Anywhere

"There's a shadow at my back saying, 'Everything's broken'

So I pointed to a star saying, 'That's where I'm going'"

-Gray Havens

 

For a couple months I have struggled to put this story together.  Bear with me if it gets disjointed or heavy.

I stared at the papers in front of me as a way of avoiding the very real suffering of a young woman on our paediatrics ward.  Inwardly I fought the temptation to leave - to walk away from that bedside and the heartbreak it held.  I wanted to escape.

"Kay" had walked into my clinic room about a week earlier bearing two baby bilums carrying her twins.  For a variety of reasons, including many outside of Kay's control, they struggled to find stability in their home and did not feed or grow well.  When I unwrapped those precious bundles two sets of weak eyes looked at me from wasted frames.  We went to the emergency room to prepare their admission to the hospital.

Over the next few days I struggled to adjust fluids, medicines, and feeds in an effort to save their lives.  But on this particular morning I approached the bed where a weeping mother sat on the floor cradling a baby in her lap as tears dropped onto its face.  Only one patient chart remained.

We dutifully and tearfully went through the medical ritual of morning rounds: "Any vomiting or diarrhea?  Was there any blood in it?  Fevers?  Did she take the feeds we gave?"  But we both struggled to put our hearts in it, dwelling instead on the ghost of that little life now missing among us.

I got through that encounter and got away quickly.

I changed departments soon after.  Several weeks passed and I no longer saw "Kay" or her baby around the hospital.  I assumed the worst and moved on.  

"Just take me anywhere - anywhere - anywhere but here"

 

Ten years serving in a mission hospital in one of the more remote parts of the world have taken me through some things I would never wish on anybody.  Losing so many patients.  Not losing others.  Performing procedures I never dreamed I would have to.  Running a treadmill clinic sometimes just to get to the end of the day.  Working seemingly endless shifts during a global pandemic when we had four doctors for half a million people.  Watching my son gasp for breath in a hospital with no ventilators. Wondering what kind of tropical fever could be afflicting my daughter.  Talking honestly with my teenager about why it is sometimes both great and awful to be a missionary.  Feeling torn between my call and my family.  Losing connections that I thought would last.

In our early years the solution to the most difficult times felt like it should be to escape them.  If only I weren't here - If only God had called somebody else to do this - I wouldn't have these challenges.  My relationships would be "happy and healthy" and I would be earning an income that allowed me to get a little more rest and recreation.

 

 

I have meditated a lot lately on Jesus' words, 

"Come to me, all who labor and are heavy laden, and I will give you rest.  Take my yoke upon you, and learn from me, for I am gentle and lowly in heart and you will find rest for your souls.  For my yoke is easy, and my burden is light." (Matthew 11:28-30).

Before and after this passage Jesus admonishes: 

"Go and learn what this means, 'I desire mercy and not sacrifice'" (9:13; 12:7).

 

Our family prepared to walk home as we concluded the weekly missionary prayer meeting on a Thursday night.  I felt a nudge in my spirit that I should return to the hospital to check on a patient, so I told Esther I would catch up back at the house.

Our newest resident had discussed her with me that morning and it was clear that she was very ill.  A tropical fever with renal failure at just about thirty-two weeks pregnant.  Regretfully I look back and see that, while I listened attentively and made some helpful suggestions, I was inwardly avoiding the thing that I knew would be the most painful: to go, sit with her, hear her story, and see a face that I may have to say goodbye to soon.  After suggesting some orders, I had gone to clinic, seen heaps of patients, and gone home thinking, "maybe tomorrow." 

But apparently the Lord felt it couldn't wait until morning, and the gravel now crunched beneath my shoes on the way back to the hospital.  I tried to imagine what I would say or do that might help.  My resident had done it all.  What was I adding?  Should I just turn home and avoid this heartache?

She joined me in the delivery room where I repeated her ultrasound to provide a "reason" for this late visit. 

And then it happened.  For the next thirty minutes she told me things she had never shared with another soul.  I mostly listened for a long while to the unfolding of a tragically familiar story, almost dreading every next turn in the tale. 

 

"But it just feels like pain, it doesn't feel like progress ..."

 

Yet slowly, miraculously, that dread ebbed away and was soon gone.  I felt a comfort and peace that could only be Divine - and knew that the middle of this pain and struggle was exactly where I was meant to be.  The tears that rimmed her eyes spoke of guilt, fear, and shame - but the tenderness of the moment promised restoration.  Jesus filled up that space not because it was good and joyful, but because it was painful and sad.  A fitting place for a rescuer.  When I shared with her about His love for us, she immediately wanted to sense it and prayed for Him to join her life.

