wrestling

I spoke to a friend today about our shared Bible reading for the week.  We covered Genesis 1-6, Psalms 1-3, and Matthew 1-3.  It was an interesting juxtaposition of passages, particularly Psalms and Matthew.  Psalm 2 talks about God's authority, scoffing (v. 4) at the kings of the earth who try to throw off his control (v. 2-3).  Psalm 3 is a psalm of David crying out to God for deliverance and protection, lying down to sleep without fear since the Lord sustains him (v. 5-6).  And in Matthew 2 in the midst of the luminous story of the Nativity with its angelic protection and guidance to the different characters' decisions lies the tragic story of the Massacre of the Innocents, where King Herod killed all baby boys two years and under in order to kill the promised newborn king of whom the Magi spoke and thus preserve his own power. 




It brought to mind the struggle I often have with trying to grapple with God's ability to do whatever he wants (Psalm 2), his ability to bring peace and protection to his people even in miraculous ways (Psalm 3), and the fact that he does not always do so (Matthew 2).  (We faced a similar dilemma in reviewing Acts 12 last night at our small group's Bible study.  James the brother of John and later Peter are both imprisoned by Herod Agrippa, the grandson of Herod the Great who murdered the babies and toddlers.  James is killed, and Peter is miraculously released by an angel.)  How can I trust this God whose decisions on when and how he acts - and doesn't act - so often lie beyond my understanding? 



My struggles to trust God end up impacting what I do with fear.  I don't like being afraid.  So I suppress those emotions and ignore them.  I don't want my life to be ruled by fear as many of the things to which God calls me - working with the poor (currently inner-city Philadelphia, future East Africa), living among them, doing cross-cultural work overseas - involve risk, and I want to be obedient to his calling.  It helps in my head to know that God could redeem even something awful happening to me, that I would be in far better place in heaven with him if I were to die, that Jesus would walk with me in my pain if my child or husband were to die.  But it doesn't change my heart's cry of what to do with all those murdered baby boys in Bethlehem or my cousin murdered in DRC nearly two months ago working for peace or the young man shot outside my house a few weeks ago on a sidewalk where I walk regularly with my toddler and infant.  It doesn't change the nightmares of my children being killed or the way my heart races now when I hear loud noises.

A year ago I was wrestling with the same question of trust and the story of Jacob came to mind.  On his way back to see his brother Esau, Jacob stops to spend the night beside a stream alone and a man comes and wrestles with him through the night.  At the end of the night, he recognizes that he was wrestling God and refuses to let him go without a blessing.  In the end, God blesses him and gives him a new name Israel but also touches his hip, giving him a limp.  He called the place Peniel, which means "face of God" (Gen. 32:22-32).  I prayed at that time that I would continue in my struggle with faith even if it meant struggling in the darkness, alone, or if I left changed or limping.  I was sharing with my friend how similar my current struggle feels and felt discouraged that I haven't learned more about how to have faith and trust God in the past year.  "But you are doing what you promised," she pointed out.  "You're still struggling with God, like Jacob."  My eyes mist over at the thought that this lack of perceived progress may not represent failure but instead a type of success.





Ultimately, I think my question of trust is less about what God chooses to do or not to do.  It is about whether I believe God is good, no matter whether I understand his choices.  If he is good, I can trust him in the inscrutability. 

A year ago, as I struggled with fear about my children in the early months of my second pregnancy, I pictured myself walking with Jesus who held out his arms, offering to carry my children.  I handed them to him with some reluctance (What if he doesn't give them back?  What will I do with empty arms?) but still felt afraid for them and ashamed of my fear.  I was invited to picture Jesus' response.  As I imagined those warm brown eyes looking at me with love instead of condemnation or even disappointment, the chokehold of fear loosened and dropped away.  Jesus, help me to learn to allow myself to sit with my fears before you so that they might lose their strength in my life.  Help me to turn to you that I may remember your goodness in the light of your face.

