Sunday, August 9, 2015

The Mundane Into The Glorious

Author’s Note:
I want to express my sincerest gratitude to those of you who read along with my blog stories and musings. I am often encouraged by the replies that I receive. Your comments serve to reinforce and further bless me in my own spiritual convictions.

Emily has been kind enough to allow me to share an excerpt from an email with me relating how our day-to-day humble service is important. The work that we might be tempted to consider dull or inconsequential or trivial is sacred

(*As usual: names, locations, identifying data have been altered)

Email Excerpt:

“Our small, insignificant mundane acts can still be sacred acts to God. Perhaps?"

Yes - definitely!

After my youngest started school, I was feeling a bit useless. I remember, after perhaps drinking a bit too much wine at home one time, bemoaning that I felt like a "waste of space".  I was missing the status of having a career and being needed 24/7 by small children. I didn't know what to do next with my life now that I was no longer “needed”.

Finally I got a job doing the bookkeeping in a little office next to a small joiners workshop with the wood dust and loud machines and loud blokes hollering and swearing. It felt like a big step down from what I was used to do, but the hours were convenient so I took the job, working for a lovely lady called Helen (*). The record books were in a terrible mess at the workshop. Helen hadn't balanced the bank accounts in over a year and I wondered how she could continue to operate. I slowly starting unpicking the figures and bringing things up to date.

So I worked at the joiners two days a week and spent the rest of the time helping my friend Miriam dig her garden allotment and chatting to my neighbour, Sandra, over her fence.

One week I sat in church and asked God what I was supposed to be doing. I asked Him what He saw in me and what was my purpose in life. The vicar was talking, but I wasn't really listening. I just stared at the pale figure of Christ in the stained glass.

Suddenly a question popped up. "Can you be a servant?" The question seemed to come from the stained-glass window I was staring at.

"But I don't want to be a servant,” I replied, without thinking it was just a little strange to be having a conversation with a stained glass window.

Then I remembered the words in the Methodist Covenant Prayer: Let me be employed for thee or laid aside for thee, exalted for thee or brought low for thee.

As I sat staring at the figure of Christ in the stained glass, I began to realise that the reason Helen hadn't been looking after the bank accounts for her workshop was that she was so busy attending to the needs of a sickly friend. Helen was unable to manage the accounts because she was spending her time, instead, taking her friend with cancer to chemotherapy appointments and looking after her friend’s children.  But now Helen had a bookkeeper (me). Now she could continue to care for her cancer friend without worrying over her business affairs. My humble tallying of mathematical figures in the joiner’s business accounts was a worthy occupation and was necessary for the smooth running of the business but also blessed others in ways I did not initially realise. Helen had peace of mind and her sick cancer friend benefited through my careful booking efforts as well. My “insignificant” efforts in balancing the business books blessed others in ways I never imagined.

As I let that first realisation sink into my consciousness, a second awareness dawned. Miriam, the neighbour that I helped dig in her garden, actually spent those long hours cultivating her allotment because it took her mind off a series of miscarriages. I couldn't fix these, but I could relate, and I could sit out in the sun and the rain with her while she grieved. To ‘weep with those who weep’ was an act of love that was within my capacity to give Miriam.

And then, as I continued to sit in church and absorb the full impact of this second act, a third thought struck me. (It was becoming a very fruitful ‘conversation’ with a stained-glass window).  I realised that the reason Sandra sat out in her garden by her fence, hour after hour, was that she was lonely. Her husband had recently died leaving her all alone but she was reluctant to go and knock on anyone's door for fear of being an "imposition". Instead she sat outside by her fence, hoping for someone to come by and talk with her. I couldn't fix the death of Sandra’s husband but I could listen and chat with her.

So, there I was in church, still staring at the pale figure of Christ in the glass window without listening to the Vicar’s message but hearing a message from God nonetheless. I’d been thinking about Solomon in the Bible when he built the temple mentioned in Chronicles. It took thirteen years with the craftsman having to make all sorts of paraphernalia out of wood and metal. Their work must have been quite boring and tedious, detailed workmanship to create such intricate temple ornaments according to the tight specifications. (In fact, just reading the story in Chronicles is rather mind numbing and a good treatment for insomnia!) Perhaps the craftsmen as they carved out yet another silver embellishment wondered why they were doing it; but, God honoured their work. When all was finished, His glory descended upon the temple and it was, well, glorious. So, too, God was being honoured by my own faithfulness to the small acts of day-to-day service opportunities. I was like the craftsmen in Chronicles with my attention to the details of my accounting, my digging, and my chatting. They were important sacred acts of loving service to God. The mundane made glorious in Christ.

