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Hello WORLD again... coming soon.
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Brave Midwives, Pregnant Teenagers….women who changed the world…. [17 Sep 2012|10:49pm]

Originally published at Perches in the Soul. You can comment here or there.

…..all I do is fret over my job options…..so tonight I am not going to talk about it.

Instead, I am going to talk about things that will anger some readers, but stick with me, I live in the trenches of a war and I am telling you what I see.

I’m living the teenage dream in adolescent clinic (a hated rotation amongst baby loving pediatricians).  I went to planned parenthood last week. ( That should be enough for potential dismissal from my potential employers.)  I saw a pap smear in a lady older than I. That was it.  But it came oddly after a week of strange events.  The first was a sermon on Exodus 1. I love Exodus! Its rich in metaphor and is a beautiful tale of grace, God’s Faithfulness and his master plan.  The sermon was centered around the Midwives named in Chapter 1, remembered for their courage in SAYING no to infanticide in the face of great personal danger, they also sort of saved the world in the process or at least the Israelites and the lineage of Jesus. This led to a blessedly brief but slightly theologically misplaced rant on abortion.  I  shifted uncomfortably…because while I see some heads nodding in the crowd, I want to put my head in my hands and weep…weep for the little girls…all the little girls growing up in the inner city who have stolen my heart. What about them?  Who will be brave for them?  While we stand here and shake our heads in our self-righteousness, who stands up for stolen childhoods of these children…

I have been passing out contraception to sexually active teenagers for two straight weeks like its a trick-a-treat event.  I have had timid, petite straight A students tell me they had sex for the first time three days ago and I have had defiant 17 yo boys brag about their exploits.  I had tearful young women tell me about their abuse, I had scared young men in prison scrubs tell me that they are afraid to go home and get hit and its better to be in jail. Still another straight -A student has developed arthritis due to caring for a bed bound parent, still another is in a homeless shelter, still another  has dropped out of school so her single grandmother and her can eat with her fast food money….There are so few parents involved, I sometimes forget that these children have parents and aren’t orphans….the parents are in jail or don’t have custody or have no idea their kid is asking me for contraception because affection in sex is the only granteed affection they have… The drugs…OH THE DRUGS….the violence…so much violence and they have been watching it their whole lives… Today I had a middle schooler ask me for birth control, she got raped last year…Her middle school friends are taking condoms to school dances……

…the worse moment by far was last Tuesday, in my OWN clinic (not in adolescent clinic), a high school freshmen came in for a sports physical. She had sex for the first time two weeks ago (ok for love, labor day weekend…she is like the fourth kid this month who debuted on that weekend…) and wants to start contraception. As I am writing her prescriptions, my nurse comes up to me and whispers…..She is pregnant….  My heart falls.  I find a box of Kleenex, I walk into the room and tell her.  Her face falls, she can’t believe it.  I stroke her hand, I hold her for a few moments.  I offer to tell her Mom for her. She nods and asks me to do it outside the room. I find her Mother in the waiting room, i find an empty exam room. The mother wails for her only child who as of today is no longer a child.

I find myself teary eyed.  Sad for everyone in the room. Wanted and Unwanted.  Child and Not Child.  Where do we begin?  Where do we go from here?

Two days later I am sitting in small group next to my friend and comrade in arms in adolescent clinic (fellow resident and believer) who is also 36 weeks pregnant. As our discussion of the sermon reached the brief rant. We pour our hearts out, so desperate to tell people the truth about our kids, our friends are intimidated by our outpouring of grief but compassionate.  We end in prayer and both my friend and I find tears on our faces, clinging to one another silently weeping for the little girls. Oh the little girls and the boys.

I am not saying they are not making poor choices but lets remember that there are so many things that they never had a choice in particularly in their fragile early childhoods….

Inner city teenagers do not look as pretty on glossy magazine covers as ultrasounds and babies….but they are dying too.


It has many forms.

But let us not be so quick to fail to understand

that not everyone gets to make choices

not all children get to be loved

and supported and fed

and loved….

do not hinder them for the kingdom of God belong to such as these…

I don’t know what that looks like

But it doesn’t look like this.

Let’s be brave.

for them.

Let’s fight

for them.


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[17 Sep 2012|09:54pm]

Originally published at Perches in the Soul. You can comment here or there.



password: is my first and last name all lower case

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When there is no Home to go back to…. (Employment Journey Part II) [19 Aug 2012|10:41pm]

Originally published at Perches in the Soul. You can comment here or there.

I can’t go home.

because there is no home.

There are moments in life where we become acutely aware of how we have grown.

Like putting on those pants you wore in high school….(or the pants you wore before shiny hips), you have grown, the pants don’t cover your ankles anymore and they are uncomfortable…confining.

Sometimes our dreams have homes, gardens. Places that have cultivated our hopes and preened our passions.  Some times our dreams grow wild beyond our carefully mended fences. Beyond the very places that have nurtured them.

For 20 years, the gentle, warm people of southern, conservative Christianity nurtured me and gave me dreams of being a doctor where there was no doctor for Jesus and for my people.  About 10 years ago, the garden of my heart started stretching tendrils beyond the steady rows of pews. Seven years ago, my heart expanded to embrace the children who changed me and taught me a different kind of gospel. Five years ago, it fell in love with medicine and the wild flowers grew outside the fence in the rocky soil of death, poverty, disease and injustice. Two years ago, with some heart break, I set out on a journey to find people who teach me the skills I needed to grow (live) the dream.

Three days ago, I sat in what should have been a crowning moment in my testimony at least of the Pollyanna, inspirational Christian youth (see Part I)  that I was, an interview for a job with the very people I had admired from afar in my travels.  As I sat there and poured my vision of teaching, caring for children and my tribe, I found myself speaking in tongues…my very language had changed. We no longer truly understood each other I found myself uncomfortable, winching at their language, I understood it but it grated on my ears like fingers on a blackboard. From Chick-fil-la to the number of white haired men in power to their lack of care for inner city work (overseas is always somehow holier) I found myself squirming in my chair.

We believe in the same God but we no longer are from the same place.  I no longer belonged there.

There was also interrogation about the disability and I found myself a changed woman than I was as a medical student where I had taken what ever people threw at me and quietly just kept going no matter how horrible what was said to me was.  Now, I was a physician from one of the top programs in the country where for the past two and half years no one has every questioned my ability to be excellent at what I do, in fact its expected. And while I was not openly defiant, I did not brush it off.  I threw it back. I offered no mercy for their ignorance, grace but no mercy.

