Wednesday, April 1, 2020

Going viral

It's been nearly 3 months since my last blog post and the world seems a completely different place.  The daily case and fatality count of COVID-19 fills every space of my laptop screen, mobile phone, hours of meetings and even my dreams.  I wake up each morning unable to turn off the gears that make me contemplate each possible action I can take to protect my family, prepare our community for an outbreak and somehow continue to bring much-needed essential care to over 300,000 Jiwakans in the highlands of Papua New Guinea.

10 days ago, Papua New Guinea reported its index case of novel Coronavirus in an expatriate mining worker recently arrived via Europe.  I was asked to join the Jiwaka government's COVID-19 Preparedness and Response Committee.  This is a multi-sector task force currently working under a State of Emergency order by the Prime Minister.  Police, Justice, Health, Administrative and Education sectors are involved as well as representatives from UN and disaster agencies.

The Jiwaka COVID-19 Response Committee

Day 1

What happened next has been a surreal "trial by fire" into the field of Public Health that I never anticipated going through.

For the first two days, the effort was to enforce the State of Emergency directives from the Prime Minister which included limited mobility of persons.  I went with the police patrols to the various market areas clustered around the highway and gave a brief 10-minute overview of Coronavirus infection and the basics of how to contain the spread of the virus (Pasim Kus, Wasim Han, Noken Bung - "Cover your cough, wash your hands, do not gather in crowds").  Within a day, this basic message was codified by the various players in PNG health into leaflets and information that could be disseminated quickly.  We need this information to go more viral than Corona.

Briefing the patrol officers on COVID-19 basics - there is a lot of fear and misinformation which has preceded the arrival of the virus.

Riding in the police cruiser - it felt important to me that basic health information should be conveyed alongside the orders for limited mobility
Atop the Toyota Land Cruiser preparing to conduct some basic awareness teaching

The next step was to identify centres in our province that could accommodate patients, oxygen therapy, and isolation.  Our Jiwaka Health team had already identified three and I was asked to consult on making preparations for the facilities and the staff in the event of a surge of patients.  While I understand the need for ventilators in places like the US and Europe (and re-tooling manufacturers to create them), in our setting we need to do as much as we can to get the basics right.  Until a specific treatment or therapy is available for Coronavirus, we will need to mitigate its severity the best that we can, given our limited resources.

As a "triage" option, patients can be maintained on cylinder oxygen while awaiting admission to an isolation facility

Powered by solar and properly divided, this unit could provide 2 liters of oxygen per minute via nasal cannula to a maximum of 4 patients in need, who will be spaced 2 meters apart in an isolation unit.
Preparing an isolation unit

There needs to be a way to protect the workers at those facilities that both screen and treat patients.  The use of separate triage / staging areas for patients with fever and cough can minimize the number of personnel potentially exposed to the virus and can maximize the efficient use of the VERY limited supply of personal protective equipment (PPE).  I developed algorithms based on the current WHO case definitions to risk stratify potential patients and allow workers to identify those that might be a "suspect case" or "person of interest" - which includes travel history, severity of illness and the lack of other explanatory reasons for their acute infection.

Separate "cough tent" screening area at Kudjip where health workers screen patients using algorithms to identify any potential "suspect case"

In an ideal world, potential cases would be tested to confirm infection, trace contacts and recommend self-isolation during treatment for those that can be managed at home.  With limited testing supplies, we are over-aggressive on patient education and recommendations for self-isolation in order to create an environment where the restrictions on mobility can be upheld in an effort to contain spread.

So you think these are rare in the U.S.?

Infection Prevention & Control will, I think, be a significant weapon against any potential COVID outbreak in settings like ours.  Patients wearing masks / covering their cough is the first step to reduce transmission to others - including health workers.  Health workers with PPE (ideally mask, goggles, gloves and a gown) can also reduce risk to them.  There are not enough.  I get that.  There is a shortage of PPE supplies in the US, but it breaks my heart to see what truly limited supplies are like in the current environment around here.

3 boxes of basic PPE made available for our provincial health workers attending a population of 300,000 - praying for more to come!
In light of those limitations, hand-washing becomes very important for the community, the patients and the health workers.  Alcohol-based sanitizer?  Not so much.  Running water?  Sometimes.  What can we do?  We create basic wash-stations and use them ALL - THE - TIME.  There are a variety of options and thankfully, Papua New Guinea receives plenty of rain.  The difficult part is catching it, storing it and distributing it with sporadic electricity.  But I had time to bring a basic wash-station to one of our nearby facilities, instruct the personnel on using it and we plan for the provincial health leaders to create and distribute these things around the other centres.

