Wednesday, February 18, 2015

The Foot Mystery


A/N: Not everything is as it appears at first glance, sometimes you have to dig deeper...


She was in her early forties, a tad overweight due to a penchant for that extra bite of chocolate or cookie that invariably sneaks into the office where those of the female gender congregate.  Her smile was infectious though and her easy-going manner lightened the atmosphere in the examination room as I settled onto the doctor’s stool at the computer screen.

“Good afternoon, Mrs H**,  my nurse tells me you’ve been having a boil on your foot recently,” I looked over at her and then down at her right foot.

She nodded in affirmation to my query.

“She also mentioned that you’ve recently taken some medication for it but it’s still not going away?”
Mrs H again nodded. “I just finished the antibiotic. Some of the redness has disappeared but it still pains and the swelling doesn’t seem to be getting any better.”

I glanced over the urgent care note from a few days ago. ‘Diabetic foot wound’. Ah, so Mrs H had diabetes. I wondered how well controlled her blood sugars were. Perhaps the foot wasn’t healing because her blood sugars were too high or she had some sort of circulation impairment in her feet? “Are you taking your diabetes medicine?”

“Yes,” she answered, and then added, “my sugars are always good too, 90s to 100 when I check them.”

“Excellent!” I praised. I noted in her electronic chart that her last haemoglobin A1c (a measure of how well her diabetes was under control) was 6.8 – collaborating with her reported fasting blood sugar readings. My theory about a non-healing foot wound due to poor control of diabetes disappeared. Poof! Gone. Time to figure out another reason that her foot wasn’t getting better.

“Are you having any fevers?”

“No,” she shook her head.

“How did this boil on your foot begin?”

“Well,” she began with an embarrassed shrug. “A couple weeks ago I got angry at my husband and kicked the door. I noticed pain in my foot and later it got all red and swelled up. A boil developed on my foot and then sort of burst when I pressed it. Pus came out. That’s when I went to the urgent care doctor and they gave me the antibiotic for the infection.”

“Ah,” I typed a few notes down in the computer. “So this all began a few weeks ago and the antibiotic helped but didn’t completely clear up the infection?”

Mrs H looked down at her sockless feet resting on the blue paper as if for confirmation of the fact. Noting the swelling on her right foot, she nodded in agreement with my summary.

Internally I summed up my understanding of the situation with Mrs H. Diabetes. Abscess on foot. Took antibiotics. Not better. Still painful too. Hum?

“Well, Mrs H, if it’s ok with you, I’ll take a look at your foot?”

She affirmed her consent with a nod. “It hurts here.” She leaned over from her seated position and indicated the top portion of her right foot.

“Ow!” she drew back when I pressed over the bones in her foot. I wondered if she might have fractured a bone when she kicked the door.

“Did they take x-rays of your foot last week when you went to the Urgent Care?”

“Yes, they said everything was fine. The bones were not broken,” she reassured me.

I continued to palpate around the small swollen area on the top of her foot. The good news – there wasn’t a lot of redness so the antibiotics had apparently done their job in eliminating the irksome bacteria. The bad news – there was still obviously a swollen small lump and pain on the foot.

“It feels like there’s something under the skin where you have the boil,” I looked up at Mrs H. “Any chance you might have caught a splinter when you foot hit the door?”

Mrs H thought for a moment and shook her head. “No,” she paused and then her face lit up, “my mom pulled a splinter out of my foot when I was a child.”

“Oh, what happened?”

“My brother and I were jumping on the bed. My foot got cut on the bedpost when it hit it as I fell. I told my mom there was something stuck in my foot. She said she pried out a piece of wood when she bandaged my foot.”

“Interesting,” I tried to figure out how a story of falling off the bed at the age of five related to her current problem of foot pain forty years later.

“You know, doctor, this foot has always acted up. I used to tell my mom that I thought there was still a splinter in my foot but she could never find anything when she poked around.”

“Oh?” Apparently there was more to the history with her foot than I’d originally assumed.

“Yes, doctor, my right foot has always been prone to getting a boils.”