I found myself in the  end though, not angry but sad….and in culture shock

As I rolled up the familiar roads of my adolescence both figuratively and literally, I found myself looking around and while I recognized the landscape, I realized that the home i had loved and had come back to was no longer there.

It was devastating and incredibly liberating in the same moment.

No longer must I trim the dream to fit the confines of the original garden, now I can let it grow freely to what ever end it finds.

I can’t go home

but I can build again.


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Poverty Part I:How Did we Get Here? [08 Aug 2012|03:31pm]

Originally published at Perches in the Soul. You can comment here or there.

I am reading several excellent books on Poverty as part of my employment journey (This is something I have wanted to do for a while!).  Part of the one book involves a lot of reflection and some of it I am going to post.

The book argues that good intentions are not enough and that most middle-class American white people rather motivated by religious obligation or compassion have a bit of a God-complex.  The book also argues that most people misunderstand poverty dramatically, they don’t understand that material poverty (what people think of) is really a symptom of REAL kinds poverty: poverty of community (broken relationships), poverty of spiritual intimacy (materialism, idols), poverty of stewardship (loss of purpose, laziness/workaholics, materialism), poverty of being (low self-esteem or God complexes).

I have been reading through my journals of growing up, trying to find out a little bit of HOW I got here.  How did a 18 yo who wanted to be a clinical geneticist and a disability rights activist decide she wanted to to move to Africa?  This is related to one of the questions I am working through in the poverty book which is WHY DO I WANT TO WORK WITH UNDERSERVED FOLKS?  I think this question is slightly different for me than the average. While growing up in a supportive home where charity and generosity were encouraged especially in regards to faith. I did not grow up with this huge ambition to save the world nor did I grow up with this idea of giving people what they did not have materially. Nor did I go to Romania with this idea that I had all the answers or I was essential to making a difference (God Complex). I came in after fighting for wheelchair ramps and writing papers about civil rights. I wanted to make a difference for my people, my tribe because we were the SAME, not because were DIFFERENT (i.e. I was somehow better).  I went to Romania at 19 because I was horrified at the treatment of children who I saw as by chance could have been me.  Perhaps I did have a bit of a God-complex in that I thought that by being example of a independent disabled woman I could make a difference but I think it was a really different sort then is described most commonly in the book.It wasn’t really entitlement that was driving me, or even good intentions, it was true empathy (perhaps misplaced). I only had a taste of what prejudice and fear of disability felt like, but I knew the bitterness of its lie by experience not by pity or good intentions.

I also think that I am viewed really different by the people receiving me which is another thing the book really emphasizes.  There was never a US (the helpers), THEM (needy) model for me because in the eyes of the average Romanian, I was in the NEEDY category (ie when the beggars help you off the bus and give you the money they made from begging…all the rich American-ness in the world isn’t going to pull you up the social ladder).  I lived strangely in between the two worlds. Did I do harm? Did I reenforce poverty?

I actually think I did OK for the average disabled person I worked with although maybe only by the grace of God.  I think I listened to a lot of stories and I know that parents especially found it encouraging to see someone with a disability not in an institution. I never claimed it was all easy or that there life would be just like mine either. I also think where I did the best was by just being there walking around, greeting the disabled beggars on the subway and such, I didn’t really do anything other than acknowledge that there were a human being. I think that I quickly learned how to talk about principals (justice, access, education, etc) in ways that were empowering, opposed to bragging about what I had or being critical, I think Laura my mentor for this. I also think  I managed not to be always right and be ok with that which is HUGE.

The mistakes I made were when I tried to go beyond the realm of disability which I think is really interesting in light of the book. For example, I bought shoes for the child I taught how to walk one summer.  While I might have helped the one child, how did the other children feel and how did the care givers feel?  Did I reenforce their shame (Poverty of Being)?  Probably. I don’t think I had any idea especially at 19 how to handle the shear material gap of the suffering I saw and I certainly don’t think I really understood that it was a symptom rather than the problem.

I do defend my psychological state a bit, if you had blue eyes and you went to a country where you visited a room where nearly all the blue eyed children were literally tied to their beds because they had blue eyes….and one of them you could help be allowed to not be tied down, if you could help him walk safely with well fitting shoes, you’d buy the shoes too.  Its hard, I think on the one hand, its a beautiful gift to be able to have a bridge of empathy to the other side, on the other hand, its really hard to overcome the empathy and make decisions that reflect solid community development and not out of the pain it is to see someone suffer and know that the only thing that saved you from this fate is your passport.  The book doesn’t talk about this because its rare to be in the middle, I live a very strange life.

Where I really related to the book, I think though there is NO doubt that the Romanians and the Belorussians especially those first two summers lifted me from my poverty. I don’t think I will ever be able to fully articulate how much life formation went into those 18 weeks of my life.  I learned more spiritually from sitting at the feet of a gnarled, elderly lady with CP who gets to go to church twice a year when someone carries her to the van than I would say in nearly all of my spiritual education up to that point.  There was no theological debate, no political spectacle or bitterness, nor even was their the allure of like minded community, there was her God, beauty, boldness and gratitude. It rocked my faith, it shaped me.  Two children changed the way I thought of myself self-esteem wise (poverty of being): one an autistic teenage girl who threw things at me the first day I met but by week six, sat in my lap, with her hand on my heart.  I realized how much fear she had of people because its all she had known from them.  While her front was behavioral, mine was in trusting in relationships and striving for perfection (because if I am better than everyone else, they can’t judge my differences). It was the same fear. She broke me and while I still struggle in this area, she is who opened my eyes to it.

The second child is the child I bought the shoes for. A child who has a disease that literally shares the same gene mine does who went blind not for lack of resources (the specialist he needed was less than 5 miles from his home) but from indifference. After his blindness, he literally withdrew into himself and regressed, he no longer walked or fed himself.  We walked together for a summer. I had to walk about a mile to get to him and I was often exhausted and I leaned on the wall while he leaned on me but we got there. Not by anything I did right but because we both wanted it so badly.  He taught me to give up my independence which was probably the biggest idol in my young adult disability world, my most treasured possession.  Interdependence is not something taught in the American system and that is our poverty of community.

