It was not my pastor. It was a kind man about my parents’ age who is also a bad evangelical who runs an intentional community.  I am not quite where he is, in that I am pretty sure he simply sees Jesus as a moral teacher. But I so greatly appreciated his story, his life and his willingness to listen to my story.

He told me that he had built his career as a missionary and now has very little to show for it because now he has evolved into a liberal that is no longer accepted in evangelical circles.  His biggest advice was to not end up that way. It will be different from me as a physician but still very good advice.

Literally 15 mins after that I sat in a strange yellow room on a sofa saying I wanted prayer for the choices I had to make.  Two things were abundantly clear to me in that moment.  This guy who is my pastor really doesn’t know me so well and well as a result its awkward. And then I also realized that while he and I on paper have similar theology, our application of that theology is completely different.  I handed them my reference form and ran to PT.

So I stand in the middle of these two extremes.  And for now that is ok.  The reality is for now I am a liberal evangelical and I am ok with that.

I like Rob Bell including his new book. (not that new any more.)

Although I don’t think either of them are heretics or the end all of preachers.

I don’t really love Campus Crusade in fact it makes me cringe.

I don’t like George Bush all that much.

Although I don’t think Obama is the end all and be all.

I think women can be ministers. In fact some of the most influential ministers of my life are women.

I dont hate gay people.

I actually have very little in common with other white middle class 20 year olds who grew up in evangelical homes. Who Knew?

Growing up looking different makes you think different. Living in the lowest caste in society for periods of time (Eastern Europe) makes you realize most of us dont get a lot of choice in the cards we get dealt socioeconomically.   Trying to pretend like this didn’t happen to me is like being in high school and trying to fit in. I just can’t do it anymore.

I am not sure what I was thinking when I moved here and joined my current church but I think I was high on the novelty of a new adventure and didn’t read the fine print.  But now 18 months in, I realize, what the heck was I was thinking?

The timing is insane….I am in the mist of applying to mission agencies.  I need references. But I can’t live the lie any more.

So Monday, I am going to try something different, something very similar to the direction the community in NC I was a part of was going.  Its just dinner.  Near my home with people who like Jesus.  People from all walks of life, I can promise you I will be the only doctor although perhaps not the only disabled person.

And I am hoping that I can be a part of a faith community and have some integrity.

As for my references….Im not sure what to do yet. I am praying about it.

Pray for me.

and I panicked.  I am also ill with some RSV like illness.

Suddenly in the last week, I have looked around realized I have it made.

I have a brilliant mentor who has actually succeeded in founding a clinic in one of the most violent neighborhoods in America that is celebrating nearly 20 years.  Not to mention his work in Africa. Not to mention, he actually seems to think I am great.  He is sending me to Malawi this July.

I work at the best childrens hospital in the world. No really….people come from EVERYWHERE to be here.  Every day we have applicants who are interviewing dying to come here. The learning here is amazing, the teaching opportunities are amazing.

Today I went to see my uber boss, to ask about writing a program director letter for me for my fellowship applications.  He hugged me and said “I brought you here….of course I will write you a letter for whatever you want.”

Yes its cold here, yes its on the wrong side of my beloved mountains, yes people here look at me funny when I say “yll” but by golly I don’t think leaving is what I want.

I want to go to Africa but I think if I could have my cake and eat it too. I want to be a fellow from here.  This is where I want to represent.

…..never mind that the fellowship only exists on paper.  And there is no actual money set aside.

I can dream, can’t I…

JANE, another colleague says, “I think BOB got that schedule because he had JESUS on his side.”

I laugh and said, well I go to the same church and it didn’t work for me.

JANE and JOAN stare for a moment.

JANE says, “I didn’t know you were an evangelical”  But she said it in such a way that it was like I didn’t know you smoked or I didn’t know you throw rocks at puppies on the weekends…..

“UM, well yeah….maybe a bit more laid back.” I flounder wanting desperately to explain I didn’t love BUSH, Im a pacifist, I haven’t bombed any abortion clinics, I watch trashy TV sometimes, I read Harry Potter and yes in my less thoughtful moments I use off color words I learned from my naval heritage.

JANE smiles, “Yeah, well I love Bob, I was just joking around.”