“That our sanctification did not depend upon changing our works, but in doing that for GOD’s sake, which we commonly do for our own. …That the most excellent method he had found of going to GOD, was that of doing our common business without any view of pleasing men, and (as far as we are capable) purely for the love of GOD.”
― Brother Lawrence, The Practice of the Presence of God

Saturday, July 25, 2015

Don't Welcome Me Back Home

Photo: Natasha Kanji 2011
A/N: Thoughts after attending the Institute of World Mission Welcome Home Family Re-entry Seminar 2015. I'd rather have a mission than welcome home accolades. 

Don’t Welcome Me Back Home

“My desire is to depart ... But to remain in the flesh is more necessary .... Convinced of this, I know that I will remain and continue with you all, for your progress and joy in the faith, so that in me you may have ample cause to glory in Christ Jesus, because of my coming to you again…”
Philippians 1:24-26

I don’t want your welcome back greetings.

Please don’t think me ungrateful. Obviously, I won’t tell you to stop since I know you mean well. Your motives are pure.

But the greeting is erroneous. I am not  back home. Not by my definition of ‘home’ anyway.  Home doesn’t represent a permanent place on earth for me. Yes, there are pockets of space where I am best adapted, places I feel safe and abide within a relatively congenial community. These locations are familiar to me. They are a domicile where I sleep and eat my meals and where I am most relaxed and at ease. But they are not home. Instead, my heart yearns for a deeper home.

As C.S. Lewis so eloquently penned in the following quote:
“If we find ourselves with a desire that nothing in this world can satisfy, the most probable explanation is that we were made for another world.”      ― C.S. Lewis

Living for any significant period in another country, another culture changes you. Whether you were an accountant, a nurse, or a pastor, you cannot leave without permanent scars. The simple act of surviving in a foreign environment spoils naïve ideas about a cohesive, simplistic worldview.  The world is a messy place to live where chaos thrives. Submerged under the colours of a strange and different culture, you emerge with multicoloured lenses. Unlike real glasses though, you can’t remove them. There is no returning to your virgin views.

Even as your heart aches for home, a permanent resting place, travelling around the world proves there is no place completely safe, completely perfect. Heaven is not yet; it is still a hope; your heart’s anticipated future. You may have citizenship in your passport country but real homage belongs to the Lord of heaven and earth. We are citizens of another world as Paul outlines in Philippians chapter 1, verse 20: “…But our citizenship is in heaven, and from it we await a Saviour, the Lord Jesus Christ…”

And so… I remind you, there’s no need to welcome me back home. No adulations, please. Don’t put me on a pestle and treat me like a hero. Don’t try to reacclimatise me to a life of mundane mediocrity with wrappings of cultural adaptation. Instead, remind me that there is a reason for reverse culture shock.  Acknowledge that there’s a basis for why I don’t feel at home. Tell me there is value in my brokenness. Comfort me with words that give meaning to the bleeding of my wounds.

Don’t tell me everything will be ok.
Don’t tell me to ‘give it time’.

Instead, remind me I’m part of a bigger picture. These tears that flow without warning from deep recesses of my soul are reminders that the process of homecoming isn’t finished. The grand universal cosmic conflict is still ongoing and I have a part to play in it.  The epic isn’t complete. The novel hasn’t come to the last page.

When I am overwhelmed by yet another teary-eyed patient in my office with problems beyond medical solutions, remind me that I’m still God’s hands to comfort the suffering.  

When the sun has set and I’m putting in prescription renewals and answering messages while completing a hectic days worth of charting, all the while tired and hungry because I’ve missed lunch and now supper, tell me that the sacrifice is worth it.

When I fear I cannot face another unsatisfied patient seeking easy fixes for unsolvable circumstances, remind me I’m an ambassador of love and not of miracles. And when he gets angry and storms out of the room because I suggest changes in diet and weight loss to ease his aching arthritic knees or bring his diabetes under control, remind me again that I can still love without expectation or reciprocity.

