Chapter 2: My masterpiece won't have a Volvo in it.

This photo has been a source of intrigue and inspiration to me for years.

It started with a little inspiration. It was this image of two motorcycles crossing a river from the 2004 movie "Motorcycle Diaries". The sky is misty and the river is bordered by thick trees, maybe in the Amazon basin or some other rain forest. The boat appears sea-worