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.

I walked into the pediatric oncology ward today and the first patient I met had a brain abscess of unknown pathogen origin but since she has cancer it could be a very, very bad bug. She was in a room with two other leukemia children one who was questionably neutropenic (no immune system). I was really, really upset. I get the whole limited resources concept. I get the whole this is not America concept but I can’t turn off the little doctor in my head that says this is a way to kill three children for the price of one. We painted their faces and make necklaces and bracelets and it was the only child life (hosp playroom) time these kids get. Their parents make their meals, give them all of their oral meds, wash them, clothe them and do all beside care that does not involve the IV pump. There are no portacaths so the kids get IVs perpetually. I was pretty saddened by the whole thing.

Especially in light of story number two. So ‘Mike’ is 16 and was my bosses’ first patient here back 1994. He has a stricture (a narrowing) of his esophagus. He needed surgery to fix it but he had to grow and there were no surgeons in Romania any way. Finally they found someone to do it after a more than a decade of suffering and being told that there was nothing to be done but wait for death, they found someone. Health care is supposed to be FREE for all children under the age of 18. And by FREE they mean that if you want your child to live the hospital alive after major surgery try a 3000 dollar bribe. That’s more than most families make here a year. And it needs to be in cash and by the way it’s all under the table so the doc will never pay taxes. The missionaries, the boy’s community and his parents have scrimped and saved and raised the funds. The boy survived the procedure and is in the ICU. The only words the surgeon told the mom was the esophagus was dilated before the stricture, we should have done this years ago. The mom has to pay a bribe every time she wants to see her son. 3000 under the table? And the mother can’t even be with her son???? 3000 untaxed dollars in a country where children with treatable cancer die because they can’t pay bribes for isolation rooms.

Don’t get me wrong I know America’s health care system is broken. But at least it is mostly honest. I mean insurance companies are evil but they are upfront about it. I would take truth even it means capitiolism runs health care over corruption running health care any day.

Also this http://www.wxii12.com/video/19854698/index.html watch it… and count the number of time they use the word inspiration or something similar. I know this girl, she is a friend of mine, and she is extremely kind and generous with herself. But I post this because it’s such a good example of America’s idea of disability. I can be a cursed beggar/prisoner of an institution or I can be a poster child for a Disney movie.

God Bless America……and Romania

Good grief. Dear God please tell me there is some happy medium in the world where gimpy people are not martyrs but rather teachers, parents, doctors, lawyers or whatever they want to be when they grow up. And no one finds it extraordinary that they managed but rather find it extraordinary that anyone would think otherwise.

….there are many kinds of freedom, and even more kinds of slavery.

End Rant.

Things are slightly better accessibility wise here. There is a van with a lift to help one get off the plane and lift into the terminal. I actually rode down the whole street today by myself in the green machine, curb cuts the whole way. I almost had tears in my eyes. Such freedom, my people here have never known such physical freedom. I learn so much of spiritual freedom from these simple things. God wants to free us from our sin and our own selfish selves but we have to let him tear down the walls (the curbs) in our life. I think often of my friend who was my initial introduction to the plight of my people who died soon after I met her. I am sad she did not live to see these days but happy to know she is with the Lord. We still have a long way to go education and health care wise, but enviromentally they are making an effort.

God is doing interesting things in my heart. I love this land and I love Eastern Europe. But Romania is chaning rapidly. Romania will need less and less missionary doctors over time. The medical missionaries who run the clinic are thinking about retiring. There is still much work to be done here but I am not sure if this is where God has me to come for the long term. So where Russia? Ukraine? Africa? I recently received an e-mail from one of my future supervisors in Africa he is asking for pediatricians with a passion for the disabled to run a rehab center in Tanzania, they want to start a series of these throughout the continent.  I am going to work in one of them in Kenya in Jan. They were very clear, that my elective is a window to employment, they are almost recruiting me 5 years early it seems. Also on my way here, I ran into a guy who works for Samarthian’s Purse who gave me his card and wants me to e-mail their medical missions dept. It seems possible jobs are growing on trees at the moment…

 

,.,,,there is so much to tell about being back here and about Spain and Italy and France…but it will take me a while to get back to speed with my blog. I am also writing my reisdency personal statement wich is a painful endless process.

Why you ask? The usual reasons things matter in foreign policy: oil, power and blood.  Russia controls a big part of Europe’s oil supply and the oil passes through many of the former soviet republics.  Russia has friends like Iran and China.  Russia is becoming better armed all time and already has increasingly bad human rights record.  I am not suggesting that we as the west should go in and try to mess around with the region and play police or micromanger for these  corrupt, struggling infant democracies but we shouldn’t take them for granted.

Let’s all remember that it was our indifference after helping the Afghans win against the soviets that brought us the Taliban…

not the same situation, but the same principal. The battle for a free whole Europe is not over, its really only just begun.