“So this isn’t the first time you’ve had an abscess on this foot?” the light was beginning to dawn on my consciousness.

“Now that you mention it, I had something like this last year too.”

“And you’ve been seen at the doctor’s office before for this abscess and they’ve never found anything?”

“I just take the medication and it seems to go away but never completely. I get pains in the foot on and off. I have to wear shoes with socks because I can’t stand for the straps from sandals or slippers to rub on the top of my foot.”

The story was becoming more complicated. More than a one time infected skin abscess. “Do you mind if I numb up this area on your foot and see if there’s anything I can find? It feels like there’s something like a splinter or toothpick in your foot.”

Mrs H agreed to my exploratory mini operation. After numbing the area with local anaesthetic, I nicked the skin over the strange solid thing that I’d felt on my exam. If nothing showed up on x-ray, it must be something organic stuck in the foot. With a fine forceps I dug into the tissue and snagged the object I’d felt.

“It looks like you’ve been keeping half a toothpick in your foot,” I pronounced to Mrs H with a triumphant smile. I held out the forceps that now grasped almost an inch long wooden splinter extracted from her foot.

Mrs H adjusted her glasses and leaned forward for a closer examination.

“It looks like you were correct. You did still have a piece of that bedpost in your foot. You want to take it to show your mom that you were right?”

Mrs H laughed. “After all these years…”

“You’re foot should heal up properly now. Without that piece of wood irritating the tissue, you shouldn’t have any more problems.”

“Wow, doctor. That’s great.” She continued to smile, still somewhat in shock, I think. She had me put the wood in a plastic wrapper for her; and in fact, did take it home. I can only imagine what she told her family.

Moral:
1.     Things are not always as simple as they might appear at the onset of a clinical situation
2.     Don’t try to keep a splinter in your body for years – it festers!


“Why do you see the speck that is in your brother’s eye, but do not notice the log that is in your own eye? Or how can you say to your brother, ‘Let me take the speck out of your eye,’ when there is the log in your own eye? You hypocrite, first take the log out of your own eye, and then you will see clearly to take the speck out of your brother’s eye.” Matthew 7:3-5


“As you slide down the banister of life, may the splinters never point the wrong way.” –Irish Proverb


**All identifying data including specific circumstances altered to protect identity.

Tuesday, January 27, 2015

Be Kind To Doctors


Actually... be kind to all those we meet... the ripples of kindness should not be underestimated...



Contrary to popular media, doctors are human too. Doctors are born, live, and die just like everyone else. There is nothing inherently magical in the preparation of physicians that mould them from soft and fleshy homo sapiens with tender souls into hardened robots with scientific logic. In fact, doctors may be more fragile than the average population if one were to consider the statistics. Increased burnout. More depression. Higher rates of suicide.

And yet, the façade persists.

On the outside, you probably won’t see a difference. I doubt it’s possible to observe the slight tremor of my hand as I log onto the computer or the subconscious tremble as I ask what I can do for you as your primary care doctor these days. I hope you won’t notice actually. You can’t see the emotional scars that I carry from working in the field of medicine and occasionally getting caught in the crossfire of a frustrated injured patient hurtling arrows of hurtful accusations at the profession, or having a previously healthy man die underneath my hands doing CPR, or failing to resuscitate a tiny stillborn baby. Some arrows hit harder than others. More recently you might have heard the pieces come cascading down in a tumbling avalanche of shattered glass in fact. Those were the broken bits of my self-confidence and belief in the goodness of humanity slipping into a million tinkling shards that were washed down the drain by a flood of invisible heart tears.

Yes, doctors are humans too.

In spite of our outward professional personas of academic intelligence and logical reasoning fraying at the edges by a frenetic schedule of sick patient-visits and overwhelming written documentation, physicians are every bit as human as the breastfeeding mother in the nursery or the elderly man who sheds tears over his wife in the ICU. Doctors find themselves in those situations too – perhaps  they’re at a disadvantage because some have sat on both sides of the fence where a certain amount of “ignorance is bliss” might have helped.  