Then one of us got paged.

….two weeks latter….

Two weeks later I am out with GABI who I have been friends with for a while but whom I find myself having a series of deep and more personal conversations with.  GABI tells me she is something akin to gnostic. She impressed I know what that means and we start talking world religions. I am holding my own.  Then she comes right out and says it:

“So you love Jesus? You’re a Christian?”

I explain that in all my studies what impressed me the most was the incarnation that God would come down and live as we do to provide a vehicle to get us out of a spiritual life the equivalent of a TO DO LIST which we could never complete  and that its all about the relationship with GOD that we can have through knowing and believing in Christ.

This question was easy.

It was the series of next questions that I found myself sweating a bit.

“So how do you feel about missionaries?” (which is a big question if you look at historically and currently) (or as I like to say do you mean in the JOSEPH CONRAD’s HEART OF DARKNESS sense?)

I start with HEART OF DARKNESS and colonialism and move on down to my own experiences. I end with saying what I believe in the context of a relationship is quite different than the HEART OF DARKNESS sense.  She nods and talks about how Church NGOs do a lot of good.

“So do you think, Christianity is the only path to heaven? DO you believe in a literal hell?”

(these are loaded questions: If the answer is YES and YES you are condemning 5 billion humans on earth today to hell).

I believe in Christ (note that I separate Christ and the gospel from Christianity which is a human construct) is the truth and the path. However, I don’t really know how it all works out.  Only God truly knows people’s hearts and knowledge.   As for Hell, Milton and Dante seem to know a lot more about it than I do because other than a parable or two in the Gospels and some heavily loaded metaphor in Revelation, Hell is not described in detail in scripture.  I know it will be separate from GOD which sounds terrible but in the spiritual sense not so much the physical sense.

At this point, GABI who is also a physician interrupts me and says “When I think of Hell, I think of homeless schizophrenics at war with their selves and living cast off from any sense of human contact.”

I nod, who knows, maybe HELL is like that.  I continue…

As for who goes to whatever it is, well again GOD only knows.   The party line Billy Graham crusade answer is that its a punch ticket kind of thing, you go through the right prayer, life style change or whatnot and you get the right ticket punch. Over the millennium Christians have  made up all kinds of ideas of  loopholes. Babies for example apparently are innocent so if they die, its OK they get to go without a ticket, developmentally disabled people too (a babe in Arms kind of ticket).  These babe in arms kind of tickets are made up, they are not in scripture, we don’t know what happens.  Now, do I honestly believe that God sends babies to Hell?  My understanding of God is somewhat different than that, so NO I don’t believe that. But I don’t how it works.  So do I believe that folks in some dark jungle who never heard about Dante or JESUS go to hell?  My church peers would say that’s on us to some degree for not going as missionaries.  Do I think God will send them to hell?  Again I do not know.  I don’t know what that looks like.  I also don’t know exactly what will happen to all the people pre-Jesus. I don’t know.  SO do I believe people, go to hell, YES but I don’t know who or where or what exactly it is.

As for Heaven, some believe the Kingdom of God will come to earth over time as we build it, some believe we will go to it.  I think the former is ambitious and maybe a bit impossible but I think the Gospels are pretty clear about trying anyway. While I am interested in hell, I am far more interested in what we do now to mirror heaven and spread its seeds in the mud and mire of the hellish elements of now.

I explain as well that while I believe in things absolutely, I live with mystery in my faith, of unanswered questions and gratitude to a GOD who is big enough to be mysterious to my human mind. I live with unanswered questions, with faith and I am OK with that.

My friend seems impressed.   We drank our tea and then we go home.  I think she expected me to start reading Romans out loud and pray the sinner’s prayer and give her a tract.  Because I am evangelical, right?

As I go home that night, I think what would my friends from church say if they listened to this conversation? What would BOB say? What would they say if they heard me admit that I don’t have all the answers?  Would they have done the same?  Some would have, but I think most would have stayed within safety of the party line where we have the answers.  I think they would think that I lost my religion.

Am I failed evangelical?  Have  I gone native in all my intellectual quests of reading the Koran, the Mormons, the Buddhists, the Baptists, the Skeptics and the Gnostics, dissecting the layers of culture, history, human creativity from the raw text, from what we call religion?  Do I believe in nothing because I “tolerate” and analyze everything?

