manywaterscannotquench

[manywaterscannotquench]

the daily examen

So, this morning I started a new goal of doing a daily examen every day. I think, as we start to really let the reality of becoming parents sink in, that we want to be reflective and thoughtful beginning the process. So, part of that is looking for God in the everyday, and acknowledging where I find him, and where I missed his presence.

The 14th Sunday of Ordinary time, I heard this morning. Here we are, folks, buried in the thick of ordinary time. And yet, with everyday, a new beginning. A new light forms, a new possibility emerges. With everyday, the chance to find God afresh and anew.

We examine, in the face of new things. In the start of new days, of new trials, of huge immense blessings and gratitudes. We see this season of life, in all of its ordinary goodness, as something extraordinary, and we are grateful, and recognize the hand of the Lord in all that is good, because it comes from him.

A prayer for new beginnings that struck me today:

Help me to be a beginning to others, to be a singer to the songless, a storyteller to the aimless, a befriender of the friendless; to become a beginning of hope for the despairing, of assurance for the doubting, of reconciliation for the divided; to become a beginning of freedom for the oppressed, of comfort for the sorrowing, of friendship for the forgotten; to become a beginning of beauty for the forlorn, of sweetness for the soured, of gentleness for the angry, of wholeness for the broken, of peace for the frightened and violent of the earth.

Help me to believe in beginnings, to make a beginning, to be a beginning, so that I may not just grow old, but grow new each day of this wild, amazing life you call me to live with the passion of Jesus Christ.

Instructions on the Examen:

1. Become aware of God’s presence. 2. Review the day with gratitude. 3. Pay attention to your emotions. 4. Choose one feature of the day and pray from it. 5. Look toward tomorrow.

In hope, friends.

[manywaterscannotquench]

the Lord giveth

A lot has happened since I was last here. I think I was lost, perhaps, and also lost my login, and also lost my way. But I’m back, because being here is important. Because exploding my head out onto paper is important.

In the last 5 months, I have nearly finished 2nd year of residency, spent a month serving in rural Peru, started (and finished!) foster parent training, and done things like bought a stroller. A friend’s 19 year old ex-foster-son is sleeping on our couch tonight on the way to rehab tomorrow. We are becoming the people we want to be.

Today, in the cardiac ICU, I cared for a patient who eventually passed away in the late evening. I thought he was going to die in the morning; he briefly dropped his blood pressure, and I brought his wife in quickly to say goodbye. She kissed his face, and told him they had many good years together, and he was a great partner and a great friend, and to go on ahead of her, home to Jesus.

“I will find you” she said.

When he finally died, around 6pm, we pronounced him dead, and she looked up at us and said “the Lord giveth, and the Lord taketh away. Blessed be the name of the Lord.”

Amen.

[manywaterscannotquench]

I think I am broken

I don’t know where to start, so here feels as good as any place. I’m feeling lost. I feel that way all the time, which I hate, but more so right now.

I want to be friends with Josh. I want to be his best friend, who understands his needs and supports him and is excited about his goals. But instead, I often feel like I’m dumped on, his partner that he comes home to and unloads all of his baggage, taking advantage of the time to take a break for 20 minutes before he moves onto his next project. I inconvienence him, sometimes, asking him to do things, which upsets him. But I don’t feel like we are partners, right now. In fact, I did some cool stuff today -- and instead I feel that I’m keeping it from him, as a secret.

Where do I start with all of this, God? How do I find the courage to push back onto the path, to walk out of the forest?

Psalm 114, I think, talks about the offering of thanksgiving. I never understood that, it felt like a pretty crappy offering. But sometimes, when you are frustrated and alone (like now), it feels like a big ask to be thankful.

Lord, I offer you, painfully and reticently, my thankfulness. Would you take it unto yourself and find it pleasing? Would you multiply it, loaves and fishes-style?