Her physical condition did not change - but a new sense of peace visited both of us as I said goodnight, hoping against the odds that I would be able to see her again in the morning.  

 

I know I have a tendency toward being sacrificial - working hard and enduring much as a way to "prove" my own commitment or strength.  I must guard against it.  But in those moments of pressing, when I know that I am overburdened and I want to go find something easy and light, I am discovering that Christ's comfort to me is not to remove the pressure.  His solution is much better.  My yoke becomes easy, and my burden light, not because He changes it - but because He is in it.  Joined to Him I don't have to endure - but to receive mercy.  The weight lifts.  The heaviness makes me not a sacrificial martyr, but an apprentice - being formed more and more into the likeness of the One who toils alongside me.  And my soul rests, trusting that my transformed self on the other side will be a better reflection of Him to those around me.

 

 

 

One morning I called for the next patient in our clinic to join me.  I looked at the pictures drawn by my children in their younger days adorning the walls - now sun-faded.  I briefly reflected on the thousands of patients I have tended over the last decade in those walls - with a mixture of joy and sadness.  A heavy burden attempted to creep up on me.

But Jesus walked in again - disguised as Kay and her surviving baby, now gaining weight and growing. 

And I was grateful that the One who joins me to his yoke in those dying moments is just as present in the new and living ones.  

 

"So bring me to a place where I don't chase escape,

somewhere I could finally say,

'Don't take me anywhere - anywhere - anywhere but here'"

Glories stream

Robert walked along the stony roads of Jiwaka some weeks ago, unaware that his life was about to change forever.  A bulldozer worked to clear large trees in preparation for a re-working of the road not far from our home.  One tree snapped violently in half and spun out of control, striking Robert directly across the side of the head.  He lost consciousness briefly and friends brought him to the emergency room at Kudjip.

After concluding a difficult post-partum hemorrhage management in our maternity ward, a nurse summoned me to the ER where Robert's injuries quickly threatened his airway and his life.  One look and I knew that even with aggressive surgery he could die.  I phoned my incredible friend and colleague Dr. Ben Radcliffe and we quickly took Robert to the operating theatre.

Fifteen minutes into the procedure we knew Robert was in big trouble.  After creating a new airway that bypassed his injuries through his neck, the difficult work of stopping the bleeding and re-creating facial structures for Robert began.  After two hours of work, Dr. Ben placed some stabilizing arch bars across his mandible and left large balloons and packs in his nose to slow the blood loss while we prayed for his head injury to stabilize before more definitive treatment could be pursued on another day.  I found his brother waiting outside under the night sky and gave him the heavy news.  As I bundled some things away in my clinic room and prepared to go home, I said a special prayer for Robert - one like so many I have uttered in the corridors of the hospital during those long call nights. 

 

 

 

Our family just returned from what has become my favorite Christmas tradition.

Each year the missionaries of Kudjip visit the hospital on Christmas Eve to bring carols, the nativity story, and small gifts to those in our community who are too sick to be in their homes to celebrate Christ's birth.  Each year brings tears to my eyes.

I miss the cold weather and the occasional white-morning Christmases in the U.S. but if I could choose one sensation to replace them, it would be the consistent blend of joy and gratitude that I feel during these special times with family and my patients.

 

 

As we shared Christmas presents with the suffering of the PNG highlands, a tender moment interrupted me.

After our songs and reading of the Christmas story, a seemingly new Robert smiled and spoke clearly of his gratitude to God in sparing his life as I saw him shaking hands with Dr. Ben.  Tears immediately came to my eyes as I recalled the thin, softly muttered prayer in the dark some weeks ago.  I took Robert's hand in mine and managed to choke out a "Merry Christmas."  I wasn't sure if I'd seen a more glorious sight.

Our efforts in Kudjip go far beyond medicine.  The lives of our friends and neighbors rub, and sometimes grate, against ours in ways that force us to bring God's patience, grace, forgiveness, and love to and through challenging times of ministry.  The times our mission family can share in a Christmas party or a Christmas outreach build connections that allow our friendships to transcend the difficulties of bringing health and hope to a hurting place.

And the hallowed halls and wards of the hospital become much more than just a place to practice medicine.  They have changed into a sort of home.  Not in the sense that I live in them - but, in a way, the sacred work and vulnerable people that they hold now live in me.  Sometimes I feel it strongly during times that my family can join the ministry there.  But many times I feel it most in darkened halls, whispering last resort prayers to a God that has shown himself willing to embrace the darkness of our world by joining us, dying for us, and lending His strength to us in pursuing His redemption for all people.