dreaming

post started 2/2013 but seems particularly poignant and necessary in my current context:

One of the more significant themes of which God has been reminding me lately has been the idea of dreaming - dreaming for myself, for my patients, God's dreaming for the people I encounter and His dreaming for me.  God is calling me to what Old Testament scholar Walter Brueggeman would call "the prophetic imagination" - the ability of the Old Testament prophets to imagine a different reality than the one they saw and to call people to live that alternate reality rather than the one shaped by the surrounding culture that took for granted the existence of injustice, inequality, and idolatry.  Brueggeman says that this prophetic imagination is to be a "practice that is undertaken by real believers who share the conviction of grief and hope that escapes" the cultural expectations.  As I have read several articles recently about lament, I think it is important that this imagination and my dreaming involve both grief and hope as we first recognize the shortcomings but then second realize that the shortcomings themselves make room for dreaming.

It is easy not to dream, easy to get stuck in grief.  It is easy to give up on the possibility that people's lives - my life, for that matter - could be different.  It's easy to feel that this person's addiction or that person's eating and exercise habits or this one's anxiety, depression, and somaticization are things that are immutable, that the energy to effect change would amount to an unscalable mountain. 

The invitation to dream is an invitation to believe instead that anything is possible.  It's an invitation to continue grieving when things are wrong because they are wrong.  This world is not yet as it should be, not yet as it will be.  But it's also an invitation to hope that the things that are wrong can be and will be made right.  

In order to hope in right and in order to recognize what is wrong, we need to know what is right.  We need to remember what we and others were made for.  How do we do this?  In The Message, John 3 says, "It is necessary for the Son of Man to be lifted up - and everyone who looks up to him, trusting and expectant, will gain a real life, eternal life."  I am reminded that the life of God is real life, life that lasts, life that reflects true reality. 

John goes on to explain, "God-light streamed into the world, but men and women everywhere ran for the darkness.  They went for the darkness because they were not really interested in pleasing God...addicted to denial and illusion...But anyone working and living in truth and reality welcomes God-light so the work can be seen for the God-work it is."  I see this in my patients so often.  I see this in myself so often.  We run (what an image!) from the hard choices that walk us into the light, preferring our addictions, preferring our known darkness in denial and illusion, to the adjustmentsand even initial pain of walking into and in the light. 

God calls us to work and live in truth and reality.  He calls us to do God-work and to welcome God-light.  How would my life look different if I see it in the light, in the open and vulnerable spaces where both grace and truth cast light on who I am, beloved and needy, by turns rebellious and forgiven?  How would my patients' lives look different if they were part of God-work, God-reality?  Can I even imagine it?  How would I see them differently without the shadows that enshroud who they are and are meant to be, with lives that were open and full of God-light?

My call from God to dream is simple but hard.  It involves sitting for a few minutes as I close notes at the end of the day and asking God to show me something beyond the despair and patterns and habits that I see day in and day out in myself and others.  It involves asking God to show me His dreams for his children, the images of wholeness and transformation and redemption that go beyond my limited imagination but are held within the boundless expanses of his.  It involves moving from letting the guarded wariness of cynicism shape the way I see things to allowing the tenuous frailty and surprising tenacity of hope to color the images of people that I see. 

Dreaming for people means believing and living out Tim Keller's summation of the gospel:  "[W]e are more sinful and flawed in ourselves than we ever dared to believe, and at the very same time we are more loved and accepted in Jesus Christ than we ever dared hope."  Now that's a dream worth believing and living.

loss

It's been a hard month on OB.

Obstetrics always involves some degree of unpredictability.  Things in labor can go wrong quickly, but there's always something to do (i.e. call the OB/gyn or have a C-section).  These aren't the desired outcome of normal labor, but both mom and baby make it through ok.