White coats and name titles like M.D. and D.O. do nothing to protect us against the stinging angry words of unhappy patients. 

“I find your attitude rude and arrogant!” the patient stormed out of the examination room.

“I’m so sorry. I truly didn’t mean it that way. I was just trying to provide the best health care for you…” my apology backpedalled aimlessly into the dust as the door shut against the agitated figure of the elderly patient. Her abrupt departure was unexpected to say the least.

My initial reaction was shock. What?! Did she really just leave?

Within seconds this morphed into a more enduring crush of nascent confidence. My stomach plunged to dark rocky depths in the split second it took to log off the computer and realise there was nothing I could do to placate the agitated patient-client. She was gone. Redemption disappeared at the slam of the door.

“Um,” I turned to the nurse helping me that day, embarrassment and shame slowly dawning upon me. “What should I do?” I asked her. “My patient just walked out on me. She said I was rude.” It hurt to admit anyone would ever say such a thing about me.  I like to believe that I am generally professional and able to communicate at least on a doctor-patient level with almost anyone. Clearly I’d struck a sore nerve. I had offended the patient. It was a miscommunication yet still it hurt.

It was an error in communication that ruined my day. As much as my intelligence assured me that I was still a competent doctor, I couldn’t shake that small nagging aura of foreboding. Someone out there hates me. Cognitively I know I will never please everyone but my heart still wishes such wasn’t the case.  In spite of my best efforts, I wish I could please everyone. My logical brain can accept that not everyone will be happy with my care. Statistically, I realise there will be a percentage of patients that are unhappy with my professional services for one reason or another, likely having nothing to do with my competence. Still… and yet… I felt horrible.

Yesterday a patient came to see me. “You’ve restored my faith in this organisation” she’d informed me. Her genuine gratitude brightened my day.

Others this week have smiled and thanked me for taking the time to listen to their concerns and answer their questions. “Is there anything else I can do for you?”

“No, doctor, you’ve taken care of me,” they’ve answered with smiles of relief that someone had taken the time to address their concerns. Now the multitude of their accolades was drowned out by the stormy waves of self-doubt. Why did one dissatisfied client erase so many positives? One angry customer nearly destroyed me. The peace of inner assurance in my abilities as a physician slipped away, overshadowed by the heated accusations of one unhappy customer.

Professional decorum dictates that I maintain a semblance of composure and immunity in such situations though. Tears were not appropriate. Other sick patients waited to be seen. There were many more hours to go until I could stop work. Life continued in spite of any personal feelings. “I feel terrible about this,” I lamented to my supervisor and again to my colleague.

“It’ll be ok. It’s happened to all of us,” my colleague gave me a sympathetic shrug. “Don’t worry about.”

“I know,” I gave a wan smile. “I still feel bad. It’s hard to hear how people misinterpret one’s good intentions …” my explanation trailed off. My colleague nodded. He understood. Neither of us needed to elaborate. I don’t know any physician who finds it easy to brush off the false accusations or dissatisfied frowns of short-tempered, angry sick patients.

Working with a population that is sick and frustrated with a complex healthcare system that treats them as a number and not a person, is inherently fraught with misunderstandings on all sides. Communication is never perfect and when physical illness is involved even less room for forgiveness is present. So why, in possession of this knowledge, do I feel so awful when someone is dissatisfied with my service or misinterprets my good intentions?

“I feel terrible.”

“I understand. I hate confrontation too. Even though I might not appear to mind, I still find such encounters difficult,” a more seasoned colleague tried to comfort me later.

“We’ve all had such patients,” another friend commiserated with me when I related my discouraging encounter. “It won’t be the first; it won’t be your last.”

I nod. What she says is correct. Still, it’s not terribly encouraging. Some days I think I must have chosen the wrong career. Perhaps I’m too sensitive. I wonder if I should gone into the food service business and found a job at Baskin Robbins scooping out ice cream to gleeful ice-cream fans or tossing pizzas for cheese and mushroom enthusiasts.

