Posts Tagged With: serge

Neil Young, Papal Yogaphobia, and the Power of Prayer

As I intimated in my last couple of post, I’ve been going through a down patch, experiencing some discouragement and burnout.  In our pre-deployment training, we had lectures and sessions on this, and they were helpful, but when you’re in the middle of it, it’s a little tough to see an obvious escape route.

One belief in Christianity is that we often get in the way of our own relationship with God.  The image is one of a door, with you on one side and Christ on the other.  He’s knocking to come in, but the door only has a handle on your side: God’s side of the door is blank.  We often shut the door, and then complain bitterly that God is absent, or doesn’t exist, or doesn’t care.  God is always present, waiting for us to open the door, but it doesn’t work if we close the door, close off the relationship.

Slightly cheesy Bible picture

Reaching for that handle, opening the door, re-establishing relationship with our creator, can be difficult.  Difficult not because it requires knowledge of a certain denomination, or sacrificial practice of an esoteric spiritual discipline.  Difficult not because the key to that door belongs to a certain sect, and not because one needs a mantra or wisdom from a gnome-like guru sitting cross legged in his mountain cave, or in his palace in Rome.

The opening of that door is difficult, because to grasp the handle, we must let go of what we’re holding on to.

From the Gospel of Mark:

As Jesus started on his way, a man ran up to him and fell on his knees before him. “Good teacher,” he asked, “what must I do to inherit eternal life?”…

 Jesus looked at him and loved him. “One thing you lack,” he said. “Go, sell everything you have and give to the poor, and you will have treasure in heaven. Then come, follow me.”

 At this the man’s face fell. He went away sad, because he had great wealth.”

I don’t think this passage was meant to say that everyone is supposed to go out and sell everything and give it to the poor.  If you look carefully, an unusual sentence is inserted into the passage:  “Jesus looked at him, and loved him.”  In his day, Jesus was a hugely popular and controversial figure.  He attracted crowds of thousands wherever he went.  But over and over again in the Gospels, we see Jesus as very “one on one.”  On only a few occasions does he address large groups of people.  Rather, he spent three years wandering around from town to town, engaging individuals deeply.  Touching lepers, dining with people we might despise, confronting the possessed, really “hands on”.

And in this particular circumstance, he stops, looks at this rich young man, looks into his soul,and sees what is preventing this particular person from experiencing God.  In this particular instance, this man cannot reach up and open the latch on the door because he is clinging tightly to his wealth.

The current Roman Catholic Pope Francis is a rock star.  The press loves him, mainly because he embraces humility, poverty, and authenticity, over the trappings of his office.  There was a recent flurry of concern over his comments on yoga!  Is the Pope yogaphobic?  Is he prohibiting Christians from using yoga for core strength or to get those six pack abs? If you take the time to look at what he said, you’ll find this non-controversial statement: “You can take a million catechetical courses, a million courses in spirituality, a million courses in yoga, Zen and all these things. But all of this will never be able to give you freedom”.  The Pope tells us that only the Holy Spirit can “move the heart” and make it “docile to the Lord, docile to the freedom of love”. If we are seeking a zen-like peace from yoga meditation, or wealth, or security, then we are seeking peace from the wrong source.

So the supposed papal statement on yogaphobia also includes a warning that Catholic theology classes (catechetical courses) aren’t the way to go!  It turns out that the path to peace in your heart is just letting that door open, and experiencing God directly.  But again, to do that, you have to put down what you’re grasping.

One of the great poet-sages of our time, Neil Young, captures this pretty well:

Workin’ hard every day
Never notice how
the time slips away
People come, seasons go
We got something
that’ll never grow old.

I don’t care
if the sun don’t shine
And the rain keeps pouring
down on me and mine
‘Cause our kind of love
never seems to get old
It’s better than silver and gold.

I used to have a treasure chest
Got so heavy that I had to rest
I let it slip away from me
Didn’t need it anyway
so I let it slip away.

I don’t know what Neil Young’s spiritual beliefs are, but his song “Silver and Gold” captures exactly the same point.  Holding on to wealth, pride, security, pain, whatever is in our “treasure chest”, gets very tiring.  It’s okay to rest, put down whatever you’re holding on to so tightly, and reach up for the handle on the door.

So I think the Pope and Neil Young would agree:  if what you seek is peace, no amount of striving can get you there.  If you’re burned out and discouraged, trying harder, working harder, wishing people would just see your vision and fall in line, just isn’t going to put you on your zen mountaintop.

One of the advantages of living in a village in Africa is that you can get away from people pretty quickly.  Yesterday afternoon, I was in such a black hole that I couldn’t stand myself.  I put on my running shoes, and within five minutes of old man shuffle, was on a muddy twisty mountain road with dense bush on all sides.

This is a great place to talk with God without looking like a crazy person.  No one to judge you but baboons.  I shouted, I pleaded, I got angry, I let Him know exactly what I thought about my current situation.  But the door was firmly shut.  He was nowhere to be found.  Great.

Just when I need Him, He’s either not paying attention, doesn’t care, or doesn’t exist.

The only thing listening were the baboons, and they had nothing helpful to contribute.

I expected to come back from that run rejuvenated and energized.  After all, I had done my part, I had “gone to the mountaintop”, spent some quality time with God.  It was time for him to do his part.  So why did I still feel so black?

Last evening, we had a dinner engagement at our house with some of my favorite people in Kijabe.  Chege is one of our senior trainees, and his wife Evalyn is a nurse in the operating theatres.  They have a beautiful four year old boy named Nimwell.  They are gentle, loving, kind, amazing people.  Chege is in the middle of a spine surgery fellowship in Egypt, and so hasn’t seen his family in a couple of months.  He’s spending a short break back here in Kijabe, and they were good enough to agree to have dinner with us.

We had a great dinner of Irish stew and mashed potatoes, which, it turns out, is very similar to Kikuyu cooking.  No surprise that mashed potatoes and beef with gravy are everyone’s comfort food.  Great conversation, hilarious stories, just one of those nights of fun and relaxing relationship.  As we stood up to say our good-byes, Chege asked if he could pray briefly.

