lessons from a relationship

I recently began a new relationship.  As is a new relationship's wont, it has been much on my mind.  This post goes through some of the things I have reflected upon as we have moved through the initial weeks of getting to know one another, particularly as it relates to the faith relationship I have with God.

I am struck by how much of the relationship itself consists in waiting.  We date because we don't know whether this will work out in the end, so we're waiting on a final verdict from one or both of us on the relationship itself.  Traditional in some ways at least, I (usually) wait for him to call.  We wait for the next step in the relationship itself as we gradually get to know each other better and so move to different levels of sharing.  But don't get me wrong.  Despite all the waiting inherent in this process, I am definitely enjoying the process itself!  It's just that it has struck me repeatedly that a relationship is just this:  something already but still a process of becoming what it will be.

Waiting in the context of a relationship recalls to mind the already/not yet tension present in the way Scripture talks about the Kingdom of God and Jesus' present reign on earth.  In some ways, it is already here, changing lives, working powerfully in this world, but in other, significant and substantive ways we still wait for the already-won Kingdom to be made manifest in our lives and this world.  We wait for the fuller, deeper thing even while we enjoy the very good thing we already have and glimpses in what we have of what is to come.  In this hurting yet wonder-full world and my fun yet becoming relationship, we wait, in hope.

I have been struck as well by the vulnerability that arises in me through this relationship.  I am used to being what I have been for most of my adult life:  basically an independent person.  Instead, suddenly my whole day's outlook can be changed dramatically by this single other person - whether he calls or not, what he says in an email, an unexpected letter, etc.  Just thinking of him brings a smile to my face, and my friends' teasing easily makes me blush.

So far the vulnerability has brought all good things; the cloud of euphoria that accompanies the early phase of a relationship makes me a very happy person!  But I know the power is there as well for one of us to hurt or disappoint the other, for careless words to wound, for lack of contact to inspire a loneliness I wouldn't have felt so keenly a few months ago.  It's a power that's scary to acknowledge in myself as well since both of our (not just mine) investment in the relationship and each other brings this vulnerability to the other.  It's a risk I take, acknowledging it as part of the necessary process of a relationship, but it's not one I take lightly for either of us.  It's helpful on my end to remember the trust I am forming through experience in the character of my boyfriend (and to work on making choices that form me into a person of character worthy of trust).  It is good, too, to remember other influences on my well-being - the stable, unchanging love of the Father who calls me beloved (this music video recently made me cry); the family who loves me wherever I choose to go and whatever choices I make; the friends who so willingly rejoice with me.

The next theme of my reflection has been on the idea of hope.  Two months ago, I didn't know this guy existed.  Now, my life has changed dramatically in the space of days and weeks to reflect his existence - how I spend my free time, where my thoughts are, even how I relate to others.  It's a simple but powerful reminder of how much a relationship can change us. May my relationship with Jesus affect me as much!

In Hebraic thinking, our "heart" was much more than our emotions; it also was the locus of the will and in some ways encompassed the orientation of the whole person him- or herself.  Thus, out of our hearts flow our actions, our priorities (cf. Mt. 6:21), our thoughts.  It makes me reflect carefully about where I am turning my heart, which leads me to my next thought.

I have been humbled in entering this relationship by the whole comparison of this earthly early care to my love for and relationship with God.  I am struck by how quickly my thoughts go to him, how naturally I delight in spending time with him, how easily my joy and excitement overflow into sharing about him with others.  Would that I had the same thoughtless, carefree joy and delight in my relationship with God!  How might others respond if I as easily began talking excitedly about God as I do about my last weekend?  Would they be drawn to Him when they see the glow he puts on my face?  How often do I consider Jesus' reactions to my day, ways to integrate him into the interactions I have, regular sharing of my thoughts and emotions for the sake of having another reflect on them to me, perhaps gently pointing out where I fall short of Jesus' example? 

I am sure there will be more lessons along the way, as there can be in any relationship but most strongly in the commitments where we make ourselves vulnerable.  But for now, I'm enjoying the process and learning to wait, seeking to learn to live responsibly with both my own power and vulnerability in this new context, and aiming to orient my life - this relationship included - around the one Romance that can define and transform me in ways that prepare me to live all other parts of my life.  May my love for Him grow and overflow in joyous abandonment that draws those around me to and reminds me of the worth of (as Chesterton put it in Orthodoxy) this lived Romance, a combination of strange and secure, wonder and welcome, happiness in this "wonderland" without "once being merely comfortable."

senses - hearing/sight

I'm on an ENT (ear, nose, and throat) and ophthalmology (eyes) rotation right now, so I've been doing some thinking about the senses we often take for granted when they work well.  That is, I was until this week on night float.  But we have a slower week so far, so hence the nighttime blog posts.  :)

Seeing
One of my favorite things about ophthalmology has been the simple process of seeing people's eyes being illuminated by the light as the ophthalmologist examines them.  The lamp and microscope move in front of their eyes and, at an angle as the ophthalmologist looks at the retina (back of the eye), the light reflects off the whole iris (colored part) in the darkened room, giving the patient these beautifully shining lit-up eyes that reminds me every time of the quote about the eyes being the window to the soul.  I am struck by the scene's beauty all the more for the fact that the patient can't see it.  Here's this beautifully illumined eye in all its unnoticed complexity, and they have no idea.

  http://mychinaconnection.com/wp-content/uploads/2010/12/see-eye-to-eye.jpg

Hearing
Hearing, too, is affected by things we can't see or access.  Even common wax can obstruct one's hearing without the patient knowing what it is that makes them hear less on that side (or both sides).  The inner ear itself, where the tiny middle ear bones transmit sound waves made into vibrations that are picked up by microscopic hair cells, is beyond visualization even for the ENT doctor.  It can be seen somewhat on a head CT in large scale but the hair cells that may not work as well for hearing as one ages or whose disruption with tiny stones (otoliths) can cause lifestyle-handicapping vertigo (dizziness) are beyond what we can easily access. 