“I still get sweaty palms and palpitations when I have to confront certain patients. I know I’m doing the right thing by not prescribing their opioid pain medication but I still find such encounters very stressful.” It’s a common lament from many of my colleagues. On the outside, such doctors might appear strict and unyielding but inside most hate having to say no.

I don’t know any physician who finds it easy to disclose a terminal diagnosis to a patient and their family. It’s one of those inevitable responsibilities that fall upon a doctor; one that we shoulder as bravely as possible, but, like any human, not one we ever feel happy about. It’s not easy dealing with disappointed, suffering, disillusioned populations. And yet, physicians are asked to do such all the time. Mostly we manage. We muddle through as best we can – reassuring each other we’re doing the best we can while we reaffix our masks of professionalism at the beginning of our shifts. Underneath we are human though.

Yes, I realise people will get upset at just about anyone and misunderstandings happen under the best of circumstances. Still, I just want to say, please be kind to doctors. Physicians are humans too. We have feelings. Underneath our comforting smiles, cold hands (warm hearts), and white coats, we bleed blood crimson red just like everyone else. The tears that stain our hearts are not always visible to the public but that doesn’t make them any less real.

As I type these last lines I realise that the call to kindness is universal. It’s not just physicians who are fragile human beings that, in spite of their imperfections, still need that genuine kind attitude and loving concern. Each one of us carries those wounds in our hearts, invisible to the superficial gaze, yet very much real and so easily raked raw afresh. The Golden Rule comes to mind again.
“Treat others as you wants others to treat you.”

Kindness flows outward in a ripple of influences that shimmers beyond our imagination.

Be kind to doctors. Be kind to everyone. Be kind to yourself.

“Be kind to one another, tender-hearted, forgiving one another, as God in Christ forgave you.”

Ephesians 4:32

Thursday, January 15, 2015

Perspectives

The subject that is running around my head today (and most days) is the idea of perspective - and really multiple perspectives.  The beginning of any exposition is perspective.  Each author is sharing perspective and even their perspective on multiple perspectives. 

My parents had a perspective on me as a child and I had a perspective of them as parents.  They were not perfect parents nor was I a perfect child.  But then again, what is “perfection” and we are back to perspective and multiple perspectives.  We can interview and survey vast numbers of people of what perfection is in their understanding.  Interviews will reveal stories and examples, surveys will force sort into categories (unless they allow for stories and examples).  Then it is up to the researchers to sort and code all of this.  Even the process of sorting and coding has the likelihood of bias due to the researcher perspectives.  

The Bible was written over millennia by many different authors, it has been copied and translated by many through the years.  Translation from one language to another is not an absolute - straight-forward process.  I remember when I was getting to know my wife.  I emailed her and she emailed back.  We have the potential to misunderstand each other in the same language, but she replied in a foreign language.  It took me about 30 minutes to find the language (this was before Google Translate and related tools existed).  The process to understand this new woman in my life was not only to understand her in English - we continue to work through that process still.  But having discovered the foreign language I began the process of translation.  I printed her email with gaps between the lines and then wrote in all the options that each word could mean.  Some words were very basic with one meaning and some words had several meanings depending on the context of usage.  It took me five hours to generally translate the paragraph.  This was enough time to learn basic word structure (root, prefix, suffix, etc).  Certainly not enough time to fully understand the context and culture behind the choice of words.  Since some of the meanings of the words could be benign to the risqué I did have to make choices as to her intent.  When I replied to her I did not try to prove my translation, but to respond in English my best understanding of her communication.

Though the years I have treated people through a filter of my own absolute rightness.  This is not healthy for me or the other.  Of course I have come to see through the years that I can hold something to be absolutely true for myself, but others see it otherwise. We have different interpretations of our shared experiences, different understandings of what what we read, different paradigms on which we have built our process of making sense of the world and all that it contains.


I have come to a place that I believe absolute truth exists but that none of us possess all knowledge, all understanding and thus none possess all truth. We possess a part of that truth, our lives bear witness to what we hold to be true, right, and good.  Even as I say that I realize my own continued failure to live up to all that I hold as ideal.  So the ideal may be more truth that what you see practiced in my life.  But perhaps that too bears witness to a larger truth.

