on changing the world

I wanted to change the world. 

During undergrad, a group of my friends started cooking "downtown dinners" - a weekly collaboration of boiling excessive amounts of spaghetti and warming marinara sauce (or on fancier nights, making minestrone soup). We took the food to a courtyard in downtown Gainesville where those who were chronically homeless tended to congregate. The point of the evening was to talk to those who had come to eat. To hear their stories. To listen. 

Being there was hard. It is tough to take in the stories of how someone becomes homeless. It is tough to face the societal issues that underscore these stories: systemic racism, unequal education, untreated mental illness, substance use, trauma. Each week these stories would come out - sometimes cohesively, sometimes shaped by paranoia, loose associations, and angry outbursts. We would listen.  

I don't think any of us were under the illusion that we were making a difference. After three years of these dinners, little changed in the lives of those we sat beside each week. Miss Mary and her collection of mangy dogs still lived in a decrepit tiny house without running water or electricity. Ed kept pushing his shopping cart full of garbage, telling anyone who listened about his mother who had been stolen.* Even though we knew we weren't changing anything, we still showed up each week with pasta in hand. 

A decade later, I found myself working on Skid Row** in Los Angeles during my HIV fellowship. For a year, I took care of the sickest and poorest people in this country.  Most were not housed; for those fortunate enough to be sleeping under a roof, that housing was generally not stable.  For a year, I followed a panel of patients for whom HIV was negligible in comparison to their daily battles for food and shelter and against addiction and mental illness. At the end of our year, my co-fellow and I reflected on our time there: for almost all our patients, little had changed.  A couple patients managed to secure housing. Many more had disappeared from care, lost in the throws of addiction or incarceration. One was murdered. Most are still in the same struggle simply to survive. But we were there. We fought for them to get the medical care they needed.  We listened to their stories. We let it shape our own. 

Now I work in the wealthiest county in America, where poverty and homelessness remain invisible behind the wealth that saturates the Silicon Valley.  Many of my patients are homeless, or will be once they are released from jail. I know that the thirty minute encounters I have with my patients are never going to be enough to undo the injustices in their lives. I can choose the best medicine and carefully explain their health conditions in terms they can understand. But the reality is they leave their visit with me and return to worlds I can't imagine.  Whatever love and compassion and patience I put into our encounter, it can't undo the crack their mother may have smoked while she was pregnant, or the multiple foster homes they were shuffled between, or the gang that was the first place they felt accepted, or the meth addiction that fuels cycles of incarceration, or the criminal charges that unfairly limit future employment and housing and the right to vote. 

There are millions of places of brokenness in this world, and as Sarah Kay so beautifully puts it: "No matter how wide you stretch your fingers, your hands will always be to small to catch all the pain you want to heal." 

I've stopped wanting to change the world. I still seek out the places that are broken, where injustice seems to have won. I still sit and listen and ask the questions whose answers will break my heart. But I don't go to change anyone, because I can't. I go because God is there. I go to love.  

I got a text this week: you saving the world today? 

Nope, never saving the world. Just trying to be love, and praying that in this world that has gone mad with violence and hate, that Love would be what saves us. 

*his mother had not, in fact, been stolen. We did track her down; she was living in a nursing home, trying to recover from the strain of years of caring for him and his profound schizophrenia. 

**yes, this is a real place. 

Christmas candles

The recent losses and outcries for justice in Ferguson and New York hit close to home because twice a week I work in the Los Angeles County jail, caring for men who were fortunate enough to survive their arrests. Most are young black men, who are arrested disproportionately compared with their counterparts of other races. 

I never ask my patients why they were arrested. 
Instead,I ask: what are your goals? 

The answers are humbling:
I'm taking classes so I can keep custody of my son. He's nine months now.
I want to have my own Christmas tree someday.
I'm gonna open my own accounting firm; I only need six more credits to finish my degree. 
I want to be a hairdresser. I have a lot of sisters; I'm really good at doing hair. 
I've never walked on the beach with my friend; I want to do that someday. 

