Everything for life and godliness

Excuse me for a minute while my heart bleeds a little. Sometimes life is hard and it hurts. I’m going to be honest I have let the wind and the waves take over the past few week. But God has gently reminded me that even in the midst of the storm He is there. And not only is He there but He is using the storm to teach me and draw me closer to Him. The point of the storm is not to survive- it’s to meet the savior. 

I’m going to be really sore tomorrow, and in the worst way possible. Not because of a great workout, but because I had to crack a kid’s chest today to keep his heart beating. I did it all right. I got the intraosseous line in on my first try and it worked beautifully. I did chest compressions at the right depth with good recoil and at the right rate. We did it all: the Epinephrine, the ventilator, the lines. Yet at the end of it I stood there listening to a mom try to comfort her son over a phone call as his heart was stopping. I did everything I could and yet his heart stopped. I wasn’t enough. It hurt deeply and yet I realize the sting of sin even in myself in that moment. Why wasn’t I good enough to save him? What did I miss? I have to be better. But it’s not about me. It never is, and yet I try to make it such. The God of life, the Creator who put the breath into the lungs of this child is the only One with the authority to take that very breath from him. And even when he chooses to do so, He is still good. 

To say this past month has been hard would be a major understatement. Before this month a total of 2 of my patient’s had ever passed away. Today was the 5^thin the past 30 days. We have all heard the stories. Those tragic ones where someone wakes up one morning like it’s just another day without a care in the world but then something happens that changes their life forever. Just another weekend, another day at school, another tail gate. It can be very difficult to see and open your heart to become part of those stories in their final chapter.  

How are you supposed to handle being in those final chapters and the ends that they bring? And what about when it’s not just one? What if it’s 5? How do you keep getting up after inadequate sleep and going back into the fire to take care of all the other lives that are not in their final chapter (or at least you really hope not)? What do you do when you get home from all of this after you have kept yourself from breaking all day and there is no one to catch your fall, no shoulder to cry on? What do you do when it’s just you and God and you’re breaking and you can barely utter praise because it just comes out as tears; when your prayers end up being silent sobs on behalf of so many others and you can’t even utter words? 

The worst part of it all, is that as I lay in bed last night contemplating the weight of the world I was trying to carry I finally heard His voice. And it wasn’t peace at first but the bitter sting of conviction. In all my sorrow and stress this month I had tried to put my head down and plow through. I had longed for a companion to vent to and cry to and fall into, a companion other than Christ. I had made all of it about me. How tired I was, how sad and lonely I was, how hard I was working. I had been bowing to the god of self and comfort  and looking to friends and others for support and affirmation instead of standing firm on the Rock. I chose to wallow in my hard times instead of using them to make me more Christ-like. 

Today I came across this quote, "If I complain about the difficult circumstances of my life, I impugn the sovereignty and goodness of God, and tempt my listener to do the same. In this way, my sin 'metastasizes' into the heart of another person." (Jerry Bridges in Respectable Sins). And so I apologize for complaining to you all who have read this thus far. But the point I am trying to make is that even in these circumstances, God is good and has a great and wonderful purpose. Here is what God has reminded me of this week and how He has grown my faith in Him, and made me a better physician. 

It doesn’t matter what your occupation is, what ministry you are involved in, where you are in life, God is the prize. It seems basic but that’s what I need right now. If we are not seeking Him, we are missing it and failing, period. Yes, we do have everything for life and godliness (2 Peter 1:3a), but it is only through the knowledge of Him (2 Peter 1:3b). With the Holy Spirit in us, as we set our faces towards Him and meditate on His word, this is where our strength, peace, rest, hope, joy and love come from. “How blessed is the man who does not walk in the counsel of the wicked, Nor stand in the path of sinners, Nor sit in the seat of scoffers! But his delight is in the law of the LORD, And in His law he meditates day and night. He will be like a tree firmlyplanted by streams of water, Which yields its fruit in its season And its leaf does not wither; And in whatever he does, he prospers (Psalm 1:1-3).” Meditating on God and His word, that is where success lies. Studying for boards, studying up on my patient’s disease, rest, food, it’s all important and a good use of my time. But, if I am not in the Word (and not just reading to read, but contemplating, listening and obeying) then I have missed it. It doesn’t matter if I am the best doctor or pass boards with flying colors. If I have missed God then my life is wasted and my time here and now is wasted. “Seek ye first the kingdom of God and His righteousness . . . and (then) all these things will be added to you” Matthew 6:33. Every day anew we must surrender to Him and seek His face and He will be our strength for whatever may come that day. One day at a time, or even one hour at a time, we must keep our eyes on Him. 

Here we go again . . .

You know that moment when a feeling just comes over you to go talk to someone? You may or may not know why or even what you’re supposed to say but you know you’re supposed to go. That happened to me today.  Thankfully, I listened and went. But just a few days ago I’m not sure that I would’ve listened and that scared me a little bit.