Then there is Africa and frankly it all gets a whole lot more complicated. Again, disability wise I think I did mostly OK, I treated people as humans. I wasn’t quite the pariah that I was in Eastern Europe, largely because I was white and thus always separate first although I did have some tender moments of same-ness with several disabled young women and some parents.  I think where I am really struggling is with how to be a physician and play the development game.  Being a physician means I have a highly prized set of skills, I can save babies (sometimes) and not just disabled babies. Suddenly, I can’t just GO to walk along side my tribe, suddenly he expectation is that I am a helper.  How do I not help when the stakes are so high but how to help and not hurt?


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Rest [03 Aug 2012|11:33pm]

Originally published at Perches in the Soul. You can comment here or there.

Rest is a beautiful thing. I am not talking about sleep.  Although as someone who professionally lives without sleep for extensive portions of my life, sleep is also beautiful too. But I am talking about R E S T.  Rest is deeper than sleep. Rest is sitting on the back porch and watching the fireflies come out and being a little in awe of the twilight magic. Its finding time to pray not in supplication with desperate desires but with simple gratitude for God’s provision and in praise. Its eating a home grown tomato with wonder at how that flimsy looking plant produced something some tantalizing. Appreciating the little things. Its laughing with people who you love or listening to the joys of the same people.  Its playing with a child. Rest is when instead of thinking with much anxiety about the next day, next year, next job, next life stage, you are content and hopeful where you are. Its savoring life. Its when you choose joy over fear, learning and growth over judgement and peace and contentment over status or achievement.

I am HORRIBLE at rest. Being type A (further compounded by the gimp need to prove my worth to people) and being surrounded by other type A, OCD physicians at one of the most elite programs in the country makes me in constant state of anti-rest.  I have been working on rest and this summer despite back to back ICU months, I have been getting better.

And I have been shocked at how much happier I am in life and at work. I enjoyed the PICU even amongst the death and the hours and I am enjoying the summer’s “Friday Night Lights” in the ED with all of the summer’s traumas, beads in the nose (I’m bored, what would happen if I stuff this up my nose…) and poison ivy.

Life is Good. God is good.

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That look in your eyes [13 May 2012|09:56pm]

Originally published at Perches in the Soul. You can comment here or there.

At the end of my palliative care rotation, I helped the professor clean up after our project presentations.  He looked at me, I looked at him. He makes an awkward allusion to my disability and the story I had just shared about my friend Laura. I tell him I have a genetic form of degenerative joint disease.  He pauses, his eyes are kind and for a moment we share something that is rare outside of my tribe.  “You really understand, you get all of this.” he gestures beyond the pile of projects, reflections ranging from photographs to scripture to paintings representing our palliative care experience ranging from the sacred to the mundane.

“….Yes.” I took my project from the pile and walked to my car in the fading November sunshine.  Shivering.

At the time I was 24 year old and slowly and painfully coming to grips with my failing joints and tasting the bitter, raw fear and trepidation of my own fragility and mortality.  I met a lady with RA who was in her  70s, going blind and had no hand function earlier that year and she had shattered any illusions I had of somehow being through the “worst of it” with all my childhood surgeries.  Then there was my 28 yo Romanian friend who died and a year later there would be the 18 yo with muscular dystrophy who was my first pediatric death on my watch.

I savor life differently.  I savor work differently. I savor normalcy like cooking good food,  wearing clean clothes, brushing my hair, going to church, buying my own groceries, paying bills, good conversations.  I savor and fight for weekends with my family, taking that road trip my sister and I have talked about for years even though its expensive,  moving to Africa for a season  I savor them and don’t waste time because I know that my destiny according to society was to live in my parents’ basement and because as anyone with a progressive disease knows, I never know how long anything is going to last.  My new hips could last 30 years or they could last 6 more months.

Its a crap shoot. Its a gamble.  Its anyone’s best guess.

So yes, I get it.

But don’t fool yourself, it doesn’t always make me a better doctor.

20 something yo with a neuromuscular disease that most people die from in their late teens who isn’t eating anymore, in constant pain and at one point last night said ” I want a ventilator, I’m going to die tonight.”  I couldn’t control his anxiety, I couldn’t seem to calm his breathing and I couldn’t seem to tell him the truth which is he is dying.  He knows, I know, his family knows it (although adamantly deny it), God knows it. Everyone knows it. But we are not talking about it.

I get that too.  Because I don’t talk about it either. I don’t talk about what life will be for me when I am in my 50-60s and the hips fail or my  hand arthritis is so bad i can’t palpate babies’ bellies anymore much cook, clean,  drive, etc. I don;t talk about how I sometimes worry about burdening my sisters or if i was to get married with this. And i don’t talk about how much sometimes it sucks and how scary it is to watch your body fail you and become steadily more deformed with your body attempts to grow bone or muscle to support what it can’t repair which is the crappy cartilage all the while when all your friends are having babies and wearing skimpy wedding dresses that show off their beautifully unmarred bodies. How I am happy for them but somehow all the more painfully aware that I will never be like them and my participation in their world is fragile.

I don’t REALLY get it, I don’t claim to know his experience, I ‘ve only had a taste of the feast he has been forced to ingest.  But the taste is enough to know that the other thing is while all of us medical people wonder how WE GOT HERE medically, why no one managed to talk this family into a plan, to know this young adult’s wishes….the tribe part of me that can look into his eyes and for just a moment stand in the abyss with him knows that we are here because not talking is what’s been expected of us, for the sake of normalcy, for the sake of sanity. Talking about losing function or dying young is just not what we want to talk about around the dinner table or even the examination table.  Its not the RIGHT thing to do but its what makes everyone else comfortable.

I wanted so badly to make it better for my patient, I called palliative care, I lingered at the bedside. I prayed.  I whispered to Laura to please care for him when he goes.

Because this is where the pollyanna, cute little kid in a wheelchair, chronic illness, Jerry’s Kids, Life time Origninal movie, inspirational memoir, NICU baby, special olympics thing ends.

This is the hard stuff.  The ugly stuff, the things that keep us up at night, the things that challenge our sense of right and wrong.  But for those of us who live with a taste or with feast of it, its the stuff we so desperately want to not bear alone. Don’t ignore us, don’t pretend it doesn’t happen.

So walk with us….look at us…take a moment and get it. Just a moment.

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Lies [13 May 2012|09:13pm]

Originally published at Perches in the Soul. You can comment here or there.

In my last post I said I hated the ICU.

I lied.

I actually love it. The medicine is acute, fascinating and finally teaching me all the physiology that never quite added up for me in my textbooks.

