Beautiful inconvenience

I planned to go hiking today. 

Truth is I kind of planned... 

I knew I wanted to hike  and I knew where I want to hike 

Everything in between was a matter of following directions

I had play by play steps. Turn here. This many miles to destination. 

When I got to there, i really wasn’t where I had planned to go

A nice lady at the park office gave me a map showing I was 2 hrs from my initial destination...

So instead I hiked where I was. I took in the scenery. And I found a beautiful alternative to my plans 

As I journey through this place I did not plan to be 

I struggle with the disappointment of being here

But I’m also learning to find beauty in my wilderness 

And to trust that inconvenience too has it’s purpose

Life Itself (just a little further)

It pushes me to the limit 

Sometimes it brings me to my knees  

It is at times unspeakable 

It can be unbearable 

It is unfair 

It is sad

It overwhelms

It makes me distraught 

If offends 

At any moment

Life itself surprises me

It asks me to push just a little harder 

It demands that I get up 

It allows me to cry instead of speak 

It says endure, one more time

It reminds me justice will come

It binds up sorrow with support 

It sometimes is underwhelming

It often requires focus 

It flashes sweetness in little moments

Living, breathing, being...

Life itself means I need to go just a little further 

Someday...

Going through a thing...

So I have been going through a thing for the last year
Actually, in reality, it’s been for the last six years
Its an epic thing
Extremely life altering
The last two years it has hit a climactic point
And the fall through is ongoing...

I don’t talk about it much
First I have become/am not much of a sharer
But more importantly, and this is what I truly believe,
It takes time for a person to feel safe enough to start to share anything with anyone
Sharing means giving away a part of yourself
And you can never get it back
What people do with it is up to them, not you
And that to me is scary...

So here are some thoughts...

It is a privilege to receive a part of someone’s story
Not everyone is worthy
Yes, eventually, word gets out
Controlled or uncontrolled
People, the masses, will know
But the process of getting to full exposure, as with every other process, takes time
And at the end of the day,
It’s not about you, the receiver...
All you can do is wait for the the sharer’s truth to be spoken
Believe their truth or not, that’s your decision
But be responsible with the privilege you have been given
It may never again be repeated...

My first mortality...

We have been warned many times to never write about work on public internet spaces like facebook and blogs. That's why I stopped writing about my tales of Residency. But I realize, I am one who likes to share life with others... my experiences, my failures, even my embarassment. So I will write and try to maintain HIPAA in my tale. I write today about an event that happened over 6months ago but still haunts me. I write the tale of witnessing the last breath a particular human being, a child, took before he met his maker. I write to tell of how poorly we as medical people deal with death and dying. I write with hope that this event will continue to leave its mark on me. He was 10years old and fairly sick. He had other medical problems, part of which complicated his care. There was very little we could have done to save him. It happened so quickly. I remember the nurse telling me she was concerned about his heart rate. I remember he had fever at the same time. I remember when I went to check him he complained his stomach hurt and he was thirsty. His abdomen looked much bigger than it was when myself and my Senior had checked him 3 hours prior. His mother told us then he hadn't passed stool in a few days but she didn't want him to get any help, "let's give him one more day." So I focused on his belly pain and talked with the Senior about getting an xray to be show his piping looked ok. I had the senior come check his abdomen. And then he started to complain that he couldn't breathe but his oxygen saturation was fine and it sounded like he was moving air ok in his lungs. We decided to get a chest xray as well. Just as I was about to step out of the room and order the xray, he took a big gasp of air and then stopped. He stopped everything. We never got him back. There are so many questions I have asked myself over the las few months... Should we have started antibiotics at the first sign of fever? Should we have given him more fluids? Should he not have been on as much pain medicine as he was? Regardless, you can't stop a fat embolism from happening. You can only give supportive care when it does happen. And hope it is not massive enough to cause an abrupt decline in health status. His mother ok'ed the autopsy that confirmed cause of death. It gave us all a little respite. He will be remembered always. And because of him, I am even more diligent with the patients under my care.

A Call for Intercessors

For every mountain...

Regaining our balance

Sometimes life is like that. Something unexpected upsets our routine, and we are knocked off-balance... In each case, our emotional equilibrium is hammered, and we feel as if we can’t stand. Those moments should cause us to turn to God. When we feel we are losing our balance, He can help. He provides spiritual resources to help us stand.

We can endure anything if we depend on God for everything.