So as Christmas comes, I light candles:
A candle in memory of the lives who have been lost. 
A candle for peace, that there would be racial healing and justice in this country. 
A candle of hope, that these men will get the chance to live out these dreams. 

Wishing you a new year filled with hope and peace. 

second year end, third year begin.

i started this year with deep breaths of thankfulness. i had survived what was supposedly the worst of the medical training process: intern year. the year ended with a week exploring the pacific northwest with a friend - eating our way through pike place market, kayaking around san juan island, biking and hiking in vancouver. i felt full of life.

 

second year started with continued triumphs: the color run. kayaking all summer long. a friend's wedding in india. loving work.

then things spiraled down: the death of a friend. recurrent hospitalizations. work and life becoming far too exhausting.

now this year comes to a close with another week of sickness, a chest rattling with cough, and a body heavy with fatigue.

like last year, i know life comes with both things difficult and things beautiful. and like last year, i am finding i am stronger than i imagined.
 
so i take a deep breath in and let this last year of residency begin.

enough

she asked me to tell her about myself. i grew up in south florida. moved to swaziland for a year after college to do HIV public health work. came back to go to med school. now i'm doing residency here.

do you think you'll go back to africa when you're done here? well, maybe. i want to. i have some health issues.

then the tears start. i tell her how sickness once again caught up with me. about my recent hospitalization and missed trip to europe. how i was well enough to fly to LA for the last couple days of my vacation. how i don't want to start the new IV medication they are putting me on.

she tells me how amazed she is at how much i've accomplished despite this sickness. how i managed to finish med school. how i'm finishing residency. i breathe out deep breaths of thankfulness as she says this. the stepping back to tell the whole story reminds me of how far i have come. the little losses of this past month seem small in comparison to all the huge graces that have carried me this far.

i once read about a jewish song, dayenu, that is apparently a part of Passover celebrations. the word roughly translates to me "it would have been enough for us." the song talks about how god led israel out of slavery, about the miracles god did for israel. at each point, it pauses to say "it would have been enough." if god had only given one of those gifts, it still would have been enough.  

as i told my story, the concept of dayenu kept running through my head.

if i only got the chance to live on red swazi earth for a year, it would have been enough.
if i only finished med school, it would have been enough.
if i only finished the first year of residency, it would have been enough.
if i only danced in a sari at my best friend's wedding in india, it would have been enough.
if i only had enough energy and love to get through today, it would have been enough.

the list goes on, a trail of goodness that fills the life that often feels like wilderness. i'll take the mix of good and bad: the trips to india where i pack both saris and pillboxes. the southern california sun that came after a canceled trip to europe. days in a hospital bed surrounded by amazing friends and cafeteria milkshakes. 

it is enough.

 

 

refuse to fall down

"Refuse to fall down.
If you cannot refuse to fall down,
refuse to stay down.
If you cannot refuse to stay down
lift your heart toward heaven
and like a hungry beggar,
ask that it be filled,
and it will be filled.
You may be pushed down.
You may be kept from rising.
But no one can keep you from lifting
your heart toward heaven — only you.

It is in the middle of misery that
so much becomes clear.
The one who says nothing good came of this,
is not yet listening."

a prayer - clarissa pinkola

hope without healing

honored to be here today:

I first read about Swaziland when I was eight. I learned a few key facts: Swaziland is surrounded by South Africa (I know you were wondering where it was), it is ruled by a king, and there are no lions there... (keep reading)

learning to breathe

"Let us not underestimate how hard it is to be compassionate.

Compassion is hard because it requires the inner disposition
 to go with others to the place where they are weak,
vulnerable, lonely, and broken." - Henri Nouwen

there is a tibetian practice, called tonglen apparently. a way to face the suffering around you, the darkness in this world. it is simple - when you encounter the suffering of another, you take a deep breath: breathe in suffering, breathe out compassion.

mostly, i don't do this. instead i rush from room to room, prying into people's places of pain, poking the areas that hurt the most, then leaving them alone again. mostly, i'm simply trying to survive myself. i can't handle thinking that hard about the suffering of those around me. but sometimes, there are moments where i pause. where i breathe and offer grace.

