Broken

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.

Let It Rain

“Have I not commanded you? Be strong and courageous. Do not be afraid; do not be discouraged, for the Lord your God will be with you where ever you go.” Joshua 1:9

~O~

Sometimes courage is in short supply.
Sometimes strength is found in weakness.
Sometimes the tears threaten to fall.

The glass facade trembles and nears dissolution into a broken heap of shattered remnants.

There are many things to appreciate about my life in Buea. I am surrounded by blessings in the form of friends, pets, smiles, and inspirational stories every day. I live in a people-oriented culture where people take time for people.

~O~

Sister Comfort dropped by the patient's room looking for a pair of baby's shoes. In spite of her busy schedule, she exchanged pleasantries with the new mother for a quarter of an hour before continuing on with her duties. She forgot the shoes.

~O~

A member in church is recovering from an operation at home. Each day a steady stream of brothers and sisters in Christ, visit her, delivering fruits, drinks, and companionship – distracting her from the pain and cheering her through discussions on the local events in town or reminiscing over enjoyable memories.

~O~

Even online, when I open my in-box, it spills over with messages and encouragement in daily snippet exchanges shorter than a tweet but filled with plenty of love.

Everywhere I look, I am blessed.

~O~

Still, there are the periods of loneliness, tiredness, discouragement – seasons of sadness. Or perhaps not an entire season but rather moments of melancholy? Periods in life that remind me I am human, not immune to the tribulations in life.

Sometimes the showers of blessing are showers of sadness too.

The rain outside my window tonight falls lightly, it drips in a steady flow – slow droplets from the sky sighing in their misty descent. Their melancholic liquid symphonies splashing to their death in a mournful rhythm of drip, drip, drip.

I want to join their chorus. I want to let my own tears blend and mix into the watery cascades, allow the sadness  to float away in the same rivulets as the falling water. The rainy splashes can drown out my sobs. My tears will vanish in the fleeting flowing eddies of swirling water.

I want to let the tears come and wash away  this sorrow.

~O~

Emotions are like the waves of the ocean's tide, ebbing to and fro. Sometimes content and happy. Sometimes disappointed and sad. My patience is in short supply these days. It's a thin line. I easily snap at slight provocations.

A new nurse did not know how to set up the quinine infusion for a small child properly yesterday. He almost caused a serious mishap through his ignorance by failing to ask for help in getting the dosage correct. He could have caused a major problem that might have hurt the child.

“How can you not know how to give quinine for malaria?” My voice was angry as I rebuked him for his mistake. “Haven't you worked as a nurse before in other hospitals? How is that you don't know how to set up the most commonly given infusion for malaria? You told us you could do all things. You told us in your initial interview that you were capable of all the basic duties required of a nurse.... ”

The new nurse maintained his composure. He couldn't understand my hastily spoken complaints but he understood that I was upset.

“I'm sorry, doctor,” was all he could add.

Later, I was reminded. “He's just a baby, doctor. He's new.”

It was true. In spite of his deceptions regarding his initial skills, now was not the time to deliver a lecture on his incompetence but rather move forward. Chiding his lack of abilities would not solve the issue. Berating him over his mistakes was not the solution.

I took him aside. “I am sorry for getting upset at you,” I apologized.

~O~

This morning I argued with the auntie and mother of a young child sick in our hospital. “Please, let her continue her treatment. Let her complete her medicine. She is too ill to go home.”

They were determined to go though. “Doctor, you are not getting us,” the auntie complained.

“I am getting you,” I answered. “I am just not agreeing with you.”

In the end, no matter what I said or offered, they left. Their minds were made up.

~O~

“It was the worm medication that the doctor prescribed. It was too much medicine. My doctor in Yaounde says I should not have taken it all.”

The recently bereaved woman who'd just suffered a miscarriage needed someone to blame. It didn't matter that the worm medication she believed to be the culprit for the miscarriage was part of the standard of care given to all pregnant women. She needed a reason. A reason so that she could avoid a miscarriage in the future.

“She has to blame the medication, doctor,” my astute nurse observed. “She cannot just say it happened like that. I could see that she already had it in her mind that the worm medicine was the problem. She has to tell her husband that so he doesn't blame her.”

She was correct, of course. I have to be brave and professional and accept the accusations. Arguing the scientific facts have not convinced her otherwise. She needs a scape-goat. I am that person today. Even though I know I'm innocent and haven't caused her harm, I am hurt. It is a terrible accusation to be blamed for the loss of one's baby.

I want to cry but now is not appropriate. Tears will not help. I continue on with my day. Even when I don't feel confident and brave, I can at least play the part – maintain my role as medical leader. My nurses need me.

~O~

Tonight, alone, the rain falls softly. The burdens on my heart feel extra heavy. I wish I could join the crying sky. I want to weep for all the pain and suffering I witness in my labors. I want to mourn for the tragedies that enter my sphere of awareness here in Buea.

The tears cannot come though.

Instead I let the sky do the crying for me.
Let it rain.
Let the tears from heaven come.
Cleanse away the sadness and the sorrow; make way for the sunshine tomorrow.

~O~

“My eyes fail, looking for your promise; I say, 'When will you comfort me?'” Psalm 119:82

“But those who hope in the Lord will renew their strength. They will soar on wings like eagles; they will run and not grow weary, they will walk and not be faint.” Isaiah 40:31

“This is my Father's world,
Why should my heart be sad?
The Lord is King;
Let the heavens ring!
God reigns;
Let the earth be glad.”
- This Is My Father's World.  Hymn written by Babcock

A Tiny Ethical Dilemma

A Tiny Ethical Dilemma

Life is not always so simple. Black and white moral choices. Do they even exist in such stark, contrasting colours? Seems like there are a quite a few shades of grey when it comes to ethics.  Fifty shades if you believe a certain author…

Clients old and young crammed into our clinic waiting area. Those healthy enough hung around the perimeter avoiding the sweaty, hot central node of sick bodies, nudging their way past mothers with babies strapped to their back and elderly grandparents resting against the wall grasping their walking sticks while sitting on the benches. Somehow there was an order although at the time it was difficult to conceive any sort of queue existed among the impatient patients.

My door cracked open as I sat opposite a sick client reviewing her history. “Oh, sorry,” Madam H said unapologetically. Her eyes flicked to her medical book and back to me expectantly as she pushed the door open further and shoved her book under my nose for an inspection of her lab results. She was ready for her prescription.

“Ok. Thank you,” I said, trying not to sound to exasperated. Mrs G. sat motionless and silent, suspended in animation until my intruder finished intruding on our private interview. “I will look at your labs and write the prescription after I finish with her.” I indicated Mrs G.

Madam H gave a satisfied nod and backed out, closing the door on our privacy once more. “So, you were saying you have vaginal itching but that the discharge does not have a smell….” I picked up where I’d left off in our original conversation. Amazingly, Mrs G seemed unperturbed and jumped back into a detailed description of her ailments for the past eight years.

“Yes, doctor. When I take medicine it goes but then it always comes back.”

“Any pain associated with the discharges?” I probed further into her history trying to ascertain her underlying fears and preconceptions about the problem.

“Yes, doctor, here,” she pointed to her lower abdomen.

“What is the pain like?”

She was silent a moment, trying to come up with a suitable analogy. In those brief seconds, another knock on my consultation door alerted me to the next interruption. It’s amazing I manage to get any outpatient consults done some days.

“Doc?” Nurse A poked her head into my consult room. “There’s another doctor who says he wants to talk to you.”

“Ok. After I finish here,” I nodded to Mrs G. and gave her a small nod. “Just tell him to wait and I’ll come.”

Within a few minutes, I completed my interview and examination of Mrs G. and had sent her on her way to the laboratory. I strolled out of my office and looked around. “That guy,” the nurse pointed out an average-looking middle-aged Cameroonian male standing near the doorway. He spotted me even before I could introduce myself.

“Doctor?” he held out his hand in greeting.

“Yes, I’m the doctor,” I replied hesitantly. I wondered what he could want from me. I didn’t recognise him. Why was he here? What did he want?

“Doctor, I’m happy to meet you.”

“Happy to meet you too,” I shook his hand but remained standing out in the doorway.

“Doctor, I want to talk to you.”

“Oh?” I glanced around at all the patients who were giving me less-than-patient curious stares. “I still have a lot of people to see…” I shrugged.

“It’ll only be a minute. Can we…” he indicated a more private corner, “…talk together just for a minute?”

I hesitated. There were so many people to see. Many had been waiting several hours. They were sick and didn’t feel good. Most were hungry because they had come without taking breakfast. It wasn’t fair to make them wait just because another professional colleague that I didn’t even know decided now was convenient for him to visit me.

“It will only take a minute,” he pressed his case persistently.

At last I relented. “Ok, come back here.” I indicated the bench where we do our dressing changes and injections. “Agbor, Natalie,” I called out.

The patient shouldered her purse and hurried to enter my consult room. “Have a seat inside,” I indicated the chair. “I’m coming.”

I returned my attention to my unknown, physician visitor. We sat across from each other.

“Doctor, I wanted to meet you…”

“And now you have,” I smiled.

He gave a wane smile in return. “Doctor, I work at the ___ hospital.”

“Oh?”

“Yes. I wanted to meet you so that maybe we could work together – collaborate – refer each other patients.” He paused frequently as he struggled to fish out the correct words to get his point across clearly yet subtly.

I listened. I wasn’t sure I understood his agenda yet.

“You know, doctor, I’ve been to ___ country.”

“Oh,” I nodded. I wasn’t sure why he was sharing his foreign travels with me. I’d been to other countries outside Cameroon too.

He continued. “You know, I studied many additional things.”

“Ok.”

“I’ve had training in gynaecological procedures.” He paused waiting for the light bulb to click in my mind. It didn’t.

“Knowing how to manage gynaecological problems in women is a good thing.” I filled the pause.