I don’t need a hero’s welcome home. I don’t want a hero’s welcome.
I want a hero’s mission.
Remind me I’m part of a higher calling. I’m still part of a mission. I still have a job to do on this earth to represent Christ’s love to those I come in contact with each day.

Remind me that my mission service is not over. I am not coming home. I survived five years in Cameroon as a naïve and inexperienced physician. Through threats, thefts, fire, and tragedies, I survived and came through changed for the better. When I am tempted to forget, remind me of those valuable lessons I learned through people management, administrative duties, intercultural communication, adaptation, and flexibility. I am stronger than before. I survived adversities and adulations in Cameroon. Surely I can endure the challenges of today.

When I sigh and complain that home is tedious and dull, don’t tell me to appreciate my blessed abode. . Instead, remind me that I’m not home. I remain God’s ambassador to the world, whether here or in Africa. He hasn’t called it quits on my mission yet. There is a purpose in the pain that imbues meaning in the suffering. I can accept the frustrations, disappointments, disillusionments, and fatigue when I remember that this isn’t the end. The mission continues.

“ All this is from God, who reconciled us to himself through Christ and gave us the ministry of reconciliation: that God was reconciling the world to himself in Christ, not counting people’s sins against them. And he has committed to us the message of reconciliation.  We are therefore Christ’s ambassadors, as though God were making his appeal through us.”

2 Corinthians 5: 18-20

Tuesday, June 23, 2015

Six Months and a Carpenter's Stethoscope

Disclaimer: Pardon the hiatus. I find I am out of practise with writing down stories of life and work. 

June 16, 2015

Yesterday marked the six-month anniversary of starting a new job in a very big, primary care clinic. More than sixty doctors, nurses, and physician assistants care for thousands of outpatient in the rapidly expanding urban medical complex where I work.

Did I mention it’s big? It’s a vast labyrinth of medical services. I often find myself feeling like the mouse-doc scuttling around in a medical maze and discovering a delightful piece of cheese tucked away in a hidden corner of the system.  I am constantly greeting new faces and finding new pieces of “cheese” within the clinic.

Although my work environment is a dramatic change since relocating to the Northwest there are many additional cultural differences to decipher: Church. Local community. Politics. Socials. It’s another foreign country, in a way. Portland is a ‘hipster’ city where food that is cooked without meat is no longer termed “empty”. Instead eating establishments proudly proclaim “gluten-free”, “vegan”, and “organic”.  Being a vegetarian is not on the extreme end of the spectrum. It’s more on the moderate end of a very broad spectrum of dietary preferences.  

The vast dietary spectrum of preferences if relatively an easy cultural adjustment – instead of green leaves floating in palm oil there is organic kale salad with alfalfa seeds and thistle milk or something along those lines. The bigger struggle for me has been to find a sense of belonging and assurance that I’m still ministering to others and leading a worthwhile life. I find it challenging to feel like I’m a part of a bigger picture. I have an inner, subconscious sense of losing an exclusive membership in a noble club. I find pieces of my heart sometimes shifting around uncomfortably like a loosened shingle, pulsating against the battering of life’s storms. One end is still fastened firmly to the practical, logical area of my brain and affirms that I’m still doctoring. I’m still performing a necessary service to those suffering and sick and in need. But a portion of my emotional, irrational subconscious wobbles with uncertainty and doubt when adversity and discouragement pour down in a deluge of negativity. I waffle at the fringes, constantly questioning myself:
Am I still serving God in a secular clinic?
Are my skills as a physician needed in a country with so many doctors?
Am I utilising my time appropriately seeing so few patients in comparison to Cameroon standards?
Without the external affirmations one receives as a missionary, can I believe in my calling here?
Do I believe in my heart that I’m currently where God wants me?
Do I believe He’s called me to such a large, institutionalised office to serve as His ambassador of love?

Lately I have found my creative writing energy sapped. I don’t find it easy to outline interesting and noteworthy aspects of my work. I am not involved in the same severity of life and death struggles that clawed at my work while in Cameroon.  I am surrounded by ailing people but of a different type. Sick but a different kind of sickness.