NO.

I do believe in something, actually its quite akin to what I believed when I told my parents I wanted to be baptized when I was five before I knew about all of the other stuff we tacked on to the truth.  I believe in the love of a GOD who would love me even though I hit my sisters Emily and Tori every day and some times wish I could go back to being three when I was an only child.  A GOD who created the trees, the deer behind our house that left footprints in the snow, my cat, the moon, the stars Daddy taught me the names of, a GOD who created an elaborate plan to love me  me despite the my wrongs. The plan included sending someone he loved like I loved my parents and my paternal grandparents (and mostly Emily and Tori), a piece of himself who suffered through annoying little siblings and stuff and in the end died pretty awfully  and somehow in something that seemed at the time a lot like magic came back alive to get the rest of us before he went ON so we could all still be friends with God.

GABI says her husband and I have little girl and boy souls, we still believe the same as we did when we were children.

I would say that’s actually quite biblical and I am OK with that.

What has changed somewhere between church camp and now  is that the religious brainwashing has melted gradually over the Serengeti grasses, my ferocious appetite for books and reading, the wails of orphaned, neglected Romanian babies, long nights of organic chemistry followed by ethics and human rights essays in college and blood dripping off my gloves, sweat and tears running down my face as I beat on a child’s chest trying to save their life, I lost my religion.

And found JESUS.

He left Syria in the mist of a near civil war where every day there are reports of people dying.  The Arab Spring of 2011 has not ended well in his homeland.

But for now, he is here with me taking care of ward of children who have succumbed to the various demons of winter.

Late one night, we admitted a Somali toddlerl for observation after drinking some cleaner.  When the ED called to tell us about her, both of us got excited. Me because I took care of Somali refugees in Kenya and him because many Somali folks speak Arabic.

After we had her settled in, we found ourselves walking for midnight shack in the cafeteria. We talk about the famine in Somalia  that no one is talking about, the children who are dying. How our pediatrician hearts break for the children who are caught in the crossfire of country at war with self and a divided world who cant seem to understand each other.  The West has turned their back on Somalia because they harbor terrorists. But the terrorists who have friends in high places elsewhere are not dying, its the women and children.

Our conversation turns to the ground that divides us.  How hard it was for him to get a visa because he is from the other half. How many of my countrymen suspect something of this quiet soft spoken pediatrician because of his passport and his religion. They haven’t heard his heart for children who are dying of repairable heart defects or watched him play trains with a terrified 3 yo to soothe him. And how his countrymen suspect something of me as an American, as a Christian, as a Navy brat, as a global health doctor surely, surely she is an imperialist. Surely she wants the whole world to be like America. Surely she must be like that man in FL who burned the Koran (which apparently is a popular viral you tube like video in the Middle East).  They don’t know that I took an Islam class, read the Koran and that my best friend from medical school is a Muslim. They don’t know that in the end I love the diversity of the world and dress like a Kenyan, cover my head in Eastern Europe and am mildly horrified at how viral McDonalds is much less the rest of my culture.

And our conversation stops for a quiet reflective moment.

In the end, we conclude. It all comes down to pediatrics.

No really it does.

We want a better world for our children.  A safer world. A more peaceful world.  A world where our children are not hungry, are not sick, go to school and grow up free.

We smile.  We eat our snacks and rush back to the havoc of the wards in the winter.

If only we could put aside our fear, our pride, put down our guns and realize for a moment just how simple it really is.

It renewed my desire to be a global pediatrician, to be part of the solution.