Sunday, January 4, 2015

On Doctoring Around the World...




A/N: Well, dear readers, not sure how this blog posting turned out. These are my first patient-client reminiscences since coming back from Africa. Will writing about my experiences in America be interesting and insightful to you or will they lack the exotic African edge?  You’ll have to let me know. Thanks for all your support and encouragement over the years! A new chapter has begun for me.

On Doctoring Around The World

Doctor.

The word is almost universal.
The syllables, rhythm, and enunciation are nearly ubiquitous around the world.
Call out the term, ‘doctor’, in almost any country and any passerby will immediately understand that you want medical attention – and fast. It’s a term that conjures up illness. Urgency. And, hopefully, kindly concern for humanity.

He was sturdy and rugged**. Not young but certainly not elderly and frail. The calluses on his hands bespoke of someone used to daily manual labour.

“Where do you work?” I inquired as I sought to grasp a more complete picture of my new patient. I’d just started work back in the United States and was seeking to figure out how to reintegrate myself as a professional primary care physician. I needed to understand the American culture and how to connect to my new community of Pacific Northwest natives.

“I work at Fred Meyers (huge department store),” he shrugged his shoulders. It was a job and paid his bills. He didn’t seem particularly attached to his job and yet he wasn’t unhappy in it either. “I do a lot of walking. I walk to work. I am on my feet most of the day in retail sales there, and then I walk home too. People ask me how I keep in shape.”

I glanced at his BMI, a healthy 24. “Oh?” I ply him for conversation with genuine curiosity. His success story is one that I may remember to pass on to others after him. “What do you tell people when they ask how you keep your weight under control?”

He smiled at the compliment. “I don’t do anything special. I just walk a lot and started eating more fruits and vegetables. Nothing fancy.”

“You don’t work out at the gym or anything?”

“No. I can’t afford that, doctor.” He laughed nervously. “Till last month, doc, me and my wife, we didn’t have no health insurance. Haven’t seen a doctor in years.”

“Really?” I raised an eyebrow and tried to listen, keeping half an eye on him and the other half focused on the computer screen while I keyed in orders for his blood work. While electronic medical records have many pluses, easing the burden of information data entry is not among them!

PJ graciously allowed me to continue entering information while he related his story. “My wife’s been worried about me since I’ve been having all this numbness in my body. My hands and feet especially. Sometimes my feet get so numb that I don’t really feel them.”

“How so?” I glanced up at him and tried to type and focus at the same time. “When you have these symptoms of numbness, how does it affect your daily activity?”

“My body just feels numb. I can’t feel my legs and hands. Sometimes makes me think I might stumble when I’m walking a long ways.”

“Hum?” I try to sound halfway intelligent, like I have a clue what he’s describing when in actuality my brain is still trying to translate his description of the problem into medical symptomatology that I can sort into a differential diagnosis. It’s a bit like translating from one language to another. English to Latin perhaps? I have to intake the words that he uses in the context of his experience and digest them into a pattern that is recognised in a medical dictionary.

“Tell me more,” I encouraged him as I continued my exploration his problem. “How long has this been going on, PJ? Is it getting better, worse, or staying the same? Anything seem to make the numbness worse?”

Thankfully, PJ is happy to comply with my questions. I am grateful for the extra time I have as I begin my new job at the American clinic.

I remember back five years when I was first starting out in a new culture and language in Cameroon, West Africa. Pidgin was the common language that my patients spoke there. It took me months to begin to comprehend what it meant when an elderly lady complained of ‘ma skin de hot me fo all my body’ or a pregnant woman stated ‘I spit too much’ or a mother said ‘I have fever but it doesn’t come out’. The art of medicine, of listening as a physician, involves so much more than is taught in the lecture halls or the thick dusty medical reference books.

“So this is a problem that’s been going on for about 8 months now, not really getting better or worse, and mainly affecting your feet and hands?” I summarised. “Have you been worked up for this problem anywhere else?”