sixteen, overdosed on her mom's pills. a mix of pain meds and tranquilizers, she slips in and out of consciousness. everytime we bring her back she wakes up screaming curses and begging for cigarettes. there is sadness, for the life she's given up on. i breathe in her sorrow, and it touches my sixteen year-old self that also ached to find reasons for hope. i breathe out compassion: may she find a reason to live.

five months pregnant, found unconscious. cocaine and methadone running through her blood. a tiny heart flickers on the ultrasound screen. deep breath in, a prayer exhaled out: may this baby be whole.

a birthday celebrated in the hospital, a strange milestone in her 250 day hospital stay. i leave a cupcake on her bedside table that i know she won't eat. i inhale the futility that hangs in her room, the futulity of the machines and medicines that sustain her but cannot offer healing. i breath out an aching cry: may her suffering end quickly, and may she have happiness until then.

back for the third time, now with a breathing tube in his throat. two months ago, his predicted mortality was 100%, yet he still fights. i talk with his wife in the waiting room, telling her if she didn't call when she did, he wouldn't have survived. she bursts into tears in my arms.i pull in air and her tears, and breathe out a prayer: may she not find herself a widow. may she continue to find strength.

and every day the stories keep coming, and i keep learning to breathe.

telling hope stories

it is difficult when an organization or non-profit or mission group enters a place of extreme need, to know where to begin.  so triaging occurs, attempting to reach the most broken places. the problem is sometimes gaping wounds remain untouched while attempting to salvage the most devastating injuries.  when i got to bulembu, swaziland, the gaping wound looked like this:

children, too young for school (or old enough for school but unable to pay school fees), would stay home while their parent worked.  there was no day care; even if there was, it was unlikely any parent living on US$60 a month could afford it. and so once a child was too heavy to be carried on her mother's back during work, the child would be left home, under the care of older (meaning age 5-6) children.  a pot of room-temperature cornmeal mush would be left for lunch. 



it was painful to pass these children. to know the work i was doing with children orphaned by hiv was important and necessary, but to still pass these hungry, left-alone children with scabies under their skin who were fortunate enough to still have a parent.  my housemate and i could not keep doing nothing.  we knew the organization did not have the capacity at that time to establish any long-term solution. but we knew we couldn't keep walking past, doing nothing. so on saturday afternoons, we toted tins of grapefruit and a dysfunctional can opener into their neighborhood and would play with these kids:

we were a band-aid (if that). a desperate attempt to do something, to not close our eyes to what was happening around us.  we were limited.  we cried and we prayed and we hoped that someday things would be different for these kids.  an answer to those prayers came shortly after i left swaziland: a woman from the uk came to bulembu to set up a care center for those very children that had evoked my tears and worry and food and prayers for so many months:

it is called enduduzweni, which means "place of comfort."



my friend zandi works there now. the care center has grown over the past 5 years, and it now expanding to include baby care.  i am told that zandi does an amazing job, that she has a gift for working with children. i knew that though.

this story is incomplete. it is only a small part of the story, limited by distance, detached from the daily struggles of those who now carry these children.  i am not trying to romanticize what is chronically an uphill battle.  i cannot speak to the gaping wounds that still exist that break the hearts of those who are there now.  

i know that love poured out during the day doesn't negate neglect at night. that tummies filled at lunch time may not be filled again until the next morning. that moms who build loving families and still get hiv from dads who work in the big cities. that summer floods wash away roads and houses and crops and threaten a precarious economy.

but it is still a story of hope. of tummies now filled during lunch that would have otherwise been hungry.  of kids left alone on doorsteps while their moms work now with safe places to play and learn and be cared for. of people choosing to offer love despite struggle and suffering and cost. i know what was, and what is now. and it gives me hope.  
i know that the story of these children is not over. the story of edudzuweni is not over.  the story of swaziland is not over. and so again, still, we wait for hope to come true.