 

Glories stream from Heaven afar

Heavenly hosts sing Hallelujah

Christ the savior is born

JJ Heller

More Gladness

 

“There is a far kingdom, aways from here -

Beyond the storm and the sea”

 

The Gray Havens

 

 

I completed writing the note for what felt like the hundredth patient for the day – and I hadn’t even finished rounds yet.  As I did so, a sinking feeling came over me and I went looking for the newborn I had delivered about twelve hours prior.  The nurses couldn’t tell me where he was, and I didn’t see any paperwork.  The ghost-like appearance of his skin when I did the cesarean section the night before filled my mind and brought a too-familiar premonition to my heart. 

 

I went to the nurses desk in search of paperwork – resigning myself to the sense that my operation of the night before had failed to save the little one I held so briefly on its way into the world.  Unable to locate the forms needing my signature, I decided to start in on my maternity rounds and return later to complete them.  

 

 

 

 

This was the first of our furloughs in which I did not pursue any locums work and it afforded additional time for friends, family, rest, relaxing, a trip to Canada, and some teaching at the In His Image residency.  Many things that filled my cup.

 

But I am glad to return to the care of my highlands community back at Kudjip since our stay in the US this summer. 

 

As I round most mornings, faces with bright smiles alternate with mothers just waking with the morning sun as I make my way through the hospital.  Some I need to disturb for an exam, others I let sleep while I review vital signs, lab results, nurse notations, or the reports of medical students.

 

But in recent days some great challenges threatened to overwhelm me.

 

 

 

 

A woman came to Kudjip to deliver her baby in the safety of our maternity unit, but the child was born with a significant congenital defect.  Though I attempted to provide the treatments I knew could help, the baby got weaker over the next several days and eventually passed away.

As I walked away from the family, I glanced into a delivery room and saw the face of another mother I had been caring for smiling at me.  I instinctively smiled back – but as I walked on, a heaviness descended as I reflected on who she was.

 

A colleague had evaluated her almost two weeks ago when she came to the hospital concerned about not feeling her baby move for some time.  We discovered that her little one had died in-utero and counseled and prayed for her.  But her ordeal stretched on as we struggled to effectively deliver her– hoping to avoid an operation that would result in a painful and prolonged recovery for a now-deceased child.

 

Having just had her baby, her smile conveyed gratitude that, after many attempts over several days, she did not need to have surgery.  I, too, was relieved and grateful.  Yet I pondered on that smile for some time – wondering in what kind of world a mother delivering a dead baby brings her a comfort and a smile?  Shouldn’t the world - shouldn’t I - expect better than that?

 

 

 

 

The Voyage of the Dawn Treader has always been my favorite book in the Chronicles of Narnia. Two of the Pevensie children along with Eustace and the honorable Reepicheep make a journey to the very end of the world.  There they behold an amazing thing: Aslan’s country.  Beautiful beyond description but muted a bit when gazed upon through a standing wave of the sea.  Though they do not enter his realm, the sight remains with them for the rest of their lives.  Lewis describes Lucy reflecting on that glimpse of it years later –

 

““It would break your heart.”

“Why,” said I, “was it so sad?”

“Sad? No!,” said Lucy.”

 

 

 

 

My blog entries have thinned out in their frequency down the years.  I have asked myself if I am getting calloused, or no longer moved by the suffering that often overwhelms our highland community in Papua New Guinea.

   

Have I given up on the redemption that I have heard about?  I spend so much of my time in a place where loss feels like the norm, outside of that restored kingdom, and it makes me wonder if I will ever see it.

 

 I went on with my rounds, anticipating a bit of a hollow day.

 

In bed number one, a young woman, whose face I remembered well, slept peacefully under pain medication, while a dutiful grandmother held a beautiful baby against her breast – delightfully filling himself with a first-ever meal.  That ghostly child from the night before.  Tears rimmed my eyes as I went through the rest of my ward rounds moving from patient to patient in a glad mist.

 

 

 

 

 

“There is a far kingdom on the other side of the glass

And by a faint light we see.

Still there is more gladness longing for the sight,

Than to behold, or be filled by, anything.”

 

 

After so many years of depending on God’s sovereignty in the face of my many failures, and successes, here I felt like I learned something new in that moment.  I had been given a glimpse into that restored world.  Seen, as ever, through a veil and a haze.  Yet real enough to provide more than the grace and strength to just continue – enough to receive gladness.  And I feel it during both the great privileges and the great burdens. 

 

That it is more filling to simply stand on a threshold, occasionally peering into God’s redemption, than to pursue anything else.