He shook his head no. His swaying grey hairs assured me he’s not been seen elsewhere for his current concerns.

Almost apologetically, as if he’s afraid I might scold him for not coming in sooner, he continued. “I know it been a while, my wife and I just haven’t been able to afford to see a doctor for a few years.”

He doesn’t need to apologise or explain further. I nodded. I understand his plight. Since coming back from service in Cameroon, in a bustling city centre where almost everyone could afford to see a GP at the government hospital or at least a neighbourhood nurse (granted there were some questionable levels of quality medical training and care…) it seems strange to be back in a country where not everyone can get health care if they want. A simple antibiotic for the part-time mother employed at a fast food chain is a near impossible hurdle for some.

My mind bounces back to two days prior when I stout Mexican woman proudly informed me that she’d just finished paying off her debt for her hospitalisation over two years ago. She had no idea what the total cost of the bill was; she shrugged and gave me crooked smile and said she just paid the $75 dollar per month payments that the hospital’s financial department had set up. She’d received word a couple months prior that it had been paid off. She was very happy.

Of course, I’d congratulated her, as she was clearly quite proud of her accomplishment. Inside though, I was a little sad because I have recently learned that too many of my fellow citizens are unable to pay off their hospital debts. Numerous studies that I have read online all have found that the number one reason for bankruptcy in the U.S. is from unpaid medical bills. A study in 2013 by NerdWallet Health analyzing data from the U.S. Census, Centre for Disease Control, the federal court system and the Commonwealth Fund predicts that 1.7 million will file for bankruptcy protection due to medical bills and outside of this another 56 million will struggle with overwhelming medical claims, that’s 20% of the U.S. population between 19-64. It’s hard for a missionary doctor to accept these statistics sometimes. I know it’s the reality but it doesn’t mean I like it.

For now, I concentrated on my new patient, PJ, and understanding his illness in the context of his circumstances. “What is about your symptoms that worry you? What are you afraid you might have?” I asked PJ. “You mentioned you’ve gone on the Internet and talked with your friends and wife? Is there something you’re afraid that you might have? Something your wife is concerned about?”

PJ shrugged a little embarrassed. He’s a private individual. Male reticence perhaps? “I don’t know. I’m still figuring out the culture in my new community. “You’re the doctor.” He hesitated. Clearly he did have some ideas and fears.

“Yes?” I encouraged him to express himself so I could understand.

“Well, you know, doctor,” he paused again. Then finally he added cautiously, “Some people have mentioned diabetes, vitamin deficiency, MS…” his voice trailed off.

“Cancer even?” I gave him words for his worst fears.

He nodded.

I glanced over at him and then finished typing. “Well, now that you are in the system, you’re in.” I assured him with a smile. “Now we can check everything out and figure out why you’re having the symptoms that have been bothering you for too long.”

He gave me a tentative quick smile.

I got up and did my usual physical exam. A head to toe exam that is the same in Africa as America. There is something comforting to using my stethoscope to auscultate the breath sounds of the lungs or the heart rhythm through the chest wall. It’s universal. Healthy bronchial breath sounds are the same anywhere I practice medicine. It makes me feel less homesick when I do my hands on physical.

“So far, everything appears normal.” I straighten up from my exam. “We’ll do some blood work to make sure you don’t have any diabetes. We’ll order all the tests to get you caught up on your cancer screening too. Before you leave, the nurse will give you your flu and tetanus vaccinations.”

He gives me a grateful smile.

“Don’t worry,” I tried to assure him that I cared and convey my desire to help alleviate his health fears. “You’re in good hands with your new health insurance. We’ll get you all caught up on your preventative health care and figure out your health problems now. We’ll take care of you.” I look up at him as I complete all the computer entries for his labs and vaccinations.

PJ is seated on the edge of the exam bed. He is smiling. His clear blue eyes framed by wrinkles formed over years of hard work begin to swim. Tears threaten. He catches himself before they spill over. And yet, his voice cracks ever so slightly. “Thank you, doctor,” he catches my hand as I reach out to solidify our relationship – primary care doctor and client-patient. A strong, firm handshake. Two strangers agreeing to work together toward health. Two strangers both coming back to the organised network of American managed healthcare.

