The Beauty in the Ashes

I remember watching my aunt care for her little brother. My uncle had very bad diabetes and my aunt fought hard to make sure he got the best care possible. When he went for his transplant evaluation at UVA I heard my aunt made several employees mad by the way she fought for him. She was scared and trying desperately to give him this last chance at a better life. Watching how she loved him, and how she just wanted the best for him, has given me better insight into the fears faced by these families as they watch their children suffer.

I met a father this week whose son had just been diagnosed with cancer. He is terrified that his son may be ripped away from him. He is at the best hospital in the world for his son’s cancer, and they don't have to pay a cent. Yet, since his arrival, Kevin has not ceased to push back at everything done to his son. He questions it all, asks if things can be done a better way, and is not afraid to let you know he is very angry. To the staff he is rude, belligerent, and seams to even be a danger. But all I can see is his fear. His son's cancer is not the worst kind he could have, and he has a decent chance at survival. But does that really matter? He is scared, alone, and angry that it had to be his son in this hospital bed.

I have come to find the medical community in general is much better at treating leukemia than solid tumors. Most of the leukemia patients had a pretty good chance at survival even if they were high risk leukemia. I mean, even if all else failed there is bone marrow transplant that gives hope even when nothing else works. It’s awful to watch these children suffer in the present but there is much hope that it is only temporary, and that someday they can lead a somewhat normal life.  But for brain tumors and kidney tumors, and bone tumors, the challenge is much different. Many children don’t receive a diagnosis until the tumor is in advanced stages. I do realize that the snap shot I have is a unique subpopulation of the worst cases of solid tumors in the country or even the world. But so far these cases seem much worse.

My first day on solid tumor I not only noticed the severity of the cases we were dealing with, but I also notice the major difference in the staff that work with them. There was a certain level of stress as expected, however, almost every NP, fellow, and attending I have worked with on solid tumor have a different level of hardness about them. Every day this week has been met with short remarks, cursing, and bad attitudes. At first I thought it was just the personality differences, but I really think it’s almost a coping mechanism even for these staff members. I cannot even imagine how difficult it is to continue to care for someone and their family, to go through all the complications with them, and all the emotions, knowing that all you do is not enough to prolong their few years on earth. I found myself getting frustrated with the staff, and wishing I could work with other people. But thankfully God gently reminded me to look at everything through their eyes. It is much easier to take in all they say and how they act when I take myself out of it. Don’t get me wrong, every one of them is excellent at their job, and they can turn off all their emotions and frustrations the moment they walk into a room. They bring wonderful care, but it takes a major toll on them and likewise I am sure it affects their families as well.

All week I wanted to point out to my superiors how this poor father mentioned above does not mean to be so offensive in how he has been dealing with them. I wanted to ask them to just sit and listen to him, to explain things better, or maybe just give him some time process. I wanted to ask them to take a step back and look at everything through his eyes, but I also knew that to do so, for them, might be too much. Everyone is coping their own way the best they know how. Thankfully, as the week has progressed, tension has settled and things with this father are better, but this won’t be the last time this situation occurs.

And then there is the issue of pain. As a profession we can fix pain, at least we can make it so that you don’t have to feel pain. But, it comes with its caveats. The delicate balance between taking the pain away, but not sedating the patient to the point that their family can’t talk to them, or to the point that the patient is not even aware of life. I have seen in these few weeks that children are so resilient. Through the worst of their disease, we can keep their pain away or at least tolerable, and if things are really bad, then they stay asleep the whole time and have no clue what’s going on. So many children can bounce back from chemo and even bad complications and go on to live normal lives. But, it’s the parents for whom my heart has been breaking these weeks. Day after day they sit and watch their child’s body battle. And sometimes it wins, and sometimes it doesn’t.

Needless to say, this week has been very difficult for me. It is hard to face these challenges each day. I find myself in prayer most of the day. Praying for mercy, for peace, for hope, for strength and endurance; and yet, in all the sadness I do see so much mercy. I stood praying for a young child as the thought occurred to me, “he seems so innocent, what did he do to deserve this?” and that still small voice, “Oh, my child, you all deserve this and so much worse. It is only my mercy and grace that confine this devastation to so few families. And even now, I have not forsaken them. I hear their cry, and I hurt with them.”

I am reminded of Hagar in Genesis 16, as she is fleeing from Sarah. There by a fountain of water God met with her. She was told that she would have a son, and that she should call him Ishmael, “Because the LORD has given heed to your affliction (verse 11c).”  She then called God his name El Roi, the God who sees me.

Sometimes I forget that at the same time that God is powerful, and holy, and just, that He is still perfect in His mercy, grace, and love. I can see the mixture of these attributes in these families at St Jude. His justice in allowing the consequences of sin and evil in this world wreak havoc on every human born in Adam, yet at the same instance his mercy in limiting this pain not only in the number of families who deal with it, but in each individual person watching them and holding them, whether they know it or not. “For they that sow in tears shall reap in joy” (Psalm 126:5). “You have taken account of my wanderings; Put my tears in Your bottle. Are they not in Your book” (Psalm 56:8).

God really is in control. In all His majesty and splendor, He alone can make beauty form the ashes. He is opening my eyes to more of the evilness of sin and the curse of death, and it is painful. It hurts and it cuts deeply. Yet, in seeing and growing in this knowledge of good and evil, I can say I hate sin more than I ever have before. And therefore, I see more of a glimpse of the awesomeness of God’s love, and my love for Him grows in exchange. The beauty in the ashes.

Finding Cures. Saving Children. St Jude Children's Research Hospital

This past week I made the 8 hour trek across the great state of Tennessee. Granted with family in Knoxville and in Nashville it took me 3 days because I had to stop and take advantage of seeing them. But Sunday evening I rolled into midtown Memphis. I’m not usually the sort to stay with random strangers (except almost all my trips to Africa). But, it is completely different when you know those strangers are in fact your brother and sister in Christ! Actually it makes ALL the difference. For the month of January I will be allowed to ‘work’ with hospital patients at St Jude Children’s Research Hospital. And if that wasn’t enough grace from God, He has also provided a wonderful family for me to stay with free of charge AND they even let me eat dinner with them free of charge. Like a free home cooked meal that I didn’t have to cook! I’m pretty sure every morning and every evening I sincerely thank God for each of these amazing blessings. Like I have told my sister before the big 3 for a college student or single post-grad person are 1: a warm bed 2: food 3: a place to do laundry. Jennifer graciously provides 2 of the big 3 for me on a semi regular basis for which I am eternally grateful. However, the King’s have stepped it up and have actually provided all 3 of the big 3, and I am still in amazement at their generosity!

Monday, I went to St Jude for the first time and spent all day in new employee orientation. And with it being the first Monday of 2016 there was quite the crowd.  Unfortunately, much of what they went over did not apply to me as I would not actually be receiving a pay check from them, but I did receive a really cool official St Jude bag! Tuesday I joined the inpatient leukemia team as they were doing morning table rounds. Talk about overwhelming! I realized very quickly that all of these patients are extremely complicated, and I knew I had jumped into the deep end! But as the day progressed the Heme/Onc fellow very kindly explained a lot to me and broke things down to where I could almost wrap my tiny little brain around them. Yet when I heard my attending tell her to assign me 2 patients because I was “qualified to see them” I was again terrified and questioned any sort of “qualified-ness” about me! But as with many things, once you make yourself jump in there and do it, things start to get a little easier. I have now had 2 days of successfully following my 2 patients and I have learned quite a lot. Although I still feel like I don’t know anything, so don’t ask me questions just yet!   

What has impressed me the most, however, of all the things I have learned (thus far) is what I have learned about St. Jude the institution. I always thought of it as a hospital that does research but it’s much more like a research institute that happens to have a hospital on site. Most of the buildings at St Jude are for research and I would venture to say most of their employees are scientists and not doctors or nurses. Actually, I felt a little out of place at orientation because most of the people were researchers or business men and things. Anyway, it was nice to see the amount of effort that was being put into researching childhood cancers. When St. Jude was opened in 1962 the survival rate for childhood leukemia was like 4% in just 20 years it jumped to around 75% and today it is at 94%. And even more amazing is that with a DAILY budget of 2 million dollars, all funds are raised by grants and outside donors (through ALSAC the American Lebanese Syrian Associated Charities). Patients do not pay a penny for their treatments at St Jude. It’s pretty amazing! On site they have a little mini museum telling the history of the founder Danny Thomas, the history of the research advancements and awards received etc. One of the quotes from a parent caught my eye, “when we looked out of our hospital windows at night the lights in the research buildings were always on, and it gave us hope.” The things being done at ST Jude are truly amazing, and it brings people from all over the world in search of a cure.

