i do

I've done some unique weddings, but this one was near the top of the list.  For starters the groom wore a green gown.  A green hospital gown that is, blue support socks and an oxygen cannula in his nose.  A crowd of around 30 nurses, dieticians, therapists, fellow patients and friends gathered in the sunlit alcove leading into 6 Heart.  This couple had been together for 15 years and an upcoming surgery had been their wake up call to stop just acting like they were married and really be married.


We started with the groom sharing how "this woman taught me that there is love at first sight." The bride shared why "this man" was worth marrying anywhere.  They confidently vowed to be faithful "for better or for worse, in sickness and in health."  Which really seems to ring truer in a hospital.  They'd already loved each other through all that.  I pronounced them husband and wife.  And then they kissed such a kiss that the nurses began heckling "check the heart monitor!"


Once again the hospital puts everything in perspective.  Priorities get so clear here.   I've been to many weddings.  Seen thousands of dollars spent on the perfect tux and the perfect gown.  Seen months of planning a myriad of details.  Seen flowers and cake flavors and songs agonized over.  And rarely have I seen the level of adoration and pleasure that this couple had in their impromptu pre-surgery hallway celebration.

Do I want this much clarity and confidence in my life?  I do!


Love always protects, always trusts, always hopes, always perseveres.  1 Corinthians 13:7 

helpless

Every day we visit people who are feeling helpless.  People waiting for surgery or treatments or a doctor's visit.  People who can't get out of bed or use the bathroom by themselves.  People at bedsides or waiting rooms who can't do anything for their loved ones.  Helplessness is an uncomfortable feeling.  It manifests itself in anger or depression or control.

Today I unwittingly embarked on an exercise in helplessness.  Maybe my empathy for helpless patients needed renewing.  Or maybe my car is just really old.

I left work at 5 and began my rush up the mountain.  Steve is in Maryland, so my boys were waiting for me with a friend.  While still in South Carolina I noticed my car lurch a bit.  Pretty sure that is not a good sign.  Then, just as I got the the beginning of the Saluda grade, where two highways come together, I suddenly lost all power.  There was no shoulder on the left lane and no immediate traffic to my right so I coasted across the lanes to a small V between the roads.  I got just over the yellow line and completely stopped.

AAAAHHHH.  What am I supposed to do?    I'm in the middle of nowhere, in the middle of all kinds of traffic, trucks wizzing by me. Both my husband and brother are out of town.  My boys are waiting for me.  Why couldn't this have been a day I carpooled and didn't even get in my car?  I was very clear on the physical, emotional and mental feelings of helplessness.

Then I called Steve.  Then I called a friend who is a mechanic.  He said "transmission." I don't know what a dumb transmission is, but I do know it is not something you want to break.  Then I called Barbara to see if I could borrow a car the next day.  She said she would come pick me up and was instantly on her way.  She is hereby to be referred to in all future mentions as Barbara, the angel of rescue.  Then I called Kim, who was watching the boys.  She said they were jumping on the trampoline and having a blast and she would fix them dinner.  Thank you accomodating Kim! Then I called 5 towing companies and finally found a fatherly, southern man who said a tow truck would be there in 20 minutes and would tow it to a good mechanic.  Thank you solution-oriented towing man!  Then I talked to my worried husband, my concerned in-laws, both brothers, my sister in law (all trying to figure out what they could do to help) and my mom, who had just flown across the country and landed in Charlotte.

At 8:30 I got home.  After a fun 40 minute ride with Barbara, (laughing at what lengths we would go to for a little girl time) a borrowed car, picking up my boys, and trying to take a few deep breaths.  Sometimes it really does take a village, just to get home.  I'm so very thankful for all the help given to me in my helplessness.  And yes.  My empathy is renewed.



Arise, LORD! Lift up your hand, O God. Do not forget the helpless.  Psalm 10:12

entitled

I was in a patient's room doing a stroke assessment during lunch, when I realized she hadn't eaten much of her food.  I asked her if she didn't have an appetite.  "Oh I'm hungry alright.  But this food is disgusting.  I wouldn't touch it."  This especially struck me because the last several rooms had told me how delicious their lunches were.

I got a call from the pharmacy.  "We have a patient here who you've helped financially with a perscription before.  He's demanding that you pay for this one too."

