A glass darkly

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

-All Sons & Daughters

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.