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.

A Fitting Diagnosis

(Names and details changed for privacy)

“Doc, will you see this man tomorrow?” Nurse Kay gave me a very beseeching smile. “Please.”

“You know I normally avoid non-emergency consultation on Saturday, Kay,” I replied, unconvinced.

“But doctor, he was really disturbing me when you had to go out,” Nurse Kay grimaced as she shook her braids at the memory. “I thought he was going to bite my head off.” Her gesture conveyed a genuine sense of pain regarding the recent encounter.

“Really?”

“Yes, doctor,” she added in earnest. “I really had to talk to him a lot to get him to calm down. I promised him that you would see him tomorrow at eight o’clock.”

I realised this Friday had taken its toll on everyone’s patience, including my own. Complications and emergencies in the hospital ward, unplanned procedures, a funeral to pay homage to a fallen colleague in the medical field – the day had been a blur of activity. The frustrated, impatient frowns from the outpatient clients in the waiting room had not escaped my notice earlier.

Sensing my weakening resolve, Nurse Kay pressed home her supplication. “Please, doctor, I told him to be here promptly at eight o’clock.”

“You know I have church on Saturday, though.”

“ I told him that. He said he would be here at eight. I told him if he came late you would be gone to church.”

Nurse Kay knew she’d won her case. I sighed. “I already took the history and everything for you, doc.” She smiled with a triumphant grin and handed me the patient’s book.

I opened the green paperback notebook and peeked at the chief complaint.  I wondered what dire emergency had made this man angry when he wasn’t attended to in the clinic so promptly. I hoped that if he was seriously sick he would have consented to admission after a brief consult with our competent nursing staff. Thankfully, his vital signs were normal. He was 32 years old, I noticed. I shook my head. It usually takes a lot for an otherwise healthy adult male to see a doctor.

The next morning, Saturday, I walked over to the hospital to check on the inpatients. As expected, anytime I am in the hospital, other clients find me and I found myself completely occupied until 9:30 am. I forgot that I hadn’t even seen the mysterious impatient patient from Friday. By the time I remembered, I was already in church. I had certainly given him ample time to make it to his special appointment by 8 am. I had been around until 9:30. Perhaps he’d gone on to another hospital given the urgency of his demands?

Monday came round. Mondays have a bad habit of appearing every seven days, it seems…. Anyway, the client numbers in the outpatient clinic were above 30, so, much to half the folk’s dismay, some waited quite a while to see the doctor. At the end of the day, I noticed a familiar green medical booklet in my shelf.

“I called his name several times today,” I explained to Nurse Kay. “What happened?”

“He left, doc,” Nurse Kay shrugged. “He said he couldn’t wait.”

“He was only the second patient in line to be seen today though,” I countered. “Besides, I waited for him in the hospital on Saturday and he never showed.”

Sigh.

Tuesday came. I was hurrying to open up the clinic and get morning worship going. Several clients milled around the front door, waiting for our outpatient services to get started for the day.

“Doctor, I want to see you,” a young gentleman pressed forward as I stepped up on the porch to unlock the door.

“No problem,” I gave my automatic reply. “I will see you after we have our morning staff worship. You are welcome to join us.”

“But, doctor, I’ve been waiting. I want to see you now.”

I tried to take a step back as this gentleman was rather cramming into my personal space. (I’m not one to need a huge bubble either). I held up my hand in an attempt to keep us from bumping noses. “After worship, I will start my consults.” He was clearly not dying or in any visible pain. There was nothing externally wrong with him that gave any indication he needed to be seen more urgently in the hospital and be admitted.

“But, doctor, I’ve already paid to see you.”

“And I will see you – after worship,” I re-stated firmly. I gathered up the worship hymnals and passed them out. “Here, have a book,” I indicated a place on the bench for him to sit while I held out a book of hymns. The other staff and patients were thumbing through the pages, searching for a familiar melody. Assessing the situation, he grudgingly settled down.

~o~

“Mr. Johnson,” I looked at the now recognizable green book and name. So, he was back – again.

“Coming,” a familiar gentleman rose from the waiting room bench, pocketing his mobile phone. The gears clicked. The less-than-patient gentleman of the morning was none other than the mysterious missing patient from Friday. Interesting.

I sat down at my consult table and read over Nurse Kay’s detailed history of his main reason for consulting. Mr Johnson settled in the chair opposite.

“Doctor, I’m tired,” he frowned and turned his palms upward with a dramatic sigh. “I have a lot of responsibilities. I can’t wait.”

“Ashia,” I let him continue.

“Thank you, doctor,” he automatically replied. “Doctor, I came here on Friday and you were not. They told me you were at a funeral.”

