Then Jesus told his disciples, “If anyone would come after me, let him deny himself and take up his cross and follow me. For whoever would save his life will lose it, but whoever loses his life for my sake will find it.”Matthew 16:24
This is the man I want myself to be but who cannot exist, because God does not know anything about him. And to be unknown of God is altogether too much privacy. My false and private self is the one who wants to exist outside the reach of God’s will and God’s love – outside of reality and outside of life. And such a self cannot help but be an illusion. We are not very good at recognizing illusions, least of all the ones we cherish about ourselves – the ones we were born with and which feed the roots of sin. For most people in the world, there is no greater subjective reality than this false self of theirs, which cannot exist.Thomas Merton, quoted from Brennan Manning’s, “Abba’s Child”
One month ago, I was walking through our ER, on my way to lunch, when I saw two of my colleagues doing CPR on a small child. I walked over to see if I could help. I began bagging the child so my colleague could focus on running the resuscitation. The small mask covered the child’s small mouth, and I delivered a breath every few seconds. The child had vomited, so we paused briefly to suction out his mother’s milk which ran down his cheek. We did everything we could, but after a long time there was still no flicker of heartbeat on ultrasound. We pronounced the child dead and the child’s mother collapsed in a heap. A few seconds later she stood up, clutched her child’s limp body, and began to rock him back and forth while she wailed. The child was a little younger than Milo. He had died from dehydration secondary to diarrhea. No kid should die from diarrhea; we were just too late. I walked out of the ER and headed home for lunch.
This week, I cared for a 20-year-old girl on our inpatient medical ward. She had been admitted for back pain and fever. She was quite sick at first, but after a day or two on fluids and antibiotics she had improved dramatically. I checked labs and urine, and she had an obvious urinary infection. It was a clear case of pyelonephritis, and I thought, “Well here is something that is easy to treat – no mystery here, I will get her squared up and sent home in no time!” The next day she had a fever again and looked a bit worse. I decided to do an ultrasound to make sure she hadn’t developed an abscess near her kidney.
Unfortunately, when I did her ultrasound, I found that she had severe swelling of both of her kidneys. As I looked further, I found a large mass up above her bladder, which had invaded both of her ureters and surrounding structures. I consulted one of our surgeons, and a short time later, both of our surgeons were at bedside repeating the ultrasound. We did radiographs and other labs. Ultimately, our surgeons determined that this cancerous mass, likely a sarcoma, was too far advanced for operation, and there was no curative option we could offer. We told her this news as she nursed her first child, who was just a few months old. We prayed with her. Our chaplains met with her. She went home on palliative care later that afternoon.
Last week I had a low point being here. I spent the afternoon lying in bed and dreading my call shift. When I got called into the hospital late that evening I lamented, out loud, “God, I am sick of it here! I don’t want to go to work anymore!” I spurted my complaints into the night and felt justified in my bad attitude and self-pity. I kicked a rock as I walked into the hospital. It was quite the noble temper tantrum.
One of the blessings of marriage is that when one of us is low, the other is usually okay (woeful are the times we are both struggling!) and thankfully, I leaned heavily on Genae’s attitude and perspective last week. She was patient and loving when I complained about being here. She showed me graphs of “culture shock”, a known phenomenon whereby people living in new cultures have the greatest difficulty about 5-7 months in, and she reassured me that what I was feeling was normal. We prayed together and I trudged on.
Later in the week, I had a helpful insight. I realized that many of the things I found identity in while in the US have been taken away here. For example, I had worked at my previous ER job for 4 years, and I was knowledgeable about the system and the medicine. When newer doctors had questions, they came to me. The nurses knew and trusted me. I was in a leadership position in our group. I had powerful medical tools at my disposal. I knew how to handle and rule-out most emergency conditions. I could easily communicate with and educate my patients.
Here in Papua New Guinea, I am the new person. Learning the medicine and the system is a constant challenge. I see things every day where I think, “I have no idea what to do for this.” I ask my colleagues many questions, but I still must make serious decisions with limited knowledge and information. There are so many patients that I cannot take the time, all at once, to learn and read about everything I treat. Sometimes, even if I know what is going on, the correct treatments are not available. I have gone from being a skilled ER doctor to a less than mediocre obstetrician, pediatrician, hospitalist, orthopedist, oncologist, and infectious disease doctor. And when there is medical uncertainty, which is almost all the time, I struggle to communicate with my patients because of my limited mastery of Tok Pisin. Inadequacy has become my modus operandi.