I’ve heard Chege pray and preach before, and he is a gifted speaker.  But he was moved at this moment to pray for me, to encourage me, to lift me up, to allow me to let go of my treasure chest of pride and insult.

As he prayed, I could feel the anger, resentment, burnout, begin to melt.  I went to bed, and woke up this morning, with the blackness gone, and the enthusiasm and energy returning.

I don’t pretend to understand how prayer works.  I don’t know how Chege knew that I needed prayer to help me let go of my treasure chest.  Theologians could debate paradoxes and mysteries for lifetimes.  But like this laptop, I don’t need to know how it works.  I’m just glad that it does.

I’m heading off on an outreach trip tomorrow, and I wasn’t sure how that was going to work.  The travel, cross-cultural setting, and security measures are all exhausting.  To head into that week depleted looked like a recipe for disaster, and I had contemplated a last-minute cancellation, knowing how disruptive that would be.

But I think that all had to do with what I was holding on to.  And I think my friend Chege saw how firmly I was holding that door closed.  His prayer helped me to just let go of what was bothering me, quit taking myself so seriously, and see the beauty around me.  We hold on so tightly to the chains that bind us, hold on so tightly to what we treasure.  Too often, the peace we seek is right in front of us, but we refuse to accept it.  If you think that might be true in your current setting, I encourage you to pray, find someone to pray for you, let go of your treasure chest, and see what happens when that door opens.

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” … an erosion of the soul caused by a deterioration of one’s values, dignity, spirit and will.”

After my annual evaluation last night, I went back over some of the things I had been discussing with Ann and our team leader Bethany.  Some of the things I was saying really didn’t sound like me:  tired, purposeless, sometimes hard to remember why I came here in the first place.  I do get fatigued here, as much from the cross-cultural differences as from the work itself.  But why was I sounding so negative?  The cross cultural stress inventory didn’t paint a pretty picture.Screen Shot 2015-05-20 at 10.53.50 PM

I got to thinking about burn out.  In the US, physicians experience real burnout at some point in their careers at close to 100% incidence.  Cross cultural living and working also has a pretty high burn out rate.  Hmm, so if I’m a physician in a cross-cultural setting, any chance at all that I might be experiencing a little burn out?

There’s a website call happymd.com which discusses the topic at length.  If any physicians reading this want to learn more about what to look for, I’d recommend you visit.  I can’t speak for other professions, but as a physician, you either have been, are, or will be burned out at some point in your career.

The website defines burnout as being depleted to the point where you don’t bounce back from normal stresses after a day or weekend away from work.  There’s a double edged sword here when in medical work that is also a ministry:  there is no end to the need, no obvious point at which you should go home, say no to another responsibility, or go on vacation.  Serge, our sending agency, is quite intentional about avoiding burnout.  I guess you have to actually listen and take the leadership’s advice for it to work.  But it kind of feels like you’re letting down yourself, the hospital, your patients, your agency, and of course, God.

A researcher named Maslach investigated physician burnout, and describes its effects in terms of physical, emotional, and spiritual depletion.  Burnout leads to fatigue, depersonalization, cynicism, and lack of efficacy.  It has effects on work, marriage, and relationships with family and friends.  She described its effects as ” … an erosion of the soul caused by a deterioration of one’s values, dignity, spirit and will.”

Maslach created an inventory, or questionnaire, to look for and determine the severity of physician burnout.  Just for a laugh, I though I would take the test.  I kind of wish I hadn’t.Screen Shot 2015-05-20 at 10.55.23 PM

On all scales, of physical, emotional, and spiritual burnout, I fell into the “severe burnout” category.  Not good.  Really, quite a wake up call.  I feel like I’m tired, not at my best, but this really tells me I may not be functioning at a very high level.

Thankfully, there is a lot of good work done on what to do with burnout.  Less time at work isn’t necessarily the answer, but looking at what parts of work are depleting, and what parts are energizing, is vital.  The key is to structure the day, week, month, and year, to find ways to engage with those parts of the work which are invigorating, knowing that other parts of the day will be “soul eroding.”

How to reconcile this workaholic, all-responsible, soul-eroding lifestyle with a life of following Christ?  You really can’t.

The message of the Gospels never promises an easy life, or lack of suffering, when following Christ.  But they do offer hope:

I came so that everyone would have life, and have it in its fullest. “(From the Gospel of John).  Or, from the Gospel of Matthew, ““Come to me, all you who are weary and burdened, and I will give you rest.  Take my yoke upon you and learn from me, for I am gentle and humble in heart, and you will find rest for your souls.  For my yoke is easy and my burden is light.”

I have to admit, right now I’m not feeling I’m having life to the fullest, or finding the yoke easy or the burden light.  I can identify pretty strongly with the weary and burdened part, however.

So my plan is to take some steps to get back to the enthusiasm and energy that brought me here in the first place.  I’m very thankful that taking care of patients has always energized me.  Being part of a team that comes alongside the sick or injured in the healing process, talking with families, working with residents and other trainees, will always remind me of why God put me here on this Earth.

I’m heading off on an outreach trip beginning Sunday, so I will be gone for a week with some Kijabe colleagues.  I’ve been to this hospital before, and find it extremely challenging and energizing.  This small hospital, outside of a small town, in the middle of a large desert, is really striving to provide excellent and compassionate care.  I will have the privilege of doing surgeries with the resident surgeon, as well as teaching a one day seminar on the treatment of orthopaedic surgical emergencies.  I’m excited and grateful to be part of such a trip, and this is definitely part of the work which invigorates and fills the soul.

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Annual Review

Ughh.

Tonight was the night for our annual review.  Both Ann and I had to review our job descriptions, fill out self-assessments, and then complete a “stress survey.”  I accidentally tore the stress survey into a thousand pieces, so I’m pretty sure I didn’t need to take it anyway.

In all seriousness, these are really useful exercises.  Living outside your home country, in a place where the language, culture, and work practices are unfamiliar, is really stressful.  Researchers have found that levels of the stress hormone, cortisol, rise abruptly just by looking at a roadside sign in a foreign language.  Being immersed in a culture not your own creates a constant low level of stress, that needs to be acknowledged and dealt with.

Bethany is our amazing Serge team leader.  I think most people’s first impression of her would be that she is a kind, gentle person, probably suited to counseling or teaching.  Which is exactly what she does!  And she is amazing at it.  We are blessed to have her as our team leader, as she combines great leadership and organizational skills with the compassionate heart of a counselor.

Having a team leader, and being accountable to an organization, might seem a bit odd, but is an integral part of the work here.  Nothing we do is independent:  everything is interdependent, and all of it is dependent on God’s grace and mercy to sustain us.

Our Serge team here fills the role that an extended family might have filled in more traditional societies.  We all fall down, look silly, fail at our appointed assignments.  But we have a group of people who know us at our best and at our worst, and for some reason still love and support us.  Our team is an amazing group of individuals, couples, and families, who we can trust to be there when we just need support and someone to be with.

We meet with our team for dinner every Thursday, and get together on a Friday for a discussion every 6 to 8 weeks.  We look forward to these times, to learning how everyone’s week has gone, what joys and successes, disappointments and frustrations have punctuated the days since we last sat down together.

These dinners have a sacramental quality.  We get together at someone’s house, relax, and break bread together.  It’s fun just to catch up, get up to date on each other’s work, follow up on some concern or problem.  We share a casual dinner, prepared by the host, and then sit down for a time of prayer together.  It really feels like the early church must have felt, and how church could ideally work now.  No big ceremony, just people who love God getting together to be friends and support each other.

So we spent the evening discussing with Bethany our roles here, what has gone well, what has been frustrating, and what changes we could put in place to help things go more smoothly.  It’s encouraging to be part of such a great team.

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Difficult Discussions: Flunking Sainthood Day 24

Busy day in surgery today, as well as seeing consults between cases.  The surgeries went fine, but what was really hanging over the orthopaedic resident and I today was a discussion we needed to have with a patient and his family.  Last week, we worked hard to save the life of the man who had a terrible injury to his pelvis and leg.  You might remember a photograph of a mangled leg accompanied by warnings not to look if you would find it disturbing.

Thankfully, he has stabilized.  He has gone from the intensive care unit, to the intermediate care unit, and today was able to transfer to the regular men’s ward.  His blood pressure has stabilized, and we have been taking him to surgery every two or three days to clean out his wounds, and remove damaged tissue.

The leg is teetering on the edge of being salvageable.  The bones and muscles are so damaged that he has little hope of a well-functioning limb.  Though his hip, knee, and ankle are fine, the areas in between are mostly devoid of functioning muscle, and severely fractured.  We have had discussions with him over the last days, but wanted to have a family care conference today so everyone was on the same page.

His social situation is far more complex than I could have imagined.  He is an orphan.  Both his mother and father have died, but we did not discuss how they died.  His father had three wives, two of whom are still living, so we had the discussion with a dizzying array of uncles, in addition to his brother and older sister.  Decision making authority rests with the patient, as he is lucid and capable of making his own choices.  Kenya has a strongly family-oriented culture, however, so group discussions and consensus building are vital.

The relatives strongly recognize that they may be held accountable by other family members for medical decisions, so they made it clear that they would abide by “whatever the doctors decide.”  This puts a little too much authority in our hands, however, as the final decision needs to be up to the patient.

Thankfully, the family had outstanding English skills, and communication skills in general, and the Kenyan resident I’m working with filled in my language and cultural blind spots.  We had a long and intricate discussion, and each person voiced his perspective and concerns.  I’ve been in discussions like this a number of times, and I’m often struck by the patience, careful listening, and gentle pace of the dialogue.  It is vital for the health care providers to understand the depth and breadth of implications of decisions like this.  In the end, we met privately with the patient, who was markedly comforted by the group consensus.  We discussed his options again, prayed with him, and he expressed his decision.

The plan is to do everything we can to save his leg, regardless of cost, number of surgeries, or length of treatment.  If at any point we feel like the endeavor is hopeless, or is putting his life at risk, we will communicate this with the patient and with the family.

For this man, I think this is the best decision.  If things go well, his leg will work a little better than a prosthesis would.  Moreover, his psychological and social situation would make amputation an unusually devastating blow.  He and his extended family realize that this is a real possibility, but they would all rest easier with this decision knowing that every effort had been made.  Remarkably, one of the uncles present is on a disability awareness council, and repeated the mantra that “disability doesn’t mean no ability.”  He is encouraging his nephew that, regardless if he winds up with an amputation or not, he can continue with a productive life.

I feel privileged, if also saddened, to be part of discussions like this.  Kenya is a country with a high incidence of motor vehicle violence, and few doctors to treat the suffering.  We may or may not succeed in saving this man’s leg, but I am pleased that he knows he is cared for by his family and by the staff here at Kijabe.

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French Toast and Trauma: Warning, Disturbing Image

Weekends are hard to predict around here.

I’m on trauma call for the hospital, so I need to stay close to home and close to my phone.  But beyond that, life goes on as usual.  Saturdays and Sunday are great family days, we try to sleep in, make coffee, and I’m on breakfast duty.

Saturday morning French Toast, Bacon, and Hot Coffee

Saturday morning French Toast, Bacon, and Hot Coffee

The kids get “screen time”:  Finding Nemo for Jane, Minecraft or reading books for Michael.  It’s the cold and rainy season, so a roaring fire and fuzzy PJ’s are mandatory.

Contented and Cozy

Content and Cozy

It’s great not having to rush off somewhere or have anything to do.  I make my way down to the hospital storage room to organize some donated equipment and get rid of a huge pile of useless junk.

The kids have friends within walking distance, RVA has high school rugby games to go watch, and dinner plans with great friends round out a perfect Saturday.  A peaceful start to the weekend.

Organizing the Store Room

Organizing the Store Room

Sunday is another story.  My phone jars me out of a sound sleep, the screen tells me it is the ortho resident calling.  I don’t really know what time it is, I just know it’s dark.

