Joy in the Morning

Three years ago when I was in the mist of my third year of medical school. I went through a 2 month period where I rarely slept more than a few hours at a time. It wasn’t the call schedule, it wasn’t the stress of residency applications or Step 2, it wasnt even entirely the pain that gnawed my left side at times to the point of tears. It was the creeping waves of anxiety of a young doctor to be who knew exactly what was happening to her in exquisite detail. In my minds eye I could see the holes in the cartilage, in which glistening white bone lay naked and scraped. The dying cartilage and wounded bone making something akin to broken glass in a small tight dark space lacking adequate blood supply for even the chance of healing despite my immune system attempts, in the end the immune responders led to an army of inflammation and pain.  I dreamed about this.  Then I would dream of the OR a place that as a med student I always felt like an escaped patient masquerading as a young student doctor to be. I had a recurrent dream that I was found out, carried down the hall, stripped of my scrubs and then rolled back to the OR screaming that I was just not ready but no one heard me.

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.

Drowning

Last night I had  a dream that I was drowning in a enclosed space.

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.

Someone’s Drug Baby, Unwed mother, HIV positive, Gimptastic, Homeless, Homosexual Leper

I find myself smiling knowingly. It’s not faith healing that our leader is preaching, its wholeness. Its realization that what we see as doctors, as humans is only a small part of what makes a person. The illnesses we seem so keen on fighting are a part of a larger whole. He is talking about how people are never bad outcomes. But as I look at my peers’ expression I shift uncomfortably. I realize that I am once again in the minority. I get this because this is fundametal to who I am, to how I see the world as a wounded healer. To my young, healthy, ambitious peers this is a very hard concept.

He goes further and begins to tip another sacred cow of medicine… He says a word that we say all the time in church but really has lost the luster it had centuries ago: L E P E R. He tells the story of St. Francis of Assisi walking down the road and hearing the clanging of a cow bell. He tried to get out of the way but found himself transfixed to the spot in the middle of the road as a leper with a warning bell around his neck approaches. He talks to the LEPER who is shocked that he is spoken to. As he turns to go, the LEPER turns into Jesus for a split second. St. Francis is brought to his knees.

I have never met a patient with leprosy. But I know about LEPERS.

These are all real stories of real people who I have met who all needed physical healing of some sort but what they really needed was understanding and compassion. Some of them had done things to themselves but most were a vicitim of how they were born, somone’s else choices or worst of all society’s warped conception of their lives.

I took a chance and tell perhaps the least offensive story for my audience (the one about the street child on the subway). At the end I briefly mention some of the other new forms of lepsory that exisit in our medical and wider culture.

It makes us all cringe a bit.

But I think that is the bibical meaning of the word Leper….it was not meant to be PC or assuage our sensitivites it was to call us to radical wholeness, compassion and sharing of brokeness with our fellow man.

147 Million………..

yesterday I went to adoption clinic…and I think it gave me PTSD in reverse.

The smell of urine,  sunbeams through a barred window, the feeling of chapped hands, the smell of stale bread and boiled cabbage….  These are the things that take me back to being 19 yo, young, idealist who walked down the OTHER hallway at child protective services in Bucharest…

July 13, 2004 (from my journal)

Eerie silence echoed through the long, narrow, gray room. It was frozen in time; the light from the singled barred window on the far side seemed listless, much like the occupants of the cribs. I tiptoed over to the first crib:  there was a heap of brown curls wet with tears, sweat and urine scrunched in the far corner. At the sound of my footsteps, she jerked her head up from her hushed sobbing and looked at toward my quiet steps, scars of untreated infantile galucoma clouded her sky blue eyes. How could a eight year-old know such grief, such fear? I reached down to pick her up:  she was weightless it seemed. I let her down gently to the floor. She stood slowly, her tear streaked face seemed to come alive.  She held my hand with a death grip:  don’t let go, don’t let me go.  She walked with careful steps fearful of the monsters she could no longer see.  At the dark end of the room, another crib had been pushed away from the others.  .I heard the sound of metal striking metal against the rail of the crib. Then I saw a hand and unnaturally slender wrist is covered with red welts and oozing blisters. I peer into the crib and discover the etiology of his suffering. A single piece of cloth encircles his other wrist and the bar of his crib. I gasped, on the sign above the stated this child was 14 but he was the size of a toddler. His head was grotesquely mishapen with untreated hydrocephalus. No wonder she was so afraid, no wonder she grieved. This was not a hospital for disabled children, it was a prison.