I discovered when I first met Mr AT that he had been having ankle pain for years. It had been worse lately with all the activity necessary in his new job as a construction worker. He’s already been appropriately treated with the anti-inflammatory medications (Aleve, Advil). He had an ankle brace. Work notes that dictate modified work activity had been written. Physical therapy had been offered although he couldn’t find the time to attend such therapy sessions due his demanding daytime job schedule.  

“What are you hoping to get out of your visit today?” I searched his face for a truthful explanation. I dreaded his answer though as I was pretty sure I knew what it was going to be.

“Well, doctor, I guess I was hoping maybe you could just fix things, make all the pain go away.” Mr AT laughed nervously and gave an apologetic shrug.

I return his laugh with an echoing helpless shrug. “I wish I had my magic wand and could fix all your problems. It sounds like you already know what you need to do to fix your ankle though. You’ve just told me that your ankle is fine on the weekend after you rest it.”

He nods.

I continue. “Either you need a new job, one that doesn’t involve all the heavy labour that you’re doing; or, you need a younger body, a new ankle. I’m not sure how to give you either of those though.”

Mr AT gave a rueful smile. He understood I couldn’t satisfy his wish to make all his problems disappear. I could listen. I could empathise. I could affirm him in what he already knew. But, I couldn’t cure him of chronic ankle pain. In the end, we agreed upon the imperfect solution of partially masking the pain with pain killers while he promised to try eating healthier and losing weight – two modifiers that were controllable unlike his job duties and taxing work schedule. It was a temporary patch and not completely satisfactory for either of us. I would have loved to have taken away his diseased ankle and vanquished his pain forever. However, such was not going to happen. It wasn’t even possible under the circumstances to enact physical therapy and a different job. Those were the long-term solutions he really needed for ankle healing. Such situations leave me feeling helpless and frustration. I wonder if this is really what God is asking from me: to temporarily placate people’s pain brought on by poor lifestyles and bad luck?

Work days in Cameroon could be long and emotionally challenging. A frenetic pace from 8 o’clock in the morning with staff worship until the last patient of the day was served. Some days were certainly busier than others. It was hard to quantify the hours spent in the hospital and clinic. Now my days are more regimented. No early morning doorbell signalling a hospital emergency or midnight obstetric summons. Four days a week I walk to work, closing the door behind me at 6:30 in the morning and generally wrapping up the last of my charting and phone messages by 6:30 at night. Long days but defined “off time” away from sick patients and clinic duties. No call except the occasional urgent care shifts. So why is it that I feel less productive overall? Why do I feel like I accomplish less outside work than when I lived and breathed hospital air in the same mission compound? I am still sorting out that answer. Twelve hour days, four times a week, should give me plenty of free time, right?

Perhaps part of the reason for my lassitude outside clinic is due to the emotional tragedies that siphon off energies previously used in other pursuits.

Madam T came in for anxiety and depression. It’s a very common problem in Portland. People are “weird” here but also rather prone to worry-laden depression.  As I sat down to listen to Madam T, the floodgates opened and she spilled out a story of woe rivalling Lemony Snicket’s [series of unfortunate events].  Reflective empathetic statements of compassion are appropriate in such times and yet incapable of dispelling the sad consequences. Life is unfair. I wished for a loving community safety net that I could toss her into for that moral support she needed. Does they exist in Portland? Are there communities that have the resources to help such sad souls in need of a friend? Traditional medicine is not designed to manage the intricacies of psychiatric depression and anxiety. It’s frustrating.

“I know I need to call the mental help line, I just don’t have the energy,” Madam T laments.

I nod. “I wish circumstances were different for you. If I could change them for you, I would.” I pass her the box of tissues so she can wipe her tears and blow her nose.

By the time we part with appointments scheduled to touch base again on the telephone, I find myself relieved to escape. The atmosphere is full of suffocating despair.  I feel for her but I don’t want to absorb all the misery and bitterness she carries. I rather doubt that I’ve done anything clinically to improve her health. I’m not sure if we’ve connected at a therapeutic emotional level either. She’s still shedding tears when I exit. Is this what God has planned for me? Are these the type of encounters He wants me to keep muddling through year after year?  My emotional fatigue level leaves a huge margin of doubt on the reasonable longevity of such a plan.