“28 year old guy on a piki (motorcycle), hit by a bus about 4 o’clock this morning.  Pelvic fracture, bad open floating knee.  Has had 4 units of blood, his BP is 100/50, and we’re on our way to theatre. His Hemoglobin level is 5 after the third unit of blood”  To translate, this man is bleeding to death, he has already lost at least two thirds of his blood volume.  Only healthy young people survive such blood loss, but they can die very quickly once their ability to compensate is overwhelmed.

Okay, I’m awake now.  I volley back some questions:  is the pelvic fracture stabilized with a binder, does he have two IV’s flowing wide open,  is more blood available, is he alert, can you feel a pulse in his leg, have antibiotics been started, has he gotten a tetanus shot, any chest or abdominal trauma, has his c-spine been cleared?

Yes, yes, yes, yes….The systems have worked, protocols have been followed, and this young man is going to have the best chance he can at survival and keeping his leg.  I’d like to repeat that sentence 10 more times, because it is amazing.  At this little hospital clinging to a muddy hillside in rural Kenya, this patient is receiving world class trauma care.  This is all down to the excellent work of the junior residents who met this man in the emergency department.  We don’t have a sophisticated lab to know his acid-base balance, we don’t have invasive monitoring to know his exact fluid resuscitation status, but within our abilities, every possible thing has been done, and is being done, to save this man’s life and limb.  In medical parlance, we move into “damage control” surgery.

The goal of damage control surgery is to stabilize the patient, quickly clean wounds, stop bleeding, and  get him into the expert hands of the intensive care unit doctors.  Damage control does not involve meticulous repair of wounds or fractures, just quickly trying to move him out of a life-threatening situation.

I gulp down a cup of instant coffee to clear my head and walk into the pink sky of the breaking dawn and down to the operating room.  The patient is just being wheeled into theatre, and I introduce myself and talk to him, in as reassuring tones as I can, about his injuries.  I’ve had more than one patient here with these same injuries never wake up from surgery, but he doesn’t need to know that right now.  “Your blood pressure has stabilized, things are looking good, we’re going to clean up your wounds and begin stabilizing your broken bones.”

With that, the nurse anesthetist gets him off to sleep while we stabilize his neck.  He hasn’t yet gotten an Xray of his neck, and has no pain there, but could easily have a broken neck and not know it.  The pelvic and limb fractures are painful enough to mask the pain of other injuries, so we always assume the spine is broken until proven otherwise.

The leg looks bad.  The thigh bone (femur) is broken and sticking out the front.  A large segment of the tibia bone is missing beneath the knee, and there is a clot of blood behind the knee.  Through my gloves, I can feel a pulse behind his knee, so we know the main artery to his leg is intact.  With a doppler probe, we can see that he has good blood supply to his foot.  So the leg is probably salvageable. But that clot behind the knee looks ominous.  We leave it alone, to be looked at more carefully a bit later.   Before he went to sleep, we had tested his ability to move and feel his toes, and this was normal.  Some reasons for optimism.  But the clot worries me.

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Floating Knee:  Open Fractures of the Femur and Tibia

Floating Knee: Open Fractures of the Femur and Tibia

We wash debris, paint chips, gravel, sand, and pieces of his trousers out of the wounds.  The fractured ends of the bones are tattooed blue from the paint on the bumper of the bus.  We meticulously clean everything, excising dead tissue, until the wounds look clean.  The residents and I install an external fixator, a stabilizing device which uses pins inserted into the bone to attach to a carbon graphite frame.  This can be applied in a matter of minutes, from his upper thigh to just above the ankle, to provide some stability to the leg.

The patient is getting cold.  Hypothermia, or below normal body temperature, is a common and ominous sign in severe trauma.  We get hot water bottles and blankets to cover every square inch of the patient that is not being operated on.  A cold patient can have severe metabolic disruption, including losing the ability to clot his blood.  This can be irreversible and fatal in a severely injured patient.  We turn the room temperature up to 86 degrees Fahrenheit.  While garbed in hats, masks, gowns, and lead vests, this becomes very uncomfortable, but is standard trauma protocol.

The wounds are clean, the fractures stabilized, and now it is time to go back and look at that clot.  I carefully place retractors to hold the surrounding tissues out of the way, and gently remove the clotted blood.  Before the case started, I had insisted that everyone in the room was wearing eye protection.  And this was why.  As I removed the clot, bright red blood began spraying out of the wound.  We had found the reason his hemoglobin blood levels were so low.  As the bumper of the bus hit his leg, one of the bone fragments had torn a hole in an artery in the back of his leg.  Gentle fingertip pressure stopped the bleeding, and we called for the talented general surgeon, Dr. Jack Baraza.

Jack was waiting in the wings, and quickly arrived to calmly explore the vascular injury.  There are three vessels which supply blood to the lower leg, and two were still intact.  So the repair was a simple matter of isolating and tying sutures around the offending blood vessel.  We rechecked the blood supply to the foot, and after a few tense moments, were rewarded with pink toes and a visible pulse on the doppler ultrasound screen.

Dr. Baraza checking the blood supply to the foot

Dr. Baraza checking the blood supply to the foot

Thick dressings are applied, a plaster splint reinforces the external fixator, some other wounds are quickly sutured, and the patient is ready for transport to the ICU.  He has a long and difficult struggle ahead of him.  The next 48 hours will show us how much reserve he has left.  As he stabilizes, we can begin to plan reconstructive surgeries to fix his pelvic and femur fractures, and restore the bone missing from his leg.

I walk back home to an empty house.  Ann and the kids are enjoying Mother’s Day by going on a hike at Crescent Island with some friends, so I have some breakfast and get ready for a nap.

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Of Fibonacci, Logos, and Chaos: a Theology of Surgery

I believe our world is broken.

I believe our reality includes suffering, chaos, loss, and death.

I believe it wasn’t meant to be this way.

Turning and turning in the widening gyre
    The falcon cannot hear the falconer;
    Things fall apart; the centre cannot hold;
    Mere anarchy is loosed upon the world,
    The blood-dimmed tide is loosed, and everywhere
    The ceremony of innocence is drowned;
    The best lack all conviction, while the worst
    Are full of passionate intensity.