I nodded in confirmation.

“I couldn’t wait until you came back.”

“I looked for you on Saturday,” I replied. “I waited for you until I went to church.”

“I came, doc, and you were not,” he insisted.

“Didn’t the nurse tell you to come at 8 am?”

“Yes, but doctor, you were not.”

“I waited for you until I went to church at 9:30 am.”

“But, doc, I came.”

“You came after I’d already left for church.”

He conceded the fact with a nod. “But, doc, when I came you were not.”

“I was at church.” Since church is generally considered a legitimate reason to abscond from the hospital, I knew Mr Johnson had little recourse to argue now. As I expected, my pronouncement silenced his complaints for a few moments.

“I’m here now,” I attempted to clear away the past and re-focus our meeting on the present. I gave him my full attention. “Now tell me about your problem. What brought you here to consult?”

Mr Johnson gathered his thoughts for a few moments and let them sort. He took a breath and released it slowly. Then he began. “Doctor, my girlfriend,” he paused, “my girlfriend’s not happy. When we make love my stamina is not too strong. I weaken too fast.”

“You mean that when you have an erection, you climax too quickly?” I clarified.

He nodded.

Diagnosis: Premature Ejaculation

Rather fitting, given the circumstances?

 ~o~

“We can rejoice, too, when we run into problems and trials, for we know that they are good for us—they help us learn to be patient. And patience develops strength of character in us and helps us trust God more each time we use it until finally our hope and faith are strong and steady.”

Romans 5:3,4

Practising the Ancient Art of Bloodletting in the Modern Era of Online Communication

Blood Letting in the "Olden Days"

I can remember as a child being fascinated by the apothecary shop. The shop was a Colonial era rendition of what a doctor-pharmacy habitation might have been like in the 1700s. As the aromas of dried herbs and potions wafted round the wooden timbers and layer of sawdust strategically spread over the floor beams, the historical enactor in petticoats and apron, held up a jar of live leeches. “These were used for those with a bit of blood congestion after a long winter.” One of the black slug-like critters swivelled his sleek body in a u-shape and smirked through the glass. I stepped closer for a better view.

“Over on this table you can see some of the knives that the Dr Hugh Mercer used to cut his patients who needed to lose more substantial quantities of blood. Different sizes were used depending on how much blood the doctor felt needed to come out.”  Several smallish metal contraptions with one or more lancets, including one with rolling cutting blades that resembled a primeval torture device, rested benignly on the table. Gruesome, spine chilling, and fascinating!

Fast forward to current time period. Haemoglobin levels are measured by handheld devices now. Too little blood or too much blood have fancy technical terms like anaemia and polycytosis. Physicians are much more prone to infuse blood into the body’s veins than let it drain out although there are a few instances where blood donation is beneficial such as Polycythemia vera.  I’ve never planned to practise the art of bloodletting though! Vampires don’t seem to run in my family heritage.

Nifty little cutter for making multiple cuts at once -- improving blood letting efficiency!

NN had already met with the young mother and father of the patient, a youngster of almost 2 years. AJ clung to his mummy with his little fingers grasping at her shirt while his mother patiently consoled him by breastfeeding.

“Doctor, they’re just from hospital X,” NN informed me as I joined her in the consultation room.

“Tell me what you’ve discussed already,” I requested and sat across from AJ, still clinging to his mother.

“He was admitted in hospital Y a few days ago. He had malaria and was given quinine drips and antibiotics. He also was given one bag of blood. Now he has no more fever but he’s weak.”

“So he is taking breast well? No vomiting? No fevers? Normal stools? Everything is fine except that he’s weak?” I turned to the parents.

They looked down at their baby and nodded together. “Yes, doctor,” they chorused.

“Ok…” I wondered if there was more to the story. “Let’s examine him. Bring him over to the table.”

Mom detached AJ from her breast in spite of his protests and placed him before me. He was not happy at this separation and made sure everyone understood such.

Crying. Good sign. I mentally catalogued the information as I noted his pink conjunctiva and fingertips with a brisk capillary refill. Certainly not a haemoglobin of 5.1 g/dl anymore! After stalling for time by doing an extra long examination of AJ, all I came up with were some rough sounding lung sounds and mild oedema of the fingers and feet.

“Doctor, let me explain something,” AJ’s auntie joined the conversation. “At the hospital they gave him too much blood. See.” She pointed out some figures and written orders in AJ’s medical booklet. From her description of what actually happened versus the orders in the book, it did appear that AJ might have received more than his fair share of blood.

Although he was not critical, he was not well. AJ’s parents’ observation that he was weak was accurate.