Second Lie:

I do care about what happens job wise in 13 months. And as I brave as I sound. I have only begun to come to terms with how hard it will be to leave a place like where i work.  I would leave the best all around children hospital in the world, anywhere is going to be a change.  Moving to Africa will be bit like academic suicide or at least feel like it. Above all its kind of scary even though its a dream.


there I told the truth

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Post Residency Bucket List [01 May 2012|06:44pm]

Originally published at Perches in the Soul. You can comment here or there.

Well the ICU is mostly what I expected.  I think my biggest problem in medicine is I am just over doing things I do not find super educational (there is learning to be had in the ICU but its hard to do when your role is to do paperwork and field pages for flush orders) and that resemble slave labor (I barely touched actual children…I wrote orders all night long…you could train a computer to do my job)….  Ready to be a human being again.

While becoming a doctor has been the fulfillment of a dream.  Its not the only dream I have. And in 13 months for better or for worse.  I will be done with my required education related to that dream. Thank GOD.

What I want to do in terms of earning money to eat and maintain health insurance in 14 months is unclear exactly. And honestly I have gotten to the point I just don’t care (I mean do obviously I have sent out countless global health applications and tried relentlessly to create my own academic peds/global health fellowship but in the end as long as I get to take care of kids for some percentage of my day to day life, I don’t care the details much anymore).

What I really want to talk about is everything else I am going to do….

I have the following list thus far:

~Sleeping on a regular basis like every night… or at least at some point during the 24 hour period. Beyond being overseas (which is different), I am going to do my utmost to never work in house 24 hour+ call again.

~Finding a church/community that will not stone me for being a pacifist, a children’s/minority/disability rights activist, for thinking women have a role in church beyond raising babies BUT still believe in Jesus….

~On a related note, becoming a part of/forming/etc a Christian woman’s ministry where talk about something other than getting married and raising babies (both of which I would like to do but that I think are not actually my reason for existence (which is of course, glorifying God)).

~I would like to live in intentional community FOR REAL. Not just sort of halfheartedly

~Going back to Romania, find Aurel, Christine and Rapheal. And even if it requires 12 hours on a train, go see Laura’s Grave. Pray there and thank her for the vision she gave me in our short time together. Tell her I became a physician and that I carry her with me every time I speak for our people.

~Going back to East Africa and I would like to take my family with me.

~Live Abroad for at least 6 months but up to forever subject to God, my cartilage and all these other things.

~Writing THE BOOK that I have been talking about for 10 years even if it means I have to tell the truth about how bad medical school was at times

~Spending at least an entire week in the Outer Banks at my Grandfather’s where I eat fresh sea food every night, go sailing with my Granddaddy, losing myself in the Elizabethen Gardens and then waking up and doing it all over again.

~Spending a week with my Paternal Grandparents either on a road trip (they love to drive across country) or at their home. Learn to cook from my Grandmama (again!) and talk theology and writing with my Grandpapa.

~Spend some time with parents. Going on a Father/Daughter trip with my Dad that has NOTHING to do with trying to become a disabled doctor/pioneer/take some nasty exam.  Hang out with my Mom, listen to her and not spending the entirely of time together  with me venting about how much my blank rotation the previous month was the worst thing that ever happened…./her caring for me after some life altering, horribly stressful (for all involved you imagine watching your first born go under anesthesia 25 times+ ) and painful medical procedure.

~Go back to AAMC with protest signs/hunger strike if necessary and say they need to get over their able-ish and put a disabled physician on the committee for disability (GOD FORBID we actually have representation) and be a some what gracious but fierce activist with impeccable credentials (you can’t argue that I am just a med student any more, I will be a board certified pediatrician from of the top programs in the world). (this may or may not be related to the BOOK project)

~GO on a trip with just Emily and Victoria. Even if its just to a Holiday Inn in Vinton (which is like 10 minutes from our parents’ home)

~Go on a medical mission trip with Jessica

~Go visit my friends in Oregon

~See the Grand Canyon (actually going next month a year early)

~Really learn how to cook rather than occasionally dabbling

~Go on a silent prayer retreat

~Write some travel writing type essasys

~Go to Ireland

~Get the Sacred Tuesday Group back together for a crazy retreat/reunion/celebration somewhere (ANYWHERE)

~Help write some transition related stuff for kids with skeletal dysplasia (ok so nearly work related…but I have come to the stunning conclusion I might be the only human being currently alive who actually can/wants to do this)

~Read SMART books that are not about medicine

~Relearn all the theology/religion major stuff that I have suppressed in order to make room for the Krebs Cycle and organic chemistry (worthless)

~Need some sort of theater in my life again beyond the annual Long Family insanity known as MY MOM’S CHILDREN THEATER PLAY WEEKEND

~Figure out my opinion about about the laundry issues of social/theological issues that have come up in the last 7 years that I have not had time to research or pray about fully.

~Successfully plan and care for a garden without having either things die due to neglect or never getting it in all the way due to time constraints

~Go to the San Diego Zoo

~Read all the books on my list (really long)

~Learn to play an instrument (even if Emily says there is no hope for my deaf little ears)

~Buy a hammock, lay in it.

~Go through the phone book of where-ever I am living particularly if its a large city and eat all the different ethnic food restaurants from Albanian to Zambian.

~Make a recipe book of all my favorite Romanian/Russian/British/Scottish/Chinese/Kenyan/etc dishes that I have accumulated over the years from all my travels

~Take a photography class or at least dabble more officially

Longer term goals:

~Get married

~If that doesn’t work out, adopt anyway

~Scrapbook/Journal/DO better keeping up documenting

that’s it for now but this list will be growing over the next 13 months. Stay tuned.


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True Story…Best weekend…. [22 Apr 2012|09:02pm]

Originally published at Perches in the Soul. You can comment here or there.

1. I only live 5.5 hours from Asheville….I swear life will never be the same.

2. Mountains calm and center me.

3. As much drama on and off the stage….Parables was one of the greatest things that ever happened to me. The people are my second family (along with Sacred Tuesday crowd). I can walk into a room with two parables one of whom I have barely seen in the last four years…and pick up right where we left off. Within 5 mins we can discuss death, books, chest tubes, Jesus and Africa. Its like coming home after a long trip.