Getting ready to see a patient in one isolation unit

So the rapid response to an outbreak in our setting follows the same basic principles in any other place: awareness, infection prevention and control (including PPE for healthworkers), surveillance and testing, isolation and treatment - recovery.  Unfortunately the challenges will be felt on an exponential scale if there is a significant surge in ill patients.  Praise the Lord there haven't been other confirmed cases - but with limited surveillance capabilities it is possible they are coming and we are taking an active and precautionary approach.

While this happens, the essential services that were provided before the outbreak need to be provided during it and be continued afterward.

The only place in Jiwaka that a patient can receive surgery, advanced maternal care or a blood transfusion continues to be Nazarene General Hospital at Kudjip.  We need to provide this care because we are the ONLY facility that can do it.  We can help other centres establish screening, work on hand-washing and protection, advise isolation and even, in some cases, administer oxygen.  But we cannot create operating theatres or blood banks rapidly.

This was brought home to me last night on call.  One of the other doctors and I were covering the Emergency Department and Maternity units.  I triaged a cough/fever patient in our screening area (donning and doffing one of our limited sets of PPE) before returning to the Emergency Room to perform a lumbar puncture on a patient with meningitis.  

Just after getting home, I received the call from Maternity ward, "Doctor, there is a patient here who has a breech baby stuck.  The baby has already died."  Patient X felt contractions at home during her 4th pregnancy and before she could get to her local health centre the baby was born, feet first, to the belly-button.  At the facility, the baby delivered up to the entrapped head, which couldn't be relieved there.  During transport to Kudjip, the baby died.

On arrival, the mom was in distress from a hyper-stimulated uterus which was contracting without pause in an effort to relieve the obstruction.  After establishing IV access and giving her some fluids and antibiotics, I performed a special maneuver to flex the deceased baby's head through the birth canal.  After the delivery, I examined the mother and realized that there was extensive damage that needed repairing in the operating room.  An hour later, cutting the last stitch, I was summoned to the Emergency Room again to attend a child with a diffuse infection in the leg threatening to penetrate into the bone.  After days of making preparedness plans for a potential outbreak of a deadly virus, I was reminded of the very real and equally deadly challenges facing my Melanesian neighbors in the here and now.

I pray that we do not see a significant outbreak of Coronavirus.  If we don't, we have made preparations and improved the resiliency of our health system for today's needs and future difficulties.  If we do, we will continue to provide the care that we can, for those that we can, in the ways that we can, for as long as we can.

Pray for our hospital, its staff, the community around us, our leaders - and for the financial provisions needed to support the ongoing work here - which will likely be significantly impacted by this global race to stem the pandemic.

Wednesday, January 8, 2020

Freed from optimism

 
A couple months ago, during my on-call night, a young woman came to the labor and delivery room at Kudjip.  The feet and legs of a baby presented through her birth canal, but the unborn head had been trapped in her uterus for several hours.  Sister Theresia, a dedicated nurse working at Kudjip, assisted in delivering a deceased baby boy.  Lo and behold, another baby quickly presented, head-first, and delivered – kicking and screaming – into Theresia’s waiting arms.  After addressing this healthy girl’s immediate needs, our nursing students, alongside the grandmother, turned their attention to her baby brother’s preparation for burial.  The bittersweet blend of joy and sadness, so pervasive in the highlands of Papua New Guinea, weighed down the room.



            Our family has been in Tulsa the past few months on furlough, giving me a little breathing room from the daily grind.  I have reflected on an important spiritual lesson that my mentor, IHI alumni Dr. Bill McCoy, taught me as we shared heartaches in the crowded hospital halls at Kudjip.  Hope is not the same thing as optimism.  Optimism posits that something good is going to happen, regardless of circumstances.  While something good may happen from any situation, I do not believe that, as Christians, we have any guarantee of good outcomes in this world.  Conversely, hope is a persevering belief that anything can be redeemed for good.  God can take difficult, even devastating, situations and redeem them for His purposes – not because those times are good, but because He is. 

Hope is one of the three abiding virtues (I Cor 13:13).  It is also an anchor for the soul (Hebrews 6:19).  The suffering of this world, that we battle daily, is not a piece of some optimistic jigsaw puzzle – it is a field of hopeful opportunity.  If I can appreciate this and leave the outcomes and results to God, my faith may be pressed – but it will not be crushed.  This faith, as David Bentley Hart says, “has set us free from optimism, and taught us Hope instead”. 