WB Yeats “The Second Coming”

Anarchy is loosed upon the world.  As in every age, this age seems ruled by the headlines.  ISIS, Leukemia, divorce, war.

Partisan hatred, global warming, spiraling health costs, corrupt institutions.

Young men so devoid of purpose they grasp at fundamentalist straws.  Crowded cities conceal suicidal loneliness.  Young women defined by ad agencies, dying to be thin.

Those south of the equator dying from too little food, those north of it from too much.

I believe it wasn’t meant to be this way.

The falcon spins away from the falconer in the widening gyre.  Society, decency, kindness, gentleness, overwhelmed by division, violence, hatred, ignorance.

But I believe it wasn’t meant to be this way, and Yeats catches himself in a contradiction.  The falcon turns away in an ever widening gyre.  Let’s back up a bit.  A gyre is a spiral, extended into space in three dimensions.  A gyre has structure, mathematical perfection, elegance.  A gyre is the opposite of anarchy.

If we look at the falcons’s gyre, or the arrangement of petals on a flower, or the shell of a chambered nautilus, we find a numerically perfect order, or logic, which in mathematics is called the Golden Proportions.Fibona52  Fibona50 Fibona51

The golden proportions are defined by a simple series of numbers:  0 1 1 2 3 5 8 13 21 34 55 89…..  Add two numbers together, and it creates the next number in the sequence.  This series of numbers is called the Fibonacci sequence.  Divide any number by the number before it, and the result comes out approximating an infinitely long number that starts with 1.618033988749894848204586834.  This number is the golden proportion.  The further out you go in the sequence, the closer the ratio comes to the golden proportion.

What does the golden proportion have to do with chaos, a broken world, and surgery?

It turns out, the Fibonacci sequence and resulting golden proportion are more than a mathematical curiosity.  If we look to nature, we find this order, this organizing principle, everywhere.  Subatomic particles arrange themselves according to the golden ratio.  Galaxies rotate in values proportional to the Fibonacci sequence.  Plant leaves arrange themselves, nautilus shells spiral, pine cones, roses and sunflowers all dance to the music of tFibona48he golden proportion.  Computer programs and search engines rely on the Fibonacci sequence.  Most remarkably for me, the length of the bones in our hands follows a Fibonacci sequence, so as we make a fist, we echo the grace of the spiraling nautilus shell.

The bones of the hand describe a Fibonacci sequence

The bones of the hand describe a Fibonacci sequence

So the falcon, even as he ascends away from the falconer, even as things fall apart, describes an arc which betrays the underlying grace and structure of his being.

How can this be?  How can this world of chaos reveal an underlying structure, an underlying organizing principle?

I believe a clue to this mathematical marvel can be found in the Bible:

In the beginning was the Word, and the Word was with God, and the Word was God.  He was with God in the beginning.  Through him all things were made; without him nothing was made that has been made.  In him was life, and that life was the light of all mankind.  The light shines in the darkness, and the darkness has not overcome it.

This beautiful poem was originally written in Greek, and is the opening verse of the Gospel of John.  The word “word” was originally written as the Greek word “logos.”  We don’t have an exact translation of “logos” into English, but it is the word from which we get logic.  The idea of logos is structure, order, the premise upon which everything else follows.

You’ll notice that the opening verse of this poem is identical to the opening of the Hebrew book of Genesis, the opening words of the Bible:  “In the beginning…”

This puts us intentionally at the beginning of time, the beginning of existence, physicists would say at the moment of the big bang.  And the author of the Gospel of John tells us that God was there, in the form of order, in the form of an organizing principle, in the vibration and spin of the subatomic particles that would give rise to galaxies, stars, planets, earth, and life.

The Logos was there at the beginning, and the darkness has not overcome it.  The falcon’s gyre is ever widening, he cannot hear the falconer, but even in his betrayal, he cannot escape the inherent order of his being as he ascends in a graceful spiral.  This world was created, by whatever means you may believe, but I believe it was created for order.

The Jewish and Christian faiths share what anthropologists call their “creation myth.”  Myth in this sense is a technical term which means a story of ancient and important truth.  We tend to use the term to mean untrue, mythical, like bigfoot.  But anthropologist recognize that creation myths hold great truth for their culture.

The Judeo-Christian creation myth began as an oral tradition, and was eventually written down as the book of Genesis.  Christians believe it is inspired revelation, and there are various interpretations as to how it should be read.  Regardless of interpretation, we see a world created in Logos, in order, in perfection.  Only when mankind chose pride, knowledge, and power over kinship with the Logos did things fall apart, and mere anarchy was loosed upon the world. 

So I believe our world is broken.  It was created for logos, for order, for perfection, for shalom.  But separation from the Logos, the creator, leaves us with mere anarchy.

This would all seem a bit dark, but for one thing.  Christians also believe that the Logos, the organizing principle of the universe, returned, and entered human history, entered time and space, as a human being.  He entered this world of anarchy, and by perfect Logos, perfect order entering this world, he redeemed it.  He began the process of restoring it to its rightful state.  He didn’t come only to save souls, to redeem individuals, but to redeem creation itself.

What would this look like, a redeemed creation?  I can’t begin to imagine.  It’s easier for me to imagine what it is not: it is not suffering, it is not loss, it is not loneliness or death, it is not painful separation from our creator.

From the standpoint of a surgeon, a redeemed creation does not include broken femurs, shattered pelvis’, or children with bone infections or incurable tumors.

There is no doubt in my mind that we live in a dark world, but I take hope in the fact that “the light shines in the darkness, and the darkness has not overcome it.”

Yeats stumbles again when he declares that “the best lack all conviction.”  I believe this is precisely where he was wrong, and I believe this is precisely how the darkness cannot overcome the light.  God calls us to be that light, to work with and be part of the Logos, the redemption of this broken world.  He calls us not to lack conviction, but to stand convicted.  To struggle in the chaos,to lose our way, but in our efforts describe the breathtaking spiral of love, compassion and beauty we were created for.