Contentment is something I struggle with.  Being content with waiting on God or wait on public transport or simply being happy with I have at that given moment. Its so easy to give into complaining or whining about what I wish could happen faster or what I wish I had or what I wish could be different.  There are so many things I want and so few things that I don’t have that I actually I need.  You go to any book store and you will find oodles of books about finding peace and contentment.  And there are a great variety of such books in the religion section alone from prosperity gospel to physics to magic formulas, but no ONE HAS AN ANSWER….

God provides in his own time, his own season and his own way or so we are taught in church.   But how do we learn to wait, to trust. Oswald Chambers says the most important word Christ ever spoke to his disciples was abandon.

What does abandon truly look like?  Can we truly be joyful and grateful for what we have and live in the moment? Can we drop everything and truly live with abandon? Reckless abandon??

So different from what our culture tells us…and in the end I think thats the key. Its recklass abandon of what wer are told to worry about, told we should want and need for instead embracing what we have and what God has for us.

I am not sure what that looks like exactly but I am praying God coninutes to show me.

Over break I went through my medical records (I have my own small archive of films and records taking up an entire corner of the attic) for the first time as a medical student. It was surreal, the words were familiar to me. I speak the language fluently now, grammar, the note structure, the acronyms all make sense. I was looking for my original audiogram (hearing test) and the Kniest diagnosis paperwork.

I had never read the 10 page genetics paperwork fully. Anyone who has ever had any exposure to genetics knows that geneticists are meticulous (I spent a week on it during peds). They look at ever freckle, every toenail  and scrutinize it for answers of what  kind of biochemical diaster you are… I found it, read it, copied it and put in my folder with my audiology stff (hearing aide stuff), letters from the Dean, my high school IEP (plan for accomdation for a student K-12), Wake and my Rheumatologist’s letter. Today I stuffed it in an envlope with a personal statement (yes they require this) explaining my disease, my good standing as a medical student, species, etc. And for some odd reason I felt violated.

I mean the whole thing is ridiculous…I mean would anyone really tell a disabled person they couldn’t take their wheelchair or hearing aides….I mean this exam (which 95% of US grads pass) is one of the tests that decides if I get to be a doctor to deprive me of my hearing aides in particular would severely hurt my chances of doing well. The fact I have to prove to the NBME I need them is just flat out laughable….or is it…see sometimes I forget.

I have forgotten the awkward admission questions, the fact that my friends get rejected because of their disabilities, i forgot the surgery attending who stopped me on the elevator last July to ask how the heck I thought I was going to pass his rotation or the int med attending who stopped rounds half way through on my first day on the service to ask what my limitations were (in front our entire team, nurses, etc) or the peds attending who is a former AAP president who asked me in the middle of morning report what page are YOU on in Smith’s Book (the illustrated peds bible of  genetic syndromes…I am pg 412 (I think)  of the newest edition).  Oh right…I have forgotten I am actually reinventing wheel…

I’m sorry but is it too much to ask to have something sacred here??? Is it absolutely necessary that the people who write my medical liscene have to know every freaking birthmark, freckle and toenail I have???  Do I have no right or privacy…HIPPA applies to everyone except patients who want to be doctors (or lawyers from what I have been told).

and unfortunately its not just the NBME…This week I e-mailed my Rheumatology (arthritis doc) fellow  a question, he is a really decent doc who I really respect. I mentioned my pain had been worse in the past few months on medicine. He wrote me back an answer to my question and then mentioned that my medicine clerkship director (NOT RHEUM) happened to be sharing clinic space and overheard the fellow talking to the Rheum attending about me.  She apparently had a conversation about me with the Rheums, about my work (good, she says) and her sincere desire for me not to be abused on her rotation (good intentions yes).  I know she meant well but if I wanted her to know I would have e-mailed. her .  You know maybe I didn’t need the person writing my medicine grade and comment summary to know the imtiate details of my chronic pain issues.

sigh.

I could go into a long rant about power issues and about history and how such information could be used aganist me by insurance people or yes gatekeepers who have often historically been physicians who made decisions for my tribe without our input. But really its not about that.

I am not ashamed of any of it, I am not afraid of persecution, there is nothing to really hide…I just would like to be a student doctor…who yes happens to use a wheelchair but who mostly just happens to be a  third year medical student who is a decent one at that.

Yes I really would just like to be a medical student.  Why must I keep proving my right to do that?

yes I am a medical student  with a wheelchair, and a big medical file and hearing aides and FLK on my birth certificate.

it time for the world to get over it…I mean at least by the time I graduate.

All of the sudden I felt an arm around me I look up to my patient’s smiling face. She closes her eyes and proceeds to pray loudly to the point where everyone in the busy nurse’s station is now staring at the two of us. I stand there at a complete loss of what to do. Among the professional ethics scenarios I was never given any guidance on what one is to do when your patient tries to faith heal you. I find myself fighting embarrassment and annoyance. She prayed on and on it seemed (I don’t think it was particularly that long) about God healing the places where my legs had been broken and the spirit descending and such. Her AMEN brought a sigh of relief for me. I mumbled Thanks because well it seemed like the only polite response and then walked away (dare I say limp away) from the counter. I found myself oddly comforted by each bit crackling of my limbs, nothing happened.

