The sorrow may last for the night….but J O Y comes in the morning

Child birth.

Let me tell you its messy for the mom, for the family, for the baby, for the doctor, etc. And not just physically messy. I delivered four babies and received about 40-60ish now (the pediatrician who resuscitates the baby in the delivery room or just dries them off depending how messy it all is).

Its painful and sometimes the sorrow in that room from things not going the way we all hoped is bottomless.

Pregnancy is painful.  Parenting is painful.

Believe while I don’t know personally, I live so close to it on a daily basis ,I know.

Last night I went to the woman’s bible study.  Because it was Monday and my Roommate is interviewing and eating grits (for the first time)  in Charleston, SC. She called me and said Amy, how did you ever leave the 60 degrees in Feb, the friendliness and the laid back, sit on your porch and watch the world go by kind of place.?  I told her I have no idea what came over me.  Basically I was homesick and lonely so I went to bible study even after telling myself that a bible study that looked at biblical womanhood in a church that currently loves Mark Driscoll a wee bit too much was a BAD BAD idea for me.

The passage we looked at was 1 Timothy 2, the part where we talk about not braiding our hair, not wearing gold or pearls and that we will be saved through childbearing.  We spent 45 minutes talking about the pain of womanhood from menstruation to labor to motherhood.  Don’t get me wrong, there are times where being a girl is not awesome but there was this sense of shame in the room. Shame about not controlling our emotions, shame about how painful pregnancy, childbirth, etc is.   I finally just came out and said what was flashing in my brain not out of anger but because I just couldn’t bear to watch the other ladies sit there squirming. And because I have worked 95+ hours in the last week and there is no filter anymore, there is just words.

There is no mold of a perfect woman in Christ, its not the secular mold, its not the evangelical mold (gasp).  This should be  liberating not condemning.  My comment actually was not poorly received, the word liberating caused some general discomfort (tragic…read Galatians…please).   Now I will give this church credit while I have never been to the men’s bible study naturally I have heard the sermon excerpts geared toward guys and they are equally hard on men which is a refreshing change in some ways from the norm.  So I don’t think this is one of those “Its all Eve’s fault” kind of things.  Yet I still don’t think most of those ladies left convicted and liberated.  Just convicted and guilty,

The elephant in the room….is when Paul says women will be saved through childbearing, I don’t think he meant the literal practice, I think he was using it as a metaphor. This is especially important because we take the rest of the passage as metaphoric (we still braid our hair and wear jewelery) , I don’t love the lets pick the metaphors out of literal sentence game…either this is a literal passage or its not. Don’t dance around it to the parts you like.

Child bearing results in children and for someone who spends a lot of time with babies….95 hours in the last 7 days.  Babies are complicated and messy and yes they can even bring us pain.  But for the 40-60 mothers who I passed their child to them for the first time….it was pure joy.  A joy that I don’t think happens to men in the same way and I don’t think there are many better pictures of unconditional love.  Being a woman means we have a special understanding of this because we have the capacity to bear children and experience this.So yes we (men too)  are saved through childbearing…through unconditional love, the kind of love that lays down one’s life for one child or one friend.

kind of like Jesus.

Perfect love drives out all fear, drives out sin and pain and brokenness. That’s the gospel.  God has made a curse into something beautiful.

but we didn’t talk about that. and my 95+ hour work brain couldn’t articulate as well I wanted to in the moment.

A Good Death

Nights in the NICU anywhere is to stand in the strange gap between heaven and earth.  Everyone is coming and going somewhere.

In Africa, we would run our list prior to call and come across a name of a baby who was struggling or had an infection we could not beat, there were no ventilators or was just too small, too early for us to give it a fighting chance with what we had.  We would say, Baby so and so is going home tonight. It doesn’t meant we won’t try, it doesn’t mean we haven’t racked our brains of what we can do with with what we have. But we know our limitations and we also know that us beating on the chest of a premature new born who needs a ventilator we don’t have is not going to help anyone.