I passed two staff members during a break.  I heard one say "Well, if they don't approve those days off, I will just quit.  I'm going to the beach no matter what."

Art critic Robert Hughes wrote about American society a few years ago in The Culture of Complaint.  His thesis is that we live in a society where people perceive themselves to be entitled to having all desires fulfilled.  We take this to be part of our birthright.  We accord ourselves victim status when it doesn't happen.  We live in a culture of complaint.  It forms our minds and hearts.*

I see it in my life.  When I get caught up in the things I want but don't have.  When I look at something in my life and say "it's not fair".  When I am reminded that I am in the top 5% of wealthiest people in the world.  When I take for granted that at the end of each day I get to leave the hospital and go home.  It's so easy to complain....when I have so very much to be grateful for.

G.K. Chesterton once said, "Here ends another day during which I have had eyes, ears, hands, and the great world around me, and tomorrow begins another.  Why am I allowed two?"*

..that my heart may sing to you and not be silent. O LORD my God, I will give you thanks forever. Psalms 30:12


 *from Love Beyond Reason, John Ortberg

acuity

There is a big sign on the wall in the Emergency Center's waiting room.  PATIENTS WILL BE SEEN IN ORDER OF ACUITY, NOT IN ORDER OF ARRIVAL.  I don't think I ever noticed the sign until today.  Today the waiting room was packed.  Weak people leaning on someone else.  Hurting people doubled over.  Coughing people who looked worn out.  Everyone waiting their turn.  Sometimes for hours.


I was standing at the front desk talking to the greeter.  All of a sudden three young guys came in.  Two guys helping a third.  The first thing I noticed was that he looked very unsteady and pale.  And then I saw his hand wrapped in a bloody sock.  As his friends blurted out that they thought his fingers were severed I began to feel unsteady and pale.  The greeter knew acuity when he saw it.  He jumped up and rushed the guy into a triage room where a doctor immediately came in.


As our cpe class work winds up I think about all the things waiting to be done.  Case studies, final evaluations, certification requirements, applications and resumes, on calls and final projects.  And those are just the chaplain related things! Just looking at my to do list makes me feel unsteady and pale.  Sometimes I wish for my own version of a greeter who will say "here is what is really urgent" and then wisk me away to do only that.


I once heard that in our world today people have a desperate need for quiet.  More than relief from horns honking and phones beeping.  The kind of quiet that comes inside your head when you are calm and peaceful.  When your priorities are straight.  When you have a clear sense of what really is acute and what is just waiting around to be done.  It is the kind of quiet that comes after the storm has been calmed.  It is the whisper that comes after the earthquake and the fire.


That is the triage room I want to be sitting in.

And this righteousness will bring peace.  Yes, it will bring quietness and confidence forever.  My people will live in safety, quietly at home. They will be at rest.  Isaiah 32:17,18 NLT

beloved

I have always wanted to see a baby be born. 


My brother Ben was born in the back seat of our car on the way to the hospital.  I was 10.  And terrified that my mother was in pain.  So I put my head under my coat, prayed hard, and missed a great opportunity.


My two boys should have been my chance.  But after two and a half hours of intense pushing  I was much more focused on "getting this thing out" than the miracle of birth.  My eyes were grimaced shut, my preganant belly compromising my view and again I missed my chances.


A few weeks ago I pled my case before the director of labor and delivery. She agreed.  I needed to pick a day and they would page me.


I had taken one bite of salad when the pager went off.  I jumped up announcing "I have to go deliver a baby!"


Actually three.


While we were waiting for things to heat up in rooms 3 and 5, the mother in room 8 started yelling.  The medical team converged.  I hung back til the nurse beckoned.  "Erin, if you want to see this you better get in here."  30 seconds later a little baby girl emerged.  Cute and mad.  Amazing.

I got to room 3 with only 15 minutes left in the action.  Contractions and encouragement helped mom squeeze out another little girl.  This one quiet and squinty.  Amazing.

I spent over an hour in room 5.  This was the definition of labor.  Pushing and pulling for every centimeter.  At point I felt dizzy, and then realized that I was holding my breath with Mom to "help" her push.  Finally the baby crowned.  Mom was exhausted.  She was ready to give up, when the doctor took her her hand and had her feel the top of her baby's head.  Fortified with the realization that this was really happening, Mom rallied.  Seconds later a big, healthy boy emerged.  Amazing.

