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.

Going Home

I gave my annual lecture at Wake Forest last week. It was a beautiful tapestry of beginnings and endings of my life.

Becoming a disabled physician is one of the greatest things I have done in my life but it also was among the most painful.  Being told that you have no right to be here either in attitude or in voice is not pleasant. Being a pioneer is life defining but it also emotionally and psychologically exhausting. At the end of my time at Wake Forest there was a series of unfortunate events, attempt to fix it and the epic fail.  I left some what devastated but determined to go out into the world of medicine and make my difference with or without my esteemed Alma mater’s support. Because while I may have failed in some regard as a pioneer I did what I set out to do which is become a physician.

I heard rumors last year that they had interviewed a disabled applicant here and there. I rolled my eyes and dreamed of telling them of going elsewhere although knowing that there were no safe places for us in the world of medicine as student doctors.  I went home and lectured last year and was welcomed like somewhat of a returning hero which was odd and bit over the top.

Then I heard nothing for a long time. I grew as a young physician in an environment where I am not entirely at home but am safe from the constant pecking at my heart that I will never be good enough although I have relapses.  I suture, I LP, I travel back to KENYA and take attending call, I get my first job offer, I move to a house and no longer feel like I am camping in exile.  I move on.

But I return home again to give lecture to another group of young student doctors who meet the cut that I apparently never quite made.  I am again welcomed. As I walk into the classroom I see something that nearly takes mybreath away.  There is a student on front row sitting with a place at the table literally (the classroom was not wheelchair accessible till my second or third year) in a power chair.  I have tears in my eyes.  In all my moving on, I had forgotten how much this matters to me, how deeply I was hurt and even though I had gotten the diploma, how much I felt like I had lost an equally important battle.

But in fact I won.  We won.

I corner the  Dean and demand why no one told me, he smiles sheepishly. I though you knew, he tells me.  I thought you knew.  I welcome the new student, she has heard so about me. She thanks me for paving the way. She applied at 31 schools, Wake Forest was the only one that accepted her despite her double degrees, top grades, from a dare I say more famous Carolinan institution with a unspeakable mascot that is percuilar shade of blue in Durham.  They chose me, she says,  and I know its partly because of you.  She has dreams of working with our tribe, of impacting children.  According to her anatomy professor she is top of her class.(a better student than I ever was…hehehe)

I give my lecture, I think the best I have ever done. The Dean says I have grown into a public speaker in my own right from being a terrified first year medical student. I look at him and I try politely to tell him that I no longer have anything to fear.

It didn’t end there, I had glorious Carolina afternoon catching up with friends, mentors and basking in the sunshine.  I sit and drink tea and laugh late into the night with old dear friends as we talk theology, justice, nostalgia and wit.

The next day, the Dean of Faculty (Dr BIGSHOT) calls me and asks me to come see him (he was out of town the day before). I show up in jeans in his formal office, he hugs me.  He immediately turns to the young woman I met the day before, isn’t it great he says. He goes on to tell me about what happened after I left.  He confronted the ED doctors who were fighting so hard to change our standards. In a faculty meeting, they gave presentation. They argued that if you asked 50 people out on the street if you want their doctor to run to a code, they would say yes.   Dr. B said, “Yes and 50 years ago people would have said they wanted their doctor to be white and male.”     That was the end of that he tells me.

We talk of global health and he gives me the finest career advice I had despite my esteemed current employer.  He tells me, pack your suitcase and go to Kenya you will figure the rest out as you go along.   He encourages me to follow my dreams and not be confined by the mold of the academic rat race in less I wanted to be.

But as I leave what sticks with me is that its rare in our lives that we are allowed to know the extent of impact we have on our piece of world.  I will never be able to put this on my CV or even discuss in an interview. I will never get an award for it or get my name published in a top journal.  But I will go to my grave knowing that I was privileged enough to change a few hearts in regards of my tribe.  I was able to at least for now make a safe place for disabled student doctors to study and grow and find their piece of the world to change.

A few days later in the mist of my ED shift, I got an e-mail from the Dean who told me that he overheard some first years talking about my lecture and how they would never use the word inspirational again (ha!) and how I had changed the way they think.

The movement goes on.

I tried so hard to be a good pioneer so people would wake up and take notice and now for the last year and half I did everything to just conform so that I could just be another physician.  I realize both are only fragments of the woman God has me becoming.  And finally after five years of wandering and feeling a little lost, I came home to myself an feel a sense of contentment.

Rites of Passage

Last Monday night I stood in the hallway between A and B buildings on the 5th floor and pondered the end of my career as I know it… The end of intern year.  It seemed like it was supposed to be momentous as if I should stand for a moment in the gulf between the future and past and ponder.  Its was 1 AM and I was on Heme/Onc call and I should have been sleeping but in the quiet  enfolds of the hospital at night I sometimes do my best thinking.  A year ago on the eve of my intern year I was bouncing between butterflies and homesickness wondering how I managed to end up at a program with so many smart people.