This month has felt full of outcomes that aren't like that.  We've had several patients with severe preclampsia (a blood pressure and kidney problem resulting from problems with the placenta) who ended up delivering early at 27 and 32 weeks to try to preserve the moms' health.  We had a 35 week fetal death who came in after her PCP couldn't find the baby's heartbeat in the office.  I ended up delivering her just days after her baby shower.  We've had a veritable rash of women coming in with their water breaking early (PPROM, for you medical readers) at 31-32 weeks leading to an early delivery and an anticipated minimum two-month NICU stay for their preemature babies.  And we've had several people come in with placental abruption, early separation of the placenta from the uterus causing sometimes-dangerous bleeding for both mom and baby - mom for the loss of her blood, baby for the loss of nutrients as the placenta separates.  Both of those patients went for stat cesarean sections.

On top of these early deliveries with tiny babies who will probably make it and may or may not have infections or other complications due to their prematurity, we've had a couple of late miscarriages at 15 and 16 weeks.  I've been involved in both of them, holding the palm-sized baby after the delivery and trying to comfort the mom while acutely feeling my own helplessness.  One today particularly tore me up.


It is the patient's fourth loss.  She's been through so much that she can't even keep straight the stories of the other pregnancies and in what years the various losses occurred (between 12-22 weeks) over the past five years.  She came in with bleeding, worried about the pregnancy at 16 weeks.  "I'm 38," she confided to the intern and me before we ordered the ultrasound that showed a half-completed miscarriage, "and I'm worried that I'm running out of time [to have children]."

I recalled how it felt to walk with a couple in my church a year and a half ago who lost their baby at 20 weeks after years of struggling with infertility and then months on bedrest when they had finally achieved this pregnancy.   Then I tried to imagine going through that again.  And again.  And now - after today - yet again.  The anxiety of coming in, the waiting for test results, the despair of yet another loss.

I tried to imagine what it would feel like to watch your body fail you again.  The sense of betrayal.  How can I not carry another pregnancy?  How can my body not do what it was made to do?  What is wrong with me?  Why is my own body turning against me and failing me in this way? 

It is a similar feeling to what I imagine couples struggling with infertility must feel. The unpredictability.  The helplessness.  The disappointment.  The recurrent sense of loss.  Loss of hopes.  Loss of dreams.  Loss of plans. 


When I helped deliver the fetal demise (stillbirth) a couple weeks ago, the father turned to me in anguish as he looked at their dead little one after the delivery.

"How can you do this?" he asked me, his face crumpling.  "Do all the live babies make up for the dead ones?"

I told him how I felt privileged to be part of their grief, to be the one who walked with them and sorrowed with them in their suffering.  I told him how I would rather be there than have their baby be delivered by someone who didn't care.  I would rather be there to try to ease the harshness of their grief as its waves crash with a soft touch and gentle words.  Those are true things.  And yet I still hear his question ringing in my ears, in my heart, especially today.

What makes the pain worth it?


It isn't as simple as the good and joyful things outweighing the bad and sorrowful ones.  It's not a simple matter of addition or subtraction and whether you end up with a positive tally.  No, the depth of suffering and the sense of how wrong things are requires more than that.  It requires a hope for redemption.  Not that the bad things will be merely outnumbered by the good but that they themselves can be transformed into good things.

I think again of that sense of betrayal I feel when when I put myself in my patient's place, in that hospital bed hearing the news of another loss.  I imagine that sense of helplessness and betrayal.  It feels like part of the creation groaning for redemption - part of the echoing knowledge of creation itself that things are not right, that things break down and fail and even our very bodies do not always work the way they're supposed to.  Some part of me stands outside the pain of the loss itself and aches and mourns for the fact that losses happen, that things go wrong.  And the groaning that mourning represents reminds me of another groaning.  Later in Romans 8, Paul reminds us that the Holy Spirit groans our requests and needs and longings before God when we do not even know what to pray for.  So somehow my longing and aching and mourning is gathered up in wordless pleas made by God the Spirit to God the Father.

