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.

Trasition Saga Part II

SO I called my PMD (a real one who is not a geneticist, does Pap Smears and make me feel not like a pariah) and while I am waiting for her to call me back. One of my classmates over hears me talking in the house staff lounge and suggests PMR (Physical Medicine and Rehab)gently and sweetly. I get a referral and then call to make an appointment:

Amy:  Hi, this is Amy. I’m a patient of Dr. PMD. I need to make a PMR appointment.

Random Medical Assistant (RMA): OK well when are you free?

Amy: July 25 and 26.

RMA: When else?

Amy: July 25 and 26

RMA: Are you going out of town?

Amy: No. I work as a pediatric resident at Childrens.

RMA: What are your hours?

Amy: 6 AM to 6PM and every fourth day 3o hours.

RMA: Oh…. Let me transfer you.

…

Amy: Hi, this is Amy, Patient of Dr. PMD. I need to make a PMR appointment and I have some scheduling issues. I am a resident at Childrens.

RMA2: What do you need out of the PMR appointment?

Amy: I have a rare form of arthritis that I was born with. I had a hip replacement in 2009. The other hip now is deteriorating. I need a steroid shot to help me be able to keep working.

RMA2: Oh….well how about Dr. PMR1, she is an expert in acupuncture.

(oh for the love)

Amy: Does she do hip injections?

RMA2:  Yes and acupuncture. You could also see Dr. PMR 2.

Amy: Whats the difference?

RMA2: Well PMR 1 is a girl, PMR 2 is a guy. and PMR 1 does acupuncture.

Amy: Do they both do hip injections.

RMA2: Oh yes.

Amy: Who can see me July 25/26?

…..a 15 minute repetitive conversation ensues about the fact that I work 80 hours a week and have these two days off….finally I secure a appt with Dr. PMR 1 who of course only has availability at an office 30 minutes away from where I live.

RMA2: Do you have back pain? Neck pain?  Knee Pain? ….

Amy: No…No…No…No…just hip pain.

RM2: Is this a worker’s comp case?

Amy (who has now been on the phone for 35 minutes):  No its a being born comp.

RMA2: You were born with hip pain?

Amy (at the point of throwing the phone across the room): SO July 25 7:45 at Office Far, Far, Far Away and Dr. PMR 1 can do a hip injection that day and you scheduled enough time for this?

RMA2: Oh yes, yes, yes plenty of time for her to do acunputure or the shot.

Amy: Thank you.

….

…..

Hope

There are  147 million orphans in the world.

1 of them is an adorable Kenyan little girl named Hope.

She was born and abandoned. She was a perfectly healthy term baby.  She spent two months in the Nursery while our faithful social workers tried everything they could to find a Kenyan relative or home that could take Hope. None could be found.    My friend Jackie (a pediatric registrar in Nairobi now) and the Nursery nurses named her Hope. They fed her, held her, prayed for her that a family would come forth.   She was well cared for so unlike the precious Romanian babies who stole my heart and changed the course of my life at 19.  Finally one day a wonderful American dentist and his family who had been practicing in Africa for 20 years said “We will take her for a while.”

The while turned into a family. Hope became a daughter, a sister and she gained siblings and parents.  The siblings are growing up and family back in the States are getting older and its time for the Dentist Family to go “home” for a time.  Thus began a year struggle with the Kenyan government where Kenyans, Americans and admirers from the four corners of the world got on their knees and prayed that God would give us compassionate lawyers and judges  who would see past passports and politics and see a family.  Our prayers were answered on April 28, Hope was an orphan no longer in the eyes of her homeland.  The adoption was legal.  We rejoiced.

Now the time had come to go to the Americans….a land of freedom where H O P E is quite the buzzword these days.  But America is also a land of fear, freedom has a vulnerable underbelly and like most nations its a land of redtape.  The American Embassy despite numerous letters, pleas and prayers has now repeatably denied Hope a visa, passport, etc.   Rather HOPE is a mini terrorist or simply an unacceptable exception in the spider web of the sometime impossible to pin down laws of international adoption is unclear.    HOPE’s sister is going away to college without HOPE. Her parents are making difficult decisions of how to manage two daughters, two continents and how to keep their family together while they are being split up.

SO please pray or what   you do that is prayer like for HOPE, pray that the American officials in Nairobi will find compassion and see beyond their stamps and fears and stand up and fight for families and orphans and Hope for the children of the world….all 147 million of them who are still waiting.

Complications…

Life is so much harder sometimes than I saw it going in my head….or maybe it is how I saw it going in my head….

6 years ago while I was in Belarus, my best friend from childhood got married against her parents’ wishes.  My family went to the wedding and my sister Victoria stood in for me as a bridesmaid.  I remember crying laying on my bed in my stuffy little room in Mogilev because I could not be there. I also remember suppressing the image of opening a door one day with her holding a suitcase saying it was over.