“You see, doctor,” he resumed his explanation, “I have additional training in how to manage bleeding in women, like after a miscarriage.”

“Like a dilation and curettage?” The light bulb was beginning to turn on.

“Yes, I can do D&Cs.” He was pleased I seemed to understand him now. He paused again.

I waited for him to continue. I wanted him to verbalise the point of his visit more clearly and confirm what I was beginning to suspect.

“Well, you see, doctor, like yourself, I have training in helping take care of women. I can help them. Sometimes you see women who come here for an echography.”

“True.”

“Sometimes they come for an echo and they don’t want it.”

“You mean, when we confirm that a woman is pregnant but she doesn’t want to be pregnant?”

He nodded.

“I can help them. You can send them to me.”

I now understood my colleague’s visit. He was soliciting referrals for dilation and curettage (D&C) for patients who came and wanted an early abortion.

“I am trained in that way.”

The light bulb was fully illuminated in my brain. I understood his request perfectly.

For now, I didn’t have any cases to refer to him. Thankfully, most women recognise that we are a church-based mission hospital and a D&C to abort an unwanted pregnancy is not possible at such a health institution. And yet, sometimes we do diagnose a pregnancy and the dilemma arises: what to do?

Does one refer a young lady to a doctor who can perform a D&C relatively safely and in antiseptic conditions in a hospital? Does one council and pray with this woman and hope that she abandons all thoughts of ridding herself of the pregnancy? Does one refuse to discuss anything outside of maintaining the pregnancy and pray she doesn’t go in secret for an abortion under unsanitary conditions by unqualified people with no training that masquerade as “doctors”?

I have seen some horrible complications of abortions done in shady clinics and even homes by unqualified persons. Sometimes the reason for a woman seeking an abortion can be quite compelling. Losing a job. Being thrown out of the house onto the streets to fend alone. Sent home to the village in shame while forced to abandon hope of a higher education. Pregnancy because of rape and incest. The list is long and complicated and heart-rending.  I once had a young woman of the age of 16 or 17 dragged by her auntie to the clinic – auntie demanding an echo to determine if her niece was pregnant or not. In the privacy of the exam room, the girl fell down on her knees and with clasped hands begged me, tears streaming down her dusty face, to please write that she was not pregnant. She’d had sex with a man in order to obtain money for her brother in prison. If she was found out pregnant, her family would throw her out and she would never be able to finish her education. Intense times. With little resources (not even a positive pregnancy test), she’d gone for a “backyard abortion” and yet she was terrified that the ultrasound might show she was pregnant.

Choices are not always so clear. Fuzziness lies on the edges. Greyscale predominates over defined black and white. To refer or not to refer?

Revelations and Dreams

Revelations

A/N: As a way to encourage each other spiritually, a dear friend and I have agreed to share a favourite and meaningful Bible verse with each other at the end of each week. I’m a little late. This is the result of my musings on a favourite verse… a bit longer than usual. I don’t think she’ll mind if I share with you all.

“Trust in the Lord with all your heart

    And lean not on your own understanding;

 in all your ways submit to him,

    And he will make your paths straight.

 Do not be wise in your own eyes;

    Fear the Lord and shun evil.

 This will bring health to your body

    And nourishment to your bones.”

Proverbs 3:5-8

(A story… names and events have been altered a bit to ensure privacy)

“After I have poured out my rains again, I will pour out my Spirit upon all of you! Your sons and daughters will prophesy; your old men will dream dreams, and your young men see visions.” Joel 2:28

Like Ruth of the Old Testament, she was a stranger in a strange land and now her husband was missing.

Earlier that morning, she’d awoken from a disturbing revelation. “Darling,” she’d turned over in bed, sleepily looking over at her pastor-husband who was dressing to go to work, “I had a dream.”

“Oh,” he replied, adjusting his tie in the dim light of the early morning.

“In my dream, I heard that someone was going to die.”

“All of us are going to die one day, honey,” he replied.

“I know. But in my dream, the woman claimed that God said someone close to me, someone in our family, was going to go back to God in heaven.”

“Did this same woman say when?”

“No.”

“Well, then, we’ll just have to trust God like always, my dear.” Pastor Henry popped his laptop into his business case and began walking out the door.

Cherie was not completely satisfied. She still had a vague sense of impending doom. Her subconscious was not quite comfortable.

“Daddy, daddy,” Doris came rushing out her room to intercept her father before work. Normally she was still asleep at this hour. It was uncharacteristic of her to bother her daddy as he was trying to get to work on time.

“Daddy,” she tugged on her father’s trousers, begging to be lifted up, “can you bring back pizza tonight? I want pizza.” She smiled. “Pizza with lots of extra cheese,” frowning ever so slightly she added, “and no onions or peppers. I don’t like onions or peppers.”

Daddy gave his daughter a hug. “OK, daughter, I’ll bring back pizza for supper tonight if you are a good girl and help mummy around the house today. Remember,” he pointed to the bedroom door where his wife leaned sleepily against the doorframe, “mummy’s going to have a baby soon. She needs extra help from a strong girl like yourself.”