“Thank you,” he huskily echoes.

“You’re most welcome,” I heartily assure him.

Truly, I am grateful for the reminder. He reminds me that I have a mission to care for people no matter what culture or country I find myself serving. My mission is not confined to a particular corner of the world. Sick people are everywhere. And anywhere I go, I will find those underrepresented and underserved who need an advocate to voice their story. They need a translator to hear their fears and address their health concerns. Whether in an “under developed” country or a “developed” country I can still be a missionary, an ambassador for Christ through loving medical ministry.


**Names and identifying information are changed to protect privacy.

Thursday, November 13, 2014

Homeless


Jesus replied, “Foxes have dens and birds have nests, but the Son of Man has no place to lay his head.” Matthew 8:20

I’m tired.
I want to go home.
What home?
Oh, yeah, right, I’m homeless.
Jesus' comment to the potential recruit in Matthew has new meaning for me:

Over the past couple months, Bill and I have been dependent on other people’s charity. Now don’t get me wrong. I am deeply appreciative of the generous hospitality shown to us. It’s not easy inviting two people that you might not have seen for a few years, or at least a year, into one’s house and having them invade your privacy, disrupt your routine, and block your vehicle in the driveway. I am very much indebted to the wonderful welcome so many of our friends and family have shown us. In fact, I am so thankful that I am also struggling with guilt. Why am I so unsettled and tired of living from house to house when so much kindness has been floated my direction? I feel ungrateful.

I should be more thankful. Less unsettled. Less grumpy.

Guilt and loneliness has a way of sneaking up and rearing its sinister little tongue in my ear at the most inopportune moments. For example, driving down the speedway from Zion National Park to San Bernardino California after a fabulous camping trip. And when I say fabulous, I mean it was perfect. Great weather. Great company. Delicious food. Inspiring views of nature’s beauty. It was a flawless get-a-way. I couldn’t have asked for a more perfect adventure.

It’s over now. We’re driving away toward the smog of the L.A. West. We’ve packed up the little red Honda Fit once again. Although our clothes smell like campfire smoke and items might have “shifted” a bit making the piles in the back more ‘poofy’, everything is settled enough that one can view out the rear-view mirror. Our temporary tent shelter is cleaned and packed and now a distant memory. We are driving onward to another yet another temporary shelter.

Our yellow duffle bags contain most of our clothes. Our two backpacks contain the other essentials, like a laptop computer, documents, and electrical wires for charging the mobile phone and iPad. The camera and day planner are in my shoulder bag. Bill and I can carry all our necessities in two hands.  We don’t need much: deodorant, toothbrush, clean underwear, pyjamas, and a nail clipper. Our life on the road is pared down to the bare essentials. And yet, with all our comforts more than amply supplied, why do I feel so “homeless”? Like a vagrant or a gypsy?

How many more WiFi network passwords can our MacBook remember? McDonalds, Starbucks, Panara, and even Zion National Park have public Internet access now. I’ve used them all. The downside of daily changes in my IP address was that my Google account locked me out. It noticed "erratic usage patterns" in my account!

How many different ways of brewing coffee can we learn? Instant…Drip… Pods… Press… Fancy machines and not so fancy machines…
How many varieties of soaps and shampoos will our skin adapt to?
How quickly can our bodies adapt to the ever-changing time zones and schedules?
How many different brands of washing machines and dryers are available in the U.S. these days? The fully automated ones practically require a PhD to be able to utilize. I never new laundering a pair of wool socks was such a complicated science!

Our new Honda Fit has driven over 16,000 miles in under 4 months and passed through 26 different U.S. States. Our Visa company is almost on speed dial so we can let them know we’re in yet another country.

I have one address on my driver’s license. Another address for my Visa Card. When someone asks for a mailing address, which one should I give? My Amazon account contains over 20 potential addresses for shipping.