 

 

“I would rather be a gatekeeper in the house of the Lord 

than live the good life in the land of the wicked”

 

Psalm 84:10 (NASV)

 

 

 

 

 

Strength Indeed Small

 

I entered my clinic room after rounding on about twenty patients in our medical ward.  I felt the draw of returning to perform a lumbar puncture and ultrasound examinations but stopped by my office to pick up some things I would need.  A small stack of papers awaited me, left by our medical records officer – death certificates needing my signature.

 

With several of our doctors out on furlough, I have been working in our nursery in addition to my medical ward rounds the past few weeks.  It has been a while since I’ve consistently been there and I don’t think I’m exaggerating to say its busier than I think we’ve ever seen it.  Mothers and babies cluster close together in a room designed to trap their body heat and warm the little lives under our care.  IV poles drip fluids into tiny veins, a cylinder leaks out small amounts of supplement oxygen through split tubing into frail lungs, medicines are prepared in insulin syringes to accommodate the miniscule volumes about to be administered, a nurse dutifully prepares charts, and a missionary doctor scans the room hoping to see all the faces he encountered yesterday.  But some are nearly always missing, their short lives momentarily recalled in a day or two when I sign that stack of papers. 

 

I hear the savior say,

“They strength indeed is small.

Child of weakness watch and pray.

Find in Me, thine all in all.”

 

A baby I will call Anna delivered prematurely to an unmarried University student two months ago.  After a few weeks of tending this little one, her mother returned to school, leaving the child’s grandmother as her sole custodian.  Routinely, I asked if the baby was breastfeeding and was told, “Nogat – mama I go bek lo skul pinis.  Em mi yet tasol.”  “No – her mother is gone.  It’s just me now.”

 

We discussed the proper way to prepare formula for this premature baby, being careful to make sure the water and equipment was clean.  I asked if there were any women in the family who could breastfeed the baby.  No – but grandma was determined that she could prepare and give the feeds properly.

 

I moved on to my other tiny patients, their small lungs using every bit of their energy to take their next breaths, and I feared that their strength would give out.  All I can do is watch and pray.

 

 

 

 

 

In the next bassinet I pause before asking mom to accompany me to a more secluded part of the ward.

 

“I have tried everything to help your baby but nothing’s working.  You’ve been a long way from home for two months.  I’m worried about your family.  Yesterday, you asked if you could just take your baby home and give her to God.  I agree.  This illness cannot be cured.”

 

She thanked me for my care, took my hands, heard my prayer of surrender, and bundled her baby into a string bag hung over her head to begin a long journey into a remote corner of our province – most likely to begin preparations for a burial.

 

Lord now indeed I find

Thy pow'r and Thine alone

Can change a leper's spots

And melt the heart of stone

 

When I set out upon this entry, I planned to draw parallels between Christ’s triumphant resurrection and a miraculous story of recovery.  I began to write the story of how Anna’s baby returned having gained weight, when I received the phone call from the emergency room.  “Dokta, mipela I gat wanpela boi na ka I bampim em.”  A young boy we will call Norman was crossing the highway after getting dropped off near his home from Sunday Lotu when a large truck struck him.  Thrown across the ground, bystanders quickly rushed him to the Kudjip emergency room.  The next two hours I spent administering sedating drugs to alleviate the agitation from my patient’s severe head injury while cleaning and stitching multiple lacerations, reducing and splinting his femur fracture, and providing breathing support for his pulmonary contusion.  After stabilizing him to the best of my ability, I took the hands of his parents in our crowded emergency room on Easter Sunday and prayed that God might join the work of our medicines and treatments in healing him while giving peace to the hearts of his parents.

 

 

I do not preach many sermons.  I do not plant churches, though the work of our hospital has started several them.  But I have found a unique niche in meeting some of the great physical needs of our community while attempting to bring Christ’s love to bear on my patients.  I have seen many of them embrace His salvation and I pray and hope that they will help bring the change to this country that is desperately needed.

 

About two weeks ago I entered the emergency room and examined the first chart handed to me by the nurse in charge.  A young woman we will call Lucy on bed six had delivered her baby at Kudjip ten days prior, but now suffered from fevers and weakness.  Upon discharge she and her infant had been given a supply of anti-retroviral medications for HIV.