[manywaterscannotquench]

if I have not love

There is a reason that there is a normal range for vital signs, and if you're going to ignore something outside of the normal range, you better have a good reason. Tonight I'm taking care of a woman with metastatic pancreatic cancer, who has had it for 2 years (?!) and lived, so far, and somewhat thrived -- is at least still working, still working out. But she's here with a dreaded end-stage complication, that of malignant small bowel obstruction. Her colon (that gross organ we never want to think about, until we remember that it's amazing and beautiful and perfect, and when it doesn't work, it is NONE of those things) is blocked by tumor, and her belly is 8 months' pregnant with tumor, and she has a tube in her nose to decompress her belly. And tonight, she's looking like she's starting to die, and I'm trying to stop it, but not entirely sure how. One of the biggest challenges of this job is that it's hard to know where to start when you need to learn, when you need to ask for help. Do you start with the gas? With the CXR? With the talking to your co-resident, or calling the fellow, or walking down to ask the MICU attending? Who is the person in house who has just a little bit more knowledge than you, and can make you feel comfortable thinking through a process? So I find myself in this unique position -- poking and sticking the arteries of a woman who essentially wants to be left alone, to be made comfortable, but who is telling me she wants to "keep fighting" without remembering that this is what keeping fighting looks like -- war is brutal, and exhausting, and bloody, and they never let you sleep. I'm sure soldiers in foxholes had q1 hour shelling, in the same way we do q1 hour vitals. I hope I'm reading enough. I hope I've thought about this in the right way. I hope I have enough explanations for everything I'm thinking and/or worried about. I hope she is doing okay. As Paul said, "if I have all knowledge and can fathom all mystery but have not love, I am no more than a resounding gong or a clanging symbol." And yet, probably because of that, when I hold the warm, thin wrist of this woman on my lap and stab it with a big needle, drawing out the warm, bright red blood of her artery -- I feel the incongruity of that statement. Please, let me have the knowledge I need, or know where to find it. Let me also have the love I desire, and know how to share it.

[manywaterscannotquench]

reflection on the election, part 1 of 2

Dear warrior women, creatures of great value and worth, vessels of light:

This has been a hard last two days. Oh, the upheaval – I left one floor (oncology) on Tuesday, full of hope and a sense of completion, the gift that is the knowledge that you’ve done all you can, that you tried your hardest. I left that floor, came home, and fell asleep in front of optimistic commentators: “And, only 48% of Florida has counted their votes, Wolf, so there’s still much more to come, the most urban counties aren’t included yet.”

I woke up Wednesday morning to a feeling women have had for generations; for my mother, it was when her brother’s draft number was pulled, and they fitted him for a starched green suit jacket. For my grandmother, when her mother held her tightly, age 9, and they listened to the radio declaring that Pearl Harbor had been bombed, and they were at war. For my great-grandmother, it was probably the same moment. And in a quick second, all of these women thudded deeply into my chest, all at the same time, and it knocked the wind out of me – fear, helplessness, and the reminder that a campaign of hope that brought us a president of respect (and even faith) was now over.

How can hope be over? Where do we go from here?

I imagine myself, staring at my son, the black plastic nametag surreal with my last name etched into it, pinned to his chest – the knowledge that I can do everything, say anything – and still the government pulls the strings—it leaves me breathless.

I cried for 20 minutes in bed Wednesday, at 5am. I cried because 24 hours later I had awoken with excitement, knowing it was voting day, knowing I could go to work wearing the “I voted” sticker and chastise the other residents to get out early, to go make their voice heard – because I was full of hope for a world in which a woman could be president, in which people could marry those they love, in which all people were welcomed to a melting pot country full of languages and colors and flavors and struggles and joys, in which paid maternity leave and subsidized child care were real possibilities, in which my patients could not be afraid they wouldn’t be able to pay for all of their medicines this month, in which Josh’s students would double (or triple!) as the college prep charter school model closed the achievement gap for students of color in America.

Some people voted out of fear of a world in which Trump would be president. I did not vote out of fear, I voted out of hope. And I was proud of that, proud to be a daughter raised by parents who taught her to have courage. Proud to have stood for my friends of color, friends who don't speak English, friends who are Muslin or LGBT or undocumented or women or have disabilities. Proud to have stood on the margins, where Jesus stands.