Doris nodded. “OK, daddy.”

Pastor Henry hugged his daughter and then gave his wife a farewell kiss and headed out the door. He took the family car down the long, bumpy dirt road to his office in the city.

Evening came. No Pastor Henry. No husband. No daddy.

“Where’s daddy, mummy?” Doris asked for the hundredth time.

“I don’t know, daughter.” She tried to call him on his mobile phone without success. The phone rang and rang. When she tried his colleagues and friends, no one had seen him since that afternoon. Doris stayed up late in hopes of pizza but in vain. Finally around midnight, Cherie tucked her sad little girl into bed. “Daddy will be home tomorrow. Time to sleep.” She soothed her with soft words and hoped silently that she was right.

Where was her husband? All sorts of horrible thoughts flashed through her mind. Stranded without a car in the country, there was nothing to do but pray. “Please, God, please….” Eventually she drifted off into a troubled sleep.

The next day, she arranged transport. They found her husband slumped unconscious at his work site. At the hospital, he was found to have suffered a massive haemorrhagic stroke – a bleed in the brain. He was transferred to a specialty hospital in critical condition.

“I don’t want to give you false hope,” the doctor cautioned gravely when he spoke to Cherie. “Your husband may not survive the operation.”

“Please, God,” she begged, “save my husband and my children’s father.” Tears streamed down her face as she prostrated herself in the hospital chapel.

“He will be all right. Trust me.” Cherie felt the words pierce her sorrow-laden heart. She stopped crying. “I am with your husband. He will be ok. You will see him well again.” The inaudible assurance saturated her mind and suddenly, from that moment forward, she was no longer afraid.

“Thank you, God,” she bowed her head. She went home and slept.

~o~

“…Dost thou still retain thine integrity? curse God, and die. But he said unto her, Thou speakest as one of the foolish women speaketh. What? shall we receive good at the hand of God, and shall we not receive evil?”

Job 2:9

“There’s been a complication,” the neurosurgeon stood at the bedside of Pastor Henry who recovering from his recent operation for a stroke that had ruptured the blood vessels in his brain necessitating emergency surgery to relieve the pressure that built up under his skull.

The pastor’s wife, Cherie, sitting next to him gasped. “No!” How can this happen after all we’ve been through? She thought inwardly.

“You husband has developed a blood clot in his leg, something we call a DVT – a deep venous thrombosis. Normally we would give some medications to dissolve the clot but because of your husband’s recent stroke, we cannot give that medication or he would bleed into his brain again. He’s too unstable for us to put in a filter.”

“What can be done, doctor?” Cherie glanced anxiously at her frail husband who was not yet extubated from the ventilator that supported his breathing after his operation.

The doctor shrugged helplessly. “We will give him a milder version of medication to help with the clot and we will hope and pray.”

Cherie nodded wordlessly. She wanted to scream and cry at the same time. Why, God? She sobbed inwardly.

That night as she rested fitfully, almost nine months pregnant, she had another vision. Jesus, shining in light and glory, wrapped his arms around her and whispered in her ear, “My daughter, don’t worry. Remember, I said before that everything would be all right. You will see and talk to your husband again. He is my child as much as he is your husband. I am with you both. I will not forsake Henry now. I have not forsaken you.”

She awoke reassured. And yet, her problems were not over. Not for her; not for her husband who by a miracle continued to improve day by day from his stroke. He could move all his limbs. He motioned to her, clearly recognising her as his wife. When the tube was finally removed, he could talk. His mind was sharp and clear as ever. Cherie rejoiced. Her heart smiled. “Thank you, God,” she rejoiced.

“We are going to transfer him to a general hospital ward now.” The doctor wrote Henry’s transfer orders back to the original hospital. “He will continue his recovery there. He no longer needs the high-level of specialty care  here.”

At the general hospital, Pastor Henry’s recovery did not go as smoothly as hoped though.

“He has pressure ulcers, bed sores,” the new doctor informed the couple. “He will need a minor surgery to debride and clean the wounds so they can heal.”

Cherie sighed, “Please God,” she prayed the now familiar prayer.

“Please bring my daddy home from the hospital soon,” Doris prayed from her bed each night before she went to sleep.

The surgery was a success. The wounds on Pastor Henry’s body began to heal, slowly but steadily. Cherie clung to her vision of God’s promise that her husband would be healed. She delivered their son in the same hospital in which he was a patient. It wasn’t easy taking care of a 4 year old, a newborn baby, and a husband that was still ill in the hospital. Somehow, Cherie found the strength. Every other day she’d travel the bumpy roads from their country home to spend the day with her husband in the general city hospital.

“You’re going to be ok, honey,” she murmured as she helped bathe him in the hospital.

Then one night, Cherie was violently awakened from another of her dreams. A dark shadow of doom engulfed her senses. Quickly she dialled her family. “God just showed me in a vision that someone is going to die. I think it’s Henry,” she cried to her sister.