"for there is still a vision for the appointed time;
it speaks of the end, and does not lie.
if it seems to tarry, wait for it;

it will surely come, it will not delay." - habbakuk 2:3

(ps - if you want to give to enduduzweni, click here. it costs US$150 a day to run the center - which feeds 100 children, pays the salaries of 8 caregivers and cooks, and assists vulnerable children with medical care and school fees.)

one of those days

"i think part of the struggle just of everyday life is

remembering that the love is there...to wake up in
the morning and realize that love is there in the world -

if i can do that, that's half the battle." - kathleen norris

i was grumpy. and exhausted. and sick.  and i had an out. 

but i was also stubborn and trying to prove i wasn't that weak, and i said i would go see patients in clinic that afternoon anyway.  then take a sick day tomorrow. 

i regretted that decision as soon as i walked into the building.  it hit me how very tired i was. how i could be home napping instead. but it was too late now.  oh well.

the first chart i grabbed wasn't that heavy. i figured it would be an easy patient. until i realized that this was chart volume 2.  i scanned the face sheet: hiv. bone disease causing 2 hip fractures. cancer. depression. chronic pain. neuropathy. 

as i was heading down the hall, the nurse practitioner gave me a heads up: he just got a new electric wheelchair. and he cut his hair.

i walked in the room, expecting someone grumpy and bitter and sick.  instead, he was smiling. 

how are you, i asked. honestly, i think this is the best i have been in my life, he said. 

how is the pain? it's there. but i have this new wheelchair and it's totally opened up the world for me. i can go places now, i don't have to sit in my apartment. i may try to take a computer class at the senior center soon. they offer them sometimes.    

i hear you cut your hair?  yeah, i donated it to locks of love. i wanted to give back. i smiled inside, wondering what kind of wig would be made from middle-age, graying, ex-hippie hair.

the attending physician came in. we talked some more, sorted out some medicines, set up follow-up visits.  at the end, the attending prayed with him: god, we thank you for the blessings you have brought in this man's life, for his health, for your grace.

i cringed inside.  blessing? very little of his story felt like blessing.  but he took those small moments - leaving his house without the pain of walking and giving away his hair - as gifts.  and i was humbled...because i know there is sickness in my body too. there are limits and exhaustion and fevers and feeling like i am missing out on life and worry that these little symptoms now could be harbingers of a coming disaster. but there are moments of grace too - people that notice when i need a day off, sunflowers blooming on my walk home, sisters who don't care if you use their popcorn maker, dinners with friends, and patients who remind me to name the good in my life.

on healing

do you think god will heal anyone who asks and has faith? my sister asks me. 

me, who witnesses sickness every day in the lives of my patients.
me, who lived in the nation with the highest hiv rate in the world, who buried friends before they reached age thirty because they were born in the wrong place as the wrong gender.
me, who carries sickness in my body every day. 

if the answer to her question is no, then why pray?

and if the answer is yes, then where have my prayers for healing gone? why do my swazi friends still fight HIV despite their prayers (and lives) of faith?  why does my body still feel like it's breaking even though i have lit candles and cried out, "how long, o lord?"

i don't have an answer for her question. i only have a story, one i re-tell myself in the moments i feel faint:

i met jabu shortly after i arrived in swaziland.  her name means "happiness" and that is what she was.  she got sick quickly though as HIV spread through her body.  she shuffled slowly down the hill as if every step took all that she had.  she seemed to get smaller every day.  soon, she just stayed home. 

i stopped by to visit jabu one afternoon, like usual.  only this time, she was barely moving, barely opening her eyes. her mom stood fanning her, trying to move the heavy african air across her feverish body.  we lifted her into the car and sped across the 30km of curving dirt roads to the nearest hospital.  by the time we got there, she wasn't opening her eyes at all.  her blood pressure was unreadable on the archaic cuff they used to measure it, barely palpable.  the doctor looked at us sadly: we have no beds left. and there is nothing we can do anyway. 

 we begged for them to keep her, knonwing if we took her home, she would surely die.  knowing too that if she stayed, she would still likely die.  the doctor finally caved, offering the floor under the bed of another patient.  we left her that night, her tiny body on the floor under the bed of another dying woman.  chickens walked past her spot on the floor.  a meager bag of IV fluids hung - the only attempt at treatment offered for her. 