Here I was excelling in medical school, living my dream, planning my first trip to Africa and having no idea if I would be physically able to continue in a few months, years. I finally found the courage to get x-rays, a kind rheumatology fellow who I frankly owe my sanity to paged me and went over the films with me gently. He talked me into a steroid shot in which a the radiologist furthered my anxiety with talk of strange anatomy and bone density.  I made an appointment with the hip surgeon who I had met several years earlier and wrung my hands as I studied for Step 2, started my residency essays. The visit upset me even though I knew what was coming and gave me the strange transition of me explaining to my anxious mother what the doctors were saying. He gave me another steroid shot that was amazingly effective and I lived with denial for a summer, went to Romania and pretended that everything was ok. Perfected my residency essay, then my peds AI hit me like a freight train and my denial started to crumble.  My first patient died of pneumonia related to muscular dystrophy in an all night vigil of wailing parents and I was reminded of my sweet Romanian friend whose similar death had rocked my world in college.  Our parallel diseases differed in two major ways, there was a palliative yet potentially close to curative treatment for the symptoms of mine and even when I had no cartilage left…I wouldn’t die.  Visions of a beloved elderly patient with RA who had movement in her hands, was going blind and couldn’t get out of bed flashed through my brain…could I live with that reality?  Visions of the synthetic hip failing because of my bone density and knowing that once we took my femoral head they was no going back, if the prosthesis failed, I wouldn’t walk again.  After the on call vigil, I drove home to the mountains then onward to get a steroid shot.

Within in weeks, I could no longer deny it, the shot failed. I wasn’t sleeping now because of the pain.  It was everything I could do to keep the facade that I was just another medical student. I called my surgeon’s PA and cried in the child psych copy room and told her I wanted to do the surgery now.  (yes I had a nervous break down on the pysch floor…fun yes). Things fell into place, the surgeon fit me in (I am sure he was shaking his head thinking finally I was ready a year ago, this girl is nuts).  I passed Step 2, got my first residency interview and with tachycardia to the 120s, lectured my anesthesiologist on the decreased number of DVTs with spinals opposed to general as they rolled me into the OR.

I was a neurotic post-operative patient but I went back to medical school three weeks later, line danced at 5 weeks, interviewed for residency at 6 weeks, Kenya at 16 weeks  and by the time match day came I was taking the steps two at a time for the first time in my life.

I went through a similar period of denial and anxiety although much milder, fought to get steroid shots in Cincy( Part II, Part III). Epic fail, telling my  chief resident was near to the copy room incident. This time the PA tried to comfort me that even though there was a boat load of hardware in the hip, they would figure it out and I would be ok. I nearly lost my insurance coverage, took the Step 3 and then spoke in DC the week before.  By the time I got to the OR I found myself in a much better place than the previous time, believing that somehow the hip would work despite the hardware weakened bone and that I would walk out of this better than ever.  I found myself telling everyone (yay versed) my bucket list of things I wanted to do with two shiny hips (I remember this prior to heavier sedation but apparently I kept right on going although I don’t remember it). I woke up to the news that miracles of miracles the hardware had not prevented them from using the best kind of hip as expected and I had a 30 year lease at minimal. I was texting everyone I knew in the PACU and thanking everyone from the jainator to God for my incredible good fortune.  My family and I survived me with five weeks of unplanned toe touch weight bearing while the hardware holes healed despite a funeral, a mild incision infection and general angst on the part of a sibling.

And I find myself at 5 weeks post op sitting in an exam room across the hall from where this all began three years ago with the visit (see above). The PA comes in and asks me when I am going back to Africa?  She hands me the films with a grin. There they are, healing perfectly. Her optimism is infectious and suddenly as I remember how fragile it all seemed three years ago.I think back though to my first pediatric death and of my sweet friend Laura who died of a similar diseases (dying muscles and connective tissue…I have dying cartilage and connective tissue) and how in some strange way of the disability tribe I feel I owe them, they expect me not to waste this, to live with reckless abandon.

I am overcome by gratitude this time sans versed.  Nearly in tears.  The attending comes in  says my name, kisses my cheek and says “You’re Done!”  He grabs his cell and proceeds to call my pediatric ortho to tell him the good news. (yay for transition..although it was kind of a weird move)  He draws me my “life plan”  which includes one more visit at 6 months, then no more visits for 2 years.   It doesn’t seem real. No more hip pain, no more hip precautions, an inch taller (much to my sister’s dismay) I can throw away my crutches, 6 weeks of PT and then welcome to the rest of my life.

Mom and I drive back down the familiar spine of our beloved mountains, a little giddy despite the recent family sorrow, amazed at marvels of modern medicine, of grace and of the incredible joy of sweet relief and the sweet ability to dream.

Praise God.