I will spare you the details.  Wow, there were a lot of details.  But it really was one of the most wonderful things I have ever seen.  The absolute miracle of birth.  Three rooms full of tenderness and tears of joy.  Three sets of parents welcoming in these new creatures to their lives.  Three first glimpses at brand new but already beloved babies.  Three proclaimations of the names these babies would be known as for the rest of their lives. 

In Abba's Child, Brennan Manning talks about our need to realize that we are also the center of that much love.
"Living in awareness of our belovedness is the axis around which the Christian life revolves.  Being the beloved is our identity, the core of our existence.  It is not merely a lofty thought, an inspiring idea, or one name among many.  It is the name by which God knows us and the way He relates to us.  Our identity rests in God's relentless tenderness for us revealed in Jesus Christ."

How great is the love the Father has lavished on us, that we should be called children of God! And that is what we are! 1 John 3:1

consensus

It is 7:00 AM.  I could be all cozy in bed.  I could be watching Matt Lauer giving the news.  I could be taming my boys hair for school.  But no.  I'm attending a Tumor Board Review. It's one of the "perks" of an oncology rotation.  It feels too early in the morning to be listening to words like incurable, survival rate, devasting and malignant.  But that is what I am hearing.


The Tumor Board Review is a team approach to treatment  "in which experts in different medical specialties review and discuss the condition and treatment options of a patient. In cancer treatment, a tumor board review may include that of a medical oncologist (treatment with drugs), a surgical oncologist (treatment with surgery), and a radiation oncologist ( treatment with radiation)."  Today, we had twenty specialists. They gather every Wednesday morning, fortified by a yummy hospital-provided breakfast buffet, and deliberate recent cases.


This morning there were two cases.  A man with lung cancer and a woman with an abdominal tumor.  I catch about 3% of what is being said.  Something about fibropsuedo extronominalies and lymphocytastices, whether the mass is psydostatic or psydotoxic, should treatment be chemotherapy, radiation therapy, immunotherapy, or photodynamic therapy (which sounds the most positive to me). After the detailed explaination is given, micrographs of the tumor and MRI's of the body are shown.  I could not find the tumor in the first patient, though everyone else seemed to immediately.  In the abdominal MRI I was relieved to quickly discern the large mass.  Then the speaker identified something smaller and lower while stating that "clearly this large object is the stomach." Oh well.


What I did understand was the final step of the meeting.  After presenting all the facts about each patient, and after each specialist gives their opinion on treatment, the entire group comes to a plan of care consensus.  The primary care doctor then takes this consensus to the patient to start treatment.


I love the honesty in this room.  There is a problem - no minimizing or disguising or beating around the bush.  Someone is sick and desperate.  With open hands they come looking for help and hope and healing.


This recognition of need, this consensus of a problem, is the starting line for Christians.


Douglas Coupland ended his book Life After God with these words.  "My secret is that I need God - that I am sick and can no longer make it alone.  I need God to help me give, because I no longer seem to be capable of giving; to help me be kind, as I no longer seem capable of kindness, to help me love, as I seem beyond being able to love."


My grace is enough; it's all you need.   My strength comes into its own in your weakness.  
1 Corinthians 12:9 Message

protection

I was paged to MICU to pray with a patient who was being taken off life support.  When I got to the room, the nurse warned me that I needed to take MRSA precautions.  I sanitized, gowned, gloved, masked, prayed and resanitized.  A bit of work, but worth it for the patient and the protection.


On the way back to the office I passed 2 guys from Environmental Services changing batteries in the smoke detectors.  I exchanged hellos with a security guard, noticing the gun and holster at his waist.  It reminded me that there is more than germs in this hospital that I am being protected from.


On the way into my case study evaluation - a nerve wracking meeting with 3 board certified chaplains - my supervisor stopped me and gave me a pep talk.  "You are a great pastor.  You know how to connect and care for your patients. Don't forget that in there."  His encouragement formed a shield of protection around me during the meeting.