“Call the hospital,” her sister admonished.

“It’s 2 am though,” Cherie lamented.

“That’s ok. The nurses are awake. Just call them.”

As Cherie hung up her phone, her hands trembled. What was going on? Didn’t God say everything was going to be ok? Didn’t God promise that Henry would be healed to talk and walk with her again? “Please, God, please keep him safe!” She couldn’t shake the dreadful feeling of death that gripped her heart.

Her phone rang. It was the hospital. “Can you come to the hospital now?” The nurse on the other line spoke crisply. “He’s taken a turn for the worse. We don’t know what will happen.”

“I’m coming.” Cherie had never driven into town before but somehow she managed to take their vehicle over rocky country roads and into congested city traffic without accident.

Her husband died shortly after her arrival to the hospital. This can’t be happening? Her thoughts were torn and confused. No, no… “God, you raised Lazarus from the dead. You can raise my husband from the dead. Please.”

Even as the funeral preparations ensued she held out hope. “I know you can raise the dead. Surely you can raise my husband. You promised he’d be ok, God. Please, please. Please bring my husband back to me.” Even as the embalmer spoke to her about the process she held out hope. He could be the first person God’s brought back to life after embalming, she reasoned.

Only when his body was buried beneath the heavy clay-earth of his childhood village did his death begin to sink into her own soul. The fact that he was gone began to penetrate her consciousness  for real. He really had died.

~o~

“Then Job arose, and rent his mantle, and shaved his head, and fell down upon the ground, and worshipped, and said,

Naked came I out of my mother’s womb,

and naked shall I return thither:

the Lord gave, and the Lord hath taken away;

blessed be the name of the Lord.”

Job 1:21

~o~

“Where’s daddy?” Doris asked.

“He’s gone to heaven, my daughter.”

“But I want daddy to come home,” Doris said anxiously. The little girl folded her hands and closed her eyes. “Please God, please let daddy come home from heaven soon.”

“No, no, my darling,” Cherie put her arms around her daughter. “Daddy can’t come back from heaven.”

“Then can we go to see daddy in heaven?” Doris asked.

“Only when God is ready for us. None of knows the exact time. We have to stay here until God says it is time for us to go to heaven and join daddy.”

“Daddy never did bring me any pizza,” Doris noted and crossed her small arms as she slid under the covers.

Cherie kissed her daughter goodnight. “I’m sure he is saving us lots of pizza to eat with him when we see him in heaven. Goodnight.”

The new baby and dealing with a four-year-old grieving the loss of her daddy were enough to keep Cherie busy during the day. She was lonely at night. He wasn’t coming home. Henry would never lie next to her in bed. So many empty places in her life that her husband, Henry, used to fill. They were all hollow and empty. Why, God? She asked herself again and again. You gave me those visions that gave me peace and assured me that Henry would be ok. Why did you give me such revelations? He’s dead.

Softly, faintly at first, then gradually increasing in clarity, the answer came. “The revelations were for you, my daughter. I gave them to comfort you. Henry is ok. And you are ok. I am with you.”

~o~

Cherie sips tea across from me and shows me photographs of her daughter and baby son. She beams with pride as I comment on baby’s plumb cheeks and Doris’s beautiful smile.

“I understand now that God gave me those revelations to comfort me. Who knows what might have happened without those messages to give me peace when I needed it most.” Her face is full of enthusiasm as she testifies to the goodness of God. “God gave me those revelations when I needed them. I don’t always understand why but I trust that He does lead and guide us daily. And, one day, I know I will be with Henry in heaven.”

I smile at her obvious joy. She’s a young widow recently bereaved of her husband after a tragic loss. We should be weeping together but instead we’re smiling and rejoicing together in the hope of heaven.

“You know, one time, Doris, my daughter, asked me why she couldn’t see daddy anymore. I didn’t have an answer. Then, one day, when she was spending the night at her auntie’s house, she came home all excited.”

“Mummy, I saw daddy with Jesus in my dream!”

Cherie shrugged with a small smile. “I don’t know. God speaks to adults through visions, why not children?”

This world is not heaven. We are children of God, citizens of another country, and pilgrims on our way to our heavenly home. None of us knows the time when God will call each of us home. This we can know, He is with us always.

“…and be sure of this—that I am with you always, even to the end of the world.” Matthew 28:20

“In the world ye shall have tribulation: but be of good cheer; I have overcome the world.”

John 16:32-33

Dyspnea

I’m supposed to write something inspirational. Something uplifting. Encouraging to the soul.

I don’t feel like writing anything cheery.

She’s dead.

I knew she was going to die. I could see it in her eyes. The heaviness. The weariness.

Pleading.

A resigned exhaustion.

Haunted by her existence.

Yearning for her release.

The look of death.

Yeah… this isn’t turning into a bright and happy piece of writing, is it?

Madam H was 50 years old. She came early in the morning. Too early in the morning. Concerned relatives had packed her into the car and shuffled her from hospital X to our health centre after she failed to respond to the treatment regime she was receiving.

