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.

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.

….

…..

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.

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…

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…

I heard a sermon this weekend, the first sermon I had heard in a month, on biblical manhood. It was actually decent. He discussed how men have lost a sense of purpose, have a prolonged adolescence and a lost a sense of value for women and children. And frankly any pediatrician with half a brain has to affirm all of this.  But then at  the bitter end, it all went wrong.  The elder started talking about providing and dependents on his taxes and then he went there.  He said, “If given the choice nearly all women would stay at home and care for their children.”   I nearly stood up and marched out in a huff of self-righteousness as a young women physician not only for my own choices but because he had dove into the pool of fundamentalist, SBC BS clothed in biblical language.  What he intended was not nearly as important as what the congregation heard.

First I refer back to this from 2009 in which I previously spoke to the subject.   and then I echo my last paragraph…

Could you imagine a woman would shrewdly crush the head of a foreign general (either figuratively or literally, diplomatically)? Or could you imagine a woman so strong and wise that a general refuses to go to battle without her? Could you imagine if there was a woman like Esther who would go before the governments of nations where genocides, other hate crimes or gross human rights violations are happening and convince them to stop? Could you imagine if women would support their elderly, widowed family members like Ruth rather than sending them to nursing homes or griping about them? Could you imagine if women of the world fought back against violence toward women and children like Tamar? Could you imagine if the women of the world embraced the children born unplanned or unwanted? Could you imagine if women in nations where there is no freedom of religion quietly yet openly worshiped and ministered like the women at the tomb? Could you imagine if women stepped up as leaders yes pastors, ministers, teachers in places where there is no faith or where faith has died?

How different would our churches be?

How different would our families be?

How different would our world be?

…if every woman got up from the mud of our world that exploits women and their bodies and brushed off the dirt of centuries of fear and ignorance hidden in church tradition but lacking biblical substance and embraced her calling…whatever that calling may be from motherhood (yes even the stay at home kind…love ya MOM!) to ministry to beyond.

how desperate our world is for biblical womanhood….how desperate…

This is what I want.   I am tired of apologizing for my extra X chromosome or my kooky religion. I want to find a place where they can coexist as they were intended to in harmony.

Key sign that my intern mental health might be fraying.  I think I am reaching the breaking point.  I wish Kenya was next month.  I need it to remind me why all of this is worth it.

What I am drowning in:

• See Previous entry:  choosing between my fading passion and what I actually enjoy….and am building passion for…find freedom in not being defined by my differences but not losing who I am in the process…small stuff really…
• Its February, its snowing and icing and I am done with it.  Its not going to be past freezing today.
• My right hip is on the cusp of dying and I am ok with it, at least more ok with it than last time. I have confidence in my surgeons. But my schedule is a night mare and because I am not a 100% WHEN I want to do it so I don’t know how to go to the chiefs. Plus admitting to my bosses is harder than admitting it to my friends. We all know that last time I end up admitting this with tears rolling down my face in the psych copy room. Yeah I suck at admitting weakness.  Not to mention that even after that there is the question…can I do this living alone in OHIO???  My support network in NC was huge and varied.  Nothing technically ever happened  that required roommates to intervene but is really safe to live with the risk of not having anyone… but how to I place an ad on Craig’s list…HI I need a roommate to be there when I get a shiny new hip so if I fall and do something crazy someone will be there to pick up the pieces…
• I feel like I suck at my job which is mostly not true but my burnout is not  helping my morale or my confidence.
• I miss home….yes I am falling back into the 8 yo away at summer camp mode.  I dream about being back at Wake, I miss the intimacy, I miss not having to explain things and more than anything I miss my friends particularly their diversity in that many of them are not doctors.
• Speaking of which I MISS MY CHURCH even though it  doesn’t exist as I knew it.   I miss the freedom, the lack of formalities, I miss eating bad Mexican food every Sunday.  I miss doing life with SACRED TUESDAY, the small group we created without any guidance but out the desire to know one another and laugh at life and the questions we didn’t always understand.  I miss being able to curl up into the corner of the coach and just be or occasionally cry as long as I needed to about the dying patient, my dying hip 1.0 or the joy of it all.
• I feel like I am missing out.  My sisters are both living at home right now one because she is doing a her student teaching and one because well she can’t handle college away.  NOW I KNOW that I pride myself in my independence and I do. But  I love my family and its hard to talk to them on the phone and listen to them all hanging out and laughing while I am here in 20 degree weather by myself in OHIO looking at erythema toxicum all day (it  is a completely benign newborn rash that is meaningless).
• I miss Romania and this above all is the most futile.  I know I can’t be a doctor there. I cant get excited about Kenya in April or Zambia vs. Cameroon vs. Togo for next year. Or even the Ukraine….I just want to go and sit in a corner in a crumbling hospital building that I have memorized every inch of with a scarf over my head and hold a baby and not care about his erthema toxicum even though I know eventually would miss the medicine right now its killing me and I just want to love children without having to analyze their every freckle.

