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.