Let Freedom Ring: A reflection after 9/11

 October 19, 2001 

I took another road trip this weekend. Six hours (each way) alone with my mind...

 

On my mind were the terms Patriotism, and Freedom. Nearly every car I passed had a flag waving or a flag decal in the window. I wondered what the flag means to each person. Certainly showing American pride. Pride in what though? Does waving the flag mean the same for you as it does for me? For that matter I haven’t yet displayed a flag on my car. Does that make me un-American? I ran through the typical patriotic songs. “o’er the land of the free and the home of the brave” and “let freedom ring” were lines that stuck in my mind.

 

"When we let freedom ring, when we let it ring from every village and every hamlet, from every state and every city, we will be able to speed up that day when all of God's children, black men and white men, Jews and Gentiles, Protestants and Catholics, will be able to join hands and sing in the words of the old Negro spiritual, "Free at last! free at last! thank God Almighty, we are free at last!" I have a dream - MLK

What does it mean to be free? to have freedom? If we are not free what are we?

 

There was a time I recall

We played in the sunshine one and all

time of our lives when we were small

Young and full of heart

Somewhere along the weary way

Tenderness leaves the games we play

Pain is too high a price to pay

And so we drift apart...

 

Sometimes I think the best has gone

When you look around at what we’ve done

To persecute all we’re living on...

When we were children we would run

Knowing that there could be someone

To keep us from all that could go wrong

Now we face our lives...

 

“Purity”

The Promise

T ‘Pau

©1991        

 

More and more I need you now

I owe you more each passing hour

The battle between grace and pride

Given up not so long ago

so steal my heart and take the pain

and wash my feet and cleanse my pride

Take the selfish, take the weak

and all the things I cannot hide

Take the beauty, take my tears...

 

Take my world apart, take it now

 

And serve the ones I despise

And speak the words I can’t deny

Watch the world I used to know

Fall to dust and blow away...

 

“Worlds Apart”

Jars of Clay

Jars of Clay

©1995

 

To not be free is to be enslaved to something. That something will be the same yet different for each one of us. Fear comes to mind. Yet the manifestation of fear in our lives will take on various forms. Fear is immobilizing. It happens every day at work, in relationships, during recreation. We could say some types of fear are good as it puts us in check to live another day. Or would that be wisdom rather than fear? This I know: fear keeps us from moving forward. The Biblical record is filled with “Fear not” and “Don’t be afraid.”

 

Perfect love casts out fear. Love doesn’t demand its own way. It isn’t jealous or irritable. It isn’t boastful or proud. And while love does not rejoice in wrongdoing, it does rejoice in the truth. Love’s faith, hope and patience never fail. Is not this a description of God’s character?

 

“I've never been walkin' around safe in my own hometown

never bought a wedding gown or made my own sound

never come up from the underground...”

 

When we are filled with God’s character will we know fear? What has he done for us?

 

“And He said, "you can go"

and no one could believe it

when they heard

He said, "you can go"

and in the air

the world had gently turned”

 

God calls us to himself. He tells us we can go, that we are free. Something happened when God was with us. His love for his creation was quite demonstrative. He sees us as the pearl of great price. We are hiding all too well. But he knows where we are and what we can be. He sold everything he had and was to win us back to himself. He has a plan for us - a hope for our future. When we accept him we begin to change. When we let him completely inside us, we will be free.

 

“I’m walkin' around safe in my own hometown

I bought a wedding gown

I’m makin’ my own sound

I’m comin’ up from the underground...”

 

“You Can Go”

Three Days In Spring

Clarence and the neon iguanas

©1999

 

The truth will set you free. What truth? What freedom? Does the truth you believe in set you free? If the Son sets you free you are free indeed. For he has not given us a spirit of fear: but of power, and of love, and of a sound mind. Come and let us reason together...

 

Freedom. My friend, Keith Johnson put the following list together of what freedom means to him. As I read it I think of specific areas of my own life and find myself convicted of needing to let go and accept God’s freedom.

 

“To me ‘Freedom’ is:

 

1) ... Not being afraid to die; which frees me from ever having to yield to force, fear, intimidation, and manipulation, which allows me to live for integrity and the principle of love, instead of the principle of pride.

2) ...Having a clear conscience, so regrets, guilt, and shame are unable to hold me captive to my past - so I can live (act, not react) in the here and now.