And so as six days have turned into six weeks and now six months since beginning my new job in Portland, I find that the saying is true: ‘the days are long but the years are short’. It’s hard to imagine that it’s been six months. It feels like forever and yet it feels like I’ve only just begun. I have so much still to learn.

I’m still a novice with most things at work.
I am still part of the “newbie” group of primary care providers.
I still haven’t found my place in the community.
I am still a stranger at church.
I am still finding those friends that you can just “pop on by for a drop of tea and encouraging hug”.
I am still searching for a small group to nourish my spiritual fellowship needs.
I am still learning how medical services like chiropractors, massage therapists, and acupuncture work.
I am still adjusting to all the naturopaths and alternative healers available.
I still have “I miss Cameroon” days
I still refrain from mentioning my time in Cameroon for fear of being forever labelled  “the doctor from Africa”
I still worry about losing my identity as a physician with a mission heart.
I still fight against the temptation of self-pity when I work long hours without the same affirmations that come from working internationally
I still have grey days of depression and self-doubt about the future
I still am figuring out what my calling in Portland is these days.

There are a lot of unknowns. In the midst of the unknowns I have hope. God has been a guide for me in the past; I have faith he will continue to mentor me here in Portland.

Jesus spent 30 years in Nazareth, first growing up as a boy and then working as a carpenter. He spent three years in active, public ministry. Thirty years sawing wood, carving wood, pounding wood, smoothing wood, and sweeping wood dust off the floor of his tiny shop. He could have been doing spectacular, crowd-pleasing miracles like curing world hunger, walking across oceans, raising whole cemeteries, and eradicating leprosy and blindness. He could have reached more people, ministered to more sick, done more impressive feats of glory, fed millions instead of thousands, if he’d left Nazareth at 20 years instead of 30 years of age. Was it really that important to craft another kitchen table, another oxen yoke, or carve that one-hundredth window frame? Jesus spent the majority of His ministry plodding along, a faithful carpenter with the lathe and the hammer in the mundane duties of life. Perhaps I’ve re-entered the proverbial carpenter shop? Crafting another wooden stool might be compared to reassuring another sniffling American that it’s a viral respiratory infection. Hanging out in the carpenter shop chatting to a few clients over the latest design in wooden ox yokes might be like sitting next to a tearful, depressed Portland hipster and offering encouragement and a box of tissues. Our small, insignificant mundane acts can still be sacred acts to God. Perhaps?

“That we ought not to be weary of doing little things for the love of God, who regards not the greatness of the work, but the love with which it is performed.”

― Brother Lawrence, The Practice of the Presence of God

Wednesday, April 15, 2015

The Elusive Magical Fairy Wand

“Reputation is what others think of us; character is what God knows of us.”
― Shannon L. Alder

Let’s face it, if medical professionals depended on the fickle fancies of their client-patients’ enthusiastic affirmations of ‘job well done’, we’d be in trouble.

Even theoretically, few would claim it’s possible to satisfy every customer, every time. People are fallible human beings with wishy-washy whims. Most of the time we don’t even know what we want. In an age of instant gratification with expectations of continual entertainment, it’s simply not possible to meet the standards. Healthy, happy people are often disappointed. How much more difficult it is to satisfy sick clients in mental and physical pain?

Perhaps if doctors had magical wands that they could wave in a graceful arc with cascading, twinkling fairy-dust floating down over the sick patient and instantly erasing all illness…  Unfortunately, I haven’t come across such a wand. However, if anyone does, please let me know!

So, it is not easy working with people who are suffering every day. I like to see people smile. I like to cheer people up. Generally speaking, I chose a profession in medicine because I wanted to make a positive difference in the world. Without my magical fairy wand though, I seem to encounter an awful lot of disgruntled, unhappy sick people.

Madam X sat across from me with a frown and crossed her arms. “Doctor, I’m sure there’s something wrong. I’ve gained 10 pounds and I haven’t changed anything in my life. I’ve never been this heavy before. I do the same things. I haven’t changed my diet. There’s something wrong with my thyroid.”

I glanced at her recent blood work on the computer and tilted the screen for her to view the results. “Your thyroid test was normal last month,” I reassured.

“That test isn’t always accurate though, doctor. I know there are other tests to check my thyroid that are better.” Madam X leaned back and stared defiantly at the normal lab results.