“Is he peeing fine?” I asked his mother.

“He pees too much, doctor. He drinks plenty water.”

“More than normal?”

She nodded.

I added this factoid to the assorted observations floating around in my head, trying to align themselves into a coherent diagnosis. “Let’s check an Hb (haemoglobin level) and blood sugar,” I suggested to my nurse.

NN nodded and headed off to prick baby AJ. I headed in the opposite direction to retrieve my pulse oximeter. We met up in the laboratory. Haemoglobin is 17.9 g/dl (normal is 12-14 g/dl).  The Pulse oximetre beeped red and angry. It spit out a reading of “82%”. I waited a bit for AJ to stop crying. Gradually the oxygen level in his blood climbed up to 90%. Still low.

“Doctor, the blood sugar machine isn’t working,” NN interrupted my concentration.

“Oh, let me see.”

She handed me the machine.  I fiddled with it. Hum? She’s correct. Definitely not working. I pause. “Ok. Let’s check a urine analysis. We can see if he is spilling glucose, or having ketones, or if there is protein. We’ll be able to check the specific gravity too.”

She nodded. AJ had already confirmed his mother’s assertions that he “pees plenty!” He’d urinated all over the exam table when I examined him earlier. It took less than an hour and AJ let off another fountain. His father expertly caught it in the cup provided. Plenty urine! Analysis revealed dilute urine without anything else of significance. “Kidneys are working,” I commented to NN.

In spite of their initial protests, AJ’s parents agreed to admission to the hospital for treatment. I wasn’t completely sure what to do. Diagnosis – iatrogenic erythrocytosis with secondary congestive heart failure and its sequela of pulmonary oedema?

Thankfully, one does not always have to have a diagnosis in order to begin treatment. When in doubt, one can at least treat the symptoms. “Put him on oxygen. Give him a little furosemide (diuretic medication) and monitor his breathing and oxygen saturations. Can you think of anything else?” I gave NN a chance to add any insights she might have picked up on.

She shook her head. “Doc, the blood level… it’s too high.”

“Yes. It’s too high.”  She went off to carry out my instructions – strategically placing our little youngster in the adult ward since the electrical sockets actually convey electricity in the adult ward unlike our paediatric ward. I meandered back home to finish supper and mull over the case and figure out if there was more I should be doing.

A fluttering of dark evil-eyed doubts and fears danced across my consciousness. I’d Never had a case like this? Haemoglobin of 17.9 g/dl? Can all the patient’s symptoms be explained by such a concentrated blood level? Is there something else underlying the child’s weakness? … and what about all those other unknowns – the creatinine, the electrolytes? The evil grins on my self-doubts spread wide and showed their gleaming razor teeth. Ouch!  I was inexperienced and blinded by lack of further laboratory data – stumbling in the dark was no fun.

When one is the only physician in a foreign mission hospital, it is incredibly helpful to have online consultants, colleagues who can dialogue with you through email, Facebook, Skype…  I sent out several “feelers” hoping someone would be available.

A couple emails and Facebook message later, I found one of my dear friends (and co-conspirator in African mission work) available. “I have this 2 yo male with…. “

She and I exchanged ideas and thoughts in between several additional check-ups on baby AJ in the hospital. “He’s not really getting better,” I complained. “He’s generally stable but even with oxygen his blood oxygen levels are not getting above 92%.”

The network expanded. My friend sent off a question to another colleague working in Africa. Within the same night, he’d sent back his advice, “partial blood exchange transfusion…”

“I’ve never done anything like that before, have you?”

“No,” my friend admitted. “Makes sense technically though.”

“So many unknowns though. I don’t have a lot of back up. What if it changes the hemodynamics of her circulatory system too much? What if her potassium or glucose levels change too much? What if…” Doubts and questions swivelled in my mind. “I’ll wait until the morning and see how she responds over night to the furosemide since she’s overall stable,” I replied.

Morning came. I couldn’t eat breakfast until I’d seen AJ. “How is she doing?” I asked the night nurse, NN.

“A bit better,” she smiled.

Small better. This is really not as positive a response as most English speakers might imagine. I grabbed my stethoscope and pulse oximeter. “How is she?” I woke up AJ’s mother.  “A bit stronger,” she answered after blinking awake.

I bent over the sleeping form of AJ. Still rather rapid respirations. Auscultation didn’t reassure me either, coarse rales in the lungs, same as yesterday. The saturation reading of oxygen in his blood was 85% initially. I waited and found it wavered between 85-92%. Still not good. Essentially unchanged. Crumbs!

