It's been a particularly hard stretch on the adult medicine service. Of the last ten patients admitted to our service, seven have died. It's been a mixture of problems. Our malaria epidemic is tailing off, which means that our most-treatable problem has become less frequent. We've had several infrastructural difficulties, with oxygen shortages during long blackouts, and currently our X-ray machine and our blood count machine aren't working. Certainly some of these things have made a negative impact. The biggest factor is just that the patients only come to the hospital because their situation has become so dire.
However, when they arrived, I had hope (if not certitude) that they would get better. They didn't arrive with an obviously mortal problem. It was only after several days of steady worsening despite all we could do that it became evident. That's a particular challenge, since it feels like their being in the hospital is associated with them getting worse, instead of better. With death, instead of life. I know it's not like that, but that cognitive knowledge doesn't automatically vanquish the feeling.
We have new medical students this month. Very green, but making steady progress. For almost all of them, they have never been this entwined with taking care of sick people before. I wonder what kind of toll this is taking on them. It's obvious that it's difficult. Is this just a necessary crucible? Can I say something to help them endure, beat off cynicism, and retain hope?
After rounds, while walking through the hospital, I shook hands with one of our nursing assistants. She used to be on my service, but is now on another service. I say hi, and remember that her adult son was hospitalized last year with a bad case of nephrotic syndrome. I ask her how he is doing. She says he is doing fine at home, with no medicines.
This morning, I was taking our kids on an "adventure walk", back through the small footpaths in the hills. I passed a guy carrying a baby. It's a little odd to see a guy carrying a baby. Then, I realize I know him. It's the (hopefully formerly) abusive husband of my paralyzed pregnant patient Spes, that I wrote about previously. The baby looks good, and I turn around to see Spes walking towards me with a cane. She smiles at me and shakes my hand. The fact that she can make it this far on her own, and that her incredibly fractured life is doing this well is a joy.
Over the last several years, I have come up against these questions many times, with students or with new or visiting doctors, and each time I'm of course talking to myself as well. Two things, in particular, continue to be an encouragement for me.
First, if I want to be here to help, I have to be here when I can't. Every time when my patient unexpectedly dies, or the test comes back positive for the non-treatable possibility, or I'm forced to admit that my last therapeutic option just isn't working, part of me wants to abandon ship. Part of me wants to run away from all that I can't do. I know that running away won't help my patients, but I guess I want to pretend that such situations don't exist, at least not in such a common and stark form.
You can't know ahead of time who you can help, and the patients won't divide themselves up like that anyways. Sometimes we can make a great medical impact. Other times, we can't. The two are inextricably linked. Part of what we love here is the chance to dramatically alter someone's life for the better. Yet there is another side to that coin, because the magnitude and frequency of the tragedies go up, in a seemingly proportionally manner. It is something to be endured, but not just endured. This other, and difficult, side of the coin is another place where we have to learn to trust God and find some way to bless and comfort these patients with the blessings and comfort that God has given us (2 Cor 1:3-4).
Second, as Paul writes: Fight the good fight. It feels like a fight. It is a fight. But it's a good fight. So let's keep fighting it.
I've been reading Keller's book Every Good Endeavor, and he is posing these questions about our professions. What are your professions' idols, hopes, and fears? What is the storyline told by your profession? How can Christ complete the story in a different way?
I don't yet have a concise answer for these questions regarding the medical profession. Surely, there are many things we fear. We fear that we will make some great mistake. We fear that the trust people place in us will be misplaced. We fear not making any difference.
The storyline of medicine says that people's bodies and minds can be broken, but that medicine, if properly developed and applied, can fix them. It's not a bad storyline, and I'm grateful for its recognition of the brokenness of my reality. However, the solutions do leave us wanting oftentimes.
What does the story of Christ have to say? I think it's that both the brokenness and the healing run deeper than we know. It's not just my patient's body that is broken, but also our society and my profession, as well as my own heart. There are cracks all through, and no one helps from a standpoint of being completely whole.
But the healing is part of a redemption deeper even than the fissures of our brokenness. Yes, the healing comes through a faithful and just application of the principles of medicine, and we ought to be thankful and use it as well as we can. But our great hope is that the extent of the healing going on in the world does not end with the limits of medicine. God is bringing his newness in every way, in every domain, in every corner of this earth. Through us, and thankfully in spite of us and beyond us.