-- Bill Crowder

ODB

pictures from My white water rafting experience in Interlacken, Switzerland 2006

I recently had an emotional equilibrium disturbing experience at work in which circumstances were blown out of proportion. 

It was shocking to see the ripple effect but also unsettling to me and my relationship with the person who innocently started things in motion. 

I struggled with how to respond and before I even had a chance to speak, 

God in his infinite mercy provided the balm I needed to ease the situation over. 

He is an ever present help in time of trouble. 

I love you Baba. 

Increase my love for you. 

Amen. 

God Does Not Despise My Weakness

Tales of a First Year Resident: half way through intern year

So here I stand at the doorway of the mid point of intern year. 

I have two conclusions thus far. First, the hospital is not a benign place. One of two things happen in a hospital setting; you get better or you get worse. The improvement in health status can be simply because the disease course is one that improves with time and without medical intervention. Or, some intervention in the hospital worked. The same theory holds when health status worsens. It could simply be that the disease course is such that the condition worsens before it improves, it worsens permanently until death occurs, or it worsens because of some iatrogenic cause ie we in the hospital made it worse. I have not witnessed a Pediatric death yet and I am grateful but I know it is inevitable to be a doctor and not encounter the death of a patient. 


My second conclusion is that God's grace, strength and favour have carried me through. I can honestly say the hard days are days when I am not plugged in to the holy spirit and I am working from within myself. As a Christian that is not my design or purpose. Residency is teaching me how limited I am when I work from within and as if unto myself. Thank God for his infinite grace. 

I recall my toughest day at work. It was a night shift. I admitted 11 patients that night, only 2 of whom needed to be under inpatient care. The other 9 were what I call 'ER care admissions.' That means they really need ER management but the ER is too full or too busy to give the patient the time to improve under watchful waiting and so the patient gets shunted to the inpatient unit where we then do the job that should have been done in the ER. Was it hard to admit 11 patients? Yes, but that is not what made my night so tough. It was the frustration with the ER and my overwhelming need for restraint in order not to shake the parents and say to them 'you idiot! you are harming your child more by allowing them to be admitted to the hospital.' Yes, the memory reeks of not being plugged in.  


So half way through intern year do I have any regrets? Not really. I wish I had more time off. I wish residency was not so consuming. And I wish I could get more sleep. I love sleep!!! 


I am where I am meant to be and I am at peace with that. Thank God for for his infinite mercy. 

Between The Years

I stand between the years. The light of My Presence is flung across the year to come--the radiance of the Sun of Righteousness. Backward, over the past year, is My Shadow thrown, hiding trouble and sorrow and disappointment. 

Dwell not on the past--only on the present. Only use the past as the trees use My Sunlight to absorb it, to make from it in after days the warming fire-rays. So store only the blessings from Me, the Light of the World. Encourage yourselves by the thought of these. 

Bury every fear of the future, of poverty for those dear to you, of suffering, of loss. Bury all thought of unkindness and bitterness, all your dislikes, your resentments, your sense of failure, your disappointment in others and in yourselves, your gloom, your despondency, and let us leave them all, buried, and go forward to a new and risen life. 

Remember that you must not see as the world sees. I hold the year in My hands--in trust for you. But I shall guide you one day at a time. 

Leave the rest with Me. You must not anticipate the gift by fears or thoughts of the days ahead. 

And for each day I shall supply the wisdom and strength. 

--God Calling by Two Listeners

images from ijunagila flickr

A Psalm for Christmas Day

Jesus Christ

You accepted Father's plan

Left your throne not considering equality with God something to hold to

You knew in your heart its yours for all time

Made yourself nothing

You came to live with us,

Emmanuel

Incarnated as helpless babe

Your love so great

The only Son, you gave yourself

So all may believe and live with you

Father, Son, and Spirit,

for all eternity

And I too may say

Abba, Father

Jesus

You gave us true worship

For at your birth heaven's choir came down to sing

"Glory to God in the highest..."

Amazing love, o what sacrifice

The Son of God given for me

What child indeed! 

And as Simeon praised,

"Sovereign Lord, as you have promised...

a light for revelation to the Gentiles 

and for glory to your people Israel."

And man shall live forever more

because of Christmas day!

Timely...