“Umm, this blood test for thyroid problems is very accurate.”

“I had a friend who’s test was normal but then her doctor ordered some other thyroid testing and they found out she had low hormone levels.” Madam X scowled. “Doctor, there is something wrong. This weight is not normal for me.”

“All your recent blood work is normal. Sometimes as we get older, our metabolism slows down a bit and it’s easier to put on weight. Diet and exercise are still the best ways to control weight and stay healthy.”

Mrs X shifted in her chair. She was clearly not convinced. “Doctor, there’s something wrong in my body that is making me gain weight.”

I shrugged. “I’m sorry. I know it’s not easy. We can talk about some ways to improve your diet and increase your activity. There are classes and groups you can join. I can suggest some local gyms.”

“No, I’m not interested,” Madam X replied. Her tone was increasingly becoming more frustrated with the way things were going. “I know how to eat and I already walk enough at work. There’s something else wrong inside my body. You’re just not willing to order the right tests.”

She left angry and frustrated. “I’m just going to have to find help elsewhere,” she gave me a pointed glare as she packed up her purse and put on her coat.

Clearly, not a happy customer.

Madam Y dangled her legs at the end of the exam bed while she fidgeted with the elaborate beaded necklace that hung round her neck. “What a beautiful necklace,” I exclaimed as I shifted our consult from the initial verbal history of the problem to the physical exam portion. Her earrings were beaded in a matching pattern with her necklace.

“Thank you, doctor,” she turned her head for me to examine the opposite ear. “My daughter makes them.”

“You have a talented daughter, very artistic,” I added.

She nodded in agreement while I listened to her heart.

“Does it pain anywhere where I press?” I asked while I palpated her abdomen to ascertain spleen and liver size.

“Right there,” she indicated as I put pressure over the lower portion of her stomach, below her umbilicus.

“Oh?” I hadn’t expected a positive to my query, having already gone through a review of problems:  high blood pressure, migraines, and sinus allergies. I felt my pulse do a double skip. Pain in the stomach can be a bottomless pit of inquiry (pun intended). A million different things can cause stomach complaints, everything from benign indigestion to life-threatening colon cancer.

“Yes, doctor, sometimes I get this annoying pain, not really painful but, well, sort of uncomfortable down where you were pressing.” She sat up as I finished poking around on her belly, having ensured there were no big masses or obvious fibroids.

I waited for her to continue.

She shrugged with a noncommittal smile. “It’s probably nothing, doctor, but I just worry, you know. It’s nothing new. Just every now and then. I keep forgetting to mention it to the doctor when I have my appointments.”

I nodded.

“Probably has more to do with when I eat too much or have too many sweets.” She folded her hands and gave an embarrassed laugh. “I know it’s not good for me but when I go out to eat. I always have dessert.”

I went throw my list of ‘red flags’ -- danger symptoms that could indicate a patient has some perilous medical condition potentially going on in their bowels. Madam Y thankfully didn’t have any of them.

“I can’t find anything on the exam or in the symptoms that you’re having that indicate we need to do more testing. From what you’re telling me, there are no signs that anything like a nasty cancer is causing the stomach pains.” I mentally reviewed my internal checklist and again came up negative for anything concerning. “You might want to keep a symptom diary and jot down when the pains come and see if there are any particular situations or foods or patterns to the pain.”

She was quiet.

I waited for her to disagree with my predictions and recommendations.

Madam Y looked down at her slightly protruding abdominal fat roll. With a wry grin she let out a sigh. “You’re right, doctor, I really just need to eat better. I eat too much. I don’t like the added weight. I’ve sort of ignored it but I know I should be more active at the gym and cut down on my calories.”

“Choosing more healthy foods and getting more exercise is always a good idea,” I encouraged Madam Y with her inner health resolutions. “Exercise is the best medicine. It’s the closest thing there is to a panacea. It’ll help the weight and your blood pressure and reduce your risk of diabetes later on in life. Exercise is good for digestion too. I bet it will reduce the stomach pains.”

Madam Y nodded resolutely. “You’re right.”

I have never considered myself to be a great cheerleader. No pom-poms or fireworks. I smiled and nodded my affirmation then closed out her visit and went to print off her the summary. As I rose to exit she suddenly stood up. “Oh, doctor,” she exclaimed with a huge smile, “thank you so much. I just love you!” She rushed over and enveloped me in an unexpected hug.