Becoming a disabled physician is one of the greatest things I have done in my life but it also was among the most painful.  Being told that you have no right to be here either in attitude or in voice is not pleasant. Being a pioneer is life defining but it also emotionally and psychologically exhausting. At the end of my time at Wake Forest there was a series of unfortunate events, attempt to fix it and the epic fail.  I left some what devastated but determined to go out into the world of medicine and make my difference with or without my esteemed Alma mater’s support. Because while I may have failed in some regard as a pioneer I did what I set out to do which is become a physician.

I heard rumors last year that they had interviewed a disabled applicant here and there. I rolled my eyes and dreamed of telling them of going elsewhere although knowing that there were no safe places for us in the world of medicine as student doctors.  I went home and lectured last year and was welcomed like somewhat of a returning hero which was odd and bit over the top.

Then I heard nothing for a long time. I grew as a young physician in an environment where I am not entirely at home but am safe from the constant pecking at my heart that I will never be good enough although I have relapses.  I suture, I LP, I travel back to KENYA and take attending call, I get my first job offer, I move to a house and no longer feel like I am camping in exile.  I move on.

But I return home again to give lecture to another group of young student doctors who meet the cut that I apparently never quite made.  I am again welcomed. As I walk into the classroom I see something that nearly takes mybreath away.  There is a student on front row sitting with a place at the table literally (the classroom was not wheelchair accessible till my second or third year) in a power chair.  I have tears in my eyes.  In all my moving on, I had forgotten how much this matters to me, how deeply I was hurt and even though I had gotten the diploma, how much I felt like I had lost an equally important battle.

But in fact I won.  We won.

I corner the  Dean and demand why no one told me, he smiles sheepishly. I though you knew, he tells me.  I thought you knew.  I welcome the new student, she has heard so about me. She thanks me for paving the way. She applied at 31 schools, Wake Forest was the only one that accepted her despite her double degrees, top grades, from a dare I say more famous Carolinan institution with a unspeakable mascot that is percuilar shade of blue in Durham.  They chose me, she says,  and I know its partly because of you.  She has dreams of working with our tribe, of impacting children.  According to her anatomy professor she is top of her class.(a better student than I ever was…hehehe)

I give my lecture, I think the best I have ever done. The Dean says I have grown into a public speaker in my own right from being a terrified first year medical student. I look at him and I try politely to tell him that I no longer have anything to fear.

It didn’t end there, I had glorious Carolina afternoon catching up with friends, mentors and basking in the sunshine.  I sit and drink tea and laugh late into the night with old dear friends as we talk theology, justice, nostalgia and wit.

The next day, the Dean of Faculty (Dr BIGSHOT) calls me and asks me to come see him (he was out of town the day before). I show up in jeans in his formal office, he hugs me.  He immediately turns to the young woman I met the day before, isn’t it great he says. He goes on to tell me about what happened after I left.  He confronted the ED doctors who were fighting so hard to change our standards. In a faculty meeting, they gave presentation. They argued that if you asked 50 people out on the street if you want their doctor to run to a code, they would say yes.   Dr. B said, “Yes and 50 years ago people would have said they wanted their doctor to be white and male.”     That was the end of that he tells me.

We talk of global health and he gives me the finest career advice I had despite my esteemed current employer.  He tells me, pack your suitcase and go to Kenya you will figure the rest out as you go along.   He encourages me to follow my dreams and not be confined by the mold of the academic rat race in less I wanted to be.

But as I leave what sticks with me is that its rare in our lives that we are allowed to know the extent of impact we have on our piece of world.  I will never be able to put this on my CV or even discuss in an interview. I will never get an award for it or get my name published in a top journal.  But I will go to my grave knowing that I was privileged enough to change a few hearts in regards of my tribe.  I was able to at least for now make a safe place for disabled student doctors to study and grow and find their piece of the world to change.

A few days later in the mist of my ED shift, I got an e-mail from the Dean who told me that he overheard some first years talking about my lecture and how they would never use the word inspirational again (ha!) and how I had changed the way they think.

The movement goes on.

I tried so hard to be a good pioneer so people would wake up and take notice and now for the last year and half I did everything to just conform so that I could just be another physician.  I realize both are only fragments of the woman God has me becoming.  And finally after five years of wandering and feeling a little lost, I came home to myself an feel a sense of contentment.