I need some groaning right now.  I need some groaning hope of redemption.  I need the reminder that hope is what G.K. Chesterton calls an "unreasonable virtue," for "hope means hoping when things are hopeless, or it is no virtue at all."  And hope means waiting.  And trusting that hope will not disappoint us.  And believing that in all things God works for good.  Believing this doesn't require some twisted logic by which we make believe that bad things are good.  Instead it embraces bad things as they are - as bad - and yet opens up the possibility of redemption and transformation.  It opens up the possibility that good really is stronger than evil, that hope can win out over despair, that faith can withstand the darkness.

That gives me hope.  For my patients and their suffering.  But even more, for me and my shortcomings and sin.  Hope that all that I am - strengths and dismal failures alike - can be gathered up into a transforming embrace and made new and good.  It gives me hope that He who had the temerity to take on material skin and bones and live through a 1st-century teen pregnancy with all its unpredictability will continue to do the surprising and transforming work of birthing Christ in me and in us. 

Even in the midst of loss.

stories 4

Some patient encounters just stay with me.


I can still vividly remember the 40 y/o woman who casually told me as I took a sexual history during her annual gyn exam that she had been raped at age 8 and then became sexually active at age 14.  She had no idea what her lifetime number of sexual partners was because, as an addict, she sold sex for the drugs that enslave her.

Another day, I was following in a specialty clinic when we saw a 75 y/o woman with her husband and daughter.  It fell to the specialist to tell her that her brain cancer - despite surgery, radiation, and chemotherapy with all of their side effects - was spreading and that, without further treatment, her prognosis included decline in movements, sensation, and cognition.  I contemplated what it would be like to sit for a moment in her shoes - to face the knowledge that the rest of your life will be a journey of loss, whether slowly or quickly.

The statistics say that 1/4 women and 1/6 men will experience sexual assault during their lifetimes.  I've lost track of the number of women who've told me that their boyfriend or stepfather or husband raped or otherwise abused them.  I silently mourned the young woman who told me last month that she had returned to her abusive boyfriend, sure again that this time would be different.  Her physical exam included noting the scar on her shin from the last time they were together when he had kicked her.

My last inpatient month had one particularly heart-wrenching moment.  After a difficult family meeting discussing goals of care and life expectancy with the nearly-unresponsive patient and his Asian wife in the room and an English-speaking family member on the cell phone and a translator on the Cyraphone who could half-hear the goings-on, I was standing outside the room to write the note.  His wife, who cried silently during the family meeting but courageously accepted our predictions of outcome and made appropriate decisions in response, began sobbing disconsolately in the corner of the room.  How alone she must feel, I thought, wishing for her only family member to whom she could talk freely who was miles away, separated from health care providers by language, and isolated from her beloved by disability now and soon by loss.  Her helpless sobs still ring in my ears.

It is to this world that Jesus came as a baby 2,000 years ago as we remember this time of year.  A world where her acceptance of his birth could have cost his mother her life.  A world where his acceptance of God's call to take up all our sin and suffering did one day cost him his.  A world where, somehow, some way, I need to hang on to the fact that the cross is not the end of the story.  A world where - despite all appearances to the contrary - death and addiction and evil and shame and sorrow and loss do not have the final word (but instead resurrection does).  A world where because of the tear-streaked, oh-so-human face and blood-stained, wounded flesh of Christ we never have to face suffering alone.  My longing for his coming and making everything right in this season of Advent will one day be fulfilled because he did come, his first coming a down-payment on his final coming.

As Justin and Lindsey Holcomb wrote in a Christianity Today article several months ago about rape:

So now, to the pain of all of us, including those who have been raped or sexually assaulted, the gospel says, "You will be healed." To your shame, the gospel says, "You can now come to God in confidence." To your rejection, the gospel says, "You are accepted!" To your lostness, the gospel says, "You are found and I won't ever let you go." To your sin, the gospel says, "You are forgiven, and God declares you pure and righteous." To your death, the gospel says, "You were dead, but now you are alive."