And so, Wednesday (and today, and quite possibly tomorrow) I cried, and I briefly lost faith. I lamented, I mourned, I shook (and shake even now) my fists at God and ask how this is possible, how he could turn away from his people, all of his people, the BELOVED community, those he loves. How could this man be president?

I don’t believe God did this, and yet, I read the psalms of lament and they speak the words of my heart:

“You gave us up to be devoured like sheep    and have scattered us among the nations.” 12 You sold your people for a pittance,    gaining nothing from their sale.

13 You have made us a reproach to our neighbors,    the scorn and derision of those around us. 14 You have made us a byword among the nations;    the peoples shake their heads at us.” –Psalm 44

My response so far (Wednesday and today) has been this: hide. I did not read the news, I could not check social media, I ran from the TV. When a coresident tried to bring up the election in a cavalier way, “So, I just can’t believe last night, right?” I shushed him. I just can’t, I couldn’t do it, I couldn’t speak so informally, without the weight and the burden and the heaviness I feel on my shoulders, without intimacy – without sitting together, huddled for warmth, arms on each others’ shoulders, and whispering toward the shared fire above which we warm our outstretched hands: “Where do we go from here?” (If there was any question which type of mother I would be, if I was a member of the generations of women who came before me, I seem to be demonstrating that I would pick up my kid under one arm and a Bible under the other (and hopefully some food) and run away, as fast and as far as I could).

Where do we go from here? Is it time, yet, to ask that question? Or do we start with lament, and hold here for a few days – hold in the deep darkness where we feel abandoned by God and by our fellow man, where we know that people have goodness and light inside of them because we SEE it, because it is all around us, because today my medical student smiled at my on rounds and told me “this is so amazing, medicine – it’s magical.” But maybe, before we figure out how to move forward into that light, we first hold in the lament of the now, using our brothers and sisters in Charleston as a guide – I hope to get to the space where I could, as they did, keep going to a Bible Study in a church where before me, my friends and neighbors were shot down for the color of their skin. To march ahead toward Selma when those in front of you are being mown down. To show up to work on the 2nd week of coming out as transgender, after it's no longer a novelty to others, and the hard work is still to come. I need to find more examples of those in my community (big and small) who lament, such that I can learn from them.

And I need you, sweet sisters, and we need each other – because we need to remember that there is light out there, but there is also time for mourning and weeping. There is time to cling to the promises of God, but also to understand those who came before us, who said:

“Wake, Lord! Why do you sleep?    Rouse yourself! Do not reject us forever. 24 Why do you hide your face    and forget our misery and oppression?

25 We are brought down to the dust;    our bodies cling to the ground. 26 Rise up and help us;    rescue us because of your unfailing love.” – Psalm 44

Friends, I need to hear you, because the din and noise of those who celebrate and those who are angry far drowns out the quiet silence where God lives. Help me find that, in this place. And hopefully, in a few days (or hours, or perhaps moments), he will lead us, as he always does, into the light of his presence.

A good friend reminded me of the verse in 1 Kings where we remember that God meets us after the dust has settled, after the tornado and the earthquake and the thunder – that he lives in the silence. And another friend, that we are a Saturday people – we do not live in the day of the resurrection, but instead, in that nebulous in-between period where it is dusk – we believe the sun will rise, and the day will break, but we are not sure. But there is new life coming, friends. I believe it, confidently, and that in the light of day God will teach us how to find him here, and how to have hope.

But for now, let us live into the silence.

He said, “Go out and stand on the mountain before the Lord, for the Lord is about to pass by.” Now there was a great wind, so strong that it was splitting mountains and breaking rocks in pieces before the Lord, but the Lord was not in the wind; and after the wind an earthquake, but the Lord was not in the earthquake; 12 and after the earthquake a fire, but the Lord was not in the fire; and after the fire a sound of sheer silence. 13 When Elijah heard it, he wrapped his face in his mantle and went out and stood at the entrance of the cave. Then there came a voice to him that said, “What are you doing here, Elijah?” -1 Kings 19

I love you.