And then a trauma call to the emergency center.  I sat in the consult room with a mom and a dad as they waited for news from their young teenage childrens car accident.   The news was shocking.  Their son had seven broken bones and would need several surgeries.  Their daughter didn't make it.


I grabbed the box of kleenex.  Taking a few for me, I handed it to the parents.  It struck me that in a hospital full of gowns and guns and alarms, a flimsy box of kleenex was no protection at all from this devastating news.  I felt so vulnerable in the midst of such intense grief and horror. Defenseless and helpless as we waited together.


In a few minutes Grandpa arrived.  He was a large man with an aura of calm and gentleness that cut through the hysteria and brutality of the day.  He held his daughter and called for a circle of prayer.  His words were solid and heartfelt.  It was obvious that his faith was as deep as his pain and had been vital long before this day dawned or this accident rocked us.  His faith blanketed the room, a hedge of protection wrapped around broken, wounded souls.

I am in pain and distress; may your salvation, O God, protect me.   Psalm 69:29

return

I peeked into room 24 and found an elderly man smiling at me from his bed.  Mr. Barry had already been in for two days and was ready to go home.  I asked him if he been to our hospital before.  He laughed.  "A few times!"  I asked him if he was born here.  "No, I was born at home, about 12 years before the hospital opened."  His first visit was around 1933 as a young teen with a bout of appendicites.  The hospital was one building with 6 bed wards.   Nurses had just shortened their uniform dresses to mid calf length which showed off their thick white stockings and heeled shoes.  Mr. Barry approved. 

Being a healthy young man, Mr. Barry didn't return to the hospital for years.  Unless you count the waiting room of labor and delivery to get news of his children's births.  He spent 1 week here in the 60's with a broken leg.  A decade later he was rushed to the emergency center after cutting off 4 fingers in a lawnmower fiasco.  He toured the surgery wing with a bad gall bladder, and the newly built heart center for a bypass and two heart caths.  He became familiar with the oncology center long enough to put his prostate cancer in remission. 

A light stroke brought him to the hospital this weekend -A huge, sprawling medial center so changed from the original hospital he had started at.  "You would think I'd have a wing named for me, after all my business here!"  he joked.

In that moment, I loved being part of this place for him.  A consistent and trusted place where he could come to any time with any manner of illness and find healing

It reminds me of a quote I highlighted in Rob Bell's book Velvet Elvis.
There is Jesus' death on our behalf once and for all, and there is the ongoing work of the cross in our hearts and minds and souls and lives.  There is the ongoing need to return to the cross to be reminded of our brokenness and dependence on God.  There is the healing we need from the cross every single day.  A restoration.

Restore us to yourself, O LORD, that we may return; renew our days as of old.  Lamentations 5:21

chromosomes...

For months I have heard about trisomy 21, chromosome deletion and translocation, mosaic chromosomes and karyotypes.  While these terms usually soar over my head, when they are attached to a baby I like, sometimes I can ground them.


Last week I was talking to the wonderful NICU doctor about a baby with klinefelter's syndrome. (47 or XXY syndrome)  He pulled out a karyotype (an organized profile of a person's chromosomes - like the picture on the left) to explain it.  I began asking more questions.  The Jones baby with downs?  Trisomy 21. (3 chromosomes instead of 2 in the 21 space) and the baby with Cri du chat? (a deletion of a small portion of chromosome 5).  A baby that only lived one hour after birth?  (lethal chromosomal abnormality.) I learned that translocation of some chromosomes are one cause of infertility and the cause of some cancers.  Some anomalies are "incompatible with life" and the body expels them so early in the process that the parents don't even know they were pregnant.  We talked about the process of DNA replication where a baby is being formed and how fragile and specific the whole thing is.  46 chromosomes have to come together in a whole and  structured order. He said it is a total miracle that any of us are "normal".


The doctor had some babies to visit.  So he handed me a copy of the Handbook of Neurodevelopmental and Genetic Disorders.  Terrifying.  If you are thinking of getting pregnant, please do not open this book.  There are devastating mutations that can occur that I couldn't have imagined if I tried.  I had to walk right up stairs to the Well Baby Nursery and peer in the window for some equilibrium.