It’s no secret residents and physicians alike (as well as nurses and others I’m sure) struggle with burnout. That place where you’ve been working so hard for so long. Things seem the same and you start feeling really underappreciated and maybe even used. We all get there, but how do we get out? In my short time as a resident, it seems this is a never ending cycle. Happy to be there and joyful in the midst of all  the work, tired but still okay, more tired but hanging on, and then nope, I’m done. It’s not like this isn’t a rewarding job. Helping make children better is almost always rewarding as is helping parents understand pathophysiology of what’s going on with their child. But when the medicine you are practicing is not your favorite, or you really have to study for it to keep up, or the patient’s and families are extra difficult and you just need some sleep, it’s gets tough.

My problem last week was that I shifted my focus from my patient’s, and ultimately from God to myself. I am so tied, I have worked so much, I deserve a break. Why aren’t my colleges stepping up to help ME, or why are they asking ME to help don’t they know how exhausted I am? Then my focus is more on how fast can I see all my patient’s and get out of there. Granted, once I know I’ve covered everything and they are ok. But then I’m not listening to those needs that they may not be sharing, or fears they don’t want to say out loud. I’m not listening to the Spirit in me telling me there’s more going on and I need to sit and wait and listen. And when I’m so focused on me, I don’t take care of myself.  Because all I want to do is go home and watch Netflix. I don’t want to cook, or clean, or read up on my patient’s disease process or workout. And in doing so I make myself more tired and feel worse overall. Thus is the cycle of burnout. At least for me. Sometimes starting a new rotation helps, but when burnout rares it’s ugly head early in a month’s rotation, you can’t just wait until your next rotation or vacation to get over it.

I kept wishing someone would just tell me I was doing a good job, that all this work actually meant something and wasn’t just marking time until I finished residency.  Does anyone see that I’m’ working myself to exhaustion here? I was in the middle of hematology and oncology month. A time when you really really need to not be focused on yourself, because these kids have cancer.  At least most of them do. So, when I couldn’t just pick myself up by my boot straps I just got angry at myself for being so weak and selfish in such a situation. I knew I should be there for these families and patients, but I couldn’t be there like they needed me. Why can’t I be a good doctor and put myself aside and selflessly love?

But thanks be to God that He does not leave us in our sin. I was lying in bed one night and as I began praying before falling asleep the thought came “why are you not on your knees?” In the past I had set aside a part of my closet as a place to do just that. But over the past month or so I decided I could fall asleep praying instead of taking the time to get on my knees and really sit at His feet. But that night I found myself lying there trying to pray over a family who just heard that awful news that their child has cancer, and I couldn’t connect with only One who could actually do something about it.

So, I climbed out of my warm bed and got on my knees. “Lord, I can’t do this. I’m not strong enough, and I’m way too prideful.” Thankfully, the Lord heard my prayers for forgiveness and humility. In spite of my sin, He allowed me into His presence to bring this family before Him. The next morning again, on my knees, “You are God, please put me in my place. I can’t do this.”  The last few days, by God’s grace He has made me get on my knees before Him. I have been listening to podcasts by John Piper afterward while I get ready in the morning. The Lord in His grace has used this to reshape my perspective. “You are not your own, for you were bought at a price, therefore glorify God in your body” (1 Cor 6:20). “Walk by the Spirit, and you will not gratify the desires of the flesh” (Galatians 5:16). “For if we live by the Spirit, let us also walk by the Spirit” (Gal 5:25). “Reckon yourselves dead unto sin and alive unto God” (Romans 6:11). Once my perspective changed, the past few days I have felt the Spirit working in me and my entire outlook has changed. I want to help in anyway even when I’m tired or hungry or late. I want to go out of my way to make someone else feel appreciated even though it’s inconvenient. I want to be kind and gentle to nurses even when they ask me questions I have already answered.

Yes, I work a lot, and I work hard. But, I work hard for the glory of God. As long as He is glorified I need no other recognition or thanks or gratifying outcome. Even when I’m tired and hungry and just over it, He still deserves all that I have. But He is also my supply. That’s what He has impressed upon me this week. When I walk without Him, of course I burnout because I cannot do it. I am not enough. But when I walk in the Spirit, I have new desires. I don’t mind taking care of an entire team of patient’s on my own and having an extra consult and admission. I don’t mind going back to sit with a family and explain things in detail even though it will make me late getting home and I’m already hungry. In fact it’s almost as if I’m a new person when His Spirit is working in me(ok, duh that’s the point). When those thoughts of anger or pride come, I have ammunition with which to fight them off. Though I still need to fight them off all day, I cannot tell you the difference it has made in me the past few days. And then today, as I was trying to leave the hospital in a hurry I had this overwhelming feeling that I needed to go back and talk to this family I had never meet. Their child had just been diagnosed with cancer and not a great one at that. The outcome did not look good and I could only imagine the overwhelming emotions flooding their minds. Today was my last day on this service. I won’t be taking care of this child and at the time he was just a name on our team list. But I had to go back.