[manywaterscannotquench]

Pick up your mat

I'm on nights, so as usual, I'm having some reflection time thinking about these big medical questions. We talked at HG this week about the John 5 passage, when Jesus encounters the man lying on his mat next to the well, and asks him, "do you want to get well?" I'm reflecting on this acutely because I still see this woman in my head from earlier this week, on whom we were consulted as dermatology. She's obese, >400lbs, and bed-bound essentially, with some of the worst lipodermatosclerosis I've ever seen (and I didn't even know what that was until 2 weeks ago). She gets superinfections with bacteria, and antibiotics, and gets better ... until she's back again. And on top of all of that, she isn't easy to deal with. And yet, we read this passage in small group, where Jesus turns to this man on the mat, likely dirty and smelly and unloveable, and he says: do you want to get well? And then the man does something so perfectly normal, I'm still thinking about it -- he gives a list of excuses. He says no, he says "hmm," he says "but what about how no one will help me?!" And Jesus says: "Get up!" And my translation has that exclamation point, so I don't even know that I'm exaggerating the drama of it. Get up! Pick up your mat! And so I look at this patient, and I think "do you want to get well?" How do you ask that? How do we make sure we don't NOT ask it, we don't assume the answer is yes (or, worse and even more common, assume it's "no") and that we give them the chance to provide an excuse -- and ourselves the chance to respond with an invitation. Pick up your mat. Take this body that you carry around with you, the legs with flaking skin falling off, the heavy heart, the cumbersome nature of all of it -- take it, pick up your mat, and get up to walk. I'm afraid I've forgotten to ask, for this woman. And I want to always ask. What is our mat? How do we walk? And how do we bring others alongside us in accepting this invitation from Jesus?

[manywaterscannotquench]

For who is God, but the Lord? And who is the Rock, but our God?

Psalm 18:32

[manywaterscannotquench]

a little unsteady

There’s a popular song right now that starts,

“Hold onto me, because I’m a little unsteady”

that’s how I’ve been feeling recently, more often than not. unsteady about Josh’s grad school, unsteady about our life and the way we spend our time, unsteady about wanting so many BIG things--fostering, leading a small group, being a good teacher, 3 different big research directions. Just unsteady.

And then I look back at my last journal entry, and I see this reminder that we are called to look for junipers in the wasteland, and I remember that this is not, in fact, the wasteland. This is the grace-filled land, the land where the dry bones live.

It’s weird, I can be so happy all day, feel so connected to my community and my work and my family, but then come home and feel instantly tired and defeated, since Josh and i had been so disconnected.

But! There was grace yesterday, and Josh met me in that place and let me be upset and told me I was doing a good job, and then I felt better.

I need to reconnect to God, and learn about prayer. Any book suggestions?

[manywaterscannotquench]

these, still, are the things I know for sure.

I think I come to my journal the way I come to my notes, the way I cosign my intern’s admission H&Ps, the way I summarize in my own assessments:

“The patient is an XX years old little boy, presenting with XYZ, and found to have ABC. This is concerning for a broad list of things, including 1, 2, 3, and 4, but is most consistent with 1 for these reasons.”

Aka: These are the things I know for sure.

It has been a hard week. A hard PICU week, a week of dying children, of coding them, of cracking ribs in small bodies, of blue hands and feet, of the bloat around the mouth that seems to be the hallmark of pulmonary edema. Today, for the first time, I felt myself having to tune it out, or I couldn’t finish rounds. Having to tune out the sobbing in my own head when I walked into the room and his mother was curled around his death body, sobbing into his curly two year old hair. Or, even worse, when I came in later and she was still lying there, just breathing in the smell of his hair, of the soft place of skin where his cheek meets his ear.

Of watching his father walk out with an empty carseat, and the deep pain of realizing how much hope he must have had for his 2 year old, found to be dying of metastatic cancer (previously unknown) when he brought that carseat into the hospital in the first place, believing he’d better not forget it, that he’d need it to get him home.

This has been a hard week.