Her blood pressure hovered at about 80 millimeters of mercury, her pulse around 120 beats per minute, she breathed at nearly sixty times a minute, and she drifted in and out of consciousness.  No guardian stood by.  Staff and I scrambled for oxygen, IV access, and powerful antibiotics while I retrieved the ultrasound machine, worried about a postpartum infection.  As I concluded the scan, her mother and newborn child arrived at the bedside having just obtained her mandatory health book from our check-in clerk.  As I quickly transferred her back to our maternity unit, we obtained a chest X-ray that revealed a profound pneumonia in her lungs.  I could not "quick-fix" this with surgery and I was convinced that she would die, leaving her grandmother to tend another PNG highlands orphan.

I explained the situation to this sweet woman, every inch of 4-foot-10, cradling her grand-daughter in a bag over her shoulders.  Her eyes misted as she considered the severity of the situation and she asked, "The baby is hungry - can she still feed?"  I suggested that her mother was unlikely to be able to produce breast-milk and we would provide supplements for a while, but yes, she could still attempt to join baby and mother for a while.  I left the ward, along with one of our new missionary doctors, catching the image of a frail but dedicated grandmother latching her new grand-baby onto her daughter's lifeless form. 

 

 

As I enter my tenth year serving in the highlands of Papua New Guinea, I field more and more consults from my fellow doctors: seeking advice on how to evaluate certain cases, manage specific conditions, or even just to navigate the myriad challenges that buffet a physician tasked with a burden that should be shared among more colleagues.  In ten years, I have gained a little knowledge, some experience, and many scars.  I supposed one would think ten years serving in this ministry would make an “expert.”  Yet so many times my strength is small compared to the needs around me.  Like those little ones completely dependent on the few interventions that we can provide, I feel somewhat helpless.  

 

 

 

But I know that I don’t need great strength.  In fact, Paul writes that God’s strength is most manifest in my weakness.  I can and should invest my life into God’s call for the care of the sick and hurting.  But all of it depends on Him.  My watching and praying allows Him to show Himself strong.

And when before the throne

I stand in Him complete

"Jesus died my soul to save"

My lips shall still repeat.

Over the next two days, Lucy lay almost motionless connected to IV fluids, oxygen, a urinary catheter, and at times to her new daughter - dutifully placed there by a loving "bubu."  And then she started to speak in sentences, eat and drink, and even sit up on her own power.  A few days more and she was cradling her new baby lovingly to her breast, bathing her, then allowing her to nap in the ward looked after by our nurses while she went outside to see the sun a bit - resurrected to a new life with her child.

 

Today Christians all over the world celebrate that Jesus rose out of his grave to defeat sin and death.  He is risen indeed.  Though our world still hurts from the bondage of the Fall, He now rules and reigns with His Father.  His strength heals broken bodies, cares for newborn babies, and changes hearts and souls.

 

Jesus paid it all

All to Him I owe

Sin had left a crimson stain

He washed it white as snow

Waiting long

"Lonely hearts strung across the land -

They'd been waiting long for a healing hand."

Future of Forestry   

I didn't like anything about what I was seeing in front of me.  The size of the pregnant abdomen was a little too small.  The amount of contraction pain etched in the woman's face was too real.  The ultrasound monitor showed a vigorous heartbeat, but the numbers were troubling and the baby was presenting breech.  At about twenty-nine or thirty weeks gestation, this baby had a chance to survive, albeit small in our setting.  Mom had previously been through two cesarean deliveries in the past, so her uterus was likely weakened and ran a risk of significant damage in any subsequent pregnancies.  If I decided to operate on her and give her baby its best chance of survival she would need to be sterilized to prevent this.  But there was no guarantee this little one would live.

For a full minute I took slow breaths and attempted to calm my thoughts amidst the bustle of nurses placing IV lines and getting supplies for mother - and watched the flicker of that too-small heart on the monitor.

I chose the difficult road of surgery - hoping and praying that a baby's life might be saved -  though it would mean the mother could not try for other children if something went wrong.

A colleague of mine performed the surgery and a tiny baby was quickly brought to my nursery.

I was disappointed when I saw the birth weight - less than I guessed, and far less than I hoped.  But I told her grandmother that we would do everything we could to preserve this little one's life.  A prospect now made all the more important after her tubal ligation.

 

The next morning I dutifully attended to my little nursery patients and knew one was missing.  As I concluded and left the ward, the nurse handed me the all-too-familiar paperwork for a baby that had died.  I signed it and tried to bury my disappointment and get on with my day.

 

Christmas always gets me.  I enjoy nostalgic memories of family, winters, Christmas trees, hot drinks, sledding, carols, a break from school, the crisp nights with brilliant stars, time with friends, and the candle-light service at church.

But what brings me to tears on an almost daily basis during Advent is the reality of that young couple more than two thousand years ago.  Treasuring a secret hope for the entire world.  