I am haunted by these children…orphans…some abandoned because of poor resources, some because they are members of my tribe and their families left them and the stigma of raising a cursed child behind,  some born on the streets, some badly abused and taken for their own safety. But all left in a pitiless system that devalues their potential and slowly teaches them and even molds them (both physically and emotionally)  that they are not worth it.

And don’t this is about Romania or even Eastern Europe.   I could tell stories about the slums of Nairobi where children die of dehydration, HIV and TB and no one cares.  I could tell you about young beautiful African teenagers selling themselves to survive.

And don’t think this is about the developing world either. There are 888,000  children in foster care in the US.   And I shudder to tell you the stories I see every day on the pysch Ward, in the ED of abuse, neglect or kids who have never known a stable environment in their 10 years…who can tell you the top drug lords of their housing project are but can’t find the state they live in on a map….

But yesterday I saw the other side…. White people from the suburbs who I half expect to invite me to a Wednesday night church supper or run into when I shop at the uppity grocery store in uptown who have adopted from China, from Ethiopia, from the Ukraine and yes from the US of A.  People from the culture I grew up in who went to the cultures I live and work in now and brought back a child. I saw one little girl who had just come from China a week ago…she has a clef palate.  In two weeks she had advanced 2-3 months developmentally. In just 2 weeks…. I had tears in my eyes taking her history.     Because I have seen 100s of these children , room after room of babies who get fed and changed twice a day who never learn to sit up or crawl or walk much less talk or interact not because they are not capable but becuase no one holds them.

And I was overjoyed for this little girl…for this chosen one…..  But what about the others…..a 147 million others. What about them?  I found myself wanting to scream this loudly at these parents.  “WHAT ABOUT THE OTHER BABIES???”   I didn’t of course because I knew that I was being absurd.  Its just that while I love the idea of adoption and I think its a beautiful reflection of what Christ does for us…. and I admit I even plan to adopt myself  one day… its a drop in the bucket.

147 million is a lot of drops…

I want to answer the question why babies get abandoned.  I want to be about de-stigmatizing disability/birth defects in the developing world, preventing HIV in Africa, decreasing maternal mortality in the 10/40 window,  changing the way cultures think about little girls, building sustainable economies in nations so that families can keep their babies….

we are called to care for orphans and widows….but what does that mean in our modern world? what does that mean as spoiled, pretentious, well-meaning Americans… ???   I don’t know the answer but the longer I reread the gospel and the more I travel the world, the more I realize that the redeeming, trans formative answers are the ones that make me in my home culture and yes in my home religion the most uncomfortable.

My prayer is that I am ready and willing to look beyond my own fears and my own bias and believe that its possible. TO believe that there are answers and be ready to radically follow my God in search of them.

….147 million

The view from ZSR 6th floor on the eve of the rest of my life…

7 years is a long time.

I am sitting curled up in one of my favorite places in the world. The ZSR library on the Wake Forest ugrad campus. Its nooks and crannies and huge windows and high callings have facilitated my studies, my imagination and my dreams for the past 7 years.  It was here I studied for my first real exam EVER, memorized latin poetry, poured over novels, drew out organic mechanisms, took MCAT practice tests, discovered libreation theology, painstaking dissected the New Testament and the Koran and eastern European folklore. I learned EKGs and neuroanatomy on the 6th floor. I learned Rheumatology and Endocrinology over in the new wing.  I dreamed of traveling and medical school and later medical missions.  And like most young women day dreamed occasionally about boys and the future and all that is to come.  This place is full of friendly ghosts that remind me of where I have been, who I am and where I am going. Its not just nostalgia and books that live here but a sliver of my identity and the woman I have become will always find a home here.  Of all the places on the Wake Forest campus I think its the place i will miss the most when I finally physically leave Winston in May.

And that is about to come to a head. Tomorrow it begins.  I submit to the powers that be my residency application. Countless cups of tea, late nights, long hours, books, papers, notebooks, itunes, sutures, progress notes and surgeries.  seven years, six pages of resume and essay, five agonizing standardized board/admission exams, four summers loving Eastern Europe and four babies delivered, three years of med school (1 to go), 1.5 degrees, it all been for tomorrow so I can go get a job somewhere in the United States that wants a gimpy pediatrician to be with a strange love for all things from the Black Sea to the North Pole, a more than passionate obsession with disability rights who is in love with children, Jesus and comparative religion.

up, up and away.