I expected this rotation to be really hard for me emotionally. It isn’t the easiest thing to see so many children with such horrible diseases. But, to my surprise there has been a lot of joy and hope. Because we know that for most of these kids we can make them better, and that is exhilarating! I must say though, I have had my moments of hard times. My heart aches for the mother who hasn’t slept in 4 days because her son was just diagnosed with cancer and she stays awake with him all night and all day trying to wrap her head around all that has happened and all the treatments and procedures her little boy is going though. And yet, I am so thankful she is here, because I know her son will be taken care of, and so will she. It has also been hard to see the 1% of cases that are so unique that we just don’t know what to do. With all the knowledge and research we still don’t know everything. And of course, all the most difficult cases of cancer around the world come to St Jude here in Memphis. It has been amazing to sit and watch experts in the field discuss the best course of action in each case and how to adjust them for specific things. And it is incredibly humbling to realize that I am sitting among them. I don’t have an inkling of their wisdom and yet I do have something much more powerful, direct access to the Great Physician.

I was standing in a room today listening to a frightened mother question my attending physician on the course of her son’s treatment. The chemo had given him such bad side effects that we had to stop it and use different chemo drugs that wouldn’t do that. She almost broke down as she asked if these new drugs would change the overall prognosis of her son’s condition. Obviously they were second best to what he had been getting, and she feared they would not cure him. My attending tried for a long time to explain everything to her. That in medicine we must first do no harm and these drugs were harming him, but it is a fine line between harm and benefits. After a while I stopped listening and just began praying. I know she is scared, terrified actually, it seemed like a lose, lose situation. . .  But God. . . I couldn’t help but think in that moment, ‘Lord you are more powerful than any chemo regimen, and you alone can bring comfort in this situation.’ I realized that no matter the advances in cancer research Christ is still the best medicine. Deep down He is who everyone needs no matter what they are facing. Even with the best cancer care in world and the best cancer research in the world, it’s not enough for the cancer patient without Christ. They may not know that, but it is so true. And so obviously they all need our prayers; but not just the ones at St Jude but the kids with cancer in Brazil and Honduras and Finland, and Zimbabwe, and next door. They don’t all get the best care, but they can all have the Great Physician. So then, can’t we all be physicians in some regard, praying for the Great physician to bring healing? That’s the best weapon I have against cancer, and we can all fight with it! Oh to contemplate the power of prayer, and yet I tap into that great power so little for all the people in my life. Can you imagine if any of us actually prayed without ceasing? If I, as a physician, could live in an attitude of prayer such that it saturated all my patients, what amazing things could I see God do?

That is what I am learning at St. Jude. . . thus far J

The Best of Times. . . and the Worst of Times. In Loving Memory.

This has been a crazy season in my life. Interviewing for residency has left my head spinning just about all the time! For about 3 months I just kept my suit case partially packed. I’ll admit some places I applied to just because I wanted to visit family or friends that lived in the area or thought a trip to the beach in December would be rather nice, however, most places I interviewed with were places I was seriously considering for the next 3 years of my life. It has been exhausting and yet very cool to travel and see new places and imagine myself living there and learning to become a pediatrician. Friday marked my final interview and with relief I headed home from New Jersey. I have been everywhere from Danville PA to Savannah GA and many places in between.  My first interview offer was in Galveston Texas, and though I tried several times to call the coordinator by the time I got through to her every interview spot had been filled. At the time, this did not seem like a big deal. I had only applied there in hopes to go visit my grandfather and his family who live outside of Houston. And even when that interview did not work out, I had almost determined in my mind that I would still go visit sometime this year. I had not seen them since I was very little.

I always thought I would get a chance to sit down with him again and just talk. A chance to let him know we all forgave him long ago, a chance to tell him a little about me and make him feel like he was part of my life even though he really wasn’t. I thought I would have a chance to tell him how I admired him despite it all. This morning came with the cold realization that I will have no such chances. When I heard he had been in and out of the hospital several times with pneumonia that he couldn’t kick I knew he was dying, I just thought it would take a few months. When I heard he was living in the past and his mind was going I knew maybe a month. When I heard he went home on hospice I thought maybe a week. I thought I had time for at least a phone call. But today it was too late.