 

On a daily basis I am blessed and burdened to see new lives enter this world, and to see many take their leave of it.  But beyond my comprehension lies the love and strength of a God that would choose all this.  Choose to risk the dangers of His Son being born into a small corner of the Earth for the great task of saving it.  Choose a young woman to hold His life in her hands.  Choose a young man to raise Him.  Choose to use this family for the great redemption of His entire creation.  

 

Choose me - to seek and save, and to bring along in His work of restoration in what small ways I might, if I am willing.

 

And in this time we are called to remember it.  That God came down with us - Immanuel.  Not descending through the clouds into a palace fit for His position, but through the obedience of a girl and her fiance' into a crib of straw still stained with the feed of animals.  Those first cries piercing the air like any other babe - but setting the eternal realms ablaze. 

 

Just after I signed those papers, I went to check on another mother recently delivered.  On the way, I heard a colleague - "Mama, bebi i sotwin!  Na mi mas halpim yu inap long karim."  I had no doubt in her ability, but felt I might be able to help.  I collected some supplies and prepared to receive the baby.  After some herculean efforts by both mother and doctor her first baby delivered - weak and floppy - into my waiting arms.  I cleared the airway and felt for a heartbeat which was present but slow.  I began to give artificial breaths and, after a minute or so without much response, worried that this little one would also fail to see a full turn of this earth.  I kept going, from fear or determination I wasn't sure, praying that this one, at least, would fill its mother's arms.  So much long waiting in just a few moments.  The earth stood still.

 

But bit later, a gasping breath raised that little chest.  Several more followed and then the welcome noises of soft crying rang in my ears.  A refreshing gratitude settled into my heart.  I knew I could face the waiting day, with its hopes and fears, remembering the One who gave His birth, life, and death for the help and hope of this world.

"Shepherds stirred under starry skies
Tasting grace that would change their lives
The angels trembled and the demons did too
For they knew very well what pure grace would do"

Every Matter

 

 

“My life is Yours.  My hope is in You only.

My heart You hold; because You made this sinner Holy.”

 

-All Sons & Daughters

 

 

I flipped through the hand-written notes in my patient’s medical record or “scale book.”  She had been evaluated in a couple of hospitals over the past six months due to irregular bleeding.  At one she had undergone a biopsy for a “lesion” in her birth canal.  After awaiting the result of this test unsuccessfully for months, she returned to her home province of Jiwaka in the highlands to seek care at Kudjip.  She had a young child and looked about thirty-five years old to me.

 

I summoned our clerk as a chaperone and examined her with a terribly un-surprising result.  A tumor growing from her cervix encroached on the surrounding tissues.  Because of her age, I still hoped that perhaps the cancer hadn’t spread beyond the higher portion of birth canal.  I told her and her “was-meri” that I wanted to perform a scan to determine the extent of her illness, but that I was worried this might be a cancer that is beyond our treatment.  “Dispela sik I look olsem sik nogut I stap, tasol I gat lik-lik chance we mipela inap ken rausim yet.”

 

Before we could get to the ultrasound a nursing student knocked on the door and called from the other side, without opening it, “Dokta Mark – Dokta Angeline I nidim yu long D-ward hariap.”

 

I have been working with our newest PNG doctor in training for the past few weeks on the maternity service.  It has been a privilege and a joy to see her embrace caring for the women of Jiwaka and expand her obstetrical knowledge and skills.

 

As I entered delivery room number three, a vigorous but small baby lay in the basinet next to the bed.  Usually this would be the point at which the room relaxes a bit, but there was still a tension in the air as Dr. Angeline gowned up and approached our laboring mother.  While the nursing students started an IV drip, the midwife informed me, “Second baby I kam breech.”

 

I looked around Angeline’s shoulder and saw a distinct gluteal cleft approaching the perineum with mom’s contractions and pushing efforts.  I quickly asked, “How many breech deliveries have you done?”  With what I imagined was a nervous smile beneath the surgical mask, Angeline said, “None.”

 

I gently rotated the emerging baby’s pelvis to keep the back of the baby up, then placed Angeline’s hands on the sacrum.  The legs delivered and baby emerged to the umbilicus, at which point Angeline guided her hands over the baby’s back and along the arms to fold the elbows and bring the arms out.  The moment of truth had arrived – the largest part of the baby, the head, now needed to be flexed through the birth canal.  As Angeline performed the needed maneuver, mom gave a final push, and her second baby made its entrance into this world with a mighty and healthy cry.   

 

As the baby nestled onto mom’s abdomen, Angeline and I exchanged a gloved fist-bump while she prepared to conclude the delivery.  I have a passion for teaching medicine, so my heart glowed a bit as I de-gloved listening to the cries of two healthy newborns and watching my registrar competently care for her patient.