May it be so.  I tell these stories to remember the people myself and to remind myself that God does not forget them. 

bonsai and horticulture

Stuart and I went to a bonsai class at the National Arboretum in DC for National Bonsai Day a couple weeks ago.  We weren't planning on this, but it was advertised on our visit to the Arboretum, and so we sort of walked into it.  I was impressed with how much the lessons from the bonsai cultivator who gave the lesson on bonsai mirrored things that are true of our lives with God as the master gardener who cultivates his vineyard (Isa. 5:1ff, 27:2ff; Eze. 19:10ff.; Hosea 10:1ff.), of which Jesus is the best example (John 15:1ff.).  I think we've lost much of the significance of the careful cultivation of growth, fruit, and natural beauty because we simply don't do it anymore.  I have a garden, and I still didn't know much of what he said that I thought was significant for insights for our lives.  So here they are. 

First, I loved what the speaker said about how he picks plants with which to make a bonsai, a specially cultivated and shaped miniature tree:  he looks for the ugliest ones.  He didn't explain why, precisely, at least not that I remember, but it was an encouragement to me as I thought of God molding our lives.  If our speaker can intentionally pick the ugly plants, surely God can use us with the brokenness we bring and can shape us over time into creatures of beauty and fruitfulness.


http://www.asktonythegardener.com/Article/tabid/55/smid/370/ArticleID/75/reftab/36/t/Bonsai-Plant-Art/Default.aspx

Time is another bonsai requirement.  Bonsai, the teacher explained, is a long-term practice, a development of beauty of form and structure that requires patience since every change can require months to "set" and long-term shaping requires years.  Families pass a tree down through generations since it can take that long to form it.  It is a never-ending process, and you can never simply leave the tree alone as a finished work of art.  Instead, as a living piece of art, it is constantly changing and growing and so requires ongoing molding and shaping.  I remember learning in Old Testament class in college that one of the benefits of the Old Testament is seeing the work of God over years and centuries with his chosen people.  Their recurrent failures, few luminous successes, and ongoing gradual transformation through the pages of the books of Law, Prophets, and Writings encourage me that God will be faithful to continue working in my own life and the lives of those around me.

Learning what leads to and inhibits growth was also interesting.  For instance, in the process of shaping the tree to a certain shape, you often cut off much of its foliage growth.  However, it is important to maintain at least the growth at the end of the branch since the branch will die if one cuts off all of its growth.  It makes me wonder what parts of my life I expect to maintain if I do not allow room and cultivation for them to grow and be fruitful - simple things like playing piano, or certain oft-neglected relationships, sometimes even more important things like my spiritual life, etc.  In a busy lifestyle, it is easy to forget the importance of maintaining growth and exposure to light and food for the important but sometimes not-so-urgent parts of my life.

Another growth principle involves encouraging ramification (branch formation) and fuller foliage pads through pruning.  If new growth is pinched off (e.g. removing the new bright green growth in the spring), it will allow the tree to funnel more energy back into its branches and remaining leaves.  For deciduous trees, sometimes defoliation is practiced (removing all the leaves) since reformed leaves are smaller and more numerous after defoliation.  For both evergreens and deciduous trees, new branches are formed, and the remaining foliage pads that have been pinched off grow in more fully. 


http://www.mybonsaibuddy.com/749px-Trident_Maple_bonsai_52,_October_10,_2008.jpg

Pruning is always something that makes me a bit nervous in gardening.  It requires cutting off something that looks like growth (e.g. a leggy stem of my petunias with flowers on the end) and trusting that more and fuller growth (e.g. more flowers closer to the plant and a fuller, more attractive result) will result from the loss.  In the same way in my own life, pruning takes courage.  It involves passing through pain, allowing God to take away something I thought was growth and flowers and trusting that he will cause different and more beautiful growth in its place.  It can mean redirecting energy into remaining branches and leaves when distractions are fewer.  It means trusting the as-yet-unseen.