3) ...Not being afraid of the truth, along with the willingness and honesty to admit when I am wrong or I don't know (to face and conquer my fears - knowing God will be there with me).

4) ...Being free of all “pity parties” - knowing “all things work together for good...”

5) ...Not being afraid of any consequences that may come from the choices that I make (or the choices of others) and the ability to take ownership of my decisions without having to blame anybody.

6) ...Doing right, because it is right, without any external rewards or punishments.

7) ...Realizing that I am only entitled to whatever anybody is able and willing to give.

8) ...Being free of any and all inferiority and superiority complexes.

9) ...Being free of hatred and prejudices that need to victimize others in thought, word, or deed

10) ...Being free from needing others to like me, but willing to like and even love others -- regardless whether it comes back or not.

11) ...Being free to give gifts or to assist others without expecting anything in return.

12) ...Being free from obligations and expectations - in any and all relationships.

13) ...Being free to respect another person’s right to be wrong, without trying to clone them into my image. To also provide them with a safe place in the relationship to heal and mature.

14) ...Being free from superficiality and the opinions of others.

15) ...Being free to be me, without any masks - while being an all-weather, non-judgmental friend.

16) ...Realizing that my freedom ends where the other person’s freedom begins.

17) ...Being more concerned with the rights of others than my own.

18) ...Being involved in relationships without any ulterior motives.

19) ...Being real and sincere in caring about others more than myself.

20) ...Being free of jealousy and the need to compete with or control others.

21) ...Allowing anybody and everybody into my inner-circle of intimacy.

22) ...Being free to try - without fear of failing, criticism, or rejection.

23) ...Realizing that I have only one life to live and I cannot nor do I have the right to try to think for or to live anybody else’s life for them.

24) ...Being free to laugh at myself (along with others)...without embarrassment.

25) ...Realizing that the only control that I have involves my choices and my choices only! I must learn to be flexible at all times -- without allowing external stimuli to affect my peace of mind.

26) ...Being humble enough to realize that education, money, or positions of authority - never gives me the right to abuse, neglect, avoid or mistreat anybody (verbally or physically).

27) ...Mentally allowing the truth to resolve a problem, without needing any other person to admit that they were wrong or needing an apology.

28) ...Being free from needing anybody else’s affirmation or love, because when I drink from the source my “cup runneth over.”

29) ...Being free from having or needing to climb the world’s social ladder.

30) ...Accepting myself where I am, while continuing to grow (aware I can never become complacent).

31) ...Wearing my heart on my sleeve without being vulnerable.

 

Let Freedom Ring!

Thoughts on Life

November 9, 2001.

I've been reading over "Wild at Heart" in preparation for my weekly meeting with Elwyn. We are on Chapter 11 of 12. The title is "An adventure to Live". I've long looked at life as a grand story revealing itself over time. I've often wondered what stories others are living. What have they seen? What are their experiences? How do they see life?

Life for me is an adventure and this book feeds my thoughts. A key question of course is "What is adventure?" Let me put out that adventure involves the unknown (mystery perhaps) and thus, risk. The "unknown and risk" imply a lack of controllability, a lack of formulaic procedures to solve problems. The "unknown and risk" imply danger and creativity...

God created the universe, he created the creatures in heaven and on earth. Thus he created Lucifer, Adam, and Eve. His creation was perfect and free. His creativity provided mystery and risk. God did not provide a step by step plan to his creation. He provided relationship with himself. That relationship with him is as unique as each individual.

What are important areas of our lives? God? Spouse (significant other)? Close friends? Work? Do any of these seem routine? Are there unknowns? Do you know God so well that there is no more mystery? What about your spouse? Do your friends surprise you from time to time with what they think or do? Is work exactly the same day to day? Are there unknowns out of your control? What are the risks? What spiritual battles do you face? Do you deal with them the same way every time? What if God offers you a different solution? You have friends. Did you follow a formula to get to know them? Which of your friends excite or inspire you? Why do you think this might be? Have you ever felt truely alive? What was your experience? What was it that brought you to the state of being alive?

I'm still answering these for myself. But I am coming beginning to accept that God and formulaic solutions don't mix. What works for one might not work for another; that God sees unique solutions for his unique creatures, all the while bringing them to the same final solution...relationship with him. This relationship, in its truest form, is not passive. No, its quite active indeed. He is active with us and we are active with him. Our lives change the closer we get to him. If we no longer see mystery, the unknown, or realize the risk of any of our relationships, then we've stopped looking and are trying to control. Seek the danger of discovery, run the risk of finding out what really is?