I wrapped up everything else and headed back to his room. As I approached I heard voices inside and considered aborting the mission. But I walked in and saw a normal appearing family. All their faces set on me as if I had significant news to bring.  I proceeded to tell them who I was and that I was praying for them. We had a great conversation about how God was still in control even in their situation. The looks on their faces made it all worth it. As I left the hospital today I knew that not only was God gracious enough to bring me back to Himself, but He was showing Himself gracious to that family in the midst of their storm. It is an incredibly humbling thing to be used of God in such a way. And just like that I can say I am no long burnt out. At least for the time being. “For it is by the grace of God that I am what I am, but His grace towards me was not in vain but I labored more abundantly than they all, yet not I but the grace of God in me” (1Cor 15:10). I pray that the second half of this verse would be true of me someday, by His grace.  

Burn Out

From day 1 of residency this word was on my mind. We had a seminar during orientation about how to avoid burnout giving tips on taking care of yourself and finding things that you enjoy and making time for them. It all sounds like a decent plan, though no one was really paying attention as we were all so wide eyed thinking about our first day as a resident physician. Over the next year it was as if this became a bad word. Although we were all either burnt out or close to it, no one could admit it because then they would require us all to take more seminars or lectures on avoiding burnout. And it seemed like all those told us to do was be more efficient and do fun things when you go home. But what about when you’re simply too tired to do ANYTHING much less something fun? What about the times when you do only what needs to get done and then just go to sleep?

The sad truth is most residents regardless of where they go to residency or which specialty they chose want to quit by the end of their first year. I didn’t think my intern year was THAT bad in all honesty and at certain points I even said I was enjoying it, believe it or not. But then second year hit with all its new responsibilities. Along with a change back to 28 hour shifts. So, not only figure out how to supervise new interns, and run the team, and take admission from the ED, and make sure no one dies and preferably no one gets worse overnight, but also do it while adjusting to working 28 straight hours. It was rough, and I dreaded work most days, but I can look back and say I know I’m a better physician after coming out of it. But man after 2 grueling months of inpatient medicine, I was burnt out to say the least.

Seems reasonable, right? I mean anyone working those hours under that stress would be, honestly. I mean I know my coworkers were also feeling it. The problem is, as a follower of Christ, a servant of the Most High, I shouldn’t be burnt out, no matter the hours or the stress. Frankly, that is my mission field. When everyone else is burnt out and exhausted and used up to the max, I should be different.

And this doesn’t just apply to residents. I know everyone has those times in their lives when each day seems an endless checklist of things to do and just move on to the next. There’s no joy, and you seem stuck. Maybe it’s a busy day with the kids and you never seem to get enough sleep, or finish the laundry, or the kitchen sink clean. There’s always more to do. But as a believer practically how do we live differently? Because we all know there are times when even though we get up and get in the Word and pray, it seems dry and God seems far. It also gets lost on the ‘to do’ list.

This is where I was at the end of last month. Thankfully, by God’s grace I had vacation scheduled for the first week of this month. I spent the first several day catching up on sleep, and then went to a conference for medical mission work. Basically, a great time to zoom out and refocus.

Here’s the thing, I wasn’t made to be a doctor, or a perfect resident, or a perfect cajon player for the worship team, or a perfect daughter, sister, or friend. I was made for the glory of God, period. Yes, God has allowed me to be a not perfect version of these things, but first and foremost, my purpose for existence is His glory. So, when I use all my energy, and strength, and mental fortitude for these other things, I burn out. It’s inevitable. Because, I’m missing my purpose for existence. I remember in medical school, when God had so grabbed hold of my heart that I was studying the human body in light of who He is, and it was as much worship as Sunday mornings. It seems simple, but just like anything else it takes discipline. I must get up and read the Word and pray to get my heart right every day. I need a daily reminder of who it is that I serve. I need a reminder that I’m not going to work out of obligation, or because of how much debt I’m in, or even because there are tons of sick children that need help (even this motivation leads to burn out). I’m going to work because this is where God wants me to serve Him right now.

The crazy thing is the difference it makes. I’ve realized how far I have fallen mostly in my hunger for the true milk of the Word. I used to crave it and never get enough. I used to be at least more satisfied with Him alone. And, I want that back and more.