 

 

 

 

In my excitement, I had forgotten who waited in my exam room. 

 

About thirty minutes after my abrupt departure, my patient and I made our way to the ultrasound machine.  The scan confirmed that the tumor had indeed spread to involve multiple internal organs rendering it inoperable.  The warm glow in my heart felt like it had cold water poured over it.   

We returned to my exam room and I shared the diagnosis and prognosis with her and her guardian.  After answering a few questions, I wrote medicines to help with the symptoms she was currently experiencing, prayed for healing and comfort with them, and escorted them to the chaplain’s room for further counseling.

 

“For everything there is a season, and a time for every matter under heaven:

A time to be born, and a time to die”

Ecclesiastes 3:1-2

 

Some of our newer doctors recently took a much-deserved break to recharge and the clinical work of the hospital increased.  Each day wore on the next and the call nights seemed to come thick and fast.  The never-ending stream of patients transformed from an opportunity to share Christ’s love and hope to a bit of an obligation.  My temper shortened and my thoughts dwelled on all the “bad” – bad outcomes, bad news, and bad sleep.  The good continued – but I saw less of it than I wanted (or needed).  

 

 

 

 

In our first weekend in PNG I accompanied my language tutor, Gabriel, on a walk around a nearby village.  We stopped by a “haus-kapa” with a water tank just as I asked, “Gabriel – are there seasons in Papua New Guinea?  Is there a rainy season?”  He walked over to the water tank and pounded it in a few different places, discovering that the water was near the bottom and pronounced, “Yes – it is dry season.”  

 

There are no daily weather reports in our Waghi Valley.  No constant measurements of temperature and rainfall nor predictions about storms to come.  It is difficult to appreciate what kind of season we are in unless a deliberate pause is made to reflect upon it.

 

After nearly nine years of serving in the highland jungles of Papua New Guinea, I have discovered the same is often true about the seasons God brings to me in the work of serving my family, my patients, and my community.  While many days feel the same, there are changes I might notice if I took the time to do so.   Our latest season has been one of heavier work in the hospital and more demands on my time.  

 

 But God’s provision is not less in those moments simply because I do not feel Him as acutely.  In fact, it may be given in a greater share than at times I feel more composed or relaxed.  If I am willing to recognize that a season of difficulty is something ordained with a purpose, I can learn to dwell there without constantly looking for an exit.  That season can be something I endure and, one day, even embrace rather than escape.  Because there is another season coming that is ordained for refreshing and life-giving waters.  Waters made all the better because of the thirsty and dry ground they land on.

 

 

 

 

I called to the front of our outpatient queue for another patient to join me in my room.  As a young man rose and made his way toward me, a smile broke out on his face that gave me pause.  He entered and said, “Doctor, before I tell you about my illness, I want to share a story.”

 

As one of a handful of doctors working in the referral hospital for a population of 400,000 people, my margin for listening to stories is normally low and I’ve been known to interrupt patients before getting there.  But at times I bite my tongue and decided to on this occasion.

 

“About a year ago I brought my father to you, and he was very sick.  In fact, you said that he wouldn’t live.  You prayed with us.  I took him to another hospital to look for more treatment, but they were not able to help him, and he passed away shortly after.  But I never forgot that prayer.  I’m not a church-man, but I will never forget it.  Thank you for praying for us.”

 

 

“Your glory is so beautiful; I fall onto my knees in awe.

And the heartbeat of my life is to worship in your light.

Because Your Glory is so beautiful”

 

Worth fighting

 A woman presented to our hospital having seen a rush of fluid and vaginal bleeding after just five months of pregnancy.  An ultrasound scan revealed twin babies, perfectly formed, measuring about 17 weeks, but  without any of the protective fluid  in the womb needed for their growth.  Over the next couple of days, the bleeding continued and the fluid showed signs of infection.  Then the leading baby died.  The second one still had a heartbeat but no fluid, and mom's hemoglobin dropped two grams in two days.  I administered antibiotics and multiple medicines in an attempt to deliver the now deceased baby and her sister.  I felt the chances of their mother suffering a serious complication were too great.  But nothing worked.  Her body did not respond to the medications we gave and the time had come to remove her deceased baby and her terminally ill sister.  