Home is an evangelical phrase that is a reference to a verse in Paul’s letters that talks about being citizens of heaven and not of earth.

But I like it because it implies that death is not just about leaving, its also about going.  Babies don’t have the need for our theology and politics but  they remember where they came from.

In America, when a baby is dying in the NICU, we stand around running through every physiological rotation, we throw every drug we can think of, we call in the surgeons, who join the circle around the bedside, we try experiments, we give blood, fluids like we have unlimited resources,  we switch around ventilators left and right, we talk about the baby in the circle as some academic enigma whose body is just not doing what we tell it to do. The parents hover just inside the circle. Most are stoic, looking at the baby back to our circle, trying to decipher our academic whispers.  We tell them the truth, we tell them the baby is going to die.

In Africa, the mothers visit every two hours to breast feed or pump to feed through a feeding tube. They are devoted beyond belief.  We don’t mess around when a baby is dying, Mom will sit by the bedside in vigil, holding the baby, loving the baby. Other than making the baby comfortable we don’t interfere. In some ways, its the worse feeling in the world as a physician and in other ways its liberating to be able to give the baby and their family that moment.

Last night, we had a baby that had had every thing we had to offer who was dying, this went on for about 7-8 hours.  The mother was alone, young, she didn’t seem to understand what we were saying when we told her, her daughter was dying. She went home to sleep 20 mins afterwards. Perhaps it was the crowd of onlookers, the 25 people standing around still intervening. It didn’t look like the end, it looked like the middle of the battle. I called the chaplain and we called her back.  It took no less than 45 minutes to change the tubes around enough so that Mom could hold the baby.  I am watching the monitor the whole time and watching the baby heart rate drop alarmingly fast.  By the time Mom got to hold the baby the baby was purple and no longer had detectable pulses, we were breathing for the baby.   But the baby was gone.

Why did we wait I cried out internally?  What in the name of all that is good were we doing??????  WHY is she still on the dam monitor?  If we hadn’t waited till past the 11th hour, we could have found a private room for this Mom, we could have let her hold her, sing to her, cry, call her family. She never held her child alive or if she did it was for seconds to minutes. What really mattered here? We knew 8 hours ago that we were pulling for straws.  What were the extraordinary measures here?

Instead, she held a dead baby for about 45 minutes in the middle of a NICU pod with the sickest patients so with people constantly in and out. Even with screens….it was hellish.   And the moment heaven meets earth should haven’t to be.  It doesn’t have to be like this.

I am not saying the agony of what I don’t have in Africa is better but the agony of having everything except for the one thing that really matters in America is  haunting.   Its haunting because we have lost a grip on life in our attempts to foil death.

Either way the baby dies, its about how they die.

Peace and Pediatrics

My intern on nights with me this past week was a south spoken Syrian.  He spent two years working to get a visa to come and study pediatrics here. He wants to be a pediatric cardiologist. He will be one of the only in the entire nation and even surrounding nations when he goes home.

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.

Gratitude

One of the things about growing up with a progressive although manageable illness is it teaches you gratitude for the little things that make life truly beautiful.

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

I can’t save his heart but I can save his soul

Former 25 wk premies

bad lungs.

bad gut.

bad heart.

on a ventilator.

cant eat.

…can’t fix the heart. (inoperable)

The heart will be the end of him.

I got a page asking for restraints.

I go and see him

He is waving his little arms and legs.

Looking at the world.

They tell me they are afraid of toys.

Because it might overstimulate him.

Overstimulate his fragile broken heart.

I find a rattle half buried under blankets.

His eyes light up and his hands reach out.

His heart rate is steady,

his breathing is smooth and unlaboured.

He smiles.

I say to heck with his heart.

which I can’t save.

No I won’t restrain him.

Play with him. I tell them.

I cannot save his heart.

But I can save his baby soul.

A soul that just wants to learn

and play

and love

and be.