Given Much

My mentor gave Grand Rounds on Global Health yesterday.  I was post-call and in pain but I stayed the extra hour, set in the middle of the intimidating auditorium. I found myself nodding and smiling even after one of he worst two week periods of my professional life. About half way through, he quoted the bible. Most ears would not have heard it but I heard it.

“To whom much is given, much is required.”

90% of the world’s children live in the developing world and a huge chunk of them have limited access to care. In the world of endless ventilators and children who are trached and have permanent feeding tubes where I live it is easy to forget that most children are lucky if they can get IV fluids.

We have so much.  And much, much is required.

As I stare in the face SHINY HIP number two a procedure that costs 50,000 Kenyan Shillings and probably at least 30,000 to 40,000 US dollars.  I am so grateful. So grateful. That I don’t have to go beg my relatives to come up with the money or choose between eating and my medicine.  I am so grateful for my magical insurance card that several precious friends here in the States do not have. Not to mention for the divine provision that the best surgeon in the US is at my finger tips in network, four hours from my parents’ home.

I have been given so much.  And much, much is required.

I am disappointed about canceling my trip to Zambia in Jan, a casualty of the scheduling changes that took place to make way for the shiny hip. But I am so grateful. So grateful that I have been given a way out of the constant pain and the progressive disability so that I can be healthy enough to move to Africa full time a year and half post-op.

So much given and I am ready to do what is required.

I can’t save his heart but I can save his soul

Former 25 wk premies

bad lungs.

bad gut.

bad heart.

on a ventilator.

cant eat.

…can’t fix the heart. (inoperable)

The heart will be the end of him.

I got a page asking for restraints.

I go and see him

He is waving his little arms and legs.

Looking at the world.

They tell me they are afraid of toys.

Because it might overstimulate him.

Overstimulate his fragile broken heart.

I find a rattle half buried under blankets.

His eyes light up and his hands reach out.

His heart rate is steady,

his breathing is smooth and unlaboured.

He smiles.

I say to heck with his heart.

which I can’t save.

No I won’t restrain him.

Play with him. I tell them.

I cannot save his heart.

But I can save his baby soul.

A soul that just wants to learn

and play

and love

and be.

Respiratory Distress

Its the middle of the night

when I meet a teenager with a terrible disease

that is a slow, gradual but inevitable death.

Cystic Fibrosis.

She has a giant pneumothorax and a chest tube to let it drain.

Her lung function is 40% of what it should be.

She has done all the right things.

But she is losing the battle.

She has lost 8 kg (20 pounds) in 6 mons.

She looks at me through her oxygen mask with big set eyes that know what’s coming.

…

Another family, another wee hour of the morning.

A father still grieving for his lost child.

is here again with another tenuous fragile life.

in severe respiratory distress.

so bad that I can’t take them, they need to go to the ICU.

as I sit there explaining what will happen next.

Dad reaches out and grabs my arm and says

THANK YOU

I melt into a puddle of exhaustion and awe.

That this Dad in his grief and his worry would reach out and acknowledge me.

….

I have a progressive illness.

If my right hip was a lung.

It would wheeze

and collaspe some times (pneumothorax).

It would sputter and retract.

There is nothing as merciless as watching your child or your own body fail you.

I understand on some small level what that’s like.

The fear. The pain. And the complete loss of control.

But in the end my disease will not cost me my life.

And I can’t help but be impressed by the grace and hope

these children and their families find in these moments

of foreshadowing.

Reckless Abandon

“We should go until we are called to stay”

“When we lack direction it is because we lack surrender in our souls”

“The place God calls you to is where your deep gladness and the world’s deep hunger meet.”

This is shat I found when I opened my notebook on Thursday afternoon.  I had grabbed the notebook on a whim as I was running out of the house to go spend some time reading and writing at my favorite spot along the river. I had used it when i went to several global health conferences in medical school/end of college. I knew it still had a lot of blank pages so I had grabbed it.

For weeks I have been unsettled.  Unsettled and directionless.  I am watching everyone make grand plans I can’t seem to find myself quite fitting into mold of doing an fellowship. I can’t quite wrap my head of going out and getting a primary care job.  I don’t see my self with the administrative pizazz to do a chief year..  I feel burntout and somewhat jaded.

And then i realized the answer is what has been staring me in the face for the last decade.  The answer that was so easy before I was brainwashed by the top childrens hospital in the world to believe that I need a few more letters and and numbers behind my name.

I want to go overseas. I want to move to Africa and be a doctor.

Maybe I will come back and do the right thing and do the fellowship but for a little while I just want to go.

Senior Epic Fail

We got to doors of one of our patients this morning and my co-senior and I turn to the interns and say, “Who saw this patient?”

They all look bewildered….

No one saw this patient.

So we go to the next one I slip in and pre-round and in a matter of about 4.5 mins examine the child, review his vitals and labs.  I present without ever disrupting rounds.

Its every senior’s nightmare to find out that your interns have dropped the  ball so completely.. I have forgotten what it is like to be a new intern.