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."

 

Nearer

"So draw me nearer Lord

 Never let me go 

Closer to your heart 

Draw me nearer Lord"

-Meredith Andrews

Our midwife handed me a packet of papers to sign as I rounded in our nursery.  I knew what they were … I have signed so many.  Black-and-white reminders of tragedies recently played out in flesh and blood.  I set them to the side while I finished my work, planning to attend them later.

 

 
Before I could, I was summoned to delivery bed three where a first-time mother struggled to deliver her baby girl.  The nurses could no longer find heart tones with the hand-held Doppler and mom was getting tired - her pushes shortening and her face showing obvious exhaustion.

I applied a vacuum extractor to the baby’s head and told her, “Mama - mi pulim i no inap.  Yu pus i no inap.  Yumi wok-bung, em bai inap.”  On the next contraction a limp baby delivered into the bed with deeply stained amniotic fluid.  But she had a heartbeat.  We cleaned her airway and I set to work giving artificial breaths with a bag.  The mask was too big for this unexpectedly premature infant, but I started to see some movements in the chest.  All the while I awaited the telltale cry of new life … but it wouldn’t come.  I stared into that face, challenged in maintaining a good position of the over-large mask.  It stared back with a stunned and pale look.  I wondered to myself if this image would be a haunting reminder when I was forced to collects its black-and-white specter in a few days or if it might be a moment that I reflected on with privilege as a new life gained traction in our world.

After what felt like hours but was likely a few minutes, that little blank-faced baby started to gain color and grimace.  A few more breaths and the chest moved in and out on its own.  A weak cry finally escaped and I set the bag aside, still praying that I would see that face on rounds in the morning … “Just let this baby see a turn of the earth …”

 

 

I resumed caring for the patients in the ward and picked up the chart of a woman whose baby bilum rested next to her.  She looked like she was ready to leave, even though she had just had a cesarean delivery 3 days ago.  I inquired about her pain, her eating and walking.  “Na bebi i stap?”  A thin mist layered her eyes as she indicated the bag, “Em dai asde na mipela bai planim tude “.  Her deceased little one lay next to us, wrapped and shrouded - perhaps to conceal from the public motor vehicle driver that she was bringing a dead body in the car - to which there is a costly stigma attached.  “Mi sorri tru“. Had I paid more attention to those papers in the morning I would have known.  The chaplains visited them and prayed.  Next patient.

A few days ago I was really struggling with the experiences of my patients.  I actually kept a running list of those that I had to tell were dying.  In eight years I had never done that before and I don’t know why I did at the time, but I brought it home, recalled their faces through prayers, and felt better.  

The next day in clinic I watched the back of one of my HIV patients.  He had contracted the virus at birth 11 years ago and he left my room having just been told alongside his grandmother that the virus had weakened his heart and that he likely wouldn’t see his next birthday.  I felt a surge of helplessness. I want to be honest with my patients. I want them to understand what the road ahead looks like - and where it ends (in this world).  I give so much bad news. I wondered if what I do made any difference.

As the names on my list stacked up and the myriad ailments reminded me of my inabilities, I actually began to dread each pleasant smile entering my clinic door.

But there was one I could not avoid.

I wrote about my experience at Sengapi, one of our rural health centers, at the end of last year.  One of our nursing officers there was expecting a baby at the time. About a month after our team left, I received a phone call from her husband.  His crackled voice and our short conversation told me Melissa needed to be at Kudjip.  She had developed pronounced swelling and headaches in her eighth month of pregnancy.  She managed to get a medical evacuation flight out  but Issac couldn’t join her because Covid restrictions meant that only patients were allowed to travel on evacuation flights now - no guardians.  When she got to Kudjip she seemed alright, but quickly worsened over the next few days.  We needed to deliver her baby early.  Her husband tried to make it, but the rivers were flooded and he couldn’t cross them.  Her surgery went well and a vigorous baby girl went back to the ward while we finished.  When I went to check on her, a hooded figure was already next to her baby cot holding her hand.  There was Isaac.  A new father beaming down on his little girl.  MAF had managed an early flight and brought him in the morning hours while we were operating.  

 
Melissa and her baby had a few ups-and-downs for a couple weeks.  But over time and with prayer they did well.

I have never been able to untangle the great mystery of Gods grace.  I have seen and felt that it is infinite and that He spreads it far and wide.  Yet somehow none is wasted.  As though our world's separation from his perfect and peaceful presence means that a profound Grace, even limitless, is simply sufficient.  Abundant and extravagant but not wasteful.  When I watch my patient leave the room with an hourglass hanging over their days I wonder how I can see the next one in any way that shares that Grace.  Yet somehow it works.  Hearts are changed and touched - mine most of all.  Not because I have solutions.  Not because I am a miracle worker but often because I am not.  

In the next few days, our new mother and her baby girl stayed in the hospital.  The nurses dutifully checked on both of them - making sure they were doing well and that this new life was gaining the foothold it would need.  As I put my signature on their papers to leave, I reflected on the great redemption of those moments I spent looking into that apparently lifeless face.  It would be tempting to pat myself on the back.  We did well, it is true.  But we were just vessels of a greater intention.  A Grace given that I could not create or bestow - merely share.

 

"In your nearness I take shelter.

Where you are is where I'm home.

 I have need of only one thing - 

To be here before your throne"

 

As I enter our nursery I am reminded of God's presence.  All entrants must remove their shoes and wash their hands, like approaching a temple.  I go back and forth performing my doctor duties as mothers watch anxiously.  The room has a sacred quality for me because it is a place in which the most vulnerable are tended.  It draws me nearer to Him even when the end result may be a tragic reminder that His redemption is not yet full in our world.

And although I may struggle to see or feel it at times, at others all it takes is a small spark in a dark place to change the entire landscape. 

Perhaps that Grace can bring out bright blooms - even in a garden still fighting the weeds.