Some weeks ago, another young lady arrived into the labor and delivery ward at Kudjip with a referral note hastily scribbled onto scrap paper by a nursing officer working in a remote corner of our province.  This mother was barely conscious, having been struggling to deliver her baby for almost two days.  As the nurses scrambled to establish IV access and begin administering medications, I hastily performed a bedside ultrasound – with saddening results.  The baby was lodged in the uterus with its face presenting at the cervix, unable to deliver.  There was no heartbeat.  I mobilized our operating team, but knew that we were only performing surgery for this mother’s sake, since her little baby had already died.



In the operating room I worked quickly.  As I removed the lifeless form of this little one, I told the receiving nurse not to attempt any resuscitation – the baby was dead.  On her way to the basinet, she exclaimed – “Dokta Mark, em pulim win!”  “Dr. Mark, he took a breath!”  She got to work bagging the baby and, in a few moments, we heard cries of new life.  I repaired the uterus and finished mom’s surgery.  Over the next week, mom and baby recovered nicely and that fizzled spark of hope was fanned for me again.  This is what the Sovereign Lord says to these bones: I will make breath enter you, and you will come to life” (Ezekiel 37:5).  




            Now entering our seventh year working in Papua New Guinea, we see the challenges through hopeful lenses.  Our hospital has recently expanded to accommodate our growing maternity care services and surgical disease burden.  We have entered into a working relationship with the government to provide referral services for our entire province.  We are taking UPNG medical students and have taken our first surgical trainee.  Our recent Rural Health graduate has been elected President of the PNG Society for Rural & Remote Health.  Through it all, patients are being ministered to, both physically and spiritually – to the tune of about 70,000 each year!

            Our family prays to continue in God’s calling for us – in the ways that He plans.  Please consider joining us in prayers for perseverance, guidance, provision and continued Hope as we serve in the highlands of Papua New Guinea.

Tuesday, October 22, 2019

PNG Crouch Family on Mission - Open House Dates 1 & 2





Our first two PNG Crouch Family Open Houses are confirmed in Tulsa! 

Monday, November 4th at 5:30pm at the Crouch home

Thursday, November 21st at 5:30pm at Believers Church

Dinner and childcare will be provided. 

Please RSVP by email or phone so we know how much dinner to have and how many babysitters.

 Come see our family and hear some stories about what God is doing in the Melanesian highlands! Message me if you need contact information.

[We plan future open houses in December and January as well if you cannot make the above dates]

crouchm@gmail.com

Friday, October 11, 2019

To return

“But oh, oh, my heart still burns
Tells me to return
And search the fading light”
-Josh Garrels

I walked through the Paediatrics ward with my son Gabriel in tow.  A young man reached out to take my hand and I recognized him as a boy I had drained an abscess on recently.  It struck me that although I will soon leave this place, the sick and suffering of the PNG highlands will still make their way here and receive care from compassionate doctors.  The thought gave me comfort as Gabriel and I went to my office to make a few last adjustments before closing that door for a few months.  All my daily sights and sounds impressed me more and I began to miss this home already.

A few days ago I lumbered home in the late afternoon after an exhausting Sunday morning of call.  Overnight a young lady came with bleeding at just 22 weeks gestation.  Her baby passed as I began evaluating a woman in the emergency room in the same scenario.  The nurses asked me to write admission orders for another tiny baby born at home the night before weighing just 800 grams.  A mother laboring in our maternity unit needed a cesarean delivery so I notified the operating theatre.  I made my way back to the nursery and watched three premature little ones take their first and final breaths.

  

So many of the memories I make in this place seem like dark sights.  But as I prepare to return to the US for our missionary furlough I find myself more apprehensive about what I will see there.  Though I am challenged every day to encounter and combat very raw needs in our rugged highlands, I recognize that they are changing me.  I worry that I am no longer truly at home in America.

 My loved ones are the reason I want to be there.  Yet I shudder a bit to think of re-entering an old life and wondering where to start my days when my new normal has been defined by my family’s presence here in PNG.

From afar it seems that things are changing and perhaps in ways that don’t fit me.  Meanwhile, I am changed by the place I now call one of my two homes.  Its burdens, its people, its joys and its sorrows - surrounded by a ring of tropical mountains like a crown of thin air.