“Coming,” my husband unlocked the front door. We were both trying to rejoin the land of wakefulness at the early hour. Jordan, our dog, had alerted us to the nurse on our front porch with her usual energetic barking. (No need for a doorbell. Most visitors don’t even realise we have one)

“It’s the nurse,” my husband called back to me.

“What does she want?” I inquired. I sighed. Already? Couldn’t the consults wait for another hour until the clinic actually officially opened?

“I don’t know. She wants to see you.” My husband relayed the message.

“Tell her I’m coming. I’ll be over in the hospital in a few minutes.” I hurried to finish dressing. Mornings come too early.

With a growing sense of trepidation, I threaded my way to the hospital through the milieu of animated visitors who invariably come along with a sick patient. It’s actually a little intimidating to walk past the crowds of them… all waiting and watching with expectant gazes for the white doctor. Their heads turned in unison as I passed them. I ducked away from their intense stares into the general adult ward in the hospital.

Madam H was positioned in a semi-upright position with the head of the bed cranked upright. She gasped like a trout out of water for air – hungry, mouth-open, inhalations -- without finding relief from her oxygen deprivation.

“What’s the story on Madam?” I turned to the night duty nurse.

“Difficulty breathing, doctor,” the night duty nurse gave me the very abbreviated version of the patient’s medical history.

“Anything else?” I pushed for more details.

“Doctor, the family says she can’t breath. She’s been taking medicines to no avail. They brought her here because of severe neck pain.”

“Oh?” I bent over and placed my stethoscope on Madam H’s chest, listening to the air enter, listening as some unseen force halts her efforts at breathing – preventing her from taking a long, deep, satisfying, lung full of air. No crackles. No wheezes. Just rapid, gasping breathes… not shallow but not deep and gratifying either.

“How long has she been like this?”

“Ten days.”

I stared incredulously at Madam’s troubled breathing. “She’s been breathing like this for 10 days?!” I raised my eyebrows, not quite believing.

The night duty nurse looked at Madam’s medical book in her hand. “Yes, doctor.”

“And what has the family been told is the problem?” I counted Madam’s respirations. Forty breaths per minute. Not as bad as I’d initially thought. Her heart was beating regular with a pulse of about eighty. She had a little swelling in her legs but not much.

“They said she has pneumonia, doctor.”

“Can I see which medicines she’s been taking? Do they have the other lab results from the hospital?” I turned my attention to the plastic sack of medications at the bedside cupboard. Augmentin. Tot’heme. Terpone cough syrup. Ventolin inhaler spray.

I addressed Madam and held out the Ventolin spray to her. “Take,” I instructed, “then tell me if it helps you breath better.”

Without wasting air to reply, she deftly took the Ventolin asthma spray and inhaled a few puffs.

“Did it help?”

“She looked at me with vague eyes and gave a noncommittal nod of yes.” I wasn’t impressed. Certainly not a dramatic improvement. She still put enormous effort into every breath.

“Doctor, she complained of neck pain and chest pain,” the nurse reminded me.

I nodded at her words. “Any fevers?”

The sister shook her head, “No, doctor.”

“Cough?”

“No.”

“Headache?”

“No.”

“Any pain anywhere besides her neck and chest?”

“No.”

“Does she have asthma?”

“No.”

“Has she ever had diabetes or hypertension?” I noticed that her blood pressure was up. The last reading on the blood pressure machine was 160/105 mmHg.

“No, she has never had high BP,” her sister looked around at the other members of the family who offered nothing to the alternative.

“Did her breathing problem come on slowly or did she get difficulty breathing quickly?”

“It just came like that,” her sister tried to explain. “It has never happened before.”

“So, she just woke up suddenly with difficulty breathing?”

“Yes, doctor,” the sister answered with hesitation.

“Has the treatment improved her breathing at all?” I looked around at Madam H and the rest of her family. Madam was busy breathing so I relied on her entourage to fill me in on the details.

They all shook their heads empathically. “No, she has only been having this difficulty to breathe, doctor.” The sister spoke on behalf of the crowd.

“Can I see her medical books and laboratory tests?” I sat down at the nurse’s station with an assortment of papers, receipts, several paper booklets, and a chest x-ray.

HIV negative.

Random blood sugar, 117.

Malaria negative.

Chest X-ray report read, ‘bilateral pneumopathy’.

‘for right breast biopsy’… huh?

“Did they do a biopsy of her breast?” I was confused. Why was there a work up for a breast lump going on in the middle of a hospitalization for shortness of breath?

“I don’t know, doctor,” the sister answered with a shrug.

Strange. I would peruse her books a bit more but for the moment Madam H, her family, and the night-duty nurse were anxiously awaiting a plan of action.

“Check the Hb (haemoglobin level). She looks a bit pale.” I instructed. “Then tell the family to repeat the chest x-ray.”

Surprisingly, the Hb came back normal – 12.2 g/dl. The chest x-ray, when compared with the picture from 10 days ago, looked very similar. This time the report read, ‘bilateral pneumopathy with small pleural effusion’.