 

Granddad, this is Janie. I’m Gina’s 3^rd. That visit to your ranch when I was young was one of the coolest things I have ever done. I always knew I was part Texan and that I would totally fit in Texas if the occasion presented itself. I rock my boots and jeans whenever possible and even a cowboy hat at times. I’m pretty sure that my desire to have a truck as my only vehicle comes from you. I hate that I haven’t seen you all these years. I’m not the little girl I once was; the one that went crazy with the face paint at the museum in Houston and came out looking like a piece of abstract art. I’ll actually be a doctor in a few months. I had always wished somehow you would be there for my graduation though I knew it was impossible with your health. You’ve missed a lot here, and I know we’ve missed a lot there. If you could’ve waited until I was a doctor then maybe I would have the money to fly us all out there. But I’m afraid I will miss your ceremony because it is so soon and so far away. This Christmas won’t be too different for us, because you’ve never been there for it. We don’t already have presents with your name on them under our tree like your other family does. We won’t have an empty chair at our dinner table. And yet, this Christmas will be very different for us. We love you grandad, and part of us left with you today. So we, along with your family in Texas, will have great pain and sorrow as we celebrate this season. But we will celebrate. Because the baby we are celebrating is our only hope, our only comfort, and our only peace. Because Jesus came I can live and continue on in the midst of pain. I so want to believe you’re there with Him, that you are with Mamaw and Uncle Bart worshiping God and dancing before His throne. But honestly, granddad, I didn’t know you well enough to know if you are. And that, I think, hurts the worst. I don’t know why God didn’t let me come to Texas for an interview this year so I could see you one last time, but I do know His way is good and perfect.  I love you, sir. And you will always be a hero in my book. Who knows, maybe one of these days I’ll actually make it back to Texas. But, I can assure you it won’t be the same. Rest in peace granddad, knowing you are loved much by many. I hope to see you again someday!

The refiners fire

What is it about the ocean that seems to bring you to the foot stool of God? Is it the shear vastness reaching to places way beyond where we can see, or knowing that we have no control over what it does, or is it simply the natural breathtaking beauty of what God made? What a reminder of our nothingness and God's awesomeness! Sitting at the oceans edge is the solitary place where I feel like I can think the clearest, maybe because it forces me to see the big picture. 

I wasn't planning on going this year, simply because I wanted to save money for the extremely expensive 4th year of medical school. I went from my surgery rotation (which literally almost killed me from pure exhaustion. Jk) to end of year testing to studying all day for boards to taking boards. Then I had all of 1.5 weeks before I started up again. And on top of all of this as I headed into my week and a half off, I get blindsided by the Supreme Court ruling. I had no time to mentally or spiritually prepare myself for it! 

I finally felt what I believe was worthy of tearing my clothes in agony. I wanted to wear sack cloth and ashes and weep before our Lord! My sin lead to this, and my disobedience in witnessing to countless friends lead to their rejoicing over it. For a time I could not get on Facebook or social media in general, because I felt as though I was getting punched in the stomach or mouth every time. How we have profaned the name of God! How we have distorted His symbol of mercy! Repent! That's what I heard God saying to me all summer. Search your heart and turn from your wicked ways, Janie! God brought me to my knees and I almost felt crushed under the weight of the sin I felt. But thanks be to God who whispered  to me in my despair 'I already bore this weight, TAKE IT OFF!' 

My heart aches to realize how far we have strayed from the truth. But what a merciful and gracious God we serve! In the midst of all that is going on I have hope! Hope that God will continue to cleanse me and the church in America. Hope that when He does execute His judgement that He will give me the grace to endure it if I am still here. Hope that with persecution comes revival and a cleansing into something most beautiful. Hope that My God is mighty to save, and He alone can fix America's sin problem! 

I am in a way thankful for the events that have taken place. It has awakened me to the darkness here in my own home. It is easier to stand up to Satan when he is screaming at you right in your face rather than when he quietly offers you a chair and feeds you lies. We have been sitting too long! May we not forget that gay marriage is not the only issue. I would not go to a gay wedding as much as I would not go to a friends wedding where she is marrying a man she cheated on her husband with. I cannot support either.  My home state of Tennessee is number one in the country for human trafficking, all are an abomination to God. Church, just because our society has singled homosexuality out as something different, I pray we would see it all, and repent! 