"Never make a principle out of your experience; let God be as original with other people as he is with you." Oswald Chambers

"I want to love with much more abandon and stop waiting for others to love me first. I want to hurl myself into a creative work worthy of God. I want to charge the fields at Banockburn, follow Peter as he followed Christ out onto the sea, pray from my heart's true desire." John Eldredge, "Wild at Heart" p 199

"I no longer call you servants...Instead, I have called you friends." Jesus "John 15:15"

What does it mean to be friends with God? Adam, Enoch, Moses, Abraham, all the men and women of faith from Hebrews were friends with God. Take a look at their individual relationships with their Creator...

Happy Sabbath, God's blessing to you and yours

Bill

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

Missionary Dog

Jordan, Missionary Dog and Dog-Child Extraordinaire!

Hi, 

My name is Jordan. I’m a missionary dog in Cameroon. Cameroon is in West Africa in case you want to look it up on the map.

I was originally born in Southern California. For the first year of my life, I wandered the streets alone. One day I came to an animal shelter. It was there that I met my future family, Bill and Trixy. When they adopted me into their lives, I almost wagged my tail off with joy. When Trixy and Bill moved to Indiana, I went with them. Although I’d never seen snow before, I liked it. I had fun digging and running in the snow.  Then Bill and Trixy moved again – this time to my current home in Buea, Cameroon.

 Jordan digging in the snow of Indiana

It’s a lot warmer here. No snow. The temperature ranges between 70 to 85 degrees Fairehight all year round. Instead of the Spring, Summer, Autumn, Winter, we have the dry season and the rainy season. During the rainy season which begins around June and tapers off in September, it rains almost all the time. Everything moulds. Even the fur on my ears turns a bit grey with mildew if Trixy doesn’t clean them.

Besides the weather, the animals are different too! Instead of chasing after squirrels with bushy tails I now chase big lizards with scaly orange tails! Both can run fast.

Jordan stalking a lizard on the wall.

I don’t eat dry crunchy Purina dog food anymore. Instead Bill feeds me freshly cooked beans and rice every day. It can get a little boring but luckily Bill and Trixy spice it up with additions of egg, pear, papaya, and bread. For a treat, Bill will sometimes buy little pieces of meat on a stick called SOYA. And occasionally, they’ll bring back chicken and chips for me. Chips, by the way, are fried potatoes known as French fries in the Unitied States. I love chips!

Jordan jumping for chips (french fries).

Oh, I almost forgot to tell you. I have to share Bill and Trixy now. One day Trixy brought home this strange tiny fluff ball that went ‘meow’. A cat! I was curious and a bit nervous. The fluff ball could hiss and fluff out like a puffer fish when it wanted. Eventually though, Milo (that’s the fur ball’s name), and I became friends. Sometimes she tries to get me to chase her when we play in the yard. She’s ok but I’m still the boss. I let her eat my beans and rice when I’m finished. Sometimes I try to steal her fish although Bill usually keeps me inside so she can eat without me.

Jordan and Milo playing in the yard.

I spend my days watching over my family, Bill and Trixy and Milo (but don’t tell milo!). In the morning, I dance around the door and get Bill outside for his fresh air. We run around our very large yard. Later, while everyone is working, I lay around and keep alert. If anyone comes to the door, I’m the first to let people know. I’m always quicker than the doorbell.

In the afternoon, I try to get my family to go on a walk. The Cameroonians think it’s a bit strange to see a dog walking on a leash. Some of them stare. Many of the children call out ‘white man dog’! I don’t know why? I’m clearly brown.

Some people eat dogs here. Occasionally I’ll overhear people say to my family, “dash me your dog. I want to chop your dog.” (that means, ‘give me your dog because I want to eat your dog’ by the way). I’m thankful my family will never do such a thing. 

Jordan in her front yard.

Many dogs are guard dogs. Dogs that live with their family in their house and are considered pets are rare. I’m thankful for Bill and Trixy. They’re my “pack”. Even though Cameroon is a lot different than Indiana and California, I like it here. I’m happy because I’m a part of the family -- and where my family is; there is my home.

Jordan with Trixy and Bill at Christmas

 (Milo was around but was being a typical "cat" and ran out of the picture)

Strangers and Pilgrims

 Four Student Missionaries Practicing the Art of Bowl Balancing

A/N: The following poem was inspired from observations made during my yearly vacation in the U.S. from my work in Cameroon. It struck me how my husband and I can cross two cultures without even thinking. Because of our time overseas, we will never have the same perspectives and insights. We have joined the relatively fortunate few who can say they’ve lived internationally. The following verse in Hebrews reminded me that our real citizenship is in heaven.

“These all died in faith, not having received the promises but having seen them afar off, and were persuaded by them and embraced them, and confessed that they were strangers and pilgrims on the earth.”                                                                                                                          Hebrews 11:13

I.D.E.

It’s short for Interdivisional Employee

The title denotes work as a missionary

Commissioned to travel across the land and the sea

An ambassador of love in a new country

It’s a calling of excitement and adventure

With a small dash of difficulty to be sure

However extended you choose to venture

You will never emerge the same ol’ trencher

You used to belong within society

Cocooned within a wall of familiarity

Now life’s ejected you from its propriety

And you roam around with some anxiety

Your passport cover that’s within your berth

Has a color telling your place of birth

It’s a name that no longer gives much worth

To that peculiar patch of nascent earth

Typhoid malaria and midgets bold

Are just as normal as the common cold

Cockroaches and mosquitoes fourfold

Are no more foreign than the flies of old

Black white brown red or other hue untold

Dark wiry hair or tresses straight and gold

Blue eyes that calm or brown eyes that are bold

All are unique and lovely to behold

Adjustable hot water bathroom showers

Cultivated garden with neat rows of flowers

These novelties are pleasant and pass the hours

But none surpass a ‘net speed that empowers

Quiet skies with no flying jet from Boeing

In contrast noisy markets and roosters crowing

Your ears can recognize the sounds out flowing

You sleep even with taxi horns a blowing

You jam forward in funneling queue with a wink

Or stand in neatly cordoned lines without a kink

You can place your demand for fish chips and a drink

Or order ice cream from a menu on the brink

It’s nice to swallow water straight from the tap

But Berkey filters easily fill the gap

Water is quite wet anywhere on the map

Filtered or bottled you just untwist the cap

Traditional Braids and Dress

White man, nasara, mzungu, and names akin

Whatever others call you with a cheerful grin

All remind that whatever color of your skin

You’ll never be a native or blend and fit in

Always an enigma in the current population

Not once an ordinary citizen of the nation

Never a common local of current habitation

You float between different worlds like an aberration

Your culture is distinct and its own creation

Based on your experience with some frustration

Life’s not confined to one style or summation

A variety but God’s your one foundation

Even if you wanted to return to days of old

You would never fit within that former rigid mould

Branded alien foreign wild and uncontrolled

A single country can never keep you in its hold

Whether for the better or for the worse

You must now trek long and forever traverse

A broadened view of third cultural verse

Where strange and different is not a curse

You may settle or you may pick up and go

You may return and live in former chateau

Or make another place your lasting furlough

Or even stay within your current escrow

No longer a self-centered and brash young fox

You realize that now you think outside the box

On the fringe of social order wearing socks

New perspective on things that used to flummox

You’ve become a wandering pilgrim in waiting

A promised rest for body and soul awaiting

One day when Jesus appears heaven translating

Your spirit will be complete full never hating

Within heaven you are perfectly understood

Communication’s great and quarrels are withstood

All are together in unity and are good

Your lonely wandering heart is home as it should

At last you’re a pilgrim and a stranger no more

Upon the weary travelings you’ve closed the door

Your soul is content upon heaven’s dazzling shore

The label I.D.E. is gone forevermore

Closing Tradition at Church with Hand Holding - Can you find the white man?

“Now therefore, you are strangers and foreigners no more, but fellow citizens with the saints, and of the household of God.”                                                                                                            Ephesians 2:19

Matters of the Heart

She came because she desired another child. Rich or poor, university educated or not, monogamous or polygamous, Christian or animist, it doesn’t matter, a woman finds her value through the children she bears. It may not seem fair and it can be downright cruel if one cannot conceive, but the fact remains that wherever you are in Cameroon, you must have a child be worth anything as a woman. After her name, a woman will always introduce herself by stating the number of children, and grandchildren if applicable, that she has. Children are the common thread that bonds women together and distinguishes them as adults and contributing members to society. It sets them apart from girlhood.