My eyebrows nearly jumped off my face in surprise! (Thankfully, they are still attached. I checked afterward.) To say I was shocked is an understatement. I was certainly caught off guard. Not the reaction I was expecting. I’m not complaining either, mind you.

“You’re welcome,” I stammered back in response as she released her hold of me.  

Clearly, she was a happy customer.

Happy and satisfied versus frustrated and angry. I really can’t take credit for either reaction. There are too many other variables within a person’s life that affect the outcome in our clinic visits.

Madam X and Madam Y, with their contrasting attitudes, are a reminder that satisfaction comes from within. It’s a mind-set that we choose. I cannot look to customer satisfaction surveys or patients’ words of affirmation. Medicine is fraught with sickness, suffering, and people with emotional and physical pain. The courage to carry on in the midst of it all comes from outside my work.

I work for Christ, and, well, He’s already given me His stamp of approval.

1 Peter 4:11

Do you have the gift of speaking? Then speak as though God himself were speaking through you. Do you have the gift of helping others? Do it with all the strength and energy that God supplies. Then everything you do will bring glory to God through Jesus Christ. All glory and power to him forever and ever! Amen

Monday, April 6, 2015


It's not always easy to love others with the same love that Christ gives to me.

Broken  People

I’ve been back in the States and practising medicine in a traditional primary care outpatient clinic now for three months. One of the most common questions that I am asked, “What’s it like being a doctor in America again?”

Good question.
Complicated answer.

I’m not sure my language skills can quite express the every-changing kaleidoscope of reactions that whirl through my brain each day. There’s a lot I like about working in the U.S. again; there are other aspects I quite dislike.

One of the biggest challenges has been to find the assurance that my work as a primary care physician in an affluent society is worthwhile.

“I’m still searching for meaning in my job,” I reply to my colleague who asks me how it’s going over a lunch meeting.

He nods and listens as I continue.

“When I read about my colleagues that are still in Africa; read their blog stories; or exchange internet messages about the frustrations and difficulties of practising in resource-poor setting like Cameroon, Chad, or Malawi, waves of nostalgia and inadequacy wash over me.  I’m no longer the leader of the team. I’m no longer seeing 30 or 40 outpatients in a day PLUS managing a hospital and labour and delivery service. I feel so tiny when I think about the small number of people I see in clinic now and the minor ailments I attend to during the day.”

“For example, I saw a patient with insomnia and restless legs at night that had elevated blood pressure today. Compare that to a typical patient in Cameroon with severe anaemia and malaria that’s underweight with HIV and tuberculosis.”

“Give me some patients who are really sick,” I’ve said more than once in the past couple months.

At night I pray, “Lord, please help me not compare. Help me with my pride that tries to boost my inner ego by comparing herself to others and then gets discouraged when she perceives others are better and doing more important tasks.”

All around the world physicians are fighting against illness. Spiritual sickness. Emotional turmoil. Physical ailments. Mental distress. There is no comparison. Missionary doctors in Africa are under certain stressors like limited diagnostics, untrained staff, and organisational politics. Missionary doctors in America are under another set of stressors with paperwork, legal issues, and insurance limitations.

Ministering to the suffering is a challenge everywhere. I pray for my colleagues in Africa that God will give them patience in dealing with inadequate electrical power and corrupt political officials while at the same time I pray for my colleagues in America as they deal with twisted insurance prerequisites and drug addicts.

One young woman came to me last week. We’ll call her Veronica, although of course that’s not her real name.  She had a festering wound on her buttock that she’d just been seen for two days prior.

“Have you been taking the antibiotic that was prescribed?” I inquired as I looked over at Veronica, shifting uncomfortably on the exam table, dressed in a gown with a sheet over her lap.

She grimaced and I noticed little sweat beads across her forehead. Her blood pressure was a bit high too. “Yes, Doctor, but I’m not any better.” She shook her head for emphasis. “The pain is unbearable. I can’t sleep at night.” Tears welled up in her eyes as she spoke of the suffering. “I just can’t take it anymore.”

I bent over to examine the infected area on her body.

“Ouch!” she jerked away involuntarily as I touched the sore, red, spot on her skin. “Sorry,” she apologised and braced herself as I took another try at examining the infection. She winced but managed to hold still the second time.

