someday

usually, it's part of my routine:
pouring pills into my mouth every day and quickly chugging water.
having needles stuck in my arms each month so my doctors can monitor blood counts and organ function.
sitting in waiting rooms and sterile offices until the doctor comes so i can beg her to let me take fewer pills.
usually, it's all okay, and these things are inconveniences, but life moves on.

then sometimes, the routine gets shaken:
despite the medications, my body drags and aches and little things like Garmin telling me she's "recalculating" causes me to burst into tears.
blood tests come back with values that are no longer normal.
i sit in more waiting rooms, but instead of begging for fewer pills, i beg to feel well.

sometimes, the thought of more invasive testing leaves me sobbing, even though i've ordered the same invasive test on a hundred of my own patients and promised them they would be okay.
sometimes, i shudder at the memory of coughing up blood for days after my last bronchoscopy and swear that despite my doctor's recommendations, no one is putting another camera in my mouth. 
sometimes, i just don't want to do this anymore.

and someday, i hope things will be okay. 
that my body won't feel like its breaking.
that there won't be tests i'm avoiding. 
that there won't be infusions to schedule. 
that my soul won't be weary of the pills and the bloodwork and uncertainty. 
that i'll recognize the privilege in all this - that i can opt out of testing and treatment, when my swazi friend has been waiting months for a CT scan.
that i'll see that maybe, somehow, this is grace.

pray with me. please.

"no matter how wide you stretch your fingers, your hands will
always be too small to catch all the pain you want to heal."
- sarah kay, "if i should have a daughter"

over and over i'm reminded of how powerless i am across an ocean.

for months we were inseparable, wandering the hills of a near-abandoned town that previously thrived from its now-closed absestos mine. she taught me to quickly drink a can of coke after eating bad meat so the acid will hopefully kill any bacteria (i don't know if this actually worked). she built a fire to keep me warm when fever and chills left my teeth chattering and body shaking. she fed me swazi comfort food as i recovered from a crazy parasite (fyi - soured milked poured over maize meal is not a comfort if you are not swazi). she sat next to me during my first swazi funeral, translating all that was happening despite her own need to grieve. she dragged me over a mountain so we could play in a beautiful hidden waterfall. she brought me fresh donuts from the bread truck on my last morning in swaziland. 

now her places of need grow larger by the day:

...it's a bad headache. they say i am lacking blood...
...i'm losing my job, we are shutting down...

...i made it to the hospital in the capital but it was not easy to walk there. there is a blood clot in my leg. the doctors put me on a medicine called coumadin. i need a c.t. scan but it is very expensive. praise god it was not a stroke...

...the people of this town, they have no mercies for me. they want rent for the house while i have no work and am sick... 

...i trust god won't test me with something i cannot handle... 

my heart breaks over again with every message. i spread open my hands trying to catch her pain. i send out frantic emails until i find an expat who i can send money to that can get it to her. i cry out prayers and tears and beg for her to be healed. i message words of love and put airmail stamps on hallmark cards but her pain deepens.

and so...can you pray with me for zandi? for healing. for a job. for hope. for her amazing faith to continue to strengthen her. and as always, for hiv to end. soon.

intern year, end. second year, begin.

during our intern orientation last june, one of the chief residents said, "if this year isn't the worst year of your life, you've had a pretty horrible life." this past year was definitely not the worst year of my life (and i have not had a horrible life). this past year was hard, but i've had harder. this past year was hard, but there was grace.

there are things that have been difficult: a three-day hospitalization for pneumonia. turning down a residency position at hopkins because something in my heart told me i need to be here in pittsburgh for now. keeping people alive who should have been allowed to die in peace. letting people die who i wished could have lived.  

but there are also things that have been beautiful: finding out i really like seeing patients. being healthy enough to see patients. only needing to take five sick days all year (compare with at least thirty the year prior). giant chocolate chip cookies from the hospital cafeteria. being able to meet my parents for dinner after living away the past nine years.  making new friends. escaping to mexico and the pacific northwest with old friends. finding i am stronger than i imagined.  

so i take a deep breath in and let a new year begin. 

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)

what death looks like here

"Public health is the art and science of deciding who dies,

when, and with what degree of misery." - Bill Bicknell

Swaziland, December 2005
she'd been sick for a while, sent home from the government hospital because they had nothing left to offer her. HIV and t.b. combined forces to drain the life from her body. she spent her final days at her homestead, with her momma, sister, and baby boy at her side. her last night on earth was spent singing and praying. she offered up prayers of forgiveness - for the one who gave her the virus that took her life and the life of their firstborn child. my friend tells me she was at peace and that was why she could die that day. she was 27.

United States, May 2011
he'd been sick for a while. cancer and age and recurrent infections numbered his days. he spent his final days at a long-term care facility, his life sustained by machines. his heart stopped on three occasion during his last night on earth. two of those times it was forced to beat again with the help of electricity and chest compressions and chemicals pumped into his veins; ultimately, his 80-year-old heart refused to beat any longer. 

one of these deaths was inevitable. one was preventable. one called on every bit of science and technology available; the other called out to the heavens. one was alone in an ICU bed, with doctors violently attempting to bring him back to life. the other was surrounded by friends and filled with peace and acceptance. 

i know that you can't put a cost on a human life. i know we don't get to decide who lives and who dies. but i struggle with how we can spend millions of dollars to extend a life by months while not spending the hundreds of dollars that would extend a life for decades. i hate how being born on the wrong side of the equator with the wrong color skin means your life might be thirty years too short. i hate the days i go to work and order tests and medicines that will only sustain a person with a terminal condition for a few extra days. i hate that my inbox fills with messages from swazi friends who can't get to doctors or can't afford medicines for things that are treatable. i hate living between these two worlds, of seeing the injustice and disparity. i hate the powerlessness - both in futily treating terminal conditions in order to honor a patient's wishes and in being unable to treat curable conditions in those without choices or options.

why i hate missions, part 2

again, a message in my inbox from swaziland. i'm losing my job at the end of may. we are shutting down.

it's a care center for children that she is talking about. a place that feeds 100 children each day, that employs 8 swazi women (including my friend), that helps vulnerable children with medical care and school fees.

the one who created the center is leaving swaziland. i don't know the reasons behind this decision, but i'm sure it was difficult. it's always painful to leave a place that has become your home. it's excruciating when you worry the ones you leave behind may go hungry or get sick or die in your absence. she is facing challenges. it was not yet time to leave, my friend tells me.  

my friend has told this story of missionaries fighting before. the story of people coming with promises of hope and healing and living partway into those promises - only to get entangled in disagreements with each other and governing boards about theology or funding or how missions should be done. then leaving.

this cycle is wrong. to come in the name of jesus. to do beautiful things. to leave in the name of jesus, re-creating chasms of need.

is it better to not go at all?

for five years now, the kids that i knew as they sat outside their homes all day while their moms worked have had safe places to place and food to eat and medical attention.  the worms in their bellies have been treated. their bodies have grown. their minds have developed. would it have been better for them to have remained on their stoops for those years? i'm pretty sure the answer is no. but to meet a need and to create a community that depends on that need being met - then no longer being there with no option for sustainabilty? that seems like the wrong answer as well. 

and i ache for the one who has created this beautiful thing and now is leaving it. i ache for my friend who again must look for work to support her and her family as she fights her own battle with illness. i ache for the kids whose bellies may sit empty. and i wait for the day when there is no more hunger.

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.