I remember once in Belarus I was rolling along with my friend and translator Koia across a field on the way on to a home visit. When a beautiful Roma beggar with long dark hair and traditional gypsy clothing was walking in the opposite direction. She saw me and stopped and started rummaging in her purse and before I knew it she was thrusting Rubles into my lap. Koia explained…Americanka…and passed the money back to the beautiful Roma lady. She looked confused but reluctantly took the money and walked on. I sat there in shock at the realization I was living in culture where my people were lower than even the beggars. At the same time I was shocked by her compassion, as embarrassed and surprised as I was. I was shocked by her compassion when the world showed her so little. I was reminded of this experience after much reflection on my encounter with the faith healer.

Their compassion was misplaced. In the same way the beautiful Roma lady did not know that the woman in the wheelchair on the path was not a poor beggar but a rich American. The faith healer did not know that I have never questioned my wholeness before God that I found much beauty in my so called brokenness. And I realized the most remarkable thing. At bacculature I was asked to be the gospel reader I read the famous passage from Matthew 25 about how the righteous gave Christ food, clothles and shelter. And they ask when did was he hungry, naked etc? And he explains that whenever they served the poor and the outcasts they served him.

I do not pride myself in being one of the least of these nor do I truly consider myself one (that whole rich American thing) but I accept that I am easily confused as one. I think you can appreciate this passage no matter your religious background because it reveals something key about the way our world looks at others. The least of these are the people that everyone tries not to see in society. If you don’t look at them they don’t have to exist and you don’t have to feel guilty about their suffering. Yet you  never know who you are denying kindness and you never know when it will be you who is in need of it.

So even though I sincerely hope that no one tries to faith heal me (especially in the middle of clinic) me again any time soon I am convicted. Not to drop out of medical school and start a faith healing ministry but to notice the things that everyone tries to ignore. And yes to be tactful about acting on it. So I go and not royally embarrass the individual. At the same time I was convicted not to be so dam professional and polite that I miss moments to be compassionate, miss moments to remember my humanity.

I’ve tried to substitute with American summer staples like ice cream sandwiches and Popsicles. I went swimming in a clean pool with other Americans. I went to the beach a few weeks ago and am going again. I wore a tank top and and read on my porch. I’ve savored air condition. But it just doesn’t feel right. I haven’t spent a summer in America in 4 years. I don’t know what to do with myself.

Today I hung out in the special needs eye clinic. You know you would think that I would love love love American health care with all its technology and solutions for these kids. It just also makes me all the more aware of how much my people in Eastern Europe suffer. Its as if I do not understand their nakedness entirely until I see the full beauty of clothes. The more clothes I encounter the more I am ashamed of their nakedness.

yeah I keep sort of deep down wondering if I will grow out the whole e. europe thing…like if this will be some sort of phase of my life that will fade out like that time I used to sing in the choir. but it seems to be here to stay, it seems to have taken hold in strange ways.

I think I shall make a cherry pie this weekend when i go home.

Holding the hand of a child as they fall asleep.

Watching my grandparents celebrate 50 years surrounded by their children and grandchildren. Listening to their stories and remembering the miracles of the past 50 years.

Singing and laughing tucked back in a grove of trees with the same folks as the sun sets.

For the first time, diagnosing a child (a 9 mon old) with cancer and hoping and grieving with her mother.

Waking up and finding this in my garden. I didn’t plant this. I have been so busy, I haven’t had time to weed….

Sitting on a stoop in hot, humid, sultry SC with old friends from the other side of the world. Laughing, talking and just simply enjoying the company of people interested in living beyond the America bubble.

Holding my very first well child check patient and watching her eat her first birthday cake. (no HIPPA in Romania mission clinic)

That’s whats up in my life. That and lot of studying for the surgery shelf (not really so sacred).

My presentation was kind of shaky and rushed and very, very different than the other three. Mine was a narrative with a lot of photographs of children and Eastern European art and scenery. The others were very public health focused, people were cured of malaria, maternal and infant mortality were decreased. There were statistics and evidence based medicine and epi. I had a single slide of stats which were colorful and again bordered by bright eyed beautiful children.  I didn’t cure any diseases this summer, I played Nannie more than developmental pediatrician even.  I was the last presentation of the day. After 45 minutes of public health and EBM, I was anxious and uncomfortable in my semi-sensible looking professional clothling. Who was I fooling? I make a better flower child than a public health officer. peace. love and medicine. woot.

Needless to say I was bewildered when the e-mail came.  I am thrilled, its somewhat meaningless beyond an extra sentence on my CV. But its kind of nice to know that perhaps my class does not think  I am completely bonkers…  or maybe bonkers was easier to stay awake during than sane.
at least I told 100 folks about the plight of my tribe in Romania.