Now I have to go to work.  But there is the list as it stands.

So that was then.

I have no regrets about that decision. It was easy and I was born to make it.

NOW though I come to a fork in the road (or I will in about a year) that I never expected and I never would have guessed. The journey up to March 18, 2010 (Match Day!) had been centered around children with disabilities and chronic illnesses especially overseas.  A group that I had related to in a unique way and who accepted me as one of their tribe with open hearts and their beautiful stories.   It helped to that reaching this group was within the safe bounds of what I was told in medical school was open to me as a disabled physician.

Then I came here where no one cared about my lack of metacarpal mobility.  In fact no one talks about it.  I am not only expected to suture,  I am allowed to without anyone standing over my shoulder asking me if I am sure I can do this. I have sewed two lips in residency already, one unsupervised. I have intubated twice, done an LP and put in four umbilical lines.  And I loved it.   I  like managning critically ill children. I  especially love the ED where all these things happen.  I loved the randomness. I loved the acuity. I loved the procedures.  And I can do them ALL.

I want to be a Peds ED doctor.  Its perfect training for global health.

But here is the thing its a complete 180 degree turn away from my tribe.  The tribe was how I got here in the first place.  They are why I went to medical school.   Can I really leave this behind?

One of my seniors set me down the other night and she said “Amy you would be a great ED doctor but you have such a gift with chronic patients, you can connect with them and give them hope in ways I can’t, the way none of average docs can, you can’t waste it in the ED.”

She is right.

But I am still torn.   Who knew a year ago when I was killing myself to suture with a broken arm to pass ED, that I would flirt with becoming an ED doctor….

Who knew.

I decided I wanted to be a doctor in a waiting room.  I was 19 fresh (as in less than 24 hours) off a plane from Romania. I was already pre-med but my heart really didn’t commit till that moment.  It was my last pediatric visit.  There was a little girl with Downs Syndrome learning to read Dr Suess.   Culture shock from the horrors of the Romanian institution system hit home and I lost it.  Its always been about the kids, it was never the money or the science. The prestige and the hierarchy made my free spirited heart exhausted from the beginning and the hours push my own fragile at times physical health to the breaking point.  Really it was the kids.

So I should be in my bliss right?  I have arrived.  I work at a world famous children’s hospital that from my friends in Africa to every pediatric applicant envies.   And mostly I am good at it.   I get all my work done.  My team mates like me. My patients like me.  My bosses like me.  In three years I can have any fellowship or job I want.

Here the funny part.  I never see the kids.

I am too busy doing the kids’ paperwork, talking to their parents, to their primary doctors, to my supervisors, to their supervisors.

I keep waking up in my call room and I have been dreaming about Romania and halls of  the NC hospital. About laying on the dirty floor with a baby in my lap or wheelchair racing in the hallway.

The dream is still with me…I just no longer know how to achieve it

Here is the dream.