With that being said, should we not approach this as with any sin. My heart aches because I love those who are slave to this lie. A lie I may have fallen prey to apart from Christ. We must speak the truth, as with every lost soul as the Spirit leads. There is still great sin in America and at least now we see it and pray fervently for revival in our nation. May it compel us to see each day the battle field it is. May we be ready to give a defense for the hope that is within us. And may we search our own heart, and let God search them, because we all know sin lies within us as well. 

With all of this heavy on my mind I convinced mom to do a last minute beach trip with me. My hope was that God would speak to me during this time at the ocean and help me handle all that was going on. I wanted some action plan. But this time I didn't get much time at the edge of the ocean. My brother came to and for the first time since 2007 he and I both could play in the ocean together. As I watched him act just like he did as a middle school kid splashing in the waves I had a beautiful picture of him dancing before the Lord. God gave us those waves, and allowed us to be there, and there we were just playing in his creation. I realized God brought me there not to reveal some attack plan, but rather to remind me to rest in Him. The plan has been the same all along, go and preach the Gospel to all nations. 

I believe hard times are coming for us who truly believe His word. Will we be found worthy of persecution? Will we stand and fight to love with a tough but honest love? Are we willing to be searched by almighty God and have Him point out to us all our wicked ways? The days are coming where God will vomit out the lukewarm church. Where will we be? 

The Danger of Knowledge

In the Garden of Eden, God told Adam and Eve they could eat of any tree except the tree of the knowledge of good and evil. When they disobeyed and ate their eyes were opened to a world they had not known. Knowledge can be dangerous; knowledge without wisdom that is.

The more that I study for my upcoming board exams; the more I find myself stressing out and worrying about the health and wellbeing of my family and friends. It is a hard thing to know all the ways our bodies can mess up, all the complications that can happen and all the things that can end a life. I find myself not wanting my father to run or play sports because he is the prime age for a heart attack and has a few risks factors. Yet, at the same time this week I noticed a few things going on in a family member and almost starting freaking out because the signs I saw could either be several minor things that happen to be all at the same time, or it could be something serious needing prompt attention. I sat contemplating the situation but could not live with myself unless I knew there was no danger.

So what do you do? Do you call out potential though unlikely danger and freak everyone out around you and very possibly look like a paranoid hypochondriac medical student who doesn’t know anything, or do you not say anything and lose sleep praying that everything is okay? And then how do you live with the decision you have made? How could you live with yourself if your gut was right and it was serious and you didn’t say anything? See knowledge, knowledge without wisdom, is very dangerous.

On the flip side, what if I think I know exactly what’s going on in a patient and confidently move in the direction I am sure is correct, and I am actually missing something, or maybe I don’t know it all, or maybe I’m way out in left field? What happens when I am sure a patient is fine but really they are dying and I don’t catch it? These are things that help drive my study of medicine, but more than that, they drive my pursuit of Christ. My knowledge no matter how much I study or how long I practice medicine will be deficient. I will never be able to perfectly care for every patient of mine no matter how much I want to. I am inadequate, period. But, thanks be to God, when I am weak, then I am strong! He is the answer. You see if I trust my knowledge, I am lacking, but when I abide in Christ and am lead by the Holy Spirit inside me, then my knowledge becomes wisdom. God made each of us and He is intimately acquainted with everything going on in our bodies. I have the most powerful diagnostic tool in my arsenal because the very God who made my patients is living in me. So when I am debating with myself if something serious is going on or something small, my first diagnostic test is to get on myknees.

Then I am not confident in my knowledge but in His guidance, in His infinite wisdom. This is the kind of physician I want to be. One who goes to my knees before the lab. It’s not about what I can do with my knowledge, but what wants to do through me as a tool. Don’t get me wrong I am still most certainly going to study as much as I can, because it is still my responsibility to not waste the education God is giving me, but I am not studying for a degree, or for my patients, or even to be a good physician. I study as an offering, as worship, and I long for it to be an acceptable offering, a sweet smelling aroma before my Lord! Proverbs 2:6 says “For the LORD gives wisdom; from His mouth come knowledge and understanding.” I heard it said once that wisdom is the application of knowledge. I like that definition because without knowing how to use knowledge the right way what good is it? According to Proverbs not only does God give us the understanding and knowledge in the first place, but He also is the one that shows us how to use it the right way. Proverbs 1:7 tells us that “the fear of the Lord is the beginning of wisdom; fools despise wisdom and discipline” He is the answer, in searching for Him, we find everything we need.

So what about you? God has given us each a unique type of knowledge and understanding to use for Him. Even Adam and Eve in the garden, when their eyes where opened to sin and evil, what good could come from that? I mean it almost seems as though it would’ve been better if they had never sinned and as a human race we remain perfect as God created us, right? So, maybe ignorance is better than knowledge? Has it ever occurred to you that without sin and imperfection we would not be able to know God completely?  Without sin and punishment, how would we know grace or mercy? So then do we sin just to know more of God’s mercy and grace? Paul deals with this in chapter 6 of Romans “What should we say then? Should we continue in sin so that grace may multiply? Absolutely not! How can we who died to sin still live in it?” Basically, if we are truly God’s redeemed, He has so changed our hearts that we no longer want to sin because we want to glorify Him.

The point to all this madness, God has given us all knowledge and understanding.  The knowledge of good and evil (your conscience), understanding in a certain field or business, and for those of us to whom He chooses, the knowledge of Himself (Is 43:10 “You are my Witnesses, declares the Lord, and my servants whom I have chosen, to know and believe me and understand that I AM. No god was formed before me, and there will be none after Me.”).  So we all have knowledge, the question is, will we be wise with the knowledge we have or will we fall prey to its danger (using it apart from God, in our own strength).

The Other Side of the Exam Table

Today I was on the other side of telling a couple they were no longer pregnant. Can I just say I'm not a fan! I knew the ultrasound tech had already told them, but still I had to go in there and put a face, 2 faces to those ultra sound images that showed no life. When we walk in I can tell they are both trying to be so tough, but I can see the hurt behind their mask. I wanted to just go hug her and pray over her, because I know that only the God of Comfort can help in times like these. I don't know how she held it together that whole visit. She calmly asked the expected questions. What happened, why, will this effect future pregnancies? We answered them as best we could, then schedule the procedure to remove the dead fetus. Standing there hurting with this family, I just cried out for them to receive comfort and peace from Almighty God who gives and takes away. Prayed that somehow they would see Him shine through this dark hour, that The Way, The Truth, and The Life would come to their aide.

As we walked out the doctor asked if I wanted to watch this procedure. He explained it was actually the same one done if someone were to have an abortion, and I think we all know what the only difference would be. That did it for me, there's no way I would be able to hold it together while watching him removed this fetus. Life is but a vapor (Ps 39) and "as for man, his days are like grass, as the flower of the field, so he flourishes. For the wind passes over it and it is gone and it's place remembers it no more." (Ps 103:15,16) This fetus was a life, he or she fulfilled all 5 requirements of a life form not to mention that this fetus was still made in the image of Almighty God. How would I be able to hold it together while he removes him/her from his mother's womb knowing the pain to come, the void he/she will leave? Oh how it afflicts my soul to think of a physician doing this with a living fetus with a beating heart, with a chance at life! Who are we to take that away? I have said over and over and over what a miracle it is that any of us live and live healthy at that! All of the millions and billions of things that have to happen just right. Only God could make all those chromosomes line up perfectly and separate perfectly billions of times in create a precious life. But even so what is a body without a soul? That little physiologic miracle is more than a biological specimen, the very breath of God is there! How can we throw that away!

Oh God! Forgive us of our ignorance and pride! Forgive us for murdering countless lives that you Divinely created. Forgive us for trying to be our own god, thinking we have the right to chose. Forgive us Lord of our unbelief! God I pray for this precious couple, Lord fill them with your peace, and your comfort. Surround them with the support they need to weather the storm. And Oh God use this for good in their life! We know Lord that you have and are taking perfect care of their baby who is now with you, now please Lord please take care of these parents. Draw them to you in this dark hour that you may shine all the more brightly! Thank you Lord, for giving us life, for creating  life. 

Go into all the world

Dr I is only a few years older. She finished medical school here in Honduras and is now practicing as a general doctor while awaiting to get into a US residency. We really like it when she works with us at the clinic. She not only speaks English well, but she is so patient with our many questions, and all the times we ask her to act as a translator between us and our patients. She also goes the next step and uses each opportunity to teach us. She just took Step 2 CE (board written exam #2) in December so she knows what we need to study for our Step 2 in June. 

