Sunday, July 24, 2011

intricacy.

I had a cup of coffee at 8:00 tonight. The power was out all day today, and I wasn’t going to attempt to make coffee by heating water on the stove and…I don’t even know how I would’ve accomplished that. So I took the opportunity to rid myself of my caffeine headache as soon as the power came back on, which means my sleep schedule just went out the window. These ideas have been stewing in my brain for a few weeks now. Two Sundays ago Janet and I were driving out to Valley of the Angels. It was sunny and clear, allowing for beautiful, unadulterated views of the mountains. There is a vastness to the mountains here that seems different from any other “wilderness” I’ve experienced, probably due to the limited road access and overall lack of development that makes them seem so untouched. By humans, at least. I like to pick a little spot on the side of a mountain, indistinguishable from anything around it, and wonder if a single person has ever been there, in that exact spot, touching that one tree. God’s intricate design radiates from the landscape here, and some days I can only gaze in wonder at the way the sun illuminates a part of the mountainside, how the rain comes across the valley, and how a freshly-fallen Manzanita tastes like roses. I would like to think that I can fully appreciate this intricacy God has bestowed in His creation, but I feel like it is too profound, no matter how devoted I am to observing and understanding it.

The intricacy of this beauty has been so clear to me this summer, but so has the intricacy of evil. The pain of this world is specific, detailed, calculated, and unfair. One of my favorite views this summer was the glimpse out of the newly-cut window of Jessica’s house in Cataluña. The blues, greens, and greys combining into a hazy and unique sprawl of mountains and sky. Yet in the same village, in a different wooden shack with the same view, a 2 year old girl is being sexually abused, contracting the telling urinary tract infection we would diagnose during a mobile clinic two weeks later. It will never make sense, but it is delicate, disgusting, and real. I can never say that these situations, these tiny specks of the world and humanity are untouched by God. I know that’s false. He is omniscient and omnipresent. So how do I come to terms with the sharp, relentless focus of evil? Like the beauty of God’s creation, it is too profound for my full understanding. I want to reconcile it, with God, with the victims. We have at least five crying patients every day in the clinic. Most of the time it’s the toddlers who are angry at me for gagging them in order to diagnose their swollen tonsils. The other cases are women who present with insomnia, headaches, and gastritis. As per our usual consultation, Dr. Olga asks them about stress in their life, explaining how it manifests in their physical condition. Then the tears start as these women explain their husband’s drinking problem, the multiple deaths occurring among their friends, or the poor health of their pregnant teenage daughter. Like I said, relentless. Some days I space out, convincing myself I don’t understand what they’re saying, when really I just can’t understand why they have to be hurting. I don’t ever want to be ignorant of any of this, either. There have been problems in my life that are delicate, intricately positioned as to cause the most pain, and they still can’t seem to compare to the stories I hear or the pain I see in someone’s eyes.

The tiny details of this pain are powerful and can eclipse the intricate beauty of life sometimes. There’s a balance, or war, I’m pretty sure it’s both, that exists between the two. I have poignant memories of both in my life, and each has its own ability to strengthen or further define my relationship with God. I remember the desperation I felt in March and April, when I was consumed with self-doubt and terribly isolated as I poured every ounce of energy into studying for the MCAT. Then I remember being home at the end of May and looking at the peaceful, curled frame of my sleeping 3-year-old cousin just before I woke him up from his nap. These events are separate and non-reciprocating, yet provide a delicate, warring balance in my life. Good and evil are never going to one-up each other or be comparable. Relationships in my experience seem to work similarly – so much strength can be built on little moments and details of devotion, and other little aspects seemingly insignificant can cause intense pain and decay. A pro/con comparison does little to alleviate this conflict and save a relationship; a decision to work towards the good in spite of the war is necessary to do so. We are left with resolve. This war causes weariness, confusion, and doubt, yet every day when I get out of bed, I must resolve to continue towards the ultimate good that God represents without denying the strength of each opponent. And how much I have to learn about this. I can theorize and philosophize much more readily than I can employ this idea in my life.

There is an image of despair so sharp and repulsive that I witnessed a few weeks ago. I have yet to verbalize it to anyone. What is seen in Honduras affects everyone in varying degrees, and what I describe may seem mild to you. I, however, will never be rid of it. I was with Tim in his truck one day after a clinic. We were going to meet the bus at the dump and hand out pizza and water. The situation was out of hand from the start, so we had to alter our original plan. Because of the mob-like atmosphere, I stayed in the truck. While I was sitting there, a garbage truck drove past after its passengers had received the pizza and water. Standing on the back of the truck with one arm looped through the handle was a girl, 7-months pregnant. She was probably 17. Three other guys were also on the back of the garbage truck, one of them trying to grab the two pieces of pizza from the girl. She clutched the plastic bag tightly, laughing and refusing to give it to the man as the garbage truck drove away from the dump. I can’t measure the desperation present in that situation, and no beautiful facet of God’s glory on Earth can reconcile that in my mind. Yet the good will thrive and exist alongside the evil, with some of us in our insignificance working to unveil more of the good found in God’s creation.