I studied Madam B who sat opposite me at the consult table. Several old medical booklets were stacked neatly in front of her on my desk. She was not thin or slender yet the flabby obesity that plagues those who eat too much and exercise too little was not applicable either. She was a solid, stout woman. Underneath a generous layer of insulating adipose that softened her features and gave her silky, smooth, chocolate skin were layers of strong muscle cultivated over many years of labor.

Although she was a secretary and worked a sedentary job in the office, the rest of her life was not so relaxed. Every morning she walked a considerable distance from the house to the main road where she caught a taxi to work. Every evening she walked the same route back. At home she cooked the food for the family. These meals required strong arms to grind the traditional spices and to stir large pots of garri and fufu. And then there was the cleaning. Daily sweeping, scrubbing floors, washing laundry by hand, and the many other household duties a Cameroonian woman executes. It was little wonder she was so strong!

Amidst the strength of her features, it was only her facial expression that revealed her vulnerability. She looked up at me with dark brown eyes filled with a mixture of sadness and desperation. Her smart business suit with matching makeup and heeled dress shoes hid her underlying fears and disappointments masked with an outward display financial success. Despite her envious employment she was still unfulfilled.

Outside her sad eyes and shoulders that sagged like one who has suffered too many disappointments in life, she appeared calm and complacent.

Making mental note in the back of my mind, I began to delve into her history.  The question uppermost in my mind was “What brought her to the clinic today?”

“How many times have you been pregnant?” I began our conversation.

She paused several minutes before replying. “Five,” she answered without conviction.

“Do you have any children?”

“Yes, I have one. A four-year-old boy. He’s not here.”

I nodded, encouraging her to continue as I jotted some details down in her medical book. “What about your other pregnancies?”

“The baby came out.”

“How old was the baby when he came out?” I prompted.

“The first time was three months. Now just a few weeks.”

“Ok.” I said, trying to understand here exact meaning. “So the second time you got pregnant you had a miscarriage at three months?”

“Yes.”

“And the third time?”

“It came out too. At six weeks.”

“And the fourth one?”

“The same,” she continued.

“And the fifth?”

“The fifth just happened, doctor.” She dropped her eyes and looked down at her hands. I could barely hear her. “It came out last week. I’m still bleeding.”

I looked at her sympathetically.

“I did a pregnancy test that was positive when my period was late. Then I just started having cramps and bleeding.”

“So you were only about five weeks pregnant?” I clarified.

“Yes.”

I hadn’t realized she had just had a miscarriage. This must have been what finally prompted her to come to the doctor.

She narrated her obstetric history with relatively little emotion. It struck me as the typical flat, hopeless acceptance of fate that I’ve seen in other sufferers.

Not wanting to sound callous but needing to know, I asked, “How did you know you were pregnant all these times?”

“See.” She shoved her other medical books toward me. She opened them up to the appropriate pages, pointing out documented positive pregnancy tests and an ultrasound report.

I asked a few more details in an attempt to elicit a reason behind her early, recurrent miscarriages. She answered each query with patience and thoughtfulness. Despite my numerous questions and thorough history, nothing popped out to suggest a diagnosis.

“Climb up on the exam table for exam.” I pointed to the sturdy medical exam table in the corner. The mackintosh cover had a little dog-eared tear that I had stitched closed while teaching my nurse how to suture last week.

Setting her purse down, she clamored up onto the table.

I finished my writing, got up, and walked over to perform my standard physical. Although she was here for issues with recurrent miscarriage, I still felt it was important to do a complete head to toe assessment.

“Look straight ahead. Open your mouth. Take deep breaths in and out.” She acquiesced as I inspected her head, eyes, mouth, neck and lungs.

“Ok. Lie back.”

After she was settled into a supine position on the table, I placed my stethoscope on her chest. (Yes, still the flimsy black substitute!).  A regular ‘lub dub’ throbbed familiarly in my ears. But then I began to notice additional sounds. Heart sounds that should not be present. Murmurs. A higher pitch systolic murmur and a low pitch rumbling, diastolic one.

“Have you ever been told that you have a heart murmur or that anything is wrong with your heart?” I asked.

“No.” She shook her head.