I spent breakfast hunkered over my laptop looking up blood transfusion complications and updating my network of online colleagues about AJ’s condition. I received a reply from another colleague. “I’ve never had a case with such a concentrated haemoglobin.”

Hum? Should I feel special that such a unique patient resided in my hospital currently or might I instead freak out because now everything was going to be “experimental and theoretical”?

“I’ll ask another friend of mine,” she emailed back. My worldwide doctor network expanded again.

I’m afraid I wasn’t completely focused on the sermon in church that morning. So many different options and alternatives rolled around in my brain. I processed step-by-step how each might play out in real life – practical? Did we have the equipment? Would my nurse be capable of such? What would be the potential complications? Argghhh!

I anxiously checked AJ when I came back from service. No change. “A little stronger,” mother and father agreed. Basically that meant she wasn’t worse. She wasn’t getting better either. A recheck of her Hb was 18.9 g/dl.

More emails. More Facebook instant messaging. I received some great information. Options. Alternatives. Things to consider. Advice. And, most importantly, encouragement. One dear friend wrote, “I know you might be nervous about doing something like that, but you might be the best trained and equipped to do it.”  The phrase stuck in my head.

Patient consultations slowed down for the day. The labouring woman had given birth to her baby and was settled comfortably in the maternity ward. There was still no change in AJ’s status. “NT, let’s talk to the parents about removing some of AJ’s extra blood.” She helped me explain the procedure to the parents and auntie.

AJ’s father signed the consent form. He seemed rather relieved that the doctor was finally doing something that made sense – take away the extra blood his baby had received from his excessive blood transfusion.

Together then, the nurse and I gathered the materials. “Doctor, my heart, ee de fear. EE de shake inside,” NT admitted nervously.

“We’ll only remove twenty millilitres of blood at a time. We’ll go slow. It will be ok,” I consoled NT and myself.

Normal saline dripped slowly into the left ante-cubital vein on AJ. NT inserted a second IV catheter into the right arm. Mother calmed AJ by breastfeeding her. AJ was surprisingly placated with sucking. The 20 cc syringe seemed huge (4 teaspoons). AJ’s blood trickled through the tiny 24-gauge catheter and finally filled up the barrel. “One good thing about a small needle…won’t have to worry about rapid hemodynamic collapse,” I watched, amused.

Twenty millilitres of blood out; twenty millilitres of intravenous fluid in. The procedure was repeated. Over the next hour and a half, we aspirated 60 mL of blood.

“Ok, check the Hb.”

“14.2 g/dl” NT reported.

“We’ll stop the transfusion then.” She turned off the IV drip and removed the oxygen. We waited.

“How is AJ doing?” It had been about an hour. Did AJ need another dose of diuretic to help his body excrete the excess fluid on his lungs? Was he still urinating freely indicating good kidney function? Questions continued to flood my consciousness.

“He’s fine,” AJ’s mother smiled.

I checked AJ’s chest. His breathing was slower, steady. I listened to his lungs. Still a little rough but improved. His oxygen saturation even without supplemental oxygen was 92%. I smiled. He was improving. He really was better.

With joy I shared the good news with my online colleagues. Baby AJ continued to improve. The next morning he went home. At his check up he was doing perfectly. His doctor is extremely grateful to God for the healing He provides. She is also immensely indebted to her team of international physicians of various specialties who provided much needed advice, expertise, and encouragement to a lonely, anxious mission doctor practicing the ancient art of bloodletting for the first time.

Thank you!

“And my God will supply all your needs according to His riches in glory in Christ Jesus. Now to our God and Father be the glory forever and ever. Amen.” Philippians 4:19,20

Hum? Sign says "talk to your doctor"... !

But God, I Don't Want To Be A Hero

“I am fated to journey hand in hand with my strange heroes and to survey the surging immensity of life, to survey it through the laughter that all can see and through the tears unseen and unknown by anyone.”

― Nikolai Gogol

“Really, God,” I shook my head as I walked. “This is not the week that I want to test out my theories regarding human suffering and life. Don’t you think I’ve learned enough from earlier in the week?”

In spite of my protest, God wasn’t particularly amenable to my excuses. I should have guessed. Although I realise one has to keep growing in their relationship with Christ or such friendship becomes dull and boring, I wasn’t anywhere close to being excited about this “new opportunity”.

“Seriously, God, I’m quite happy not being considered brave or courageous. Heroics aren’t my thing.”

God listened but didn’t change my reality. Sigh. It was worth a try at least. The week hadn’t started out easy. Earlier I’d been discouraged and disheartened by a few “suggestions for improvement” from our community population of clients. I knew the typed critiques were obtained under less-than-ideal circumstances. I knew that sick people, impatient and feeling terrible, are not prime candidates to interview for suggestions on improving…. Still, some of the underlying accusations hurt. They stung.