I will not fail you. (Joshua 1:5) God will not let you down. He will not disappoint you, bring you halfway through, come up short, promise more than He can deliver, draw back, faint, be feeble, be slothful, be weak, or release His hold upon you.  I will not forget you. (Isaiah 49:15) God will not have a memory loss, lose interest in you, lose track of you, or lose sight of you. He will not be thinking about you one moment and forget about you the next. He will not lose track of you. He will not lead you somewhere and then forget where you are. He will always be paying attention, and He will never be oblivious to your needs or situation.  I will not lie to you. (Psalm 89:35) God will never make something up. He will not fool you or trick you in any way, at any time, or for any reason. He will never distort or deceive. He will never speak a false word in your ear, or whisper an uncaring word to your heart. He will never say anything that is “too good to be true.” I will not remember your sins. (Isaiah 43:25) God will never say to you that the blood of Jesus is not enough to wash away your sins. He will never tell you that you must do more, try harder, or wait longer in order to be forgiven. Once your sins are repented of and confessed, they are cast into the depths of the deepest sea and are no longer held against you. His forgiveness frees you from all condemnation, and keeps you from having a cloud of uncertainty hanging over your spirit.  [I will] not in any degree leave you helpless nor forsake nor let [you] down ( relax My hold on you)! (Hebrews 13:5 AMP) God will never say to you, “I’m sorry, I would like to help you, but I can’t.” You will never hear Him say, “I’m sorry, I would like to help you, but this is not a good time for me.” You will never hear Him say, “I’m sorry, I would like to help you, but you’ll have to wait your turn.” God will not fail you, so be confident; God will not forget you, so be assured; God will not lie to you, so be trusting; God will not remember your sins, so be free, cleansed, and forgiven; God will not forsake you, so be strong, bold, and fearless. God will be all these things to you and much, much more, so be courageous. --Meet Me In The Meadow

Turning

Jesus, Jesus, how I trust you. How i've proved you o'er and o'er. 

Jesus, Jesus, precious Jesus. O! for grace to trust you more...

And as I live life on the daily, the command this year is 

2 Tim 2:15 

"Do your best to present yourself to God as one approved, 

a workman who does not need to be ashamed 

and who correctly handles the word of truth."

Another year to live for Christ. 

A year in which I desire to hear audibly from God regarding his plan for my future. 

After all, Iju ngu agula (It is God who determines)

Another year in which I desire to make my Father's heart smile. 

Ps 37:4 -  A promise by the One who does not fail...

To the glory of your name Baba

It is your name at stake

Tales of a First Year Resident: When it hits close to home

Today i realized my parent's mortality and it hit hard. It hit me that what is actually going into my dad's mouth has the propensity to kill him and save his life, and it all depends on an equation tested on rats and now performed on humans which trials have shown should go according to plan. Well what happens when one of the constituents of the equation lags? It hit me as i counseled my mother about what she needs for bone health, that outside of God's own intervention, she would have been wheelchair bound and maybe we would never be having this conversation...


It's easy when you are a doctor in training to be focused on getting work done rather than enjoying the moments at work; to be focused on giving information rather than ensuring information is received; to pay attention to the check list of things to send patients home with, rather than involve myself with the change in their life with what I have given. But here I am, dealing with the medical knowledge as it applies to the people I love, and the only defence I have is to doctor it up in other not to cry...


On thanksgiving day today, I am thankful for the reminder that life is fleeting. I am thankful for the blessing to sit in the same room with my parents after 3 yrs, even if it means I get to be their doctor and daughter all it once. And I am thankful that God intervenes and doesn't wait for us to thank him only for that which we remember. I am thankful for you Lord. 

song to listen to

This is the latest song I've come across that speaks the words my heart 
is burning but unable to express as eloquently ...

All along I was looking for something else
You're something else
All along I was looking for something more
You're so much more

Reflections on love

For many, love is just a word,

A passing phase, a brief emotion;

But love that honors Christ our Lord

Responds to Him with deep devotion. 

—Hess

Love is a choice and it represents a commitment.

There's no doubt about it, attraction is uncontrollable and arousal is uncontrollable.

But attraction and arousal are not love.

They can lead to love, but they are not love.

Love is a choice.

-- Rick Warren, Purpose Driven Life Devotional

When Jesus was asked to name the greatest command in the Law, He replied, “You shall love the Lord your God with all your heart, with all your soul, and with all your mind. This is the first and great commandment” (Matt. 22:37-38). The questioner wanted to test Jesus, but the Lord answered him with the key element in pleasing God. First and foremost, our relationship with Him is a matter of the heart.