I made the incision with a heavy heart, considering the new lives we were unable to help just moments before.  A minute or two later that heaviness lifted a bit as a vigorous baby boy cried fiercely in my arms.  After concluding surgery this little one rested comfortably - ready to begin his own journey in this place.  Outside his expectant grandmother grabbed my hands.  Though she spoke no Pijin, her tear-brimmed eyes said “thank you” in a universal language.  I went to the emergency room, where more of my neighbors needed help in challenging times.

I am torn between two worlds.  Not just America and Papua New Guinea.  I am indeed a pilgrim in this earth - created for another eternal home but finding myself wandering a bit in the Creator’s world with a calling to seek and serve and save those that are lost.  Many times I may not know my real destination - what I am supposed to learn or how I am to change into the man I need to be - but I can trust the One who is directing my course. 

The thought brings peace to my anxious heart as I ready my family to journey across the world to another home.  And I can embrace the rest and privilege to spend time among loved ones there - remembering that it is not a destination, but a continued part of this journey.

“So tie me to the mast of this old ship and point me home”


Monday, August 19, 2019

The thinnest air

 "I'll take the last climb
Up the mountain, face my fears
The time has come, to make a choice
Use my voice for the love of every man
My mind's made up, never again
Never again, will I turn round"
-Josh Garrels

Many of my blog posts center around a patient's story.  This one is no exception, but it is dramatically different than most.

I was recently blown away by an experience among the mountaintops of Papua New Guinea.  Four of the doctors here, along with a couple of our closer friends from Kudjip station, made the arduous journey and trek up Mt. Wilhelm - the highest mountain in Papua New Guinea (and Oceania).  For several weeks leading up to our trip, I would load up my backpack with water bottles and textbooks and climb the various hills around Kudjip.  Other times I would strap Gabriel on and take him to "enjoy" these long walks.  I knew I needed to build up some muscles and stamina to climb 14,793 feet above sea level on rocky and narrow ledges into the clouded heights above our Waghi valley.

Our two-day adventure started on a Saturday, departing Kudjip in the morning for the nearby Simbu province where we would drive as close to the base of the mountain as we could - a town called Gembok.  Once there, we parked our car, grabbed our gear, hired a few "carriers" and started a 3-hour trek up to base camp at 11,000 feet.  As we climbed higher, the cool air began to thin and the light drizzle of surrounding clouds soaked us.  Once at camp, a small fire provided a little warmth to our chilled feet.  We needed to get an early dinner (noodles and tuna fish) because our next day's march would begin in the pitch dark at 2 o'clock in the morning.



As we ate our noodles trying to retain some heat in our extra layers, a sacred thing happened.  Our dear friend, pastor Apa, told his story.

I will not relay all of the details, but as a young man, Apa found himself entangled in many of the struggles facing Melanesians.  Through a series of tragic events, he lost his son in a flood and found himself ostracized by his family - culminating in some of his brothers beating him and leaving him for dead.  He was brought to Kudjip where he underwent surgery with Dr. Jim Radcliffe and then months of rehabilitation in the hospital.  He described times of incredible challenge while he recovered - questioning the Lord and himself, wondering where he was headed.

We finished our supper early and wrapped up in blankets and sleeping bags to snatch a few hours of sleep before the long march the next day.  At 130 I was stirred by Matt's alarm and the light of some headlamps clicking on.  Our team put some food and water into backpacks and started the trek up Mt Wilhelm.  In the pitch dark we could only see our footing by headlamps and relied heavily on our guides, but about five hours later the sun touched the horizon and we saw high ridges around us and a large mountain still above us.  We had hoped to hit the summit near sun-rise, but it took a couple more hours winding around it to strike the path that would take us to the top.




During Apa's injury and recovery at Kudjip, he turned his life over to Christ and began to seek a new road.  He ultimately landed a job working security for the mission station and then went through Bible College after being taught to read by the Bennetts - a former missionary family here.  Many years later, he now he works on station helping to keep the hospital and mission houses in good repair, but he still pastors a church and is building a home for the disabled - people often neglected in this place. 

After nearly giving up circling the summit, our guide finally directed us to the path that would take us up the steep climb to reach the top.  Apa's son, Bol, led the way showing his youth as the rest of us followed behind.  I never thought I could find a place so cold and windy on our tropical island home, but the noise of the wind and the damp of the clouds reminded me of the incredible diversity of PNG - and the incredible resolve and endurance of our Melanesian brothers and sisters to face whatever comes at them.