Tuesday, July 12, 2011

learning.

i'm at home today. i have a lovely sinus infection and respiratory congestion. it's like they say about druggies, hang around them long enough and you become one. i've been hanging out with patients all the time and now look at me. this at least gives me time to update here and upload photos. i've been here 4 weeks to the day, and have 4 weeks left. the first 3 weeks were absolute craziness. being part of a group here is always an adventure, and i've definitely been all over the place, doing all sorts of different things, with three different groups! one of the best parts about the first 3 weeks was the medical clinics. we pack up plastic bins full of donated medicine, bandages, vitamins, etc and set up usually in a church building in one of the villages we're working in. we divide the room into triage, doctor station, and pharmacy. we have translators set up at each station...they're pretty important. the first clinic we did was in los pinos. we were going to start by handing out 40 numbers to the anxious people outside the building. unfortunately an errant blank notepad and a well-meaning church member caused that number to rise to 70. THEN families were taking their number after being seen and handing it to another outside the gate. i'm not sure how many repeats we saw before we finally started collecting the numbers. we saw TONS of patients (approx. 350) and i learned so much. i was at gayle's side the whole time, listening to lungs and hearts, looking in ears and down throats. experiential learning is such a huge part of medicine, and i am so, SO blessed to get so much of it before i even start med school. a good teacher is invaluable, and gayle was amazing. we had some pretty crazy cases come through. there is so much more to being a doctor than diagnosing and treating. more about that in another post. it takes a lot of strength to sit across from a 7 year old boy who we suspect has a dissected abdominal aorta and calmly explain that he needs to go to the hospital. In the states, he would have immediate surgery. when you're in a little church building on the side of a mountain, there's not much you can do except hand a piece of paper with the name of his illness to his mother and strongly encourage them to proceed to the hospital. luckily gayle had this strength....i sat there stunned, fighting back tears. this past semester i was in honors physiology lab, where we were assigned hypothetical cases to research and diagnose. during our cardiovascular unit i was assigned a patient with a dissected aorta. she was in critical condition, but she was sent to surgery immediately and recovered quickly. this surgery is very serious, and knowing the aptitude of the local hospitals, i don't even know if they could successfully perform this surgery. what was going through my head at this point? CRAP. WHAT...I...HOW...CAN WE...CRAP. yeah i know, not very poetic. you really shouldn't lie to patients. more importantly...you shouldn't freak them out. we didn't lie, but we didn't divulge the full gravity of the situation. now, keeping someone else calm while having a silent panic attack is a skill i have yet to acquire. working on it though :)the years that lie ahead in my medical education seem so daunting, and actually practicing medicine even more so. books i can learn, memorize if i have to. but knowing how to trust and be trusted by, calm, comfort, and chastise patients will take so much more concentrated effort. now for those of you who are already drafting emails telling me to reconsider my career choice because i actually have to work on the way i behave around patients, chill. some of it comes naturally. when i'm talking to a patient about their symptoms or explaining how to take their medicine, i am relaxed, using simple terms and joking around a bit. i am starting to activate different skills, aspects of my personality that i've just never had the opportunity to use before. and i love it. what an amazing life challenge God has set before me. yeah i know, He's been pretty absent from this post so far, but definitely not from everything i've been doing.so, to be honest, i like the feel of a stethoscope around my neck. i like being introduced to patients, listening to them, speaking their language, explaining their illness, and hearing "gracias, doctora" when i give them their meds and send them on their way. it's a really good feeling. it could easily go to my head. it doesn't because of the loving, all-powerful and gracious God i choose to follow every day. every day i spend in the clinic or in another village i am humbled, almost beat to the ground because almost every day i use the words "No puedo..." in conversation. "I can't..." Even if i were the best cardiothoracic surgeon in the world I couldn't fix a 7 year old boy in the church at los pinos. at the clinic we can't give blood or urine tests or do ultrasounds or x-rays. we rely on medicines donated from the states, and we definitely don't have every type of medicine our patients need. i'm learning medicine by leaps and bounds, yet there will never be a day when I can fix everything. especially here. i'm not sure how doctors who don't believe in the ultimate Physician go to a third world country and practice medicine. because in these helpless moments, when a solution exists in other parts of the world but not here, I pray. I can't fix it, but I can pray to the God who can. it's almost forced, like i literally have no other option...which is probably good for me, seeing as prayer is a reflex for me only in extreme situations. so as I am confronted with my limits on a daily basis, God is teaching me to push them and accept them at the same time, relying on Him more completely than I ever have in my life. here i am but a humble student...being led toward God every day, because sometimes its hard for me to do the walking on my own.I'm thankful I have the motivation to keep blogging. it's been difficult to find the words lately. enjoy the pics!!!! love, annie














check out annie's green stethoscope :)














listening. writing prescriptions. soaking it all up!!!


















accosting the poor man's eye ball. this guy was pretty sick.
















los pinos church where we were set up















got a little crowded sometimes....



















this is as difficult and awkward as it looks...




















5 year old with a goiter (enlarged thyroid)...don't see that every day.



















candy is important. we're not dentists.