(side note…10 mins in someone says…so do you want a team to go to Africa…because I think we should go….!!!!!!!!!!!!!!!! (squeal)….much prayer and contemplation)

4. I fail at relationships of the romantic variety.  If I have one more guy-girl relationship that turns into an awkward guy-girl friendship I will need therapy because i will no longer be able to hold myself in from doing something I will regret (like hitting people).  OH MY HECK. I am going to die an old maid (but with the greatest friends).

5.  There are functional churches that love people, Jesus, are made up of multiple races, political ideals and generations….they just don’t exist in this CITY.  But there is hope that at some point in my life I might live somewhere that has such a place.

6. Used book stores are AMAZING. (WHERE ARE THE USED BOOK STORES IN THE MIDWEST?!?!?!!?!?!?)

7. I need to talk about non medical things more often.

8. Board Games….why did I give you up? (MED SCHOOL…booo!)

9. Theology…..why did I stop studying you?  (MED SCHOOL!! booo!)

10. Can we do this again next weekend??? if only.

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Stolen Idenity [22 Apr 2012|08:50pm]

Originally published at Perches in the Soul. You can comment here or there.

When I was in medical school, every day was HELLO…(awkward stare)….yes I am the token med student in a wheelchair.  Can we get past this?  Because every where I went (even peds) we talked about this continuously.

Then I came here i was doctor and no one really ever asked any questions.

and for a while it was amazing. Very liberating. To make matters even more amazing, I had a new hip and was walking more and more and more till I worked my way to a second hip.

Then somewhere in the mist of a new hip…3 straight months of ICU/step down units in the middle of a midwest winter….I awoke from my liberation to realize.

oh crap.

while I do not want to be a primary care doc or a developmentalist or a geneticist….I am gonna be bummed if disabled children are not part of my career personally and professionally.

It took me another month and two weeks of developmental peds and a few very persistent children for me to say that aloud but here we are.

This is going to greatly complicate life.

oh well. here we go. I need a pediatrics job that lets me A. be a hospitalist, B. Teach, C. Go abroad and D. work with kids with disabilities.

here’s to the impossible…


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the man on the stairs [06 Apr 2012|09:37am]

Originally published at Perches in the Soul. You can comment here or there.

I was driving to work the other morning. Along the way, I pass a Gothic style Catholic cathedral. When I first moved here the churches fascinated me, gone were the simple clean lines of the little NC Baptist and Methodist churches on every other corner that all look the same.  In each little neighborhood of my city there is a prominent church, most of them are Catholic although there are some lovely Protestant ones as well. Each has its own style, culture and heritage. They are nearly gaudy with their buttresses, carvings and stain glassed windows. Reminiscent of a time in our history where each neighborhood would have have been a village, often of immigrants transplanted from the old world to the new. They built their new village as a piece of old world culture and design in the wilds of a new territory. Perhaps the church would have been the center of comings and goings, many had schools attached to them  Now several of the churches have FOR SALE signs on them, although some are still active they are hardly full and most of time when I drive past them they are silent as statues.  The steeples blend into the strange hybrid of Old city, when she was what Longfellow called the Queen of the West, a cultural and commercial center at the turn of the century and NEW city with modern high rises,  Billboard ADs and homeless people. I admit half the time I don’t even notice the churches anymore.

In the tendrils of early morning sunshine, a few neighborhoods down the road toward work, in front of the large cathedral, there kneeling on the stone steps was an elderly African American man praying. He was dressed all in blue, it looked like a uniform, perhaps even the navy uniforms of the hospital janitors.  I stopped at the stop light and couldn’t help watching.  I wondered what brought him so early to the steps of this massive church, I wondered why he did not go inside?  Was it closed? Did he not feel well dressed? Did he feel he would not be welcomed inside? Was there not a service till later and he had to go to work just like I did? Was it because it was holy week?  Suddenly, he crossed himself repeatably, great emotion filled his face. Was it because he had some great supplication for God? Was someone ill, dying or in peril? Had he done something he was ashamed of, was he begging for forgiveness? Was this his confession? Or maybe they were tears of joy? Was he overwhelmed by the presence of God?

I felt embarrassed like I was spying on someone private conversation like when you walk into an exam room and your colleague has just told Ms. Jones their child has leukemia and you just needed an otoscope tip. I wondered about my fellow drivers around me, commuting downtown to work, what did they see? What did they think? Did they notice this Man crying his heart out on the stairs?

What about the people inside? Where were the priests? Where were the nuns who taught at the school next store? Were the children inside looking out their windows at the man on the stairs?  Were they wiser than me, knowing not to intrude on this man’s pleading?

In Eastern Europe, the gates and stairs of the Orthodox Churches were filled with beggars, elderly people and disabled people who begged for money of the priest and the church goes.  I remember in one of my bitter moments of frustration with the culture, the lack of care of the forgotten children who would be baptized but never cared for by the churches, I felt far more comfortable on the stairs then inside.  I arrogantly thought Jesus would too.  I thought to myself now years later, that I was right Jesus was with the beggars, the prostitutes on the stairs and the unwanted more than the religious authorities. I knew even that Jesus and later the apostles had interacted with the beggars at the Temple’s gates. What I lacked at 19 yo was the insight into the people that lived on the steps of my church. The fact there was many in America who because of their heritage, the color of their skin, their language, their sexual orientation, their bank account, their addiction, etc, etc were not welcome either because of stigma, hypocrisy or fear in our sacred spaces.  God welcomed them but we do not.

Even more, I lacked the understanding that we all belong on the stairs of heaven, none of us measure up not due to our social classification but because of our selfishness.. All of us should be sobbing amongst our transgressions and the ugliness of our hearts on the stairs.  Holy week is a celebration of grace. Jesus welcomes us through his loving self-sacrifice inside the gates.  Jesus came down the stairs to invite us but he also still sits there.  He is there on the stairs and when we invite the others on the stairs to share in his grace and compassion, we invite him to be among us.

I prayed a short prayer at the red light for the man on the stairs. A prayer of gratitude for his example, for his courage and for grace, for our shared celebration of Holy Week that I knew I would remember far more than the third refrain of the UP FROM THE GRAVE HE AROSE on Easter Sunday. I prayed that Christ would sit with him on the stairs and meet him in the heart of whatever his circumstance. And that he would sit on the stairs with me, as I confessed my unworthiness, my failings and my need for him.

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The Brown Sandals that I immediately regretted [26 Mar 2012|05:55pm]

Originally published at Perches in the Soul. You can comment here or there.

