4th of July

It was 4^th of July recently, and we were in Bismarck ND visiting Rachel’s family. With all the packing, moving, planning, discussion, and preparation for Africa on my mind, stopping to reflect on our nation, culture, and homeland felt very different this year. One phrase has really stuck with me since then:

“Thank God for the Freedoms we enjoy in this country!”

I have come to think that this is a dangerous idea, rooted in the Prosperity Gospel.

Don’t get me wrong, I love the USA and have truly been blessed here. But I decided to actually try to measure what my day to day ‘freedoms’ are, compared to Sierra Leone.  Assuming I can maintain the same wealth in West Africa, I’m not sure any of my practical freedoms would change. I could worship how I want, socialize how I want, travel how I want, think how I want, as well as eat, talk, evangelize, influence politics, buy all the same technology, watch the same Netflix, and really just live how I want.

‘But what about China?’ they say. Of course, you can find places the rule doesn’t fit. Comparing my life to North Korea is just unfair. But by and large, what people are thankful for on the 4^th is wealth. Wealth can be a blessing from God, but not always.

I think it’s important to really quantify what we are thankful for, rather than just comparing ourselves to the worst global situations. When the majority of actual freedoms are largely similar across the globe, wealth is what people notice. When comparing our situation to North Korea it’s easy to get complacent, but to look your homeless neighbor in the eye and discuss their ‘freedom’ is a whole other issue.

You say, ‘I am rich; I have acquired wealth and do not need a thing.’ But you do not realize that you are wretched, pitiful, poor, blind and naked.

Is this not the fast that I have chosen:
To loose the bonds of wickedness,
To undo the heavy burdens,
To let the oppressed go free,
And that you break every yoke?
Is it not to share your bread with the hungry,
And that you bring to your house the poor who are cast out;
When you see the naked, that you cover him,
And not hide yourself from your own flesh?

   Revelation 3:17

   Isaiah 58:6-7

Happy Independence Day

Lurking Emotions

I’ve had an emotion lurking for quite some time that has been hard to quantify. But I certainly know how it manifests. Every time, in the last few months, when the conversation gets close to the topic of Africa, Rachel and I try to divert the topic somewhere else. When we get cornered into it, we give a brief summary, leaving out that we’re committing 5 years. Usually that strategy works and most people then ask “what are you doing with the dog?”

Why are we having this reaction?

At first it seemed like we wanted to avoid the humble brag.

Then it felt like it was all people wanted to talk about and it was dominating our lives.

Now, at least for me, it’s morphed into something else much more emotional.

We’re in this weird place where all our hopes and dreams have come true: I’ve finished residency, we found great community and friends in Spokane, Rachel feels more actualized in her job than ever, we have an exciting future and all the church bureaucracy seems to be working in our favor currently. There should be nothing but excitement, right?

Yesterday morning at 4 AM, Rachel said goodbye to her sister Becca. There was crying, as expected, but it still somehow caught me off guard. The gravity of the situation started to weigh on me: Every interaction for the next 2 months is going to be complicated by the “sad goodbye.” We won’t know when, where, or how we will see any of these people again. The realities of growing apart, forgetting to write, and diverging paths are more and more apparent.

It has been very strange to be in transition for the last few months. All of our dreams and aspirations are nearer than ever, but I also feel compelled to look back at all the things we love and have to leave. We stand to gain so much, but the loss is much more present and palpable.

Today we started mission institute at Andrews, surrounded by experienced and seasoned missionaries. We are clearly the amateurs in the group, since we haven’t been to our field yet. It is impressive how our peers really have different the questions and conversations. The struggles and conflict I experience are implicitly acknowledged and validated. It’s like peeking into our own future. We really are going to be different people in a few short years.

Packing

Wow, wow, wow. Predicting the future is hard.

We are packing right now and it's a struggle. Every item we pick up requires us to peer into the future to decide how useful it will be in a variety of settings. For example, our boxes have a duct tape color coding system that indicates the fate of each box. We have 5 colors:
- Purple: These boxes are going to be shipped to my parent's house in TN, to permanently stay in storage till we get back from Sierra Leone.
- Yellow: Shipped to TN, opened and used in TN (while we live there for a month), then subsequently shipped to Africa.
- Green: Shipped straight to Africa. But these boxes are sent by ship, and will arrive 2-6 months after we arrive. Each of these boxes needs the following data compiled in an excel sheet: 1) Replacement cost for the whole box, for insurance purposes. 2) Every item worth >$100 needs a specific line with Make, Model, Serial number, and replacement cost. 3) Resale value for all the items in the box, for customs purposes.
- Pink: This stuff goes to TN, then is packed into suitcases to be flown to Sierra Leone. We have to bring enough suitcases to live out of for 2-6 months, before our shipping container arrives: Air mattress, Sheets, Towels, Clothes, Pots, Pans, Spices, Cutlery, Toiletries, etc. I've heard it's not unreasonable to check 12 suitcases.
- Unlabeled: After leaving Spokane on the 30th, we are living out of our suitcases for the next 4 weeks. So everything else goes into the car: clothes, laptop, dog and dog food, and most importantly bonsai trees!

Every evening I come home and Rachel is physically and emotionally exhausted. The deluge of decisions is overwhelming. She is selling stuff, packing stuff, cleaning stuff, even buying stuff that we'll need in Africa. Marie Kondo has helped some, but we're way beyond "bringing joy" at this point.

Actually, I've been thinking a lot recently about the psychology of hoarders. It's normal to people to identify with their stuff; kids segregate by clothes, people identify by their houses and neighborhoods, men over-compensate with trucks and cars. Our stuff is a part of us. This is normal.
Hoarders just have a much stronger connection with their stuff. They are their stuff. To lose it is physically painful. A human body can become dilapidated, obese, and worn down and its still identified as 'self.' So even a house filled with junk covered in mildew and mouse poop can still be part of your personhood.