--David C. McCasland

When you're truly in love, you go to great lengths to be with the one you love. You'll drive for hours to be together, even if it's only for a short while. You don't mind staying up late to talk. Walking in the rain is romantic, not annoying. You'll willingly spend a small fortune on the one you're crazy about. When you are apart from each other, it's painful, even miserable. He or she is all you think about; you jump at any chance to be together.

--Francis Chan, Crazy Love

Love is not a place

To come and go as we please 

It's a house we enter in Then commit to never leave

--Warren Barfield

Is God in this situation?

Remember the dark and distressing situation of Jesus on the night of his betrayal... 
Even Christ pleaded for the cup to be taken from him (Matt 26:39).
However, he knew that the hand which would for our redemption hold the cup to his lips 
was not the hand of Judas or Caiaphas or Pilate. 
It was the hand of His loving Father intent on redeeming us.


We learn the lesson of trust in the school of trial.

(adapted from Our Daily Bread 2009, March 20th)

Tales of a First Year Medical Resident: Failure to thrive

'Failure to thrive' (FTT) has many definitions but it is essentially the inability of an infant or child, regardless of the cause, to gain sufficient weight to sustain growth.

I have an FTT infant on my service. He is literally skin and bones. He reminds me of the babies you see when world vision or some other NGO shows a video to raise funds for "the starving children in Africa." The only difference between my patient and these other children is he is dressed better. His weight and height are less than the 3rd percentile for his age. His head circumference is at the 75th percentile for his age. Babies heads are bigger than their bodies anyway, but this is a significant contrast.

His mom, his sole care provider, is what we call 'a difficult mother' mostly because every time the nurses feed the baby and he throws up she yells and when she feeds the baby and he throws up, she yells. She yells all the time. She is frustrated and upset with us because "we are not doing anything for my son." That in fact is untrue. Speaking of facts, let me mention a few.
Fact 1: The baby lost two pounds over a month at home, under his mother's care, became skin and bones, and it was not until he was referred to the ED by her baby's doctor that she brought him in for an intervention.
Fact 2: Since being with us (a total of 6 days) he has gained 0.34kg or 340g. Babies his age should gain 20g a day which would mean 120g in 6 days. He has actually gained much more than that, almost 3 times that amount which means something we are doing is working!!!!
Fact 3: We did some studies and found that he has significant reflux so we started him on medication and have thickened his feeds. He is still throwing up (mom told us he was doing this after every feed at home) but less so than he was at home (mother's own words).
Fact 4: I have repeatedly (almost daily) explained to mom the symptoms of reflux, and the goal of her son's hospital stay.

The baby's mother decided to have a 'yell at the doctor' session today. Who was the doctor? Your's truly. In fact she was yelling so loudly the nurse called security to ensure I was safe.

Her complaints: She's sick of being in the hospital with nothing being done for her baby. Nothing has changed he is still the same. She wants the specialist to come and take a look at him now because he threw up almost all of what he ate. She's transferring her baby to another hospital because we are not helping. We are blaming her for his weight loss.

Thankfully the baby's dad was there so I was able to speak to him and explain to him, like I had to mom every day for the last week, what we were doing, the improvement in his weight, the daily goal of caloric intake for his son, the symptoms of reflux, and why we were hesitant to jump to something more invasive when his son was indeed gaining weight. The last thing I explained to dad is that there are psychosocial elements to a baby's ability to thrive which my team and I had also spoken to mom about. If mom is depressed, anxious, unable to bond with her son, or has any medical conditions that prevent her from caring from her baby as she should, he will fail to thrive. Even the gastroenterologist had explained this to mom. We were not blaming her for his weight loss we were simply stating the facts and trying to counsel her about the effects on her baby.

Still mother wants to transfer her baby. What can I do? I am learning when to hand responsibility back to the parents/care-givers of each and every patient I have. So I explained to them it is important that the hospital they plan to go to calls us and let us know they would like to initiate the transfer before mom leaves the hospital with the baby. That way we can send over the appropriate documents. Otherwise if she walks out of the hospital she would be leaving the hospital against medical advice (AMA). Leaving the hospital AMA is never a good thing when there is evidence of improved health status of the patient in question. I have many question re: what happens in the home for my patient but my shift is over, I have taken work home with me once again and I need to get some studying done.

Until I return to work tomorrow if God wills it.

images from google images