“how does it feel to be recognized by so many black birds”

I’m not sure I know what to feel, completely. Not sure I know how to feel less attached, or more attached, or the right (or wrong) kind of attached. Not sure how upset I am, but sure it will surprise me, shock me later, when all of a sudden I remember that I live in a world where 2 year olds die, where cancer isn’t always caught early, where septic shock truly has a high mortality rate, where pulmonary hypertension doesn’t respond to pressors, or nitric oxide, or 100% oxygen, and you stand helpless watching the monitored beeps slow down, lines start to crawl, nail beds turn cyanotic.

And yet, as God says:

I, the Lord—with the first of them    and with the last—I am he.”

“I will set junipers in the wasteland,    the fir and the cypress together, so that people may see and know,    may consider and understand, that the hand of the Lord has done this,    that the Holy One of Israel has created it.“ - Isaiah 41

There are junipers in the wasteland, God reminds us. There are glimpses of his kingdom, that we would know he has done this. There are hugs, and debriefing sessions, and poetry, and there is the mortar of faith. There is the reminder, as always, that “love is what death would intend if it had the choice,” as John Stone reminds us.

It helps to believe. And I believe there is deep meaning and purpose in this, that there is a beautiful power and honor in shepherding people through death and dying, and that people will die, and we will not know why.

But I will look for the junipers in the wasteland.

[manywaterscannotquench]

I don’t really know what to say right now.

I’ve started 2nd year, PGY-2, and despite the fact that it seemed last year that this, finally being a senior (”!!”) would make me happy, it doesn’t. Not truly, anyway. There’s still complaining, and even though I feel more like “part of the crowd” that’s doing the complaining, I’m not sure that’s what I want to be known for, anyway.

So far, 2nd year has been hard. Mostly because i start on a wards month just after a busy wards month, which means no weekends and no time with Josh and feeling left out of everything he is doing. And just feeling left; left behind, left to figure things out on my own, just left.

This has been a hard week in the world, much harder than the week I’m having. A hard week full of sick children, of grown men being shot in their cars, of bitterness and anger and tears of rage.

“And still the world begins its furious erasure.”

I don’t know where to begin, because I have lost the threads of the start of this ball of yarn that I’m trying to untangle, because I have let go of what is important to me. I feel disengaged from what matters to me, from the purpose of all of this. I feel much more overwrought with the finite details, the running here and there, the running of the team and never having read quite enough, having planned quite enough, having run the list enough. Somehow things become crazy and you lose sight of that.

In the deepest places, I worry I am not worthy. I am not doing enough to be a good wife. I am not living up to the vows we recite together in the darkness, at 11pm on our anniversary, reminding each other that these things are still important.

I am learning more about listening prayer. Father, you have met me in my hunger and thirst to know more about you, and to listen to your word, and I pray you would meet me here. Give me a word; remind me who you are, where you are, and that I am with you.

“Here I am, Lord is it I, Lord? I have heard you calling in the night. I will go, Lord if you lead me I will hold your people in my heart.” - Old Catholic hymn

I want to be met in my anxious scurrying, in my in-between places. I want to see God’s hands standing over all that I do, over all that I am. Over my schedule, on days or nights, and over my whole mind, my whole self.  I want to go in full of energy that comes only from you, and to jump up and say YES in all of the dark corners where no one is listening.

I am your offspring, Father, and I know that I only live, move, and exist in you. Would your presence be so clear to me tomorrow that I could not imagine myself any other way?

“For in Him, we live and move and exist. As even some of your own poets have said, we are also His offspring.” - Acts 17:28.

[manywaterscannotquench]

Who am I?

Something else that I need to think about:

“Who am I, that I should go?”

How often do I ask God this? How often do I not feel worthy? How often do I bargain with God (Lord, please send someone else) even after he explains himself?

Let this be the refrain of my next year, if I’m already allowed to pick one before intern year is over -- “Who am I, that I should go?” “I will be with you.”

[manywaterscannotquench]

Moises

Como mis pacientes dirían.

Reading a cool bible study right now that’s on Exodus chapters 1-2, and it’s focusing on the choices on Moses. Something really beautiful they just said, in reference to Moses killing the Egyptian slave master, when he stumbled upon him mistreating an Israelite -- “When God opened Moses’s eyes to the oppression of his people, he was moved to defend them, however imperfectly.”