My feet are funny shaped. At some point in college I participated in my first foot washing in which I found myself keenly aware that my feet were not so beautiful rather then brought the good news or not.  I knew that wasn’t the point but the human inside of me couldn’t quite get past it.

I can remember the thrill of NEW shoes for school each year. I would go with my Mom on a special shopping trip before school started. We would go to Stride Rite , The Navy Exchange or JC Penny’s and we would find sneakers and then a pair School/church shoes. My all time favorite was a pair of black Mary Janes that had faint embroidery on the toe of tic-tac-toe in light green and red. I got them just in time to start 2nd Grade.  This was also the phase where I refused to wear pants, only dresses. I would accept leggings if it was cold out of necessity. So there I was in my early 90s bright colored dress and leggings and black Mary Janes. In hindsight, sort of dorky but at the time those little shoes made me feel so grown up.

Somewhere around the age of 9 or 10 when my growth plates were bending in unfortunate directions and I was coming to grips with the reality of chronic pain. Shoes started being a source of great angst.  This was also the time when shoes were changing and no longer was it cool enough to wear my black Mary Janes or My Little Pony Sneakers.  No longer could I wear what my classmates wore. All the girls were wearing jelly shoes or canvas shoes with no support.  We would go to shoe store after shoe store, nothing would fit except for Velcro sort of sneakers that the kindergarteners were wearing and not the middle schoolers.

I went through a combat boot phase in sixth grade. They were a statement and in middle school that seems to be the goal of foot wear. But they also offered my poor ankles some support. This again in hindsight was a fashion low point of my life in which I wore Christian T-shirts (that said things like Got Jesus?) and baggy jeans and combat boots.  One of the security guards who drove me around in the golf cart to band and lunch (which were a bit of a hike) commented that my choice foot wear was probably not the best thing for my feet.  I was horrified being a Type-A people please-er of adults in my world.  Thus ended the combat boot stage. Looking back, he probably did me a favor.

In high school, they started introducing the concept of FORMAL WEAR.  I knew I was in deep trouble the first time I went shopping for shoes for my first prom. Strapy, stringy, heeled plastic things that cost 70 dollars and were a tibia fracture waiting to happen. My sweet mother dyed ballet slippers for me. They had no support but they matched my dress.  I survived without any ER visits.  Then there was the uncovered shoulder ISSUE (previously described) in which I showed my keloided scars to the world. I was not a fan. As if I needed to be more of a freak show.

I then went through an extended phase where I just decided I hated dressing up. Sad thinking that in elementary school, I wanted to dress up and be girly EVERY DAY. I decided I was going to be a hippee who wore peasant boluses, carpi pants or longish skirts and grow my hair (already longer than most girls) longer.  This sustained me through the beginnings of college where I at least in part to thanks my mother and sister switched the hippee skirts for cuter knee length numbers for the Carolina sunshine.

I vividly remember kicking and screaming my junior year of college when all my friends and I decided to go to the Non-Greek formal. My roommates had to nearly  hold me down to put my hair up and do my make up. WE have pictures and evidence of this.  I wore mary janes that I also wore to interview for medical school in. As for interviews, I was so grateful for the stylish gray paint suit for interviews. my grandmother and I found in an expensive store in the big Mall in Norfolk that covered most of my shoes and all of my shoulders.

Then came weddings. It was prom on steroids except now the pictures will actually matter beyond the age of 18, someone will be looking at them for the next 50 years. And those people are my closest friends.  The first wedding I was in had brown dresses which while I did not love, I loved that I could wear small brown flats without concern.  Then I was in two weddings where I was thankfully allowed to wear black and red and thus black flats.

In medical school everyone got cute Danskos and such for the wards. None of  which I could get my feet in. I became mildly obessessed with KEEN shoes. Black and Brown Mary Janes that I wore to pieces in Kenyan Mud. I wore black chaco sandals to my doctorate hooding partly by accident (left my black flats in the car) and partly out of sheer spite of professional shoe wear.

Then came this year. Summer wedding. Yellow dress.  My big toe on the left has this gout like bunion on the metatarsal joint that makes even ballet flats uncomfortable. Again the strappy, string, heeled things are going to be a disaster. My friend tells me you can wear anything but CHACOS.  I go to the comfortable shoe store here and to my horror the only thing they have is a pair of brown Chaco flip flops. I was post call, on my way home for the weekend which included a dress fitting. I was out of time. So I bought them. They didn’t look like CHACOs. They look liked brown flip flops. 20 minutes later I was already regretting spending so much money on ugly flip flops.  My Southern Bell (on occasion) mother gritted her teeth when she saw them. She would later tell me that she had already decided that there was NO WAY I was walking down the aisle in those horrible shoes. I reminded her that at least they were not combat boots.  I got fitted for the dress in the shoes. And then promptly returned them when I got back to OHIO.

I decided at this point I was going to go bare foot. Meanwhile, my PT here when I got my initial post op eval was MORTIFIED that I made it through life so long without orthotics. I told her I had PTSD from such things as a child. She chided me, throwing the whole MD thing at me. I relented and found she was right my feet felt better. On the up side,  I recently discovered that I could wear wedges when I was given a pair of Allergia shoes for work. I loved them so much I bought a second pair in another color. For the first time in my life, people complemented me on my foot wear! I felt strangely like I had in second grade over those dorky tic-tac toe mary janes! So proud and grown up. Oddly, one would think I would get past this, not so much.

With this in mind, I prepared myself mentally for another go shopping again to look at spring wedding shoes.  There had to be something out there, if I could find professional shoes that were NOT so bad, maybe there was hope. One pretty spring afternoon walk resulted in the purchase of a somewhat NOT awful  pair of sparkly sandals with a slight wedge.  My mother approved via cell phone pictures!!! Even my bunion approved with the adjustable straps. I breathed a sign of relief that the pain of shoe buying was over for another year. Already plotting that I could wear the SAME shoes for the Indian wedding I am scheduled to be in next Spring. Maybe I can make it two years if I didn’t wear them in Africa.

As I walked out the of shoe store, I looked down at my feet in CHACOs no less. And I smiled, you know they are funny shaped and they cant wear shoes to save their little soles. But they have grown on me. We’ve been through a lot together. They have gotten me where I have wanted to go, where I have needed to go without cartilage and against the laws of bio-mechanics.  Yes they are calloused, crooked and lumpy but they also tell my story with their stronger contours.  They tell a story of faithfulness even in the mist of suffering. And maybe that is the point.  Maybe I have beautiful feet that tell a beautiful story after all.