The kind of friends who you can show up dripping wet on their door step after the worst day and they will let you in, let you cry a bit, tell you to clear off the laundry from the sofa and rest or hand you a crying baby and to get busy (which ever seems the right reaction).  The kind who tell you the truth both good and bad. And the kind of friends that point you to Christ and speak wisdom into your life.

I am blessed young woman. Because at quick count I can count about 10 friends like that in my life.

Then the sermon went on to making your life where you are, finding those friends where you are and locally because thats how the local church was. The elder argued that we cant live elsewhere. We have to live here and now.

I shifted uncomfortably. I have tried very, very hard to build roots like that here. But frankly they just have not dug deep.  I go to things post-call, I go to things when I am so sleepy I can’t stay awake, I am in a small group, I go to social events, I go to church and I have done these things for a year an half but the people who are the friends that keep me sane are not here.

One out the 10 are local and they followed me here from NC.  You may ask how I make this work. How I deal with my best friends being far way? How I keep myself accountable? How I keep myself sane?  Well when you grew up all over the US and plan on living all over the world…you learn fast.

I felt guilty about this and then I just realized you know this is  a season of my life.  God knows I have tried and he seems to have brought people into my life for the right seasons. I have faith he has done the same here.

Maybe its not the 15 people in my small group, maybe its the 6 amazing young women in my residency program who I spend consistent time with. Maybe its the children who steal my heart, maybe its the preparation for having my friends a continent a way.

Here’s the truth. I am a little bit more of a Paul/Priscilla kind of figure than a Lydia or Mary/Martha. Jesus have multiple friends in different cities.  I am a nomad by birth and by calling.

So make new friends, invest in where you are, yes.  But keep the old.

Yesterday was Grand Rounds and I was post call. It was on chronic pain in connective tissue disorders….NO REALLY it was.  I slumped in the back, ate my oatmeal and hoped that sleep would overtake me quickly. It was all fun and games while the geneticist gave an explanation of connective tissue disorders. Then the rheumatologist went on about Fibromyalgia and JIA.  I drifted in and out. Then the psychologist got up to talk and went on about chronic pain and patients (our) poor quality of life.  And how much they (we) feel persecuted in the hospital when they come seeking meds and how they pass up activites they would otherwise enjoy and then how there is a higher rate of suicide. They went on to talk about new research studies that were ongoing looking at day hospital treatment for chronic pain. and cognitive therapy.

I sat there in the corner in my imaginary white coat (I never wear one, it scares kids) and shook my sleepy head at this. Its all fun and games until someone misses the point.  Maybe part of why we have a higher rate of suicide and “poor quality of life “is not so much our pain but the medicine we use to treat it. And medicine in the literal and larger sense.

What if instead of taking our chronic pain patients out of society and out of school to be in a day hospital program, we find ways to help them engage in life? What if instead of giving narcotics like candy to our sickle cell population, we tired alternate methods or we at least stop complaining about how they are addicts because WE (the doctors WE) gave them their addiction!! What if we stop trying to make pain less depressing and find ways to make life more worth living? What is our goal, be pain free, or be living our lives?

I agree grand rounds friends, chronic pain is a mind game.

But its some what clear to me that you have never played.

Chronic pain is a series of choices.  Difficult choices. Defining choices but choices never the less.  Every day you wake up and you decide what rules today?  My life or my pain?  Do I fit my pain around my life or fit my life around my pain?  You can tiptoe around on eggshells and slip and fall or you can run and not look back.  You don’t choose to live with pain but you do choose to live to the fullest. TO live with joy. To live with gratitude.

Doctors, all the study show we are actually quite bad at understanding what “quality of life” means to our patients so maybe we should listen to them.

I rolled my eyes and my wheels and took my poor quality of life upstairs to rounds and helped save some lives. Then I went home, had a mug of tea, a long bath and a nap. I woke up and read a book, went to bible study, came home and finished the book.

Like I said me and my poor quality of life…..

Baking something yummy.

North Carolina Wine

Old Friends.

New Friends.

Summer Nights.

Clean clothes.

Good Books

Clean hair.

Pedicures

Grace

Children and their wisdom.

A Good Night’s Sleep