Lord, would you make my heart such that I am also moved to imperfect but passionate defense of your people, in response to the things that are said, in response to my own family or community, in response to the world? Would you teach me where to stick a flag in the ground and proudly declare no, that this is not ok, that this makes me uncomfortable -- would you teach me where YOU are asking me to make your name known as deliverer, as redeemer of broken things?

You are the great deliverer. Let me trust your past faithfulness for my future deliverance. And let me know how to make that manifest in our world.

Isaiah 64:1-4 is SPECTACULAR, and I always feel like Isaiah is a treasure trove of information, since I never have read the whole thing through start to finish. Maybe that’ll be my next goal! For now, though, I love how God speaks to me of things I’ve never known from there:

“Oh, that you would rend the heavens and come down, that the mountains would tremble before you! [...] For you did awesome things that we did not expect, and the mountains trembled before you. Since ancient times no one has heard, no ear has perceived, no eye has seen ANY God besides you, who acts on behalf of those who wait for him.”

But those who wait on the Lord will renew their strength.

Lord, teach me to wait, even if I regret asking. Give me opportunities to wait, that I might be stronger, that in my strength and my waiting I could give you the chance to walk in faith before me, to act on my behalf.

A-freaking-men.

[manywaterscannotquench]

2015

How do you summarize a year?

I know it feels so silly, thinking back on musicals like Rent, or Les Mis, but there’s a song from the latter that’s been sticking in my head recently: “there’s a grief that can’t be spoken / there’s a pain goes on and on.”

Oh 2015. What a year of great joy, of deep grief, of near-despair, of loneliness, of redemption, of freedom. Of lying in the grasses in the backyard staring into the bright blue sky on a Tuesday and wondering why, and how. Of having a backyard. Of leaving a city we loved, and moving into a city we hope to love, in a state that feels far and different but also full of possibility.

I cried so hard this year, and so much. One of the med-peds senior residents told me she was at an interview day dinner, where the visiting 4th years come to see if they want to be at this program, and they asked what she thought of it, and she said, “well, I like it. I cry a lot, but I like it.” And they were horrified. But I heard such honesty and truth in that. Such grace. Such hope. Such forgiveness of herself, of being who she is.

2015 was a year of waiting, of expectant waiting for match day, and of the practice of putting Josh’s desires ahead of my own, of really learning what sacrifice in marriage looks like. And we did it, and I opened that envelope and saw Yale and cried. And I looked into Amber’s face and cried. And even now, I find the email the PD at Hopkins sent me after match day and I read it with such deep... something. Not quite sadness, believing this was the right choice for us, and not grief, because I refuse to mourn what I can instead delight in (I think we were made more for joy than for sadness), not quite loss or longing... I’m not sure what the emotion is. But it’s a mixture, and it’s heavy.

But then, things were in store for us to move across the country. And move we did, leaving a city that impacted us probably more than we did it, but leaving at least some corners where we knew all of the homeless men’s names. (The day or two before we left I shared a burger with a homeless man who looked up into the sky during our lunch on the stoop and said “wow, can you believe people think God isn’t good who makes days like today?” and I sat in wonder.). And we moved to CT, and I started residency, and wow.

(I, for all of my bounciness and goofiness, am not good at meeting people. I want deep relationships fast, and I hate superficial “hi, I’m from Chicago” conversations). So the beginning was hard, and even today, I sent out a mass text trying to make new years’ eve plans, and no one responded. So not the easiest, but I pushed myself out of my comfort zone and went to meet and greets, to dinners, to peoples’ parties... I met people. And we made friends, many through church that I think we’ll end up being close with. And church has been such a blessing on our lives here.

And then Jimmy died. And the world was flung out of orbit.