In addition to the medical side of things, there is the spiritual side of things. Back in Wisconsin, in my community, I found identity by being someone who was spiritually mature and could help others grow closer to God. Here, I am surrounded by co-missionaries who are more spiritually mature than I am, and who have walked with God in deeper and more intimate ways. My identity as the “most spiritually mature” guy is out the window. Humorously, I enjoyed playing guitar and leading worship back in the US, even though music is not a natural gift for me. Here, I don’t know anyone who doesn’t know how to play guitar, and who isn’t more musically inclined than I am!
I have been trying to hang onto many identity pegs that are not meant to support that weight.
I happened to be reading the parable of the rich young ruler earlier this week (Luke 18:18-30). The cliff notes of the story is that there was a powerful and wealthy young man who came up to Jesus and said, “What must I do to inherit eternal life?” Jesus lists some of the 10 commandments and the rich young ruler says, “I’ve done all those things, I’ve kept the commandments, I have lived a moral and righteous life.” Jesus then cuts him to the heart and says, “One thing you still lack. Sell all that you have and distribute to the poor, and you will have treasure in heaven; and come, follow me.” It says that when the rich young ruler “heard these things, he became very sad, for he was extremely rich.”
It is an interesting parable on many levels. The rich young ruler proclaims outwardly that he wants to inherit eternal life – he wants to follow God. He then puffs up his chest and says, “Look, I have lived a moral life, I have kept the commandments, I am better than my peers.” But Jesus exposes the idolatry festering in his heart when he asks him to sell all that he has. Nowhere else in the Bible is “selling all you have” a pre-requisite step for eternal life and union with God. But Jesus knows that the rich young ruler isn’t as righteous as he seems to be. Though he is blind to it, the rich young ruler has broken the very first commandment, “You shall have no other gods before me.” In his heart, his identity is wrapped up in his riches and his power. He goes away sad because he doesn’t want to part with his idols.
I identify with the rich young ruler. As a medical missionary, I face death without every day. But I also face death within. I confront dying to my secret idols of control, esteem, respect, achievement, and being thought well of. These idols lurk behind every action of mine (even writing a blog). Am I a volunteer, here to serve God on my terms, in ways that make me look good, in ways that are comfortable and powerful, in ways that puff up the image I present to myself and the world? Or do I count these things as rubbish and listen to the words of Christ, “whoever loses his life for my sake will find it”?
I want to live life as a beloved son of God and let his love for me be enough. I want to walk in communion with him. I don’t want to live for praise, accolades, self-sufficiency, achievement, or riches. Nothing else but the love of God will fill up my heart. “Our hearts are restless, O God, until they find their rest in you.”
Two weeks ago, I cared for another young child who was in shock from a diarrheal illness. The child was limp and could barely open his eyes. He didn’t make any noise as the nurses poked him with IV’s, trying to thread a small catheter into a vein collapsed by dehydration. With flashbacks of a mother rocking her dead child, I grabbed an intraosseous needle, and by hand twisted the large needle into the child’s tibia, so we could infuse fluid directly into his bone marrow. With the fluids flowing, I started antibiotics, did a lumbar puncture, prayed with the child’s mother, and admitted him to the hospital.
I cared for the child the day before we left for an in-country vacation. While on vacation, I thought often of the child and his mother. When we got back, I anxiously asked the doctor who had been on the pediatric ward, “Do you remember this child, Dima, an 11-month-old little boy, admitted to A10 for dehydration and shock with fluids through an IO?” She looked up at me and I prepared myself for the worst. After a moment of reflection, her eyes lit up, “Yes! He did great! He started to wake up, feed, and went home with his mother a few days later. He fully recovered!”
The landscape here is rugged and majestic. Dense jungle peaks soar over river-crossed valleys. This scene is not an unfitting picture of life here writ large. We are wrapped by unspeakable beauty, but also witnesses to crushing human tragedy. When we signed up to come to Papua New Guinea, I expected to face death and suffering without. After all, this country has fewer doctors than almost anywhere else in the world. What I did not expect, however, was to be called so soon to die to myself.
- That we would persevere in living in close communion with God and rely on his strength.
- That God would help us form deep relationships with the people of Papua New Guinea.
- That our hearts would assume the posture of loving servants.
- For health (Jake has struggled with asthma, and Genae and the kids with frequent fevers and GI bugs).
- For joy!