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