And we came back, and residency was busy, and Josh was succeeding at everything he does... and when we pause, and reflect (thanks to people like Alyssa, KK, and Pauline for making me) there’s these big moments of YES --> that’s God, that’s where he was. And sometimes it’s mixed up in that grief that can’t be spoken, in those moments of sitting beside someone holding their hand, or rubbing their arm while crouched on the floor. It’s in the time that I listened to Jimmy’s voicemails while biking at the gym and just cried, cried and sweated and salty water ran down my face and dripped onto the bike and no one knew. God was in those moments, and there were many this year. And in addition to the in-between, God is in the busy, mundane stuff too -- the note writing, in reminding me to be a person of principles (write what you did, not what you didn’t or forgot to), in reminding me to say what I mean on rounds, to speak gently and kindly to the rude anesthesia resident, in giving the student feedback that is kind and authoritative, helpful and gentle.

But my favorite moments have been the in-betweens. The weekends we steal the time together and have a shared day off to wake up together, or the incredible blessing of falling asleep at the same time after I come off another 2 week stretch on nights. The ability to work out, both in the time and in the physical ability of my body to work hard and sweat and grow. The gift of cooking quinoa to feed my family and me a healthy lunch when otherwise it’d be pizza. The promises of God, dosed out in glimpses of his Word, in stolen half-prayers on my way to sleep, in the love of my mother and father, and friends who point me to him. The moments with patients that weren’t supposed to happen, conversations that run over so I’m late for the next 10 patients but this one really needed it, or the end of life conversations at 3am, or the woman who I reassured while treating her SVT. The resident and I sharing graham crackers side by side on stretchers in the hallway at 4am, thinking about life and the world.

In the in between, we find hope. In the normalcy, in the mundane tasks, in the graces of today, there is such peace that surpasses all understanding. Sometimes I am too fixated on the promises, instead of slowing down to focus on the peace, on the daily grace in metered dosing like an inhaler.

God knew the israelites couldn’t handle all the manna at once; he metered out his blessing in a dose they could handle, and told them not to take more than they needed for the day. I pray that this would be me in 2016; less focus on storing up the manna, on hoping God’s promises might become true faster, or that I could learn the things I need to sooner, or become the advanced senior resident I want to be quicker.

But I’m still trying to ferret this out through prayer and conversation with mentors -- but I think God is trying to tell me to slow down, to notice him, to bring him into the places where I don’t feel him because he is there too, and it is my choice to acknowledge his presence in the room with the dead body I didn’t feel like I saved, or not. The Bible says we get to carry both of these things with us always, Jesus’s life and death, that we choose to manifest our joy, to manifest his life, with the knowledge that we also carry in us the ability to understand that deep pain, that grief that can’t be spoken.

8 We are afflicted in every way, but not crushed; perplexed, but not driven to despair; 9 persecuted, but not forsaken; struck down, but not destroyed; 10 always carrying in the body the death of Jesus, so that the life of Jesus may also be manifested in our bodies. -2 Cor 4

I don’t know where I’m ending 2015, or where I’m starting 2016. 2015 was so much different than I expected, and then, like CS Lewis, I am always so surprised by Joy. Surprised by and yet expecting it, leaping out from every moment and every in-between breath; the joy of sleeping, the joy of the gym, the joy of seeing a limerick written by Josh when I came home from working nights. The joy of laughing with RNs or coresidents, or smiling with a kiddo, or snuggling a new baby, or being welcomed as a friend, of being known.

I am starting 2016 being more fully known than I was here in 2015, and for that I am eternally grateful -- more known by NH and by Josh, by Yale peeps and by myself. And God, who has always known me, is revealing more of himself for me to know, everyday.

To him who does more than we could ever ask or imagine be the glory in the church, and in Christ (and in the world!), now and forever.

And the people said: Amen.

[manywaterscannotquench]

What the doctor said

What the doctor said by Raymond Carver

He said it doesn't look good he said it looks bad in fact real bad he said I counted thirty-two of them on one lung before I quit counting them I said I'm glad I wouldn't want to know about any more being there than that he said are you a religious man do you kneel down in forest groves and let yourself ask for help when you come to a waterfall mist blowing against your face and arms do you stop and ask for understanding at those moments I said not yet but I intend to start today he said I'm real sorry he said I wish I had some other kind of news to give you I said Amen and he said something else I didn't catch and not knowing what else to do and not wanting him to have to repeat it and me to have to fully digest it I just looked at him for a minute and he looked back it was then I jumped up and shook hands with this man who'd just given me Something no one else on earth had ever given me I may have even thanked him habit being so strong

[manywaterscannotquench]

Where do I begin?