Oh, and a phone number, you ask? Well….I have  a new mobile number this year. A Trac phone. One of those pay-as-you-go phones. Great for avoiding the FBI if I were a secret agent spy; not so great when others want to contact me or I want to look up a friend in my phone’s contact list.

Want to confuse someone? Try scheduling a doctor visit or a dental check-up with the receptionist. The conversation can be a bit awkward:

“I can put you in for an appointment with the doctor on Wednesday, December X,” the receptionist pauses, waiting for my affirmation.

“Um… I won’t be in Virginia then. We’re only in that State for the last week of November. Might you have another appointment slot open, please? We only come back to the U.S. for a short period of time for our annual holiday, you see. Sorry for the confusion.” I apologize. Sometimes one can make appointments more in advance but then one risks misunderstandings through the crackling, unsteady Skype connection.

The receptionist (rolling eyes on the other end of the line most likely) finally answers after a significant pause, absorbing the information, “Well…let’s see…” I wonder if she thinks I’m making up the situation to entice her to try for a more urgent slot. I have no idea.

~o~

One day it will be nice to have a home address again. A home to ship our belongings to that are scattered all over the world. Some cartons are waiting on the dock in Douala tagged to cross the Atlantic soon -- we hope. Other boxes are shelved in our longsuffering parent’s basement. Our dog is lodged temporarily with my parents while we drive across the country like migrant workers in search of a permanent position. Our cat is distributed to a friend of a friend until we have a final destination. Other mementos are stored in at my husband’s relatives. And the rest of our things -- those little essentials that we can’t bear to part with -- like our guest book, a favourite pillow, and my husband -- are nestled ‘fittingly’ into our Honda Fit.

One day Bill and I will have our own bed again. One day we’ll be able to set our toothbrushes down on the bathroom counter and not worry about forgetting them when we pack up again. One day it will us giving out the password for our own WiFi network. But, for now, we’re homeless and on the road. Two days here. Three days there. House to house. Friend to friend.

I am thankful. I am grateful. I am blessed by the interactions and the opportunities. I wouldn’t trade this unique experience of transitioning from Cameroon back to the U.S. for anything. I won’t forget it.

And yet… I  think I will be glad to finally unpack…one day. At least for a while.

~o~

Lord, I cannot fail to see the spiritual lesson in all of this. What a reminder that yes, we are pilgrims and sojourners on this earth. We cannot get too settled. Earth is not the final home; heaven is our destination. Heaven is our home. Until then, we keep travelling.

And I do ache for that heavenly home. These past few weeks have demonstrated that more than ever to me. Home is heaven.

 The hymn in church last week seemed fitting. It is probably a familiar hymn for many of you. The words have been filled with additional meaning for me recently. Here they are: (the YouTube version is quite nice, btw).

This world is not my home, I'm just passing through.
My treasures are laid up somewhere beyond the blue.
The angels beckon me from Heaven's open door
And I can't feel at home in this world anymore.
O Lord you know I have no friend like you
If Heaven's not my home, then Lord what will I do?
The angels beckon me from Heaven's open door
And I can't feel at home in this world anymore.

They're all expecting me and that's one thing I know.
My Saviour pardoned me and now I onward go.
I know He'll take me through, though I am weak and poor.
And I can't feel at home in this world anymore.
O Lord you know I have no friend like you
If Heaven's not my home, then Lord what will I do?
The angels beckon me from Heaven's open door
And I can't feel at home in this world anymore.

I have a loving Savior up in glory-land,
I don't expect to stop until I with Him stand,
He's waiting now for me in heaven's open door
And I can't feel at home in this world anymore.
O Lord you know I have no friend like you
If Heaven's not my home, then Lord what will I do?
The angels beckon me from Heaven's open door
And I can't feel at home in this world anymore.

ust up in Glory Land we'll live eternally.
The Saints on every hand are shouting victory.
Their song of sweetest praise drifts back from Heaven's shore
And I can't feel at home in this world anymore.
O Lord you know I have no friend like you
If Heaven's not my home, then Lord what will I do?
The angels beckon me from Heaven's open door
And I can't feel at home in this world anymore.