I thought I would find the thinnest air in PNG on the chilly heights of Mt. Wilhelm.  But the most sacred presence I felt was huddled into the small A-frame house at base camp listening to Apa recount his incredible tale of being lost, injured and broken - receiving healing and new spiritual life at the hospital - and his ongoing journey into God's path for his life.




Friday, May 17, 2019

A glass darkly


“I need to know that You're still holding the whole world in Your hands.”


The sun ascended slowly over the hills surrounding Kudjip station as I completed some paperwork in the operating room. I wanted to get home and eat a quick breakfast before starting my ward rounds and the full day of clinic ahead of me. But my hands literally shook as I tried to pen the last words of my note in Lucy's chart.

She arrived about 10 days before that eventful night and her difficult story unfolded like a slow train wreck. Only 25 weeks pregnant, she started bleeding. She left her three children in the care of relatives and made her way to Kudjip. An ultrasound showed a premature baby and a previa – the placenta implanted over the birth canal leading to a dangerous situation in which Lucy could bleed to death if she tried to deliver her baby vaginally.

For a week or so she stabilized. The bleeding stopped. Every few days I watched her little baby kick and suck its thumb, checking his fluid levels. Every day I notified the on-call doctor of the difficult truth – that Lucy would die if she went into labor and didn't have a cesarean section. We all knew, sadly, that this little one couldn't survive in this place.

It was on my watch that the call came. “Dokta Mark – Lucy em karim plenti blut nau”

I went to Lucy's delivery bed as a pool of blood steadily formed. Two more bags of blood were brought down to transfuse her. I prepared her for surgery and choked out a prayer that we could save her life. While the surgery felt mostly routine, the little one that I clutched in my arms before handing him over to the nurses was agonizingly small. There were no cries.

I managed to complete my notes and the orders for Lucy's post-op recovery. She needed some sedation at the end of the procedure and drowsed comfortably as they took her back to the ward. I skipped breakfast and went into the nursery. A tiny but perfectly formed baby passed away just as his mother was opening her eyes to the first rays of tropical sunlight. The birds were singing – but somehow the songs seemed all wrong.


To the deceased,

I hope you can forgive me. I did what I thought had to be done. Perhaps my prayers and tears at the end were enough to convince you.

Your mother loved you and wanted you in her arms. Even in the short couple of days that I saw your heartbeat I wanted you to join them. Your brother and sisters wanted you. But I think they needed your mother more, and I couldn't save you both.

If we lived somewhere else perhaps it would be different. But in this place – where lives are broken and the earth groans for its redemption – it simply cannot be.

I hope that your new home is a true paradise. I hope that these last few days can be forgotten. I hope that you can tell Him I'm sorry – though I have a million times. I hope you can receive me with forgiveness when my time comes.




 I recently discussed with one of the other doctors the challenge of having to make difficult decisions and seeing subsequent poor outcomes here. From the U.S. I remember imagining myself bringing critical medical care to the truly hurting and sick of our world. I believed there would be lives I could change or save. I failed to grapple with the hard truth that many of the things determining life and death in this place would be completely out of my control. My patients are often sicker than any illnesses I would encounter back home. I must make decisions that seem like a cold calculus at times: thinking about the number of blood bags the hospital has, how many patients the nursing staff can truly handle, or whether I have the physical, spiritual and emotional reserves to take on ill-fated heroic efforts.

My son Levi provided the answer. We sat on the porch, swinging in the hammock enjoying some down-time during my Saturday call. I asked him to practice some memory verses with me and he gave me the entire chapter of 1 Corinthians. I teared up as he approached verse 12: “But now we see through a glass darkly”

So many of my challenges in taking care of patients here come from staring at that dim looking glass. I don't have the information, the resources, the specialists or the technologies that I would want. I must make hurried decisions affecting life and death as I wander in a fog of uncertainty. Yet I have this hope as an anchor for the soul – that I may be greatly encouraged. Though I must make decisions that are beyond me, I do not make them alone. Once my knowledge, strength or skill have been exhausted, another joins my efforts. One day I will see clearly, but for now I must pray and trust it is enough.