I wrote orders for IV antibiotics and furosemide (diuretic). The underlying question remained though – why was Madam having pneumonia that wasn’t responding to appropriate oral antibiotics? Where was the pleural effusion coming from? Why wasn’t she having any fevers? Was the neck and chest pain related to the lungs or the heart or something else?

Time is a funny thing in medicine. It can pass in what seems like one blink of the eye or it can drag on forever, counted second by endless second with each laboured breath.

“How is she?” I came to check on madam in the afternoon after most of the consultations on the outpatients were finished. “She’s ok, doc,” the nurse shrugged without enthusiasm. “Her blood pressure is high.”

“How is her breathing? Any better?”

“Not really, doc. She’s complaining that the Lasilex makes her chest pain more when I give it.”

“Ok,” I acknowledge this odd factoid.

On examination at the bedside, I found madam sitting up. “Does she breath better when she’s sitting?”

“Yes,” the sister confirmed.

Her oxygen saturation was 99%. Her pulse and blood pressure were relatively unchanged. Respirations were still laboured. Her lungs on auscultation with my stethoscope sounded the same. No change. And, she still didn’t have even the faintest hint of a fever. I examined her conjunctiva. White.

“Check her Hb again,” I requested.

I searched through her records again. I found evidence for a ten-year history of breast pain and a small surgery with excision of a breast lump several years ago. Otherwise, I could not find anything new. I didn’t know what to think.  Her symptoms did not add up to equal simple pneumonia. They didn’t fit a simple pleural effusion either. In spite of producing plenty of urine, her breathing had not improved at all. My mind stared grasping for other explanations. Pulmonary embolus? Heart attack? Cancer? Pericardiac effusion? Pericarditis? Parapneumonic effusion? Questions; no answers.

I felt like an idiot. The family stared at me like I was an idiot too. How come the white doctor couldn’t tell them exactly what was wrong with Madam H and fix her? Their silent stares and background animated chatter felt eerie and accusing every time I passed the hospital entrance.

“I feel like I’m missing something.” I lamented to a friend online. “What is it?”

She graciously messaged with me and helped alleviate my insecurities. I felt somewhat more confident that at least my line of reasoning was logical, medically speaking, afterward.

I plunged forward with my questions and investigations while Madam H continued to struggle to breath. She was able to sleep and relax a bit when we gave her oxygen. I left the oxygen concentrator next to her bedside. Anything to alleviate her air hunger and discomfort even though it wasn’t the solution.

I took photographs of her chest X-rays and emailed them to another friend for reassurance that the local radiologist and myself weren’t missing anything significant on the films.

An ultrasound doppler study of her leg veins failed to show any blood clots. The sonographer didn’t feel there were any signs of a dilated right heart ventricle or atrium. “It just looks like congestive heart failure.” She gave her opinion of the ultrasound study as I discussed it with her.

So… no definitive answers.

“What was the repeat Hb?” I stood at the nurses station trying to decide what else to do. Nothing seemed to be helping.

“Her Hb was 13.3 g/dl,” the nurse informed me.

“How can that be?” I asked, still not believing. “She’s white. You’ve seen her, right?”

“Yes, doc.”

Madam H’s conjunctivas were white, her tongue was pale, her fingers appeared bloodless. I searched my memory banks for anything that would make her Hb falsely elevated. And yet, her pulse was not tachycardic. Her blood pressure was high; not low. The haemoglobin metre had churned out appropriate low values of 8.7 g/dl and 9.9 earlier.

“How are you?” I walked over to Madam H’s bedside and addressed her. During her entire stay, she’d barely uttered more than a yes or no. All oxygen was savoured in favour of expending her efforts to breath.

She stared at me with tired eyes. I didn’t need her to tell me. She wasn’t better. She was worse.

I checked her oxygen saturation. Sitting straight up with her legs dangling over the side, the oxygen saturation levels rose to a meagre 89%. When she leaned back into the bed, in spite of the inclined head of the bed, her saturations dropped to the 70s. Not good.

“Can you think of anything else?” I turned to my nurses at their station.

They shook their heads. “Doctor, I think we need to transfer her.”

Wearily I agreed. She was clearly not improving.

“We’ve tried everything we can here at our small health centre…” I began as Madam’s relatives sat opposite me in the make-shift family conference room. “I don’t know what all is causing her difficulty breathing. It’s more than a simple pneumonia though. She needs to go to the big hospital in D_____ where there are more specialists and capabilities to treat her.”

“You’re right, doctor,” one of the male relatives spoke and nodded.

“Don’t waste your time going to the other small hospitals. Just go to D_____ now. You’ve already been to one other hospital and I know the hospitals here in Buea are not big enough to do anything more than we’ve done for her here. Go to D_____.”

“Ok, doctor.”

We wrote up the appropriate paperwork and helped the family load Madam H into the waiting taxi.

I was relieved that she was going somewhere that could do more for her. I was frustrated that I couldn’t help her. I felt drained and apathetic. Discouraged. Empty.