As Jesus loved and served, it is our mission to serve and love the people of Buea by providing access to world class health services and education; and to encourage our clients to total health: spiritual; physical; emotional; and intellectual.

This is our health centre’s mission statement. It’s a lofty goal. One that I have not attained but one that keeps me focused in the proper direction. Contrary to what some might believe about doctors, we are not immune to discouragement – at least, I’m not. In fact, I’m one of the worst. In the face of numerous encouraging friends and positive feedback, a few negative comments can derail me. I realise they shouldn’t but they do sometimes. In spite of all the sacrifices required working in Cameroon as a missionary doctor – pouring out one’s soul – not everyone is appreciative. And, as much as I despised myself for feeling this way – I let those negativities ruin my joy. The words hurt.

I walked at a rapid step along the main road of Buea. Cars and trucks zoomed past at reckless speeds. Adults and children laughed and gossiped around me. Other than the off-hand remark of ‘white man’ or ‘white man dog’ and the occasional good afternoon… I passed without notice. A similar stream of negative traffic cruised around in my head. Why?! Why?! I try my best. I give my all. I work hard – no off weekends, always on-call for anything that goes wrong in the hospital, and yet… still, people aren’t happy.

Complain and whine. It wasn’t a beautiful symphony but rather a high-pitched irritating grating that did nothing to improve the situation. Rather futile circles of self-reproach and self-pity. I am no hero. I am not perfect. Although I knew it was not the right attitude, I didn’t stop the cycle.

Then, suddenly, a thought surfaced from the recesses of my memory. “ Remember what I told you: ‘A servant is not greater than his master.’ If they persecuted me, they will persecute you also.” John 15:20

Christ was the perfect man. He lived perfect love. He was Saviour to the world and went around healing all manner of disease – both mind and body. Yet, not everyone loved Him. He was falsely accused and eventually crucified. In the face of it all, He didn’t even get defensive. The events of the past week; the hurtful reviews from the community began to assume their proper perspective.  

“I have given them your word and the world has hated them, for they are not of the world any more than I am of the world. “ John 17:14

Crisis averted. Then Wednesday came…

Call me. I need to talk with you. It didn’t take a genius detective to read between the lines in the email. They say it is cancer. No one was expecting it. No warning. No clues. Overnight life trajectories altered by a six-letter word.

Back to my earlier conversation. “God, are you sure this is the best week for me to test-drive all those grand philosophies about human suffering?” I doubted His wisdom in the timing.

“I know I write about valuing life and treasuring each moment.” I shook my head at the irony. “I realise that we are all born to die. I’ve written blog stories about how there is no guarantee for tomorrow…. Can’t we test those theories another time… in a different family even? I don’t want the practise. I’m not ready to be that ‘gold – purified in the fiery trials of life’.”

God nodded but didn’t agree.

Illness and threat of death had never hit quite so close to home for me. “Really, God, I get enough practise in my work. I don’t need a more close up experience.”

Certainly, I don’t believe God punishes people with illness. I wasn’t feeling picked on or singled out. I just wasn’t interested in testing my philosophies regarding God and suffering in my own family this week.

However, that was not my choice to make.

You can choose how you will respond -- Hum? The phrase sounded vaguely familiar. Yes, I’d given the same advice to others when they faced similar angst. My stubborn sense of humour couldn’t help but smile wryly at the thought.

I believe the human spirit is generally capable of dealing with almost anything… eventually. People learn to translate tribulations and suffering into something meaningful. It’s a natural coping mechanism. So, perhaps it is the uncertainty, the not knowing, that is actually more difficult. How can the psyche come to grips with shifting uncertainties? Facts can be dealt with. Unknowns are constantly slipping away between our fingers – we try to mould them into something useful or meaningful – we try to categorise them and file them away but then they infuriatingly morph into another silhouette and we’re back to the beginning.

This past week has only been the tip of the iceberg – the small glimpse – into my own human frailties. I am not a brave person. I’m not capable of standing alone against the onslaught of an imperfect world. Thankfully there are heroes around me. They are the people that give me the strength and the courage to smile and look forward to tomorrow. My husband. My family. My friends. My faith. I know that the hurricanes of uncertainly are still coming and when they’re gone, other storms will come. I am grateful, yes, thankful, that I don’t face them alone.  

“I have told you these things, so that in me you may have peace. In this world you will have trouble. But take heart! I have overcome the world.” John 16:33