For a surgeon this means working to restore the order of the human body, approximating the way the Logos intended it to be.  It means healing those who can be healed, and comforting those who cannot.  It means teaching others to view their job as their calling, as a priesthood, as a privileged servant-hood allowing us to shine the light of God’s love into the darkness of suffering.  It means being the light to those overcome by the darkness as we cling to the hope of the redeemer, the centre that will always hold.

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Mountain Bike Safari (Flunking Sainthood Day 9)

One of the great joys of living at Kijabe is living on the Rift Valley Escarpment, a 2,000 foot ridge which drops from the alpine forests above us to the semi-arid plains below.  There are no level surfaces here:  every road, driveway, and forest sits on a steep pitch.  Combined with the heavy foot traffic and herds of cows, sheep, and goats, the area is interlaced with world class ready-made mountain bike trails.  Over the years, different people living here have pieced together routes to nearby villages, as well as faraway towns and lakes, entirely on trails.  We decided to set out today on a mountain bike safari.

There are a handful of bikes and bikers here, and we have two skilled mountain bikers visiting, Thomas and Meghan Higgins.  They live at 6,000 feet in Salt Lake City, and love to mountain bike, so they are looking forward to the challenge.  Both Thomas and I are not on call this weekend, so we decided to put together an adventure.

We’re grateful for the loan of David Shirk’s mountain bike, as he is back in the US at the moment.  Four of us assembled at our house, got tires pumped up, found helmets that fit, and packed enough food and water to get to our destination, a small hostel called Longonot Lodge, about 20 miles away.  This lodge sits on a stunning plateau, surrounded by plains full of zebra, Thompson gazelle, hartebeest, and the occasional giraffe and buffalo, and ostrich.  The lodge was originally built by Ernest Hemingway for his wife, and is now run by a German/Kenyan couple as a guest house.  We had called the day before to book lunch at their outdoor restaurant.

We set out mid-morning, a brief climb followed by a high speed descent on a twisty, muddy road which descends through dense bush to “Old Kijabe Town”.  This is the real Kenyan village, Kijabe Hospital being a later addition about a hundred years ago.  As we reached the village, Michael suffered an early set back, a flat tire.  We spent a good bit of time getting this fixed, as we went through two spare inner tubes which had holes in them, a pump which didn’t work, and finally used the wrong-size tube for his tire.  Any port in a storm.

We continued the journey, climbing up above the village to bypass a deep ravine filled with stinging nettles.  A brief, twisting descent on cow trails brought us to a broad, rolling trail called “old railway bed.”  A non-imaginative name, as this trail represents the remnants of the colonial era Mombasa-Uganda railway, otherwise known as “the Lunatic Express.”  This railways features in movies such as “Out of Africa” and “The Ghost and the Darkness”, and is best known for the two male lions of Tsavo which ate many workers and nearly halted the railways construction.  As we ride, we are journeying over dark history, as the railway represents the worst of colonial ambitions.

We make our way down the fast paced, twisting trails.  Segments of mud, spectacular vistas over the Kenyan planes, deep ravines where we form a human chain to transit bikes and each other to the far side.  Thumping drum beats from local village churches , squealing groups of children, intimidating cacti lining the trail, dodging herds of cattle, goats, and sheep, and finally we arrive in the heat and humidity of the valley floor.

The trail is a major route for herders.

The trail is a major route for herders.

Meghan makes some friends

Meghan makes some friends

Next, we pass across the current railway, underneath a two lane highway, and set out alongside Mt Longonot, a dormant volcano that the Higgins family climbed several days ago.  With Mt Longonot on our left, we wrap around its flank on dirt roads, climb up a thin steep road through a lava flow, and then a blazing descent onto the plain nestled between the heights of Mt. Longonot to the south and the glistening expanse of hippo-laden Lake Naivasha to our north.

We come to a crude gate, manned by no less than three “guards” who are a bit startled by our arrival.  In a halting mix of swahili and English, we struggle to understand each other.  Ann has passed by here an hour earlier with both ours and the Higgins children in the car, so we are eventually ushered onto the property.  This gate marks the boundary of a massive land holding, Kedong Ranch, which itself is part of the bloody history of the Lunatic Express Railway.  We descend further onto the plain, and enter paradise.

We are many miles from the nearest building, the nearest paved road, or any other signs of civilization.  As we pedal across the plain, we are surrounded by herds of hartebeest, Thompson gazelle, and zebra.  The many giraffe and buffalo in this region are nowhere to be seen today, and the ostrich are hiding somewhere as well.  A short climb brings us to the top of the hill, where Ann and the children are already enjoying the peace of Longonot Lodge.

We sit down to a lovely lunch of locally caught tilapia (fish), buttery potatoes, and slivered carrots.  Not bad for the middle of nowhere!  The lodge uses solar water heating, and has a small wind farm for electricity.  Hot coffee washes down the delicious food, and helps energize us after the long and tiring ride.  The fatigue, gentle heat, lazy breeze, and overwhelming vista lull everyone into a state of relaxed contentment.

But the inevitable time for departure arrives, we load the bikes onto the car, and head back to Kijabe.

Bikes loaded up for the trip home.

Bikes loaded up for the trip home.

The trusty rig, ready to take us home.

The trusty rig, ready to take us home.

A quick check shows that the patients for tomorrow include the man who suffered a machete attack with multiple fractures who needs his wound covered with a “flap”, two women with broken legs, one with a broken ankle, and the lady with a broken wrist who was cancelled last week due to high blood pressure.

Weekends like this really allow us to dive into the week ahead with enthusiasm and energy, hopefully giving the best to our patients and staff.  Family time, laughs with friends, and enjoying the amazing creation surrounding us fill our souls and make us all thankful for the work we’ve been called to do.

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The Big Fig

Saturday, a break in the rain, blue skies with serrated clouds, brilliant sunshine.  Time for a hike!  The Big Fig is a famous tree near Kijabe, with huge roots winding through boulders, perched on the edge of a 200 foot drop into a small canyon.  The tree is about an hour’s hike through the bush from Kijabe.  We gather our friends the Heins and Higgins families, load back packs with snacks and water bottles, and head out.  Our first stop is at our friends the Davis’ house, where Rich bluetooths the path from his gps to mine.  Once you’re in the bush, it’s difficult to follow the correct twists and turns to the Big Fig, so now we have satellite navigation!  The Davis’ dog Radar decides to abandon his family and join us on the hike.