I couldn’t even figure out what the real problem was. She was dying and I didn’t have a clear picture of what was really happening. There could still be a pulmonary embolus. Perhaps it was heart failure from a recent heart attack… maybe it was complications from breast cancer…. a resistant pneumonia… anaemia (even though our metre pointed to an alternative diagnosis she still looked very very pale). Too many questions. My mind wouldn’t stop processing Madam’s case. In spite of my musings, the meagre facts of the case swirled around without coalescing into any solid diagnosis. Like a computer trying to open a bad file, my brain whirled endlessly and fruitlessly. No program loaded. No answers popped up.

These types of medical cases are difficult. They drain my psyche insidiously and poison my confidence. So much effort with no return on the investment. I knew I’d probably never hear from the family again. I’d sent them off into the mysterious depths of the system of specialists in D_____. Historical experience informed me that there was a 95% chance I’d never know what happened.

Postscript:

The family took Madam H to another nearby hospital in Buea. They did not go to D____. At the hospital, they were again referred to D___ but instead chose to remain. Madam died at in the hospital the next day. The impression by the doctors at the other hospital was that she died of congestive heart failure brought on complications from breast cancer.

One may be tempted to lay blame on the family for not transporting her to a big, expensive specialty hospital where she’d have the best chances of survival. However, perhaps the family, like myself, saw the ‘handwriting on the wall’. Knowing that she was near death, they chose to let her die in her hometown and save the resources it would have cost just to get her through the front gate of the D____ hospital. Contrary to certain cultural attitudes in other parts of the world, there are financial limits and medical care is not an unlimited resource.

 “Who comforts us in all our troubles, so that we can comfort those in any trouble with the comfort we ourselves receive from God. For just as we share abundantly in the sufferings of Christ, so also our comfort abounds through Christ.”

2 Corinthians 1:4,5

Swan Songs

“Where were you when I laid the foundations of the earth? Tell me, if you know so much. …What supports its foundations, and who laid its cornerstone as the morning stars sang together and all the angels shouted for joy?”   Job 38:4-7

“After Jesus was born in Bethlehem in Judea, during the time of King Herod, Magi from the east came to Jerusalem and asked, “Where is the one who has been born king of the Jews? We saw his star when it rose and have come to worship him.”  Matthew 2:1,2

 ~ooo~

Really smart people who study astronomy and physics talk about supernovae and black holes and star songs. I recently read that dying stars write their own unique death symphony. A swan song, per se.

This week I’ve contemplated that idea as I’ve met with a multitude of various clients in our health centre. An elderly woman with haemoptysis (coughing up blood) now told she has HIV. Three women with their hopes crushed when ultrasound revealed their baby was dead inside. Infant referred to a bigger hospital just barely hanging onto life. Assault. Trauma. Addiction…. So many stories.

Like the innumerable stars and their singular, soulful songs, each human is a unique creation – an intricate conglomeration of cells and genetic make-up that form a human being. Even if these matchless works of art crumble and fall apart prematurely, they too leave behind a legacy. A ghost of memories, however faint and haunting.

When a supernova begins to decay in it’s last few light-years, it will spin and pulsate in such a way that it radiates brighter -- intense luminosity. Are there parallels in the human generations? Many great writers, artists, and musicians crafted glorious creations and lived short lives. Did all their brilliance cause them to crash and run out of fuel too soon? Unborn babies that die before they are born, are they so full of intense potential that their death is inevitable?

Life is a cycle of births and deaths – coming and going. In death, gifts of knowledge are left behind to be absorbed by the next cohort. Building blocks upon which to expand the world’s information storage banks. Tools to potentially discover a cure for a deadly virus or invent teleportation. In death, both humans and stars release the elements of carbon, oxygen, and nitrogen, fertilising earth and outer space. Giving back to enrich the next generation.

With the right “ears” each star’s death melody can be heard. Tales of violence and brilliance are expressed. Expansion. Contraction. Cooling. And, finally, an ending explosion. Likewise, old or young, sick or healthy, pale or dark, every human has a voice and a vivid saga to be told. If we will listen, we may come to understand these legends of stellar magnitude. Not legends like Hollywood dramas. Legends composed of millions of sparking moments. Holding a hand when comfort was needed. Writing a letter of warm friendship. Making a phone call. Sharing a smile. Spending time together. The little notes in each life add up to a unique melody – and at the end – an opus is unveiled. Trailing stardust upon the winds of change.  A eulogy. A swan song. Their voices echo from the skies – every song – every star -- every person.

“When I consider your heavens,

    the work of your fingers,

the moon and the stars,

    which you have set in place,

what is mankind that you are mindful of them,

    human beings that you care for them?”

Psalm 8: 3,4

“God who is eternally complete, who directs the stars, who is the master of fates, who elevates man from his lowliness to Himself, who speaks from the cosmos to every single human soul, is the most brilliant manifestation of the goal of perfection.”   ~ Alfred Adler