I celebrated with my classmates rafting in Indiana and then flew home to join my family at the Lake. It was a dazzling four days of sunshine, brilliant blue skies, green mountains, hiking, boating, good food, family, naps and good books. The trip was a blur, a smooshing of all that is happening in the lives of the ones I love into the four day pause between my 90 hour work weeks. Victoria has own her apartment. My best friend from high school is trying to get pregnant. We discussed it all over french food.  My best friend from childhood is getting a divorce. Emily is buying manipulatives for her classroom, preparing her lessons plans. My best friend from college is starting her internship in Family Medicine. We all went shopping for professional clothes (well Tori went shopping for shorts to wear while scooping ice cream).  And my Dad has decided the time has come to play match maker and has declared he wants grandchildren. Thing seem to be progressing at rapid speeds. I have whiplash from the changes, the leaving behind, the moving forward. There is sadness and joy….so much joy and anticipation of new chapters of life.

I came back to the world I had left except that now they call me Senior.  I am in the ED which is supposed to be what I want to do. Its confusing. I love the ED. I loved my first night in the trauma bay (the privilege of a Sr. resident). I love the speed, the variety and the acuity. But I also like sleeping and the month of ED nights is waring on me.  The wide eyed interns look terrified with every presentation they make remind me of how I far I have come. As I watch my four close friends in the program apply to second year match fellowships in GI, Cards, Pulm.  I feel the vice of pressure to be a rockstar if I want to do ED I have to prove my worth to the department….. I realize how much I just want to be done with the academic rat race that has been my environment for the last two decades.  Decisions, checks in the boxes, you graduate from intern year….now is time to have your life together….If I don’t do ED fellowship that means Africa in 23 months….that is so close…am I ready for that?

I dont know.  There are a lot of things I dont know. But for now I pause before jumping back into the eb and flow of change and moving forward. I pause to say how grateful for how amazing my life is.  For the grace for the last year, for the wonderful people who love me all over the world, for the opportunities to learn the art of medicine and the science of saving babies.  And even for the choices that terrify me but also motivate me to keep treading, keep moving on.  To choose one’s  life work is such a privilege.  To trust God with them is also a privilege.

I rest in that thought.

Where is my compassion?

Its 4 AM.

I am so tired I can hardly move much less make a life altering decision for someone else’s baby.   I am so tired that despite my fleece, knee high socks and scrubs I am shivering. My body aches, my right hip feels like its going to burst and the muscles around the shiny hip are stained.  I am tired to the point that I am short tempered, angry and I can’t remember why I am doing this no matter how hard I try all I can feel is anger. Anger at the child. At the parent. At the nurse. I try so hard not but all i feel is anger. Its not the baby’s fault. Its not the baby’s fault I say to myself.  As I drag myself to the room of another sick child, I can’t remember the child’s name and awkwardly refer to them as “the sweet baby” or “pretty little girl” or “buddy”.  I am covering 60 kids and I am on hour 23 of call and I just can’t bring myself to care beyond just making it another two hours to sign out when my comrades will get there…..and beyond to 7 hours from now when I can go home and sleep in my warm bed….

I look down at the baby, someone’s child and all I can think is how did I get here and why am I going through this torture.  Where is the compassion I had in medical school? Where is the excitement I had in college? Where is the dream?

I am making preparations for Kenya. I am counting down the hours till I can pack up my little CRV and drive across the mountains home for a night, north for a precious and much needed steroid shot and then boarding a plane to take me EAST…..

and then SOUTH. to warmth.

escape.

to more sick children….but somehow in Kenya its different.  Maybe it waking up to the Great Rift Valley with the mist burning off the smoldering African plains, maybe its the craziness, the chaos that is a hospital in rural East Africa, maybe its the grateful smiles of every parent, maybe its quiet morning prayers. Maybe its that life exists on Africa time.  Maybe its that I can’t call for 20 consults.  Maybe its that the internet works ON A GOOD DAY only. Maybe its because for a little while I can be Amy again not Amy the super intern at a top program or Amy who wants a competitive fellowship or chief spot.  I can just be Amy who knows some medicine, who knows what its like to suffer and who works to find some way to bring those things together in a productive way that brings healing. Maybe I can just be.

Its the 4 AM of my 12 month internship and I am tired, cold, sore and angry.

so I do the only thing I know how to do….fly, fly, fly away to somewhere life is harsher yet simpler.   Somewhere that i knew and learned compassion and that I pray will be gracious enough to teach and humble me again.

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