My heart weighed heavier and heavier as I approached the task ahead of me.  I tried so hard to avoid it, but now I prepared to perform one the procedures I have come to abhor.  I have only been forced into it a handful of times, but each one is hauntingly painful.  I sensed myself bargaining.  Perhaps another emergent case would come up and derail this one.  Perhaps the surgery team wouldn't be ready in time and I would hand it off to the on-call doctor, who said she would be willing to complete it for me.  But in my heart, I knew the burden of my decision and that it should be my responsibility.  Mom understood and, having felt sicker each morning for the past three days, asked me to proceed.

"It's all wrong.  By rights we shouldn't even be here.  But we are."

Lord of the Rings

 

Anyone who has known me for more than a day or two probably knows that I am a Tolkien fan.  In the Lord of the Rings, Frodo and Sam undertake a perilous journey to rid the world of a great evil.  In doing so, Frodo nearly succumbs to despair.  Upon realizing that his own soul is changing because of the evil he sees and carries with him, he wants to give up.  But his companion Sam sees beauty and light on the other side of their present darkness.

 

Some months ago a young woman presented to the hospital with painful contractions after just seven months of pregnancy.  She delivered not one but three very low birth-weight babies ranging from 900 to 1,200 grams.  In our setting, these little ones faced almost impossible odds to survive.  In those early days I counseled mom with a desperate realism - that we would do everything we could for them, but I did not think they would live.  Each day I attempted to prepare her for the difficult road ahead and the likelihood that at least one, if not all, of her babies would die in the hospital.  When they all started losing weight, I began to dread rounding on those three babies cuddled together in their single warmer.  The smallest developed an infection and difficulty breathing.  When I moved to a different ward of the hospital I felt guiltily grateful that I might not have to be the one to pronounce them.  I nearly despaired.

"It's like in the great stories, Mr. Frodo - the ones that really mattered.  Full of darkness and danger they were.  And sometimes you didn't want to know the end, because how could the end be happy?  How could the world go back to the way it was when so much bad had happened?"

Some weeks later a colleague of mine shared a request in our prayer meeting for three small premature babies in the nursery - triplets that, despite being small and seemingly frail, appeared to be making a turnaround.  My heart was buoyed by the news.  But I have held more tightly to cautious and expectant hope rather than unrealistic optimism.  I remained downcast.

 

Some time later, I returned to our maternity ward.  After a glance over the charts of the twelve expectant mothers we were managing that day, I entered our nursery.  I could hear the hymns of the nearby church beginning the Sunday service.  The crowded room bustled with young mothers and their little treasures - changing clothes for the doctor's arrival while delicately navigating intravenous lines and oxygen tubing.  Several greetings of "moning" welcomed me and I collected papers, afraid that I might need to ruin many of those smiles with the day's news.

The first warmer I came to took my breath away.

Three healthy babies cuddled together wearing matching Sunday dresses.  A young mother and a new grandmother smiled at my surprise.  They were now the seasoned veterans of our nursery and could even be seen advising newer arrivals on how to look after their little ones.  As I perused their growth charts I grew more and more stunned.  Not only were they growing, but breastfeeding and approaching a healthy discharge home from the hospital!  As the hymns continued in the background, I enjoyed a silent and misty-eyed moment of reverent gratitude.   

 

 

"But in the end, it's only a passing thing, this shadow.  Even darkness must pass.  A new day will come.  And when the sun shines it will shine out the clearer.  Those are the stories that stayed with you, that meant something, even if you were too small to understand why."

"But I think, Mr. Frodo, I do understand.  I know now.  Folk in those stories had lots of chances of turning back, only they didn't.  They kept going.  Because they were holding on to something."

A decade ago we felt the distinct call of God to pursue caring for the least, the last, and the lost in the highlands of Papua New Guinea.  Over the years, my initial heroic optimism has matured into a persevering hope.  The enduring effects of our service here are evident in the children I see running around our village that I delivered, in the new doctors that I have taught, and in the grateful smiles of families I've cared for as we go to and from the market.  But every once in a while, a moment of miserable darkness threatens to to blot it out.  When another child dies, a mother loses her newborn, or the endless tribal violence fills our wards with casualties, I begin to wonder what I am holding onto.   In some of my most challenging call nights, I have thought it would be simplest and easiest to leave these daily battles to someone else.  

When I reflect on that call, I know now.  I am not called to great accomplishments and great victories.  Not even to be successful, though with God's grace we often are.  I am called to fight for what Christ fought for - God's redemption of this world through the rescue of individual hearts.  A contest filled with miracles, narrow escapes, blood, trials, deaths, and resurrection.  At times, the gravity of it escapes me - while at others I cannot escape it.  But in all times, I pray I would continue steadfastly in His hope.

"What are we holding onto, Sam?"

"That's there's some good in this world, Mr. Frodo.  And it's worth fighting for."