A final aspect of growth involves growth that can be missed - that of the roots.  The overall picture and part of the beauty of a bonsai tree involves the roots.  They are considered in deciding how to shape the tree, and they grow when the tree seems most dead:  in the winter.  It is encouraging to me to think that the foundational strength of the tree, the ability to stand tall against storms and winds, the deep reaching for water, the stability and, well, rootedness of the tree actually grow when the tree looks dead.  As I look at my own life and the lives of those around me, where could growth be occurring under the surface where things look lifeless?  When we pass through periods of barrenness and cold and lack of fruit, can we trust God to be causing our roots to grow, actually to make us more stable in the very times when we feel least productive and secure?


http://mfs.piccsy.com/t/pall-bonsai-winter-156626-475-545.jpg

Besides organic growth, the bonsai maker/cultivator actually shapes the branches and directs where they will grow.  He does this by first wiring the branches, using flexible coated wire to wrap in spiral fashion the branches nearly from the extremity on one branch to the trunk and back out to the small distant parts of another branch.  Once all the branches are wrapped, he starts to shape them, moving them into the position he wants them from bends in the branches themselves to their overall direction so that foliage pads are placed in pleasing, balanced ways.  It reminds me of how God wants to be Lord of all of my life, shaping and forming and crafting all of it from major branches to smaller parts to be an overall picture of beauty and wholeness.

An interesting part of bonsai's idea of beauty is the idea of dead wood.  Part of the ideal of bonsai beauty is the idea of age, and the bonsai maker will cultivate bends in the branches and an overall downward, weighted-down droop to the branches of even a young bonsai tree to simulate age.  Another way to simulate age is through dead wood on the trunk (shari) and branches (jin) where the bark is literally torn away to leave dead wood and simulate the wearing experience of age in a young tree. 

In other words, the creator of bonsai actually intentionally makes scars to contribute to the beauty of the tree.  I don't think God necessarily wounds us intentionally, although pruning can feel like it; we probably create enough wounds of our own as we pass through life and fall into scrapes and pits we could have avoided if we had listened.  But the idea that the scars can be part of the beauty is intriguing.  Do we lament our wounds instead of offering them to God to be formed into part of the work he is making?  Do we try to cover scars that could be used to nourish others' healing as they see how the scars form part of the beauty in us?  Do we really trust - in pain or in plenty - that God knows what he is doing in us?

http://artofbonsai.org/galleries/images/stemberger/small/stemberger_juniperus_procumbens.jpg

The final insight I gathered about bonsai making is that the artist shows through in the art.  Some bonsai are crafted to look windswept and forlorn, evoking a favorite gnarled tree near the artist's usual hiking trail.  Others are upright and stately, reminiscent of a childhood tree that perhaps housed a swing or treehouse.  No matter the story behind it, the artist's own person shows up in some way in the art.  And that is the goal of God's working in us as well:  that we would reflect his image.  The reason God got so riled up in the Old Testament about idols was that they showed how completely Israel had missed the point:  instead of being the image of God, the reflection of his character and glory to those around them, they were worshipping images of wood and stone.  What further purpose could we want but to reflect back the shining grace, strong justice, and tender mercy of our Father?  As we come to know him, we will grow in love of him, and we will grow more like the One we love.  This is what it means to be a tree "planted by streams of water, which yields its fruit in season and whose leaf does not wither" (Ps. 1:3).



http://en.wikipedia.org/wiki/Bonsai


Of note, Stuart will have a lot more time to continue learning these and other lessons.  There was a raffle at the end of the bonsai class.  He won the demonstration bonsai.  :)

reflections

written 5/6/12 on the train on the way back from the airport

After 17 hours en route, I arrived back to Lancaster today.  I did my best to say my despedidas (farewells) well as I left.  Before I start a busy month on OB tomorrow, I wanted to try to process some of the rotation today.  