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Changes [05 Mar 2012|06:03am]

Originally published at Perches in the Soul. You can comment here or there.

I usually am quite adaptable being a Navy Brat and a Gimp.

But on my third month’s of sleep deprivation in a ROW, I am anxious and a wee bit strung out. Easily in a state of anxiety. Somewhere in the mist of all that I finally got the courage to try out different churches.
My second try, I met a Kenyan and  a Ukrainian, we talked East African tribes, Swahili , sekuma (food item) and the Belarussian dictators, freedom of speech and about my Romanian babies. It was like coming home by remembering leaving home.  The Americans I met were nice too.  The church is less than a mile from my current one.

The Kenyan and I are getting together and making Kenyan food next Saturday so why do I feel anxious and why oh why do I feel sad about leaving a place that really not supported me well and/or theologically fed me entirely. Is it just because its March and Im exhausted? Is the Sam’s Purse situation? Is it the people I am leaving behind, one family in particular who is one of my best friends from the residency program?

or is it that I should just be the voice of change for the next 14 months and just stay where I am because no place is perfect? And either way I have new Kenyan friends….

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Body Language [23 Feb 2012|06:12am]

Originally published at Perches in the Soul. You can comment here or there.

I would love to tell you that I always love my body.

That I appreciate my scars for the story they tell.
That I value the oddly shaped contours of my poor long bones.

That I love the strange angles that my contracted ankles and elbows grace me with.

But I would be lying.

But then again I have been lying a lot today.

All three of my best friends are getting married in the next 18 months.  Today I went to get fitted for my first of several bridesmaid dresses at the infamous David’s Bridal which has never been my favorite.  The dress is sleek, asymmetrical, one shoulder empire waist canary colored gown.  My shoulders have some impressive scars. My elbows are awkwardly angled. All around me are girls with shoulders with no scars, with normal contours.  And for a moment I feel naked, exposed and ancient.

I rip the dress off, buy it (ugh!) and run home. My best friend who knew I was going dress shopping calls me all excited. I try so hard to keep up the level of excitement because its her wedding.  And I want her to be happy.   She nearly drags it out of me, I dance around the issue a bit, mumbilng a bit.  She tells me I can return the dress, I can wear a shawl.  She is upset.  I tell her its fine.  SO FINE.  DOn’t worry about it, its not her, its not the dress its just me.

My disability mentor Bliss tells me  that I should embrace my body and I wholeheartedly agree.

Its the practice that sometimes hard, especially when you are in your 20s and have to wear frequent formal wear not designed for anyone but especially not for bodies that are different than average.

One of my friends here who has Marfan’s and some other skeletal issues has had some “work” done on several scars.  I wish I had her courage, however, the whole starving children in Africa and my intense PTSD/extreme dislike for being a surgical patient rule this out. She tells me either way that my feelings are normal.  I want them to be normal but I also dislike the idea of hating the body I have.

Because in my head I agree with Bliss, bodies are beautiful in all shapes, sizes and with many marks and contours that tell our stories. So I pray God gives me grace to love my body and help others love theirs.

i’m getting married in chacos and capri pants.

OK so maybe not capri pants but chacos and a dress that drapes my shoulders a bit and doesn’t make me feel like a member of an alien race.


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The Dream Revisited [23 Feb 2012|06:00am]

Originally published at Perches in the Soul. You can comment here or there.

Publishing old saved drafts….

from July…although hauntingly still true.


Long ago and far away I spent my summers wandering the streets of Bucharest playing with street kids, finding babies in back rooms of crumbling, stifling Soviet bloc hospitals. These summers defined me and it was here the dream was born to be a really excellent activist and pediatrician who could save babies from disease and from the poverty and stigma that they live under.    Then somewhere along the way I got caught up in a dream to study at a world class childrens hospital and caught up in all the academic rigmarole and danced the dance and sang the songs and won my way into a place that is so far removed from the  that dream that sometimes I still wake up and have to remind myself that I am not living in an alternate universe.

I am bruntout on the alternate universe. I am tired of staying up all night. I am tired of parents telling me they want me touch their children with my inexperienced, tired hands. I am tired of getting e-mails in my box that I only reviewed 9 systems in my review of system rather than 10 and the ED attending can’t get paid if I only have 9 in my note. I am tired fighting to put checks in an imaginary series of check boxes to fit some sort of magical mold that an elite pediatric resident is supposed to fit. And I keep waking up with a start because in my dreams I am doing what I have done every summer for the past 7 years up till this one, riding buses and fighting for forgotten children.   Suddenly in stead of falling in love with academic medicine or fellowship or something will give my pre-existing condition gimpy self sustainable health insurance I am missing as if I have lost my first love. As if we are painfully separated by a dream not deferred but given up and revised.

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The sorrow may last for the night….but J O Y comes in the morning [22 Feb 2012|06:09am]

Originally published at Perches in the Soul. You can comment here or there.

Child birth.

Let me tell you its messy for the mom, for the family, for the baby, for the doctor, etc. And not just physically messy. I delivered four babies and received about 40-60ish now (the pediatrician who resuscitates the baby in the delivery room or just dries them off depending how messy it all is).

Its painful and sometimes the sorrow in that room from things not going the way we all hoped is bottomless.

Pregnancy is painful.  Parenting is painful.

Believe while I don’t know personally, I live so close to it on a daily basis ,I know.

Last night I went to the woman’s bible study.  Because it was Monday and my Roommate is interviewing and eating grits (for the first time)  in Charleston, SC. She called me and said Amy, how did you ever leave the 60 degrees in Feb, the friendliness and the laid back, sit on your porch and watch the world go by kind of place.?  I told her I have no idea what came over me.  Basically I was homesick and lonely so I went to bible study even after telling myself that a bible study that looked at biblical womanhood in a church that currently loves Mark Driscoll a wee bit too much was a BAD BAD idea for me.

The passage we looked at was 1 Timothy 2, the part where we talk about not braiding our hair, not wearing gold or pearls and that we will be saved through childbearing.  We spent 45 minutes talking about the pain of womanhood from menstruation to labor to motherhood.  Don’t get me wrong, there are times where being a girl is not awesome but there was this sense of shame in the room. Shame about not controlling our emotions, shame about how painful pregnancy, childbirth, etc is.   I finally just came out and said what was flashing in my brain not out of anger but because I just couldn’t bear to watch the other ladies sit there squirming. And because I have worked 95+ hours in the last week and there is no filter anymore, there is just words.