Combined with the loss of leaving jobs and colleagues we loved, a beautiful city filled with wonderful things to do, a church community, dear friends, and soon the comforts of the western world, we are also having to deal with a loss of our stuff. It's difficult to articulate, but it's hard to leave Spokane for many many reasons.
But right now, I'm going to blame our stuff for making things so difficult.

Precariousness

There is a yearly essay contest in Spokane with the topic of "being a physician." Insomnia is rare for me, but it struck a few weeks ago and the backbone of this essay was the result. I just submitted the essay today, so I have no idea if it's a 'winner' or not. But I thought the ideas would also fit nicely here.

Precariousness

Being a physician grapples with the extremes of life: euphoric triumphs and crushing defeats, both joy and prolonged suffering, generosity and selfishness, birth and death. Practicing medicine can soften a soul to be more human and compassionate or harden someone to be jaded and disconnected.

Frankly, being a physician sucks.

You sacrifice your youth on the altar of medicine; I missed my wife’s graduation from her Masters program for a medical student surgical rotation.

A sense of inadequacy and imposter syndrome hangs over everything; my long time patient has one visit with another physician and they make an obvious and life altering diagnosis.

Societal and social pressures are awkward and embarrassing; I routinely try to hide my profession when meeting people for the first time.

Suffering becomes routine; I had to tell a 21 year old man that the mass in his neck he was ignoring was cancer.

Taking the blame for suffering is something you volunteer for; ‘Why would I ever let you vaccinate my child? Do you just want to give them autism?’

Helplessness is a constant companion; pregnant women return to their substance abuse and the men who give them orbital fractures.

Randomness is your worst enemy; I was the one who discovered an unborn baby, dead at term, when only 3 days ago it was alive when Mom decided to delay an elective induction.

Normal life is ripped from you by a sense of professional obligation; I had to meet my next door neighbors for the first time in the ER, then watch as their mother’s mucous membranes sloughed off and she died leaving a broken and dysfunctional family.

Dude, being a doctor is awesome!

People trust you enough to share their most subtle achievements; my patient just cut back from smoking a cigarette every 30 minutes to every 45 minutes!

New life dawning on the world is something you can participate in; I have the fortune of facilitating the making of a perfect family even more whole.

Physical and emotional suffering are treatable; my palliative care patient physically relaxes once the pain is adequately treated which literally changes the trajectory of an entire family rocked by grief and loss.

The brightest minds around collaborate on the toughest problems; I am routinely both challenged and educated by my peers, on both medicine, social, and personal issues.

Watching children grow is like absolutely nothing else; delivering a child and then caring for them over years is having the honor of joining in on the molding of a new spirit.

Passing on a legacy of compassion to the future is a humbling responsibility; fostering the bright spark in a medical student’s heart and teaching them how to protect that in a broken system may be the biggest impact I ever make.

When the oppressed rise above their circumstances, you are there to give a hand; my OB patient had nothing, no support from family or the father, she was addicted to drugs, and by sheer force of will she built the best circumstances this child could hope for.

A pedestal to fight for justice is easy to find; the societal clout afforded physicians gives us the opportunity to correct injustice for both our own patients and in the systems affecting our communities.

Donning the white coat, you are exposed to and shaped by the worst in yourself and others. But implicit with the honor of caring for others is the potential to witness and share in love, sacrifice, joy, victory over impossible situations, and all the best that humanity has to offer.

Broadcasting Suffering

Usually Rachel and I have pretty light and fluffy conversation at home. For example, this week we spent some time reading the Haystack (food) Wiki article. It's a pretty great article. Last week we talking about all the destruction and heartbreak that war causes. We asked ourselves, why is war so effective? What makes war work?

The answer that I settled on, for now, is that war has a way of magnifying suffering. Initially wars start over an incident that causes pain of some kind. That suffering spreads to spouses, children, parents, communities, eventually to the whole nation. It only stops when the collective suffering outweighs the cost of continuing to fight.

I think something similar is utilized in fundraising for charitable causes. Charities generate significant media that showcases human suffering. And it works. Once people can experience a part of that suffering, in a small way, they are willing to let their pocketbook suffer in a small way. For example, while we were in Sierra Leone there was a girl, likely <10 years old, with a 6" pedunculated mass growing out the front of her neck. (Picture at the bottom if you're interested in gross stuff) Unfortunately, children embody both the best and worst of humanity, she was mercilessly teased by her peers. Because the news outlets got wind of the story, people and organizations were literally queuing up at the hospital door to cover the expenses of her medical treatment. Because the Waterloo Hospital doesn't have pathology (none in Sierra Leone), intubation equipment, anesthesia machines, or an anesthetist on staff, the excellent surgeon Dr. Kabba couldn't get to the root of the mass or determine what it was. But because the community learned about her suffering, they were able to take action.

My point is, the expansion of suffering past its initial confines isn't necessarily a bad thing. In fact, I'll argue that it's necessary. Christ routinely entered into people's lives at the place of their suffering and I believe it's something that we're called to do as well. It's a humbling thing, to sign up for suffering. Since my conversation with Rachel, I've started to look for suffering. Often there are people in our lives who are silently struggling. Sharing that load and finding support for those people seems like our Christian duty.

It also makes me think about the future of this blog. It will be a platform (or outlet) for the suffering we experience and engage with, both stateside and in Sierra Leone. I anticipate that I will struggle with how best to share both suffering and triumphs to help people participate in God's work all over the world.