  

Ecuador, at least the parts I experienced, is much better off economically than either the majority of India or Zambia, my two most recent overseas points of comparison.  It shows up in little things, like the fact that having dogs as pets is common (no one can afford to feed a dog regularly where I was in Zambia when their kids come into the hospital with severe malnutrition).  Fashion in Ecuador goes beyond the usual more-dressed-up-than-your-average-American lack of cotton (usual in Latin America in my experience) and tight jeans, reflecting more the fashion mores – the little I know them – of North America and Europe with scarves, boots, and cute handbags.   The life expectancy is high, and I did see some diseases of affluence (e.g. diabetes), even if their management is more difficult (no glucometers, no lancets, etc.)

It makes me wonder if I would be needed there, medically at least.  I respect the doctors who work there, many of whom have given years of their lives to serve far from their culture of origin, families, and same-culture friends.  Their sacrifice to be obedient to God's call on them is not to be ignored or easily dismissed. 

Still, my experience also made me think about the style of missions I want to be part of.  Due in part to the need to be close to the hospital, in part to regulations requiring them to clearly demarcate the HCJB lands, and in part to security concerns, the vast majority of the missionaries from various organizations live together on a fenced in compound behind the hospital with a gate that closes and locks at night.  Most of their kids go to a missionary kid (MK) school where Spanish is taught as a language. 

I’m ambivalent about these things.  When I’m on call at night, I like the security of knowing there’s a locked gate when I walk home at one or two in the morning.  I like the fact that the walk takes me two minutes and not ten (and that would be dangerous for patient care in some situations if I couldn’t get to the hospital quickly enough).  But I don’t like the sectarian feel of living in a separated-off part of town (“Gringolandia,” as the residents called it, and even they didn’t "trespass" there) rather than with the people whom I came to serve.  

Jesus came and tabernacled among us (John 1), walking in our dust, eating our food, suffering our vulnerability in service.  If he is my model, to what extent can and should I avoid the daily complications and risks of life overseas if it lies within my power?  Eating from vendors off the street?  Risking getting a few GI bugs and parasites in order to eat with people in their homes, including vegetables and fruit that weren’t soaked in special cleaning solution?  Risking being a target of robberies or worse if I live among people as someone who is noticeably different?  How would this look with a family?  To what extent could I expose my children – Lord willing – to risks I undertake to serve him and his people?

I’m also ambivalent about the schooling.  Part of me thinks that an MK school right next door to the hospital would be attractive – a quality school where one’s children could attend in their native language without having to be far away (i.e. like the old boarding school model where one’s children were sent off starting at age five and saw their parents in the summers).  But part of me wonders what message it sends the community about my opinion of the quality of their schools, the desire (or lack thereof) for our children to be friends with their children, and the importance of language and culture learning in the nearly effortless, osmotic way that only children can learn them.   

I envision children being such a potential benefit for building relationships and bridges when in a new cultural context and for modeling in a marriage and a family what effects Jesus has on our lives.  What would it mean to do what is best for them and also avoid setting up additional barriers between me and the national people?  This is especially complicated with older children (how different can it be to learn to add and subtract, read and write in another language as long as they use the same letters and numbers? but what if they didn’t?) and when I’m not sure about coming back to the States for the children’s schooling later, meaning they would have to be able to fit back into our educational system and learning in English.

A photo of a painting by famous Ecuadorian painter Guayasamin, who broke expectations by portraying his subjects with the blunter fingers and facial planes of the indigenous people.  Ecuador does still suffer controversy regarding discrimination against its indigenous population.