He also suggested that I meet with a pre-natal genetic counselor.  She was a bright and engaging woman who talked about how to prepare parents for the challenges their chromosomally challenged baby might bring.  She offers resources and support groups and education.  As "the messenger" she sometimes gets "shot" at in the shock of discovery.  Mostly she comforts and guides.


Perfect.  Normal.  Mutated.  Incompatible with life.  That is quite a spectrum.

Yesterday Josh told me he had had an almost perfect day.  (Thanks Angela and Ashton!)  I asked what would make it totally perfect.  He said if they had also gone to Fun Depot, Sonic and Olive Garden then it would have been perfect.

I thought about all the mutations that challenge a normal day.  In my circles this week there were little mutations like allergies and taxes.  And big mutations like a fender bender and a dead engine and impossible coworkers.  I thought about the days I've had that were "incompatible with life" and how thousands of tiny pieces have to come together for a day to just be normal. - no flat tires, no family crisis, no oversleeping or stressful phone calls....  It's a miracle we survive.

I want to be more aware of the Holy counselor accessible to me for guidance, encouragement, comfort and empowering as I navigate the anomalies of life.   In this crazy world, it's really my only hope for equilibrium.



May the God of hope fill you with all joy and peace as you trust in him, so that you may overflow with hope by the power of the Holy Spirit. Romans 15:13

 Come on budding geneticists. Is the picture above a genetic code for a male or female?

caffeine

Years ago I led a parents night out at our church.  One of these nights I served 70 children a discount soda I had purchased thinking it was the equivalent of  7UP.  It was called Citrus Dew and it was loaded with caffeine.  Those were the longest 4 hours of my entire life.


Since that day I have been fanatically careful about keeping children and caffeine throughly separated.


Imagine my shock to hear each week in the NICU team meeting about which babies are given caffeine. And then to hear that some infants receive the equivalent to 4 cups of coffee.  I wondered if the point was to decrease nursing downtime?  Or maybe a sponsorship from Starbucks?  Finally I had to ask.


The patient doctor explained in detail the medical benefits of caffeine for babies.  To simplify what I think I heard - Caffeine stimulates the respiratory drive in tiny babies and encourages them to breathe rhythmically.  (It also decreases the number of apneic spells, and reduces partial tension of carbon dioxide - but I don't know what that means...)

This is my new rationale, when I'm groggily reaching for a diet Dr. Pepper.  I need to stimulate my respiratory drive and breath rhythmically.   I still would not share it with a child.

Eugene Peterson talks about what stimulates and wakes us up spiritually.

"Hope affects the Christian life by making us expectant and alive.  People with minimal hope live in drudgery and boredom because they think they know what's going to happen next.  They've made their assessment of God, the people around them, and themselves, and they know what's coming.

People who hope never know what's coming next.  They expect it is going to be good, because God is good. Even when disasters occur, people of hope look for how God will use evil for good.

A person with hope is alive to God.  Hope is powerful.  It is stimulating.  It keeps us on tiptoe, looking for the unexpected."

I'd like an IV of that!

...alert for whatever God will do next.  In alert expectancy such as this, we're never left feeling shortchanged.  Quite the contrary - we can't round up enough containers to hold everthing God generously pours into our lives through the Holy Spirit.    Romans 5:4b-5  The Message (and Living The Message, Peterson)

april fools

I talked to a patient who told me he'd been married for 62 years.  I asked him what marriage secrets he could share.  He said it wasn't all that hard.  "If we ever fight, I just apologize or tell her why she is wrong."


I talked to a woman who wanted financial assistance for the pharmacy.  She told me she had been coughing up blood but didn't tell her doctor "cause he wouldn't have cared any way."

I overheard two family members of a patient waiting in the lobby for visiting hours.  One said "I don't care what my boss says, if I don't feel like doing the work, I'm not going to do it."

I asked the soup and salad server in the cafeteria if the vegetable soup was vegetarian.  "Mostly", he replies.

Foolishness abounds.

Brennan Manning talks about the phrase you will hear sung, chanted, and recited in French churchs around Easter.  "L'amour de Diu est folie!"  The love of God is folly.

The phrase is beautiful and loaded with meaning.  But even more than that, it's understandable.  Folly is a language we all speak.

For the message of the cross is foolishness to those who are perishing, but to us who are being saved it is the power of God.  1 Corinthians 1:18