception of a hospital about an hour away. And even then, as I was told “one CT scan would blow our testing budget for the entire year.” So something we order without even thinking in the US is a COMPLETE luxury. And they make do with very basic labs and chest Xrays, and a limited supply of meds.
The children here are so stoic. I was looking at a tiny 8 year old’s anti-retrovirals. They were HUGE. Like, I would have trouble swallowing them. And that was just one pill of three, and she has to take 2 tabs twice a day. I asked her mother how she gave the pills, assuming that she crushed them in food or something. The mom looked at me, surprised, and said “well, she swallows them with water.” The children don’t complain, their parents are not thrown into anxiety about their symptoms. One boy I saw had a rash all over his chest and back. We decided it was either fungal or a complication of his HIV. In the US, he would have along the way been labeled as an “allergy to amoxicillin” (which all the kids here get at some point for their frequent pneumonias due to compromised immune systems). Here, nobody seems to be allergic to amoxicillin. In the US, it is all over the place – “rash” “GI upset,” etc. There, amoxicillin is almost the only antibiotic you can receive for pneumonia, not taking it can result in death at worst, lung damage at best, in many cases, lungs that have already had HIV complications and/or tuberculosis.
I don’t mean to bag on the US. I hope to be a parent some day, and know (esp with my medical knowledge), that I will freak out about every symptom my child has and probably make their doctors nuts. But my point is just that abundant resources allow us to be more picky, more demanding, and more whiny (myself included). I was struck this week how many of the children we saw were AIDS orphans. They were being raised by grandparents, older siblings, or themselves. You hear the statistics, and then you hear a 9 year old recite his own meds because there is nobody to be responsible for the meds except him. I was struck by the number of children who were “failure to thrive” – in other words malnourished. Their HIV is treated, they are screened for TB, treated for worms, and asked about their symtoms. If no obvious cause is then found, the children are watched, sometimes given a fortification powder. In the US, we admit these children to hospitals. I suspect, based on the town I subsequently drove through, more of these children don’t have enough to eat than their caretakers are willing to admit. In addition to there being extreme poverty, a child’s metabolism increases by 30% when they have HIV.
One story stands out to me this week. We saw a 22 month old girl who has HIV. She is the size of a 6 month old (6kg), and has the development of about the same (can only sit up, makes no cooing or babbling noises, poor social contact). Her mother is mentally retarded, and the social situation is complicated. It is unclear whether the child is receiving her antiretrovirals, and how well she is being fed. In addition, on exam, we are suspecting she has some other genetic problems. We talked later with the social worker about her. The social worker expressed her extreme concern about the child’s development. She stated that some members of the clinic wanted to take the child off ARVs and “let her die.” She felt they should do a big effort at advocacy for the child before resorting to this. I was struck by this. The whole situation is heartbreaking, however you look at it. And I guess you can look at “letting her die” in 2 ways. You can see it as compassionate, in a child who will likely not survive much longer, or you can see it as a tragedy in a setting where resources are limited. I am not sure where I stand. In the US, I would like to be able to work her up a bit more and try her in a different social situation (we are doing a bit more work-up here, but it is limited – there is no “organic acid” panel we can get). But after that, I think “letting her die” may be the most compassionate thing. In the US, she would get a G-tube, tube feeds, seizure meds, and would be in and out of the hospital all the time…Is this better? Isn’t it a bit of torture to continue to force medical procedures on a child who will never understand their benefit?
I was also struck by the story of a woman in their “inpatient” unit who had died of coughing up blood, while she had TB, and a superimposed pneumonia. All I could think of was imagining in the US her being whisked off to IR, to get her lung embolized…Here, they handed her a bucket as she coughed, and held her as she died. Would the ultimate outcome have been the same in the US? After an invasive procedure? Is it better to die in the arms of someone or on a cold operating table?
But I have been shocked at the ability of people in the US to rally after what should have been a life ending complication of disease. And they have more time, if even a month or so, to hold and be held in the arms of people they love. So I don’t think everything we do is futile, some of it is definitely life saving, and life-quality saving.
These are just questions I am wrestling with
Sunday, February 28, 2010
Thankfulness
I went on a walk today. I started off just going to the mailbox to drop in a movie from netflix, and then I pulled a Forrest Gump and felt the need to just keep walking. At first, I thought I would just go around the block, and an hour later I ended up back home. It was a nice walk, I would normally run to get some exercise, but my body wasn't feeling it, and it gave me a chance to be reflective and pray (whereas running, most of my thoughts are things like "must...push...past...pain..."). I realized I needed to focus on thanksfulness and delighting in God's provision. Some things I am thankful for this week:
1. Ms Aretha not having cancer and recovering from her mouth surgery.
2. Having kind of a profound moment with God over my cat being sick.
3. Being able to ride my bike to a lot of places and not use my car.
4. For people like the Brewsters who look at their beautiful house as a gift from God and something to be shared.
5. My community of friends and fellow mentors in San Diego.
6. A meeting with my research boss this week that went well and made me feel like all my analysis has not been for naught.
7. God using my brokeness to mentor a girl many years ago, and getting to see her this weekend and getting to hear how God is working through her in Thailand.
8. My parents who love me and my dad who lights a candle for me at church every sunday, for my health and well-being, and to find the right husband for me.
1. Ms Aretha not having cancer and recovering from her mouth surgery.
2. Having kind of a profound moment with God over my cat being sick.
3. Being able to ride my bike to a lot of places and not use my car.
4. For people like the Brewsters who look at their beautiful house as a gift from God and something to be shared.
5. My community of friends and fellow mentors in San Diego.
6. A meeting with my research boss this week that went well and made me feel like all my analysis has not been for naught.
7. God using my brokeness to mentor a girl many years ago, and getting to see her this weekend and getting to hear how God is working through her in Thailand.
8. My parents who love me and my dad who lights a candle for me at church every sunday, for my health and well-being, and to find the right husband for me.
Sunday, September 20, 2009
Dear Lord,
I hear your message today – do not fear. And yet so much of my life is about fear. So much of my life is about fearing what you are calling me to, fearing stepping off that boat, fearing that I will sink in the black murky water, and there will be no hand to pull me out.
Lord, I don’t see you even when I know you are there. I get so caught up in the hurry, bustle, stress, crisis, that I don’t see you. I don’t know you are enough, I don’t know that you are working all around me continually. I look for glimpses of you, of you “doing something cool,” when the truth is you are interwoven in every moment, and that your hand is always there as we sink into darkness.
Lord, I fear every day. I fear getting up every morning. I fear being overworked. I fear the empty spaces when the crises have passed and there is now unoccupied brain space. I fear what is left of me in those times. I fear there is nothing. I fear for the future, that I will be alone, becoming more and more drawn into myself, more attached to my routine, more tired, until I cannot focus out at all.
I fear disorganization. I arrogantly fear when I realize that I cannot keep up with everyone, I cannot be on top of all the problems of those around me. Every day I orchestrate a complex dance, with the illusion I am in control, the illusion that I can stay on top of everything…But deep down inside knowing that one unexpected event could shatter the whole thing to pieces. I fear losing that control. I fear the day when the house of cards comes falling down. What then, Lord? What is left of me when the external success has passed?
I fear the next steps of my career. I fear being on my own, not knowing what to do. I fear the possibility of going to Africa. I fear not listening closely enough to your call for me.
Lord, I lay these fears at your feet. Lord, you tell us not to fear, but only believe. You tell us perfect love drives out fear. You tell us you will guide and lead us. You tell us not to fear because you are our God. Lord, I want to knit this into my soul. I want to trust in you. Lord, I want to look for you to fill my empty spaces. Lord, I want to step into the blank slate, the unknown of the every day, stepping onto that unseen bridge, knowing that there will be solid ground under my feet. Lord, I do not want to look at unfolding events with a lens of hopelessness and overwhelmed, but with the peace that you will supply all that I need, that you are there, with a hand to pull me out of the water.
I hear your message today – do not fear. And yet so much of my life is about fear. So much of my life is about fearing what you are calling me to, fearing stepping off that boat, fearing that I will sink in the black murky water, and there will be no hand to pull me out.
Lord, I don’t see you even when I know you are there. I get so caught up in the hurry, bustle, stress, crisis, that I don’t see you. I don’t know you are enough, I don’t know that you are working all around me continually. I look for glimpses of you, of you “doing something cool,” when the truth is you are interwoven in every moment, and that your hand is always there as we sink into darkness.
Lord, I fear every day. I fear getting up every morning. I fear being overworked. I fear the empty spaces when the crises have passed and there is now unoccupied brain space. I fear what is left of me in those times. I fear there is nothing. I fear for the future, that I will be alone, becoming more and more drawn into myself, more attached to my routine, more tired, until I cannot focus out at all.
I fear disorganization. I arrogantly fear when I realize that I cannot keep up with everyone, I cannot be on top of all the problems of those around me. Every day I orchestrate a complex dance, with the illusion I am in control, the illusion that I can stay on top of everything…But deep down inside knowing that one unexpected event could shatter the whole thing to pieces. I fear losing that control. I fear the day when the house of cards comes falling down. What then, Lord? What is left of me when the external success has passed?
I fear the next steps of my career. I fear being on my own, not knowing what to do. I fear the possibility of going to Africa. I fear not listening closely enough to your call for me.
Lord, I lay these fears at your feet. Lord, you tell us not to fear, but only believe. You tell us perfect love drives out fear. You tell us you will guide and lead us. You tell us not to fear because you are our God. Lord, I want to knit this into my soul. I want to trust in you. Lord, I want to look for you to fill my empty spaces. Lord, I want to step into the blank slate, the unknown of the every day, stepping onto that unseen bridge, knowing that there will be solid ground under my feet. Lord, I do not want to look at unfolding events with a lens of hopelessness and overwhelmed, but with the peace that you will supply all that I need, that you are there, with a hand to pull me out of the water.
Wednesday, September 9, 2009
The Unit
I am back on the ICU, a month I have dreaded for a while. A little scary to be the senior resident on a month where you have to lead codes, where daily you make decisions affecting people’s mortality, etc. That said, it has been ok. I have been working with the right people, and I have had what I needed to handle any given situation at any point. Thank God. It is a tenuous balance. I led my first code without incident, put in more lines than I can count. Dealt with strokes, heart attacks, brain herniations, death, sepsis. Have gotten commended in the morning on some decisions, on others got yelled at and called an idiot. Business as usual in the ICU.
More than ever, I am acutely aware of my own mortality. Every day people show up at the ICU dancing on the line between death and life. For some of them, it is an expected outcome of a longstanding disease, for some of them, it was the result of a sudden, unexpected, life stopping event. Some of them make it out, some of them don’t. I have watched families cry at the bedside, I have watched patients breathe alone on the ventilator, and wondered where there families are. I have watched peace in some people’s eyes as they depart from this world, knowing there is something better beyond. And fear in others, as they realize they are losing control.
And in this life, with air thick and fogged with emotion and death, I feel like I am treading through. Wanting to grab onto my own family, want to make my life meaningful. I get addicted to being in that transitional space, while at the same time wanting to run away and sleep for days.
7 more days.
More than ever, I am acutely aware of my own mortality. Every day people show up at the ICU dancing on the line between death and life. For some of them, it is an expected outcome of a longstanding disease, for some of them, it was the result of a sudden, unexpected, life stopping event. Some of them make it out, some of them don’t. I have watched families cry at the bedside, I have watched patients breathe alone on the ventilator, and wondered where there families are. I have watched peace in some people’s eyes as they depart from this world, knowing there is something better beyond. And fear in others, as they realize they are losing control.
And in this life, with air thick and fogged with emotion and death, I feel like I am treading through. Wanting to grab onto my own family, want to make my life meaningful. I get addicted to being in that transitional space, while at the same time wanting to run away and sleep for days.
7 more days.
Saturday, July 25, 2009
I need you every day
Dear God,
Lord, I am empty.
My body is tired,
my emotions unstable,
my perspective smashed;
any hope and glimpse of you I quickly brush aside as it drowns in my worries and daily cares.
I am in need of you every day.
There is no day I can get through without you.
My worth as a child, meaning, drown in the messages of the world.
And Lord, I cry out to hear you.
I cry out every day.
And as a drowning victim claws onto driftwood rushing by,
I claw onto the glimpses given of you.
Keeping me afloat for a moment
Lord, teach me to swim.
I need you every day.
Not just when I am at the end of my rope.
Not just as a last resort.
I need you to keep me afloat.
To be my raft and keep me stable in the wind and waves.
I cannot control the every day.
I try to see and to learn
But ultimately, the outcome is up to you.
Help me to trust things into your hands.
And not into my illusion of control.
Lord, help me to see you in the darkest of moments
Help me to hear your voice above others
Help me to be a voice of hope and encouragement when none exists.
Help me to love and not be quick to anger.
Lord, I need you every day.
Teach me to swim.
Lord, I am empty.
My body is tired,
my emotions unstable,
my perspective smashed;
any hope and glimpse of you I quickly brush aside as it drowns in my worries and daily cares.
I am in need of you every day.
There is no day I can get through without you.
My worth as a child, meaning, drown in the messages of the world.
And Lord, I cry out to hear you.
I cry out every day.
And as a drowning victim claws onto driftwood rushing by,
I claw onto the glimpses given of you.
Keeping me afloat for a moment
Lord, teach me to swim.
I need you every day.
Not just when I am at the end of my rope.
Not just as a last resort.
I need you to keep me afloat.
To be my raft and keep me stable in the wind and waves.
I cannot control the every day.
I try to see and to learn
But ultimately, the outcome is up to you.
Help me to trust things into your hands.
And not into my illusion of control.
Lord, help me to see you in the darkest of moments
Help me to hear your voice above others
Help me to be a voice of hope and encouragement when none exists.
Help me to love and not be quick to anger.
Lord, I need you every day.
Teach me to swim.
Wednesday, July 15, 2009
Eva...My last patient essay, now 2 months old
Midnight, the melancholic mood of the evening sets in. And I get called to her room, a wild little thing, thrashing like an animal. Hair unruly and tangled, face full of bruises and dirt. Feet and legs scratched and burned, a baby cub that ventured out of the lair too soon and whose bravado let a creature bigger than her take over.
But despite the fight and scrappiness of this little girl, she is a scared little puppy, and I know she didn’t try to take anything bigger than her on. I feel fatalistic, that this situation she has been raised in has turned her into a little animal, and wonder if she can ever really recover. Maybe in the future she can regain a semblance of normalcy, and perhaps even appear normal to the outside world, until some part of that inner animal, that was taught to fight at early age kicks in…I wonder how much of that you can undo.
The next morning, I go to her room. Her covered crib, it strikes me how much those cribs look like enclosed cages, kennels, when you have a child you are trying to control. I approach slowly, just like I would a scared animal. I speak to her softly from outside her cage, offer a hand through the bars and pat her head a little to show her that I am not going to hurt her. And as she acclimates to my presence in the room, I open her little cage. Before I can even get the bars all the way down, she outstretches her arms and tumbles onto me, her spindly arms and legs wrapping around me and holding tight. Wanting to be protected, wanting to be safe in someone’s arms, burying her little face with it’s wild hair into my shoulder. She even throws her wounded, infected, burned foot around me, without carefulness to avoid touching the tender parts. And I realize that despite the animal instinct in this child, she is still love, she is still wanting that basic need met. And like an animal fighting for survival despite a deadly injury, her instinct ignores the pain so that she can keep going to reach survival. Where she can be taken care of and someone else can take over. I walk around with her a little bit to give her a break from her crib. To my surprise she can talk, and can point things out to me. She takes my stethoscope off and puts it in her ears, putting then the bell to her own heart to listen.
Because I am not allowed to ignore the fact that I still have work to do, I sit her in my lap while I am making calls and writing notes. And within minutes of sitting, she is thrashing, screaming, and I don’t understand…Until I have to put her back in the crib, and she is hard to console. Today it was the same pattern.
And hours later, it strikes me. She latches her body around me, hoping I am going to be her vehicle, transport out…To survival…And like a little refugee, she is fighting, screaming, everything in her is trying to get that last seat on the convoy going out. Like it is her last chance.
This breaks my heart and brings tears to my eyes as I realize what she is trying to do. That at 19 months her instinct for survival is so strong, and she is so smart and intuitive, so resourceful, trying to use everything she can to escape this mess. And again I feel fatalistic, because I know that chances are that she is not going to have a happy ending. The goal of the foster system is to reunite children with their families and unless something drastic happens, she will likely be back in her mother’s house.
Despite my deep sadness about what this girl’s life is and what it will bring, and what she has already overcome, I see some beauty in her spirit. In who she is, and who this has already made her. And I wonder, how can I see so much beauty in the “human spirit” of another, when I am so apt to allow my own spirit to give up?
But despite the fight and scrappiness of this little girl, she is a scared little puppy, and I know she didn’t try to take anything bigger than her on. I feel fatalistic, that this situation she has been raised in has turned her into a little animal, and wonder if she can ever really recover. Maybe in the future she can regain a semblance of normalcy, and perhaps even appear normal to the outside world, until some part of that inner animal, that was taught to fight at early age kicks in…I wonder how much of that you can undo.
The next morning, I go to her room. Her covered crib, it strikes me how much those cribs look like enclosed cages, kennels, when you have a child you are trying to control. I approach slowly, just like I would a scared animal. I speak to her softly from outside her cage, offer a hand through the bars and pat her head a little to show her that I am not going to hurt her. And as she acclimates to my presence in the room, I open her little cage. Before I can even get the bars all the way down, she outstretches her arms and tumbles onto me, her spindly arms and legs wrapping around me and holding tight. Wanting to be protected, wanting to be safe in someone’s arms, burying her little face with it’s wild hair into my shoulder. She even throws her wounded, infected, burned foot around me, without carefulness to avoid touching the tender parts. And I realize that despite the animal instinct in this child, she is still love, she is still wanting that basic need met. And like an animal fighting for survival despite a deadly injury, her instinct ignores the pain so that she can keep going to reach survival. Where she can be taken care of and someone else can take over. I walk around with her a little bit to give her a break from her crib. To my surprise she can talk, and can point things out to me. She takes my stethoscope off and puts it in her ears, putting then the bell to her own heart to listen.
Because I am not allowed to ignore the fact that I still have work to do, I sit her in my lap while I am making calls and writing notes. And within minutes of sitting, she is thrashing, screaming, and I don’t understand…Until I have to put her back in the crib, and she is hard to console. Today it was the same pattern.
And hours later, it strikes me. She latches her body around me, hoping I am going to be her vehicle, transport out…To survival…And like a little refugee, she is fighting, screaming, everything in her is trying to get that last seat on the convoy going out. Like it is her last chance.
This breaks my heart and brings tears to my eyes as I realize what she is trying to do. That at 19 months her instinct for survival is so strong, and she is so smart and intuitive, so resourceful, trying to use everything she can to escape this mess. And again I feel fatalistic, because I know that chances are that she is not going to have a happy ending. The goal of the foster system is to reunite children with their families and unless something drastic happens, she will likely be back in her mother’s house.
Despite my deep sadness about what this girl’s life is and what it will bring, and what she has already overcome, I see some beauty in her spirit. In who she is, and who this has already made her. And I wonder, how can I see so much beauty in the “human spirit” of another, when I am so apt to allow my own spirit to give up?
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