These questions aside, there are many ways in which working in a place like Hospital Vozandes del Oriente would be much easier and simpler than working in many other places I have been.  Many more lab tests and even imaging studies are available, if not at our hospital then in Quito (e.g. Pap smears, TSH) or in nearby Puyo (e.g. CT scans).  As mentioned in other posts, living and working conditions themselves are relatively easy (e.g. electricity, running water, even hot water, washer/dryer).  I would enjoy working with residents and interns, and I LOVE speaking Spanish regularly.  It certainly is a spiritually open culture where I can speak of God and people generally understand what I’m talking about and are open to hearing it.  But I still don’t know…

Underlying all these questions is the bigger question of calling.  It is not so much a question of a calling overseas itself.  I’ve heard God’s voice on that enough times to trust that he wants me somewhere for some length of time at some point in the future.  But I still don’t know where or in what sort of context, and I’m nearing a point where I may have to make some decisions as I have one year of residency left. 

In general, I do have some personal sense of the importance of serving the poor as part of what it means to be working with God to bear witness to and bring about characteristics of his Kingdom.  But does that mean a certain percentage of my patients should suffer from the diseases of poverty?  Or that I should have to live a certain standard of living to really serve the poor?  Does that mean that most of my patients would die if I weren’t there, or is that simply me wanting to feel necessary and affirmed in my work?  If I were in a situation like Zambia where there is tremendous need and simply not the resources (people- or finance-wise) to meet it, would I still have the time in my schedule and energy in my life to reach out to people’s spiritual needs, or would I be so stretched thin and overworked that all I wanted to do was go home and sleep at the end of the day?  What would that sort of life look like with a family? 

Clearly a lot of prayer and discernment is still needed in my life over the next year(s).  I think a few good books on different styles of missions might be helpful.  I hope to continue talking with both the missionary contacts I have made and with mentors and friends in the States as I walk through this process.  God has been faithful to guide me clearly in each of my major life decisions to date (college, seminary, medical school, residency), and I can choose to trust that he will continue to do so.  In the meantime, I can also look for ways to learn more medically and missiologically, seek to do my best at working cross-culturally in a sensitive fashion with patient encounters that I have, and grow in loving God and allowing his love to overflow in me to others around me so that I can offer the life-transforming power of His grace to the needs that modern medicine 

trip to Quito

My final weekend in Quito was a great time of reconnecting with some of the first group of residents/interns and doing some touristy stuff with them before I left.  I had a wonderful dinner with Marita and her family, Anita and her brother Fernando, and Gaby and her husband and son on Friday night in a beautiful part of the downtown called the Ronda.  It is in a neighborhood of restaurants and shops in the old colonial style buildings with flowerpots everywhere and live music in many of the restaurants, including ours. 

Anita graciously hosted me despite having to work at 5 am on Saturday, and her parents fed me breakfast in the morning (after meeting me for the first time since we had gotten in around 1:30 am after a late dinner the night before.  Then I headed out with Gaby and her husband Luis (and later her son Gabriel and her parents, sister, and grandmother) to La Mitad del Mundo, the traditional (although slightly off) site of the equator in Ecuador. 

I loved the afternoon festivities of group after group of various folk dances from different parts of the country.  They included different brightly colored outfits and everyone seemed to enjoy watching, including the mostly Ecuadorian audience.  I got a little more involved in the enjoyment than I planned when one of the dancers hauled me into the dance at the end when they went around trying to get other people to join them!

 

This dance was from Esmeraldas, a mostly Afro-Ecuadorian province in the north.

 

 

A good reminder of how much dancing is a part of Latin culture for old and young alike.  These little girls and their little boy partners enjoyed the dance and participated just as much as the older dancers!

At lunch afterwards with Gaby's family, I even got to try cuy, or guinea pig, an Ecuadorian specialty. 

After the lovely day, we met up with Anita who had finished work and went to the artisanry market in Quito, where I got some earrings for my sisters.  Then I returned to Anita's house and hung out with her family until it was time for me to go to the airport.  I was blessed and touched by the hospitality of my friends, despite our short acquaintance.  They welcomed me into their families and homes and lives with no self-consciousness and no hint of the effort and time that hosting me cost them.  I am grateful for the grace they showed me.  It was a wonderful ending to my time in Ecuador.