                        http://www.webmd.com/brain/picture-of-the-ear

Hearing and Seeing
In a recent conversation, I was asked which sense I would rather lose - sight or hearing?  A difficult question to answer, and one that prompted a quick evaluation of all the taken-for-granted ways these senses affect my life.  The crescendo of a piano piece or the steady patter of raindrops.  A glorious nearly-neon sunset or the color of sunlight through a leaf.  Hearing someone call my name as I walk down the hall.  Seeing the identity of the speaker or identifying them by their voice. 

Sight and hearing are linked in another way.  Both senses require two steps to achieve the appropriate perception of sound/vision.  First, the external stimulus must be perceived - cells in the retina send off signals from the eye; those hair cells from the inner ear do the same after the vibrations reach them from the bones of the middle ear.  Second, the message received in the brain must be processed appropriately for it to give us the right picture or sound.  One needs both steps to actually achieve sight or hearing that is meaningful. 

The Bible understands the importance of both of these steps, too.  God's judgment on his people when he sends them the prophet Isaiah is:  "Be ever hearing, but never understanding; be ever seeing, but never perceiving...Otherwise they might see with their eyes, hear with their ears, understand with their hearts, and turn and be healed" (6:9b-10).  This is picked up in the New Testament in Matthew 13 (as well as parallel passages in Mark 4 and Luke 8) when Jesus understands why he speaks in parables, telling stories to communicate truth to those whose ears are open and whose eyes see clearly and concealing it from those who don't. 

My experiences on ENT and ophtho make me wonder: 
1.)  What sort of unseen blockages keep me from hearing God's voice clearly?  Pride.  Busyness.  Independence.  For many patients with wax in their ears, simple daily administration of a few drops of oil can help keep the wax soft enough to move out.  What similarly mundane practices can help my ears stay open?  Daily prayer.  Meditation.  Time in nature.  Time to listen.  Cultivating the practice of listening in my relationships.  Obedience when I do hear God's direction.
2.)  What overlooked glorious beauty and light is shining around me?  A simple mirror would enable the patients being examined to see the light illuminating their eyes.  How can I be a mirror to others, reflecting the Lord's light to them?  How can I be more attentive to God's presence and work in my own life? 

              http://stevetallamy.com/wp-content/uploads/2011/04/Seeing-Beauty.jpg

pain

 As I move into my second year of residency, I have acquired a number of patients with chronic pain.  This is challenging because of the regular number of prescription refills that then fill my electronic medical record inbasket requesting opiates (narcotics).  These are not medicines I have ever started a patient on on a chronic basis, and I hope to avoid doing so.  These patients, however, have been on these medicines for years in many cases, and it is left to me to try to help them deal with the impact of chronic pain on their lives, including writing prescriptions for medicines on which their bodies are now dependent to stave off the pain that initially debilitated them in various ways. 

In addition to my discomfort with regularly prescribing (sometimes large) quantities of highly legally controlled medicines, this situation has caused me to examine myself as I see my own reactions to these patients.  My level of frustration and feeling of helplessness surpass what I would expect from the need for frequent appointments, urine tox screens to ensure there is no other drug (ab)use going on, and simple script signing associated with these patients.  I hear the same frustration in other residents as they talk about these patients.  I think it comes from a deeper cause.

When interviewing for medical school, most applicants are asked, "Why do you want to be a doctor?"  The most common answer is, "To help [hurting] people."  I think the key is here.  We go into medicine hoping to help, to cure, to be part of healing.  Most patients with chronic pain cannot be cured or healed by the reach of medicine.  We seek with the pills within our reach to do some small part of helping instead.  And even that is complex.

The medicines used for chronic pain run the gamut from medicines used for regular pain (Advil, Tylenol, Aleve) to medicines used for neuropathic pain (gabapentin, pregabalin) to antidepressants to (sometimes) opiates.  This reminds me of the complicated nature of chronic pain.  It is a case-in-point of the integrated nature of who we are as human beings.  Our emotional, mental, and spiritual status deeply impacts our physical well-being and our subjective experience of our physical illnesses. 

Pain is hard, too, since it is so subjective; with chronic pain patients, often there's nothing there to point to and say, "This hurts" as one can to a broken bone.  Do I believe my patient's report of pain without questioning?  Is their early request for a refill evidence of undertreated pain or of possible abuse, taking more of the medicine more frequently than prescribed?  There's a lot of judgment involved, and it's hard to judge another's complaint of pain.

I think dealing with chronic pain well requires a re-working of how I think about the role of medicine.  It requires seeing a good part of my role as a doctor as that of care rather than cure.  It means seeking to remember the patient is a whole person and reminding them of it, that they are more than the pain that can become so all-consuming and -defining.  It is encouraging their health in the other ways that affect their experience of physical pain - mental, emotional, relational, spiritual.  It requires a steady balance of firmness and boundaries with compassion and connection.  It is challenging, and I'm not sure that I have it worked out; sometimes I think I lean too far with one patient towards leniency and too far with the next towards strictness.  Trying to achieve some level of evenhanded fairness while still feeling with patients' expressed pain and desire for relief that I can provide, even if it means an addictive, abusable medicine, is hard.  I don't want to become jaded or cynical but allowing my patients to manipulate me into giving them what they want if they may be abusing it is not loving to them in the long run, either.  It's a hard road to walk, and I'm still figuring it out.