Later that day I met a pleasant and nearly unbelievable sight. I made my way between wards taking what I call my “bed biopsy” - assessing how many spaces were available in the hospital for the patients I would soon be tending in the clinic and emergency room. A young woman stood in crutches with her unmistakable smile. Moana had been in the hospital for a few months. When she first came she looked like a wraith – skin and bones, covered in chicken-pox and bed sores.  The infection in her bones kept her from walking, leaving her debilitated and unrecognizable. For several weeks she received treatment and once the infection stabilized, the difficult task of recovery began. Thankfully a visiting physical therapist worked with Moana every day – mobilizing her tender limbs and teaching her to use her slowly gaining strength to walk supported.

Throughout her difficult stay, Moana kept a special joy and smile – even on her toughest days.

On this day, I needed that smile more than most. A reminder that God was present among the broken lives groaning for healing in this place.


Friday, February 22, 2019

Tearless morn

"O joy that seeks me through the pain
I cannot close my heart to thee
I trace the rainbow through the rain
and feel the promise is not in vain -
that morn that shall tearless be"


I have struggled for several weeks to put down in writing the myriad emotions that have descended upon our mission here.  Our mentors and forever friends the McCoys left a career of ministry in PNG last month and I felt I needed to honor that.  We have some new physicians joining us this year and it has been exciting to see where that will go in the future.  And with it all the daily triumphs and tragedies of working in the highlands of Melanesia.

This post was supposed to be a positive reflection of Bill's more than 30 years of medical service in Africa and here in PNG.  So on our last call night we performed what we thought would be our final surgery together.  Esther came to take pictures of Bill, who attended my birth 36 years ago, performing a C-section with me.  Those pictures will not be seen, though, because like so many unfortunate times before, our interventions for this young family were unsuccessful and while Doris survived, her baby never took a first breath.  As Bill and I despondently washed our hands after the case, he said, "it makes me realize that the work isn't finished."   




Bill's legacy is palpable in this place. There are not (yet) plaques with his name on them, but the enduring compassion that he poured into the lives of people continues in those of us that refined our own ministry alongside him.

While I have learned innumerable medical pearls, I have grown the most in my ability to feel the comfort of Christ in situations that seem unbearable.  There is no way to teach this.  Only through fire can something like a persevering faith be refined.  There are few doctors in this world that possess those skills ... and those scars.  Those that do must often put on an armor that allows them to see a stream of tragedies without becoming paralyzed.  But the thick skin can be reopened, and must be at times.

Two days ago one of our new doctors and I stood around the trolley carrying the charts for our pediatric patients, deeply discussing how we approach all of the suffering we encounter.  There were a few simple ideas I could come up with ... journals, exercise, reading scripture ... because the truth is there is no anesthetic for grief.  

As if on cue, later in that busy clinic day, a young man I have known for a few months came to see me with his grandparents.  He bears the name of my own son and he thinks he is about 8 or 9 years old.  He was born with HIV and while his family has taken great care of him, the reality is that he is approaching the end of his short life expectancy.  It became clear that he was no longer responding to my care, and had developed a cardiomyopathy from a combination of his longstanding HIV and the drugs used to treat it.  I excused him to the waiting area and told his grandparents that I would try to make him as comfortable as possible, but that he would likely die within a month.  The three of us ... William, Mary and I ... clasped hands and I prayed as I often do for the peace and comfort of Christ in the face of a certain, yet tragically preventable, death.  I held it together until they left to collect some pain medicine and diuretics at our pharmacy.  Then I went to sit on the stone wall of the hospital, cry, and look over the breathtakingly beautiful scenery of the mountains. A five minute respite before returning to the long line of patients still waiting to see a doctor - some of them for the first time in their lives.



As Bill and Marsha departed PNG our mission family honored their dedicated service here in a special evening of fellowship and sharing memories and stories.  I was grateful to hear these words that night and they give me strength to continue a journey, through times of suffering, to that tearless morn:
 
"I have many times felt overwhelmed by suffering and death.  However, feeling overwhelmed is not the same as being overwhelmed.  If I were to count the cost of waging war on suffering and death, and my ledger was the sum total of my gifts, my strengths, my courage, and whatever other resources I might possess in myself, the result would be catastrophic.  Death wins by a landslide.  But that is not my fight, not my war.  Christ Jesus faced suffering and death and overcame them.  They still spit and fume, but they shall not have the last word.  The last word belongs to Christ.

We have this hope as an anchor for the soul (Hebrews 6:19). Our response to suffering and death,  very real and formidable enemies, is the test of everything we as Christ followers hold to be true.  There can be no such thing as “gospel” or “good news” unless that news addresses death. Thankfully, it does. And therefore, so must I."

-Bill McCoy