I have been reading “The Shadow of the Almighty,” on the life of Jim Elliot. I have been both encouraged and humbled, lots of humbling. My faith is so small, like do I even have a mustard seed? But oh that He would let it grow. My heart echoes these prayers of Jim, “He makes His ministers a flame of fire. Am I ignitable? God deliver me of the dreaded asbestos of ‘other things.’ Saturate me with the oil of the Spirit that I might be aflame. . .Make me thy fuel, Flame of God.” “Oh that Christ were All and Enough for me. He is supposed to be, . . . but oh to be swept away in a flood of consuming passion for Jesus, that all desire might be sublimated to Him.”  

These my prayers going forward also that He might increase and I might decrease, that my eyes and thought would remain on Him, and that as He saturates my life, it will overflow on others. This is my attack plan against burn out.

A Different Kind of Culture Shock

Sitting in the closet of a local cathedral I opened my computer and connected to our makeshift Internet, and waited for my first patient of the day. I felt at home in these surrounds; dirt floors and dust that made clean floors impossible, concrete buildings with tin roofs, and meals that always had rice as a base. This was my fourth medical brigade and though the culture and people were all too familiar this one was totally different. For starters, this was my first brigade as Doctora Janie instead of estudente de medicina. Being one of the providers brought much more responsibility and fatigue, but also great reward. The most striking difference this trip, however, was the stark contrast between my world view and that of the other 54 people on this brigade. I was very much an outsider. 

I did get to see some interesting cases this trip. And seeing them on my own was very empowering but also terrifying. I saw chikungunya, epidermolysis bullosa, club feet, pyelonephritis, and an undiagnosed congenital heart defect. The medical aspect of this trip was wonderful. And thankfully there is a great clinic in Santo Domingo that will be following up with these patients. Collectively as a team we saw over 1,000 patients. A successful trip by most accounts. But why am I here again? I do not fit in. By their account, we have done a great thing worth celebrating. But really, what have we done? I know life is eternal and if I am not impacting eternity, what help am I really giving? I have struggled most of the trip with this, wondering if I should ever do another trip like it ever again. When Christ is not the center, what's the point? Why am I here again? Especially when my little sister required a C-section to deliver her twins at 35 weeks and I wasn't there. I wasn't there when she hemorrhaged and needed a transfusion. I wasn't there when my nephew went to the NICU and my family had a million questions I could've helped with. Yes, I made some new friends and strengthened others, but was that worth not being there for my family? Why is it that the only type of culture shock I experienced was with that of my own culture and how disgusting it is.

Well, I don't know why, and I don't have to. 

One of the things I've noticed about myself is that God seems to come into much clearer view when I'm out of the States and away from all the distractions. It seems so much easier to sit at His feet. I finally had the time this week to read a book that has been sitting on my night stand for weeks, it goes through some of the attributes of God and how unlike us He is. This has been a wonderful reminder of who my God is. If nothing else, God has shown me more of himself, and more of my sin this trip, and I can honestly say that is enough. He is enough. He was there with my sister and nephews the entire time and He was and is more than enough.

This past year has made me a much better physician but it brought much depression and anxiety with it. To the point that I didn't recognize myself anymore. I couldn't process anything so it all got stuffed on top of each other until I just about blew up a couple of weeks ago. I didn't have someone to talk through things with and I honestly had a hard time talking to God. The motto God gave me when He called me into medicine was: "He is worth it. He is enough." I kept telling myself that, but I wasn't feeling it. I have been able to process difficult things alone with Him before, so why do I need a physical body to talk to now? I know the root of depression and anxiety is sin. Period. It's unbelief plain and simple; not really believing I'm secure in Him, not trusting Him to take care of the big things and the small details. When I finally had a vacation, I was praying the Lord would show up and blow my mind with Himself in such a way that made my walls fall like Jericho. But He didn't. I had a relaxing wonderful vacation but I still couldn’t completely clear my head of all the mess. But one morning as I sat on a bus in Santo Domingo Ecuador leaving the places where we served over a thousand people last week, and my head finally felt clear, free and I can honestly say I have peace again. I was exhausted from little sleep all week, but I wouldn't trade that place right now for anything. No distractions, serving people in a way that pushed me to my limits physically, mentally, and spiritually, God emptied me of myself. 

What mercy! What grace! That our Lord would pull me out of my surroundings and distractions to truly set my focus on Him again. How simple it seems that the answer to all of life’s questions is God Himself. And yet, how difficult that can be. I cannot will myself to know Him more, I cannot study and work harder to know Him more. I could read the Bible 10 times through and spend every waking hour meditating on its meaning, but apart from the grace of our Lord opening my eyes to is beauty and power it would have no impact on my life. How sweet and kind our Lord is that He reveals Himself to us and in so doing gives us all we need for life and godliness (2Peter 1:3-4). God lifted my spirit last week in a way no person or experience could, and I am so grateful. Dear reader, as you find yourself cast down, depressed, anxious, or just caught up in the everyday without joy, I urge you to run to Christ and beg Him to allow you to know Him more.