This particular morning with her first patient she came to us in the other room, and said, "you should come see this." An elderly woman lay on the table in her exam room. "Just feel her abdomen, and tell me what you find" Dr I said. So we took turns gently palpating this lady's abdomen, but lightly because she was in obvious pain. There was a large something just below her ribs on her right side. What we call the right upper quadrant. Maybe an enlarged liver? Maybe she is really really constipated? Or maybe it's a mass? Dr I then began to give us some background on this lady. She came to the clinic 6 months ago because she had pain in her abdomen and was a little constipated. Dr I felt the same 'mass' then and ordered several labs to determine what was going on. She was concerned it could be cancerous, but wasn't quite sure without proper labs. Now 6 months later this woman returns in more pain, with more constipation, and weighing much less than she did prior. (Weight loss is what we call a 'bad symptom' it means something bad is going on, like a cancer, but not always) she brought back none of the tests Dr I had ordered, stating she couldn't afford any of them. So now, all we know is that she has a mass, likely Cancer due to her weight loss. But we don't know what kind, how bad it is, or what treatment will actually help. 

Dr I tried explaining to her that she must go to the hospital. The same hospital I have worked in and written about how overcrowded it is. She tried explaining that we must see what's going on inside her belly, that it is very serious, and she must go. This lady really needed a CT scan, and a lot of labs, but there is no way she would be able to afford it, so we ordered an ultrasound instead. She and Dr I talked back and forth for a while while I just stared on without a clue what was being said. Dr I then explained that this woman told her she would rather die than go to the hospital. She had had too many bad experiences there. After some pleading Dr I made her promise to go, but the lady said if they told her to stay she wouldn't do it. Dr I knew the woman most likely would not go, but she even called the woman's daughter to try and explain the gravity of the situation. Then she called a friend of hers that works at the hospital to have him be on the look out of this woman and know what was going on. 

We were all pretty discouraged after the woman left. We knew that whatever this mass was had already taken a great toll on her body over the last 6 months and it wasn't slowing down. If she doesn't go to the hospital, or if she doesn't stay, we know this mass will take her life. But she doesn't have to die, not from this. Dr I caught it long ago, but because she is poor, nothing as been done. It is so sad to see and realize the gap that exists between the rich and the poor. This would never happen to someone with even just enough money to pay for some tests. This wouldn't even happen to the poorest of persons in the US. If a doctor in the U.S. Finds a large mass in the abdomen of a homeless person off the street, there are ways to get that person the help he/she needs. Say what you want about our health care system or the crazy people that fill our emergency rooms, but at least they are receiving care, and quality care at that. May we not forget how privileged we are. 

This begs the consideration then, what about her Spiritual condition. I didn't have the chance to talk with her directly, but what a difference it makes if she knows Christ as savior or not. God knows exactly what is happening here. He sees her pain, and the hard times she is facing. If she is His then we have full assurance that He will heal her, one way or another. We can rest in the hope that she will suffer pain no more and probably soon she will be worshiping as she was meant to for all eternity! But if she does not know Christ as savior and Lord than this situation is even more heat breaking than before! Instead of soon being relieved of her pain, she will come to know eternal pain and suffering. Oh, may we not forget the importance of the Gospel! Why do we do missions to 3rd world countries even when we can't give much medical care? Because the Gospel of Jesus Christ is the hinge on which eternity swings! It's not about catching and fixing life or death situations, it's more than life or death, it's eternity! 

And this, this is why God sends us each into the world. Teachers, business men, accountants, whatever, we have the key to eternity. And the woman who lives next door to you who is dying of cancer and doesn't know Jesus is in the same grave situation as the woman here if she doesn't know Jesus. What does it matter if she receives top notch health care if she dies only to face eternal death? The Gospel of Jesus Christ, this is our hope, this is our mission, this should be our aim each and every day! As this rotation comes to a close and I head back to the US, I am heading back into my mission field. No the people I will see won't be in as much need of medical care as those I have seen here. And I surely won't be able to offer Americans as much as I can offer Hondurans, but my people are in just as much need of Christ. The Gospel, this is what my people need more than anything, the pure unadulterated Gospel of Jesus Christ!