Figuratively that happened this week.   I find myself a marriage and then a grief counselor and in my 26 years I find little experience to channel considering I am perpetually single and my life experience consists of a lot of medical education and wheelchair backpacking. And even though I saw it coming, I had hoped it wouldn’t come. Then it did.

I am back to square 0 with the hip, the steroid shot is wearing off and it makes that tell tale sign of two unhappy surfaces crushing one another when ever I sit or stand up.  I knew this would happen in residency. I knew that transition in CIncy would be a problem.   I have even tried to find a ortho here yet I have been unsuccessful. My sweet classmates have called in every favor they have as young aspiring pediatricians for me to find me someone to give me a shot. I act as if the shots will save everything. But in the back of my mind I know I am now holding a ticking time bomb.  The shots will stop working. This is not fourth year of medical school. I can’t work if my pain is full force for longer than a month or so before I am not sleeping. The decisions I make at 4 in the morning are far too important.  I knew the right hip would fail in residency….now it is and I act like its a surprise.

I met this lovely little girl a couple of weeks ago. She has leukemia but not the good kind that has a 85% cure rate.  When I read through her story and then when I met her, a beautiful pale blue eyed 4H champion…I knew it was going to end badly.   I acted all surprised when I found she had gone to the PICU overnight but in the end looking back I knew three weeks ago.

My seniors think I am naviee because I do not believe in the infamous JINK or JUJU of call and resident life…where if you make declarative statement like “Tonight is going to be a good night” or Its quiet,  or if you say the name of a frequent patient THREE TIMES etc you are doomed.  I believe that sometimes things are just to be or not to be and there is very little you can do other than swim through what hits you…..life happens.     No I don’t believe in the juju but then again I don’t even seem to believe in the things that I know are going to happen,

I am a perpetual optimist to a fault.

alas….as my Grandfather loves to say A Cheerful Heart is a continual Feast…

The ivory tower has a view

Occasionally I stare down from my ivory tower of my home away from home… my premier world famous childrens hospital into the rainy streets  below and ponder the ironies of where I stand.

I am among a very friendly, although intense community of young physicians who inspire me and challenge me.  They also want to do things like a be a pediatric heptatologist when they grow up or a palliative care/hematologist/oncologist or be a cardiac ICU doctor.  They are impressive and are being groomed to have impressive careers.  Occasionally I get caught up in the mist of it and try to play the game  but win or lose I find myself looking down at those streets and thinking about how different my life will look in 10 years than nearly every other graduate of my program.  Sometimes I don’t know how to fit my career goal into some sort of acceptable academic mold. (Although if I was really trying to FIT IN maybe I would give up the TIE DYE t-shirt collection on call…and actually WEAR my white coat).  WHen people ask me what I want to do with my life….the expression on their face when I say global health doctor is something akin to shock or a sad smile as if to say “We’ll see how long that lasts….”  Then there are my recent attempts into the array of ACADEMIC global health which is just like what it sounds…. a complete paradox. So far it also seems like a mess….its like combining developing world bureaucracy with academic medicine bureaucracy which make s system that makes Africa time look like a New York minute and Eastern European bureaucracy look like excellent customer service… In T-minus 24 months I am supposed to have a plan. I am supposed to live the dream and all that jazz. In a year I need to be turning in applications for either EM or a mission agency.  This is it…this is what I want to do with the rest of my life…but who knew the rest of my life was only 24 months away and who the heck knows how to get there….

Then there is the typical double agent-ness.  Although its been a really good year in terms of my life as a patient. Its a calm before a familiar storm.  The steroid shot is buying me time.  How long is yet to be determined but if I have another winter like this past one I don’t think I will want to go through a third.  So despite the fact I haven’t taken the green machine to work in two weeks, I know I am simply riding a false high that will eventually bottom out most likely sometime like the middle of PICU or worse my first month as a Sr in the ED and force me to come to grips with despite two years of magic I still have a chronic illness and I am facing another life altering 6 months of a massive surgery that will most likely per usual live me with a hgb of 7.5 followed by mild hysteria over how can I work 7 days a week and go to PT 5 days a week and keep my health insurance….so that I can pay for the monstrosity and live to tell about it.  Its most likely going to happen before I graduate.    I may be the doctor now but that does not give me a immunity. I also cant help but occasionally despite how different here is than back home in terms of patient/family care….chiming in with the other half of my life on rounds….and finding everyone staring at me like I have three heads when I suggest we introduce two of our patients close in age and with the same type of cancer…. FOr the love….we can get their parents’ premission first…I am not crazy I just happen to have be a agent from the light side (for we all know that the doctors are part of the DARK SIDE )…on second thought I will go back to updating discharge summaries….ignore me I just work here…