Making a mental note of the murmurs, I finished examining abdomen and limbs.  “Come with me.” I helped Madam B get up from the exam. “I want to take a little look at your heart with my ultrasound.”

I turned on my machine and had her lay down again on the ultrasound exam table. I am not trained in cardiac echoes. Nor do I have a cardiac ultrasound machine or a special probe that is designed to look at the heart. But, in a pinch, I can use the abdominal hand probe to peek between the ribs at the heart. It is less than ideal and doesn’t give a very clear picture. It is difficult to see the entire heart. But, I was curious about this abnormal heart murmur.  Maybe I could recognize some pathology. “It’s worth a try,” I concluded inwardly.

The quiet darkness of the ultrasound room was rudely interrupted by the melodious ring tones of Madam B’s mobile phone. It was in her purse that rested in a corner of the room. Mobile phones ringing at the most awkward moments seem to be the norm in my clinic! There’s nothing the patient can do. This time, she was lying on the exam table, half exposed with gel smeared all over her chest. I, on the other hand, held the machine’s probe in one hand and operated the dials of the machine with the other. We looked at each other; I gave a helpless shrug while we listened to Canon in D until the caller finally hung up.

A shadowy black and white picture appeared on the screen of my machine. A pulsating, fist-shaped hollow, muscle, contracting and relaxing, was revealed by my ultrasonic beams. Hypnotizing, tiny flaps of tissue waved back and forth allowing blood to enter and exit through the four valves of her heart. I couldn’t see the actual blood flow but I could see the tiny flap of mitral valve halt abruptly, like it was tied to a short string, as it attempted to open. The left ventricle tried valiantly to suck more blood through this narrowed valve with a little extra “umph” without success. The fuzzy picture that I saw certainly looked like the textbook cases of mitral valve stenosis (rheumatic heart disease) that I’d seen. Given her classic heart murmurs, I had a strong suspicion for this diagnosis.

“My dear, are you sure no one has ever told you that you have a heart problem?” She had been to numerous doctors in the past few years due to her recurrent miscarriages.

“No, doctor.” She insisted.

“Ok. Well get dressed.” I helped wipe off the gel from her chest. “When you’re dressed, we’ll talk more.”

She put on her blouse and buttoned her suit jacket. She straightened out her outfit and smoothed her skirt. Finally she picked up her purse, turned off her phone, and sat down.

“My dear, I know you came here because you are worried about your womb. You want me to figure out why you keep having miscarriages and to help you prevent them in the future.” I studied her face to see if she was listening and understanding.

She nodded.

“I want to help you. I am more worried about your heart though. You need your heart in order to live. You can’t have children if you have a bad heart.”

She sat quietly in her chair. There was a glimmer of comprehension in her eyes.

“We have to first solve the problem of your heart. Only after you have a full heart check up and see the heart specialist can we think about your other problem. Heart first then baby.” I emphasized the order of things.

“Do you understand?”

“Yes, doctor.” There was a hint of comprehension in her answer at least.

“Maybe your body was protecting you when you had those miscarriages, you know that?” I tried to cast the news in a more positive light.

“When you have a problem in your heart, pregnancy can make it worse. With your heart murmur, it could have been dangerous to have a baby.”

“What should I do now?” She asked.

“You need to go to the cardiac specialty hospital to have a full heart check up. After you get your heart checked and any problems taken care of, then we can think about having a baby. You get me?” I paused.

“Heart first then baby.” At the risk of sounding like a broken record, I repeated the point of heart before baby several times.

Finally, after a few more similar questions and answers, we came to the close of our visit. “I’m glad you came today,” I told her gently. “Now we know about your heart and you can get it checked before anything worse happens. I hope I will see you back after you finish at the cardiac hospital.”

“Oh yes, I will come back!” She heartily assured me. Her voice was full of conviction.

“We’ll see,” I think. Follow up is still a difficult concept here. I do hope she comes back. From a medical point of view, I am curious to see if my diagnosis holds true. From a more personal perspective, I would really like to investigate her recurrent miscarriages and see if she might be able to have at least one more child. Only God sees the future. We both rest in His capable hands.

“Aren’t two sparrows sold for only a penny? But your Father knows when any one of them falls to the ground. Even the hairs on your head are counted. So don’t be afraid! You are worth much more than many sparrows.”  Matthew 10: 29-31