There is no mold of a perfect woman in Christ, its not the secular mold, its not the evangelical mold (gasp).  This should be  liberating not condemning.  My comment actually was not poorly received, the word liberating caused some general discomfort (tragic…read Galatians…please).   Now I will give this church credit while I have never been to the men’s bible study naturally I have heard the sermon excerpts geared toward guys and they are equally hard on men which is a refreshing change in some ways from the norm.  So I don’t think this is one of those “Its all Eve’s fault” kind of things.  Yet I still don’t think most of those ladies left convicted and liberated.  Just convicted and guilty,

The elephant in the room….is when Paul says women will be saved through childbearing, I don’t think he meant the literal practice, I think he was using it as a metaphor. This is especially important because we take the rest of the passage as metaphoric (we still braid our hair and wear jewelery) , I don’t love the lets pick the metaphors out of literal sentence game…either this is a literal passage or its not. Don’t dance around it to the parts you like.

Child bearing results in children and for someone who spends a lot of time with babies….95 hours in the last 7 days.  Babies are complicated and messy and yes they can even bring us pain.  But for the 40-60 mothers who I passed their child to them for the first time….it was pure joy.  A joy that I don’t think happens to men in the same way and I don’t think there are many better pictures of unconditional love.  Being a woman means we have a special understanding of this because we have the capacity to bear children and experience this.So yes we (men too)  are saved through childbearing…through unconditional love, the kind of love that lays down one’s life for one child or one friend.

kind of like Jesus.

Perfect love drives out all fear, drives out sin and pain and brokenness. That’s the gospel.  God has made a curse into something beautiful.

but we didn’t talk about that. and my 95+ hour work brain couldn’t articulate as well I wanted to in the moment.


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A Good Death [09 Feb 2012|06:22pm]

Originally published at Perches in the Soul. You can comment here or there.

Nights in the NICU anywhere is to stand in the strange gap between heaven and earth.  Everyone is coming and going somewhere.

In Africa, we would run our list prior to call and come across a name of a baby who was struggling or had an infection we could not beat, there were no ventilators or was just too small, too early for us to give it a fighting chance with what we had.  We would say, Baby so and so is going home tonight. It doesn’t meant we won’t try, it doesn’t mean we haven’t racked our brains of what we can do with with what we have. But we know our limitations and we also know that us beating on the chest of a premature new born who needs a ventilator we don’t have is not going to help anyone.

Home is an evangelical phrase that is a reference to a verse in Paul’s letters that talks about being citizens of heaven and not of earth.

But I like it because it implies that death is not just about leaving, its also about going.  Babies don’t have the need for our theology and politics but  they remember where they came from.

In America, when a baby is dying in the NICU, we stand around running through every physiological rotation, we throw every drug we can think of, we call in the surgeons, who join the circle around the bedside, we try experiments, we give blood, fluids like we have unlimited resources,  we switch around ventilators left and right, we talk about the baby in the circle as some academic enigma whose body is just not doing what we tell it to do. The parents hover just inside the circle. Most are stoic, looking at the baby back to our circle, trying to decipher our academic whispers.  We tell them the truth, we tell them the baby is going to die.

In Africa, the mothers visit every two hours to breast feed or pump to feed through a feeding tube. They are devoted beyond belief.  We don’t mess around when a baby is dying, Mom will sit by the bedside in vigil, holding the baby, loving the baby. Other than making the baby comfortable we don’t interfere. In some ways, its the worse feeling in the world as a physician and in other ways its liberating to be able to give the baby and their family that moment.

Last night, we had a baby that had had every thing we had to offer who was dying, this went on for about 7-8 hours.  The mother was alone, young, she didn’t seem to understand what we were saying when we told her, her daughter was dying. She went home to sleep 20 mins afterwards. Perhaps it was the crowd of onlookers, the 25 people standing around still intervening. It didn’t look like the end, it looked like the middle of the battle. I called the chaplain and we called her back.  It took no less than 45 minutes to change the tubes around enough so that Mom could hold the baby.  I am watching the monitor the whole time and watching the baby heart rate drop alarmingly fast.  By the time Mom got to hold the baby the baby was purple and no longer had detectable pulses, we were breathing for the baby.   But the baby was gone.

Why did we wait I cried out internally?  What in the name of all that is good were we doing??????  WHY is she still on the dam monitor?  If we hadn’t waited till past the 11th hour, we could have found a private room for this Mom, we could have let her hold her, sing to her, cry, call her family. She never held her child alive or if she did it was for seconds to minutes. What really mattered here? We knew 8 hours ago that we were pulling for straws.  What were the extraordinary measures here?

Instead, she held a dead baby for about 45 minutes in the middle of a NICU pod with the sickest patients so with people constantly in and out. Even with screens….it was hellish.   And the moment heaven meets earth should haven’t to be.  It doesn’t have to be like this.

I am not saying the agony of what I don’t have in Africa is better but the agony of having everything except for the one thing that really matters in America is  haunting.   Its haunting because we have lost a grip on life in our attempts to foil death.

Either way the baby dies, its about how they die.



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Confessions, awkward prayers, awakened possibilities [02 Feb 2012|04:12pm]

Originally published at Perches in the Soul. You can comment here or there.

Well I told someone exactly how I feel in terms of being a bad evangelical.

It was not my pastor. It was a kind man about my parents’ age who is also a bad evangelical who runs an intentional community.  I am not quite where he is, in that I am pretty sure he simply sees Jesus as a moral teacher. But I so greatly appreciated his story, his life and his willingness to listen to my story.

He told me that he had built his career as a missionary and now has very little to show for it because now he has evolved into a liberal that is no longer accepted in evangelical circles.  His biggest advice was to not end up that way. It will be different from me as a physician but still very good advice.

Literally 15 mins after that I sat in a strange yellow room on a sofa saying I wanted prayer for the choices I had to make.  Two things were abundantly clear to me in that moment.  This guy who is my pastor really doesn’t know me so well and well as a result its awkward. And then I also realized that while he and I on paper have similar theology, our application of that theology is completely different.  I handed them my reference form and ran to PT.

So I stand in the middle of these two extremes.  And for now that is ok.  The reality is for now I am a liberal evangelical and I am ok with that.


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