The hike down is a little muddy, but the footing is good.  Monkeys stalk us in the trees, giant centipedes wiggle across the trail, black ibis, hawks, and colorful song birds punctuate the walk.  An animal skin on the trail is animated with a lacy white fungus.  The gps takes us straight to the big fig, where we take a welcome break in its  cool shade.

The tree is remarkably large, and precariously set.  Roots more than a foot in diameter snake their way through 10 foot boulders, leaving the trunk hanging out over a precipitous drop.  We herd the kids, all kindergarten to fourth grade, away from the edge so the adults can relax.  Michael and his friend Noah impress each other by getting ever closer to the edge, pretending to slip.  Somehow we don’t find it as funny as they do.

The tree’s rocky home provides comfortable seating as we take our break.

Mara family, On the Edge!

Mara family, On the Edge!

The canyon opens up to farmers fields planted with maize and kale, and lazy cows drift from one field to the next in the valley below.  Red-garbed Masai herders dramatically decorate the lush green vegetation.  Rock hyrax duck in and out, resenting our invasion, and Jane finds an 8 inch lizard.

Heading back up, the heat kicks in, but we make good time and relax in the cool of the house.  Jane heads up to a friend’s house, I make grilled cheese sandwiches for Michael and Noah, and Ann takes Bosco out for a walk.  He’s getting a bit old, and we don’t take him on big steep hikes anymore, but he hates to be left behind.

Tonight, we’re looking forward to having the Higgins family over for dinner.  Meghan is cooking, which is a sure sign of Ann’s friendship with her.  Normally, it takes years before an Irish “mammy” will allow another woman to lift a finger in her kitchen, so they must be tight.  Either that, or Ann is just really sick of cooking dinner every night.

I had the pleasure of running into my good friend, Dan Galat, today.  Dan is my doppelganger at Tenwek hospital, about three hours west of here in Bomet, Kenya.  Dan is an orthopaedic surgeon from the US, who came to Kenya straight out of his residency at the Mayo clinic.  We are twin brothers, both sharing a passion for providing orthopaedic care and teaching Kenyan surgeons.  Dan recently started an orthopaedic surgery residency at Tenwek, and we are finding ways to collaborate for better care and training.

It’s nothing short of miraculous that I can sit here in a muddy little village in Kenya, and be working alongside talented Kenyan surgeons such as Dr.’s Muchiri and Wamae, as well as surgeons from the US.  If defies logic, but you have to get used to that once you quit living on your own power and trust that God will provide what you need, and when you need it.  You might not know what tomorrow will bring, but you can have confidence that God has it covered.  And He never fails!

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What Protestants think about Catholics (Flunking Sainthood: Day 3)

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Please share this post as widely as possible, because it relies on audience participation.  At the end, I want you to “comment” and give me some of your thoughts.  Protestants only please:  Catholics, you’ll have your turn.  Please re-blog, post on FB, share anyway you can.  I’m really interested in the feedback.

Growing up in a devout Roman Catholic family, I think it is unlikely that I draw a breath or have a thought in my head not seasoned by my rich upbringing in the Church.  A family of eight, Irish Catholic, all six children’s names from the mother land (Maureen, Shannon, Michael, Sheila, Kathleen, Colleen), all six children attended Catholic grade school and Catholic universities.  Dad was president of the parish council and church historian, mom with a masters degree in theology and another one in adult spiritual development.

The rhythm of our life was mass, the sacraments, prayer, and study.

It’s been years since I attended mass regularly or participated in the sacraments, but the reasons for this are  pragmatic as well as theological.  As a result of our upbringing, Ann and I have both had the opportunity to feel loved and loving, accepted and accepting, in both Catholic and Protestant settings.

I am not oblivious to the fact that some on each side of this divide have strong feelings about the heathens on the far shore, but I have also had the opportunity to see loving, humble servants in each camp.  My gut feeling is that “God”, whatever we make of him, is having a good chuckle at any party that thinks they have Him completely contained in their particular box.

About six times a year, our team here at Kijabe gets together to have a discussion on a Friday night.  One member leads a discussion on a topic of personal interest.  We’ve talked about Islam, spiritual disciplines, and Biblical justice.  The evenings are social, low-key, fun, and interesting.  This Friday, I’ve volunteered to talk about my upbringing in the Catholic church.

My reasons for this are several.  I have fond memories of spiritual mentors, the comfort of liturgy, and unforgettable direct experiences of the divine.  But perhaps more than this, I’ve come to understand that most Protestants’ understanding of Catholicism comes from their Protestant pastors.  These pastors, in turn, get their understanding of Catholicism from their reformation history classes in seminary or bible school.  These classes, in turn, are taught from the perspective of 16th century Church corruption and scandal.  Missing are the counter-reformation, the Council of Trent, true Catholic theology, Vatican I, Vatican II, and the fact that billions of Catholics over the last two millennia have served Christ humbly in the best way they knew how.  Once the cobwebs of the last 500 years are cleared away, the two camps look very much like earnest, truth-seeking followers of Christ.

Here’s where you come in:

I’m looking for open, honest, uncensored, thoughts, questions, opinions, conclusions, and vitriolic diatribes regarding Protestants’ views of Catholics or Catholicism.  Here’s your chance!  If it’s too nasty or profane, I won’t “approve” it to be read on the blog, but my intent is to find out what people are thinking.

To get you started:

Catholics worship Mary, pray to dead people, the Pope is perfect, and you can party all you want on Friday as long as you go to have your sins forgiven by a priest on Saturday.  The whore of Babylon, the Pope as antichrist….

Many, but not all of these ideas have kernels of truth which give them credence, and are great starting points for discussion of commonalities and differences.

Please respond, engage, participate.  And remember Catholics, you’ll have your turn!