The skin was red and inflamed and acutely painful. Without proper treatment of the infection, it could spread to the rest of her body, potentially landing her in the hospital on IV treatment if things weren’t taken care of today. I wondered why the original medications hadn’t seemed to help her. On reviewing her case, it appeared that appropriate measures had been taken. She should have been getting better by today.

“Given the fact that you’re still not improving even though you’re been taking what normally is the right medicine for this infection, I’m going to change the antibiotic,” I informed Veronica.

She nodded, grim-faced.

“I’m going to order an ultrasound exam to make sure the infection hasn’t formed a pocket of pus deep inside that might need draining too.”

Again, she nodded her understanding.

“And because I want to make sure this infection gets under control as quickly as possible, today I’m going to order for the antibiotic to be given as an injection.” I paused waiting for her response.

“Ok, doctor,” she nodded in agreement.

Satisfied that I was making the correct medical decision based on her symptoms, her exam, and the failure of her infection to respond to the initial first-line antibiotics prescribed a few days earlier, I went about typing in the orders into the computer.

“But, doctor, what about the pain?” she broke the monotone of my typing.

“Are you using ibuprofen and Tylenol?”

“Yes, but its not enough. I can’t sleep,” she winced again as she shifted her weight.

“OK, well,” I glanced at the last prescriptions given a couple days ago by the urgent care doctor, “I’ll refill the Vicodin (narcotic) pain killer that you were given before. Take it with the ibuprofen though,” I instructed.

“OK,” she relaxed.

“Now go do the ultrasound right now and get that first injection of the antibiotic,” I cautioned as she prepared to leave.

She shook my hand and thanked me.

I handed her the prescription for the Vicodin and the instructions for the ultrasound and injection.

That was the last I saw of her.

I waited for the ultrasound report. It never came. I looked her up in the computer system. She’d never gone for the test. I noticed that the Vicodin prescription had been picked up. The antibiotic prescriptions had not been filled.

I hate being snookered.

My first reaction was anger. It made me angry that Veronica would lie  and manipulate me and the medical system just to get a few narcotic pain pills. Later, I felt rather sorry for her. She wanted those pain pills so badly that she was willing to put her own physical health at jeopardy by neglecting proper antibiotic treatment for a real infection. 

Veronica was actually sicker than I’d originally assessed. It wasn’t an obvious illness amenable to a few tablets of antimalarials or antibiotics though, sadly. It was a deeper illness of the mind. Addiction.

Unfortunately, addicted and twisted minds wrapped up in a milieu of complicating psycho-social factors are not easily ‘fixed’. It takes more than a primary care doctor and a 10-minute clinic appointment to help heal the underlying suffering. Perhaps that’s why there is so little personal job satisfaction in these situations. It’s easier to prescribe a cream for the scabies rash or a worm tablet for the tummy ache or a course of Coartem (antimalarial) for the malaria.

Broken people are all around. In Africa. In America.

Perhaps some different flavours of illness hit my radar here in America versus Africa. I am trying not to compare though. Illness comes in all colours, shapes and sizes. I am continually astounded by the magnitude of broken souls that I meet.

It doesn’t matter whether it’s Africa or America, Asia or  Australia. People come with deep, penetrating wounds – raw and festering – expunging shame, guilt, depression, anxiety, unfaithfulness, and violence.

The song “people need the Lord” seems rather appropriate. God is teaching me to avoid the comparison game that only brings discouragement to my heart. Instead He is telling me to simply go forward and treat each person, whether it’s one or one-hundred, with the same love and grace that He extends to me.

Isaiah 61: 1-4 

The Spirit of the Sovereign Lord is on me,
because the Lord has anointed me
to proclaim good news to the poor.
He has sent me to bind up the broken-hearted,
to proclaim freedom for the captives
and release from darkness for the prisoners, a
to proclaim the year of the Lord’s favour
and the day of vengeance of our God,
to comfort all who mourn,
and provide for those who grieve in Zion—
to bestow on them a crown of beauty
instead of ashes,
the oil of joy
instead of mourning,
and a garment of praise
instead of a spirit of despair.
They will be called oaks of righteousness,
a planting of the Lord

for the display of his splendour.