the next morning she could open her eyes, and was discharged to home.  miraculously, over the coming weeks, jabu regained strength and life. 
we were sitting on her bed one afternoon, laughing and talking. i asked her what happened that day when we thought she would die.  she answered: i was lying there, and i was flat. i couldn't open my eyes, couldn't speak. but in my heart, i prayed "lord, extend my days." and he did.  i will never forget what the lord has done for me.  

she never forgot. she never stopped praising. one month later, jabu went to be with the one who had heard her prayer and extended her days. i'm pretty sure she's still singing her praise.

life opening

"for there is hope for a tree,
if it be cut down, that it will sprout again,
and that its shoots will not cease.
though it grow old in the earth
and its stump die in the soil,
yet at the scent of water it will bud
and put out branches like a young plant."
- Job 14:7-9

it started as a couple sticks protruding through the frozen earth.  so unimpressive that i didn't think to photograph it.  so bland that i stuck a hideous pink flamingo lawn ornament into the soil beside it. 

i didn't notice it begin to open. its growth was shadowed by daffodils, irises, and lilies that bloomed around it. 

yet despite my oblivion, it came to life:

it buds.

and blooms.

until the flowers overflow.

and in my heart, i begin to look for those ignored places of life. the ones shadowed by other things. the places that look like dead branches in an unforgiving earth. and i hope and wait for the scent of water to come and bring life.  

naming the good

she dared me to name one thousand gifts.  and i tried. kinda. twenty photos of spring happening in the back yard.  seventy written in a notebook and tossed into the abyss of my purse. 

in a late (and likely delusional) conversation, i told a friend about this list that still sat in the bottom of my purse. what if we each blog about something good each week, she asked.  to maybe try to find good amid the chaos of our lives?

this is for those two lovely ladies:

i was greeted at the door by buzz lightyear.  cinderella came running down the hall, still adjusting her elbow-length satin gloves. their beautiful mother offered the hugest hug and ushered me inside.  buzz handed me a gift bag.  we got this for you, he said.   cinderella was on my lap before i landed on the couch.  i re-introduced myself to buzz; we last met when he was only weeks old.  i told cinderella how much she had grown.  buzz helped me unwrap the gift that cinderella had clearly helped pick out.  she may have been more excited about the candy-flavored lipgloss than i was. 

i have our night planned, their beautiful mother told me. we are celebrating. are you hungry?  the answer is always yes if you just de-planed.  

over dinner, we reminisced about our college days - the people who had touched our lives, our adventures, our friendship. 

we remembered the dark ages of our lives since then. unplanned pregnancy. broken relationships. chronic illness. 

and we celebrated. two beautiful children. jobs that bring life. completed education. triumphs over seeming disasters. resilence. hope. gratitude for our persistent friendship and for the faithfulness of god in our lives. 

things that give hope

i often imagine the worst for what happens to someone when they leave the hospital.  i wrongly assume the point where i meet them is part of an immutable broken path.  

16 year-old girl, second-time pregnant. rumors float that father of the baby is her father too. 

13 year-old boy, bullet-shattered shoulder blade.  step-mom comforts. birth-mom incarcerated.

45 year-old man, heroin-infected spine. discharged to homelessness and a "business meeting." 

i fill in the blanks of their futures along the trajectory of brokenness.  it's easy to do when you see others with similar pasts continuing to live in places of despair.


at covenant house i learned to imagine hope.  

i knew her from the children's hospital.  an infection left untreated too long.  we suspected abuse and neglect.  no family visited her.  i imagined single motherhood. minimum wage or welfare. domestic violence.  then i saw her at covenant house. a step toward hope.  safe housing. job hunting. educational support.  maybe a future of something other than the worst case scenario.  maybe a chance at life.

i knew him from the trauma bay. bullet in his arm; no major injuries.  i imagined another bullet would find him soon enough.  then i saw him at covenant house, struggling to begin a new life.

i don't know what happened after covenant house for either of them. i do know that because of their courage, i am able to imagine things other than destruction and downward trajectories when i see broken points in the lives of the people i care for.