1) I begin with the basics. I admitted a sweet, 72 year old woman who’s received no medical care for 20 years, and had some hoarseness and a lump on her neck. A supraclavicular lymph node. Imaging -- and hours later, enlarged lymph nodes all over, in her chest, in her belly, in her neck. A cavitating, necrotic, spiculated mass in her left lung, and a left vocal cord that isn’t moving.

(I used to think spiculated was a way of describing galaxies, of characterizing the blinking stars I’d see, lying on my back in a field in Virginia. Now, I want to think of round things -- gumballs, regularly spherical basketballs, bubbles -- things that are safe, and benign.)

Pinpricks of stars shining bright amidst gray, undulating brain tissue.

It’s my day off, and I keep looking back at her MRI. I feel this heavy weight on me, although I know it has nothing to do with me, but wishing I had been there today to tell her. Because it wouldn’t have been me that made the difference, but I could have held her hand and looked her in the eyes and told her I was so sorry.

It was never about me. I know that. But now it’s my day off, and I’m at home with tears running down my face. I know I have to tune out the sympathy, that I can be empathetic but not sympathetic, but I don’t know how to do that, not yet. Now what I know how to do is just to know, and to be sad.

2) I begin with where others have let go. Letting things go does not come naturally to me. I take care of the patient with no insurance with which to purchase his meds, or the young woman with constant vomiting, or the frustrating nursing home placement, and I sometimes feel like I’m running uphill, trying to get people to help me push this heavy burden and I’m calling out, to the SW or the case manager or the pharmacist to help me, and they do their part and check that box as “done” and let it go, and I just can’t. I don’t know if that’s a good thing or a bad thing. But I have trouble letting go, and the reality is, that’s where God moves in power.

3) “And who knows if you have come to the kingdom for such a time as this?” - Esther.

Who does know? I’m hoping to find out.

[manywaterscannotquench]

but wait!

and there is something so beautiful about hearing your best friend open up to his friends, over the phone or in person, about how he is struggling and how God is growing and changing his heart. wow. I am so blessed.

Thank you, Lord, for the friendships that make us.

[manywaterscannotquench]

lo más mejor

the most best.

(as my patient said to me at the end of last week, Doctora, no hay un “más” mejor, en vez úse lo mejor, nada más, but I still wonder if there is a most much, a most best, a most more).

Every time I catch up with a resident and hear about their inner struggle, the spiritual dimension of pain and redemption, of hope and difficulty, that residency creates, I find myself wondering if in fact the residents are the secret pain of the hospital, the feet and the hands and the minds that keep it active, but also the hearts that keep it groaning, missing their families and lives and loves outside of the hospital’s walls.

But then! But then I am gifted the chance to peek into the hearts and minds of our families, of our patients, and I am blown away by our own shallowness, our selfishness, that in my hunger or need to pee or distraction I did not (do not) see! The 9 year old girl, originally with leukemia, which went into remission, and then with a different leukemia from the chemo used to treat the first, now status-post bone marrow transplant from her sister, and again with the low cell counts (anemia, thrombocytopenia) that herald a relapse -- the kind that, when she heard the news, made her burst into tears. (I think, in their souls, children know when they are dying, but we use words like “very poor prognosis” or “experimental chemotherapy” so we don’t have to meet them in that soul-place).

These. These are the people who create the groaning, who are the secret pain of the hospital. But also who are the secret joy, our greatest teachers. The patients we meet are the reason we don’t sit comfortably or forlornely in the dark, but instead fumble around, searching for the light that is healing. And I don’t know where that light comes from, but from God.

“Let us know; let us press on to know the LORD; his going out is sure as the dawn; he will come to us as the showers, as the spring rains that water the earth.” - Hosea 6:3

Let us press on. I do not know the answer, but I was chastised for my selfishness, rightly so, and God has abundantly blessed me, and for that I am beyond thankful.

Thank you, God, for reminding me daily to turn over what I can’t control to he who controls the universe.