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Flunking Sainthood: Day 1….make that Day 2

I just finished reading “Flunking Sainthood”, by Jana Riess.  It’s a pretty light read, documenting this spiritual tourist’s attempt to reproduce one ancient “spiritual discipline” per month, for a year.  Things don’t go as planned, as she tries to emulate a strict Jewish sabbath, practice Benedictine hospitality, tithe, and sit in contemplative prayer. flunkingsainthood But the sum is greater than its parts, as she finishes the year with some wisdom, and humility at how difficult even simple disciplines can be.  I give it two thumbs up, but I’m into this sort of thing.

Her book got me thinking about a practice I used to embrace.  In grade school, we were taught a simple prayer, traced back to the fourth century mystic “desert fathers” of Egypt.  This prayer is still practiced in Eastern Orthodox Christianity, and has recently regained a toe hold in contemplative Christian practice in the west.  How and why a Redemptorist Catholic priest in Midland, Michigan was teaching this powerful practice to 11 year olds in 1975, I can’t imagine.  But it’s stuck with me:  Breathing in: “Lord Jesus Christ;” Breathing Out: “Son of God;” in again: “Have Mercy On;”, final exhalation: “Me a sinner.”  Lather, Rinse, Repeat.  The desert fathers prayed this ceaselessly throughout the day, and some even prayed it in their sleep.  It was felt that this powerful mantra invoked the name of Jesus in his relationship as King and Son, and then placed the servant humbly in his place in the universe, in need of grace, mercy, and forgiveness.  I dare you to try it:  it’s remarkably powerful, and also a great sleep aid.

The has me considering spiritual disciplines, setting a challenge that will center me on what’s important and making time for something just because it is worth doing.

Here’s my plan: my spiritual discipline will be to write a brief blog, every day, for four weeks. At the end of four weeks, I’m going to be traveling to a country with little internet access, and zero tolerance for Christian bloggers, so that will be that.  And I wrote a blog yesterday, so this counts as day 2.  My spiritual discipline, my rules.

The concept seems a little self-indulgent, like posting on Facebook a picture of what you’ve eaten for lunch that day.  But Jana Riess wrote a whole book about her pursuit of spiritual disciplines, so I feel enabled to write a blog.  I love writing blogs, and kind of feel like it’s a chance to give a glimpse into our life for all of the people who support us emotionally, in prayer, and financially.  But too often, I’m exhausted at the end of the day, and a bowl of popcorn and episode of “Prison Break” take the place of sharing my day.  I can’t promise any profound insights, but I’ll try to just give a fair representation of the day to day here at Kijabe.

So, here we go…

Today is Sunday, and we’re deep into the rainy season.  Our cement-block house has a sheet metal roof, and the only heat is from a log-burning fireplace in the living room.  African rain can feel primordial:  it comes down so hard, so suddenly, so loudly, that it saturates the senses.  We cocoon in front of the fire, secure that our little house has stood for half a century against such tropical torrents.

Duty calls, and I’m up at 8 am to get coffee, french toast, and sausages ready for the troops.  Kenya produces dark, rich coffee beans, the sausages come from Nairobi, and the eggs are laid here in Kijabe. The kids have been on school break for a month, but go back to school tomorrow.  Ann and the kids get ready to go to the chapel up at Rift Valley Academy, but I am on call and have to go in to the hospital.

The northern parts of Kenya, bordering South Sudan, Ethiopia, and Somalia, are very remote and largely outside the rule of law.  Sadly, a wedding party was ambushed by bandits in Marsabit yesterday, on their way to the ceremony.  Multiple members of the wedding party, in traditional garments and face paint, were gunned down.  The survivors were swept up by a missionary pilot in a bush plane, and deposited at our gravel airstrip.  The victims have been undergoing surgery, one after the other, since yesterday afternoon.  Only one of the patients had a fracture, so that waits until this morning.

The surgery goes well, the bone is shattered, but the nerves and blood vessels are okay.

Gunshot wound to the humerus.

Gunshot wound to the humerus.

I just clean out the wounds, apply a splint, and we’ll come back later in the week to put a SIGN nail down the humerus to let it heal.  He should be fine.

Next up, a disaster.  Kenya has one of the deadliest road systems in the world.  14-passenger vans, often dilapidated wrecks, serve as share taxis:  Uber taxis on drugs.  The drivers are often lawless, pulling out into oncoming traffic to pass, forcing drivers to the shoulder of the road or be hit head on.  Eventually, the Pauli exclusion principle prevails, and people are horribly injured.

Kamau was a passenger in such a vehicle, and survived with a relatively simple tibia (leg) fracture, which had protruded through the skin.  He was taken to a rural hospital, where antibiotics were started, and surgery performed to clean out his wounds.  Perfect care, up until this point.  Unfortunately, at the end of the surgery, they tightly sutured his wounds, trapping any residual infection inside.  Over the next week, huge amounts of pus built up, eventually stretching the surrounding skin to the point where it died.

Kamau came to us with fevers, a horrible smell, and whitish green pus dripping through his bandages.  After his spinal anesthetic was placed, we peeled back his splint and dressings.  Seasoned operating room tech’s fought the urge to gag from the stench.  The skin of the leg was dead from knee to ankle.  Pus dripped from his leg, onto the operating room table, and pooled on the floor. We spent the next two hours excising dead skin and muscle, finding yet another pocket of pus, cleaning the infected bones, and applying an external fixator to stabilize the fractures and allow access for wound care.  At the end of the surgery, the wounds looked much cleaner, but he will need several more surgeries to eradicate the infection.

Leg cleaned out, external fixation applied.

Leg cleaned out, external fixation applied.

Once the infection is under control, we can swing muscle flaps to cover the exposed bone, and then skin graft over the muscle flaps.  He’ll probably be in the hospital for a month or so.

As I finished the surgery, the heavens open again.  I walk home grateful for the cool, cleansing shower, the scent of wet grass and mud replacing the terrible stench of infection.  Surgical scrubs go into a bucket filled with bleach and water, and I climb straight into the shower, fearful that I could bring these aggressive drug resistant bacteria into the house. Ann has been hanging out with our new friends the Higgins family, who are here for three months from Utah.  The kids are off playing somewhere, and we start organizing for dinner.  The night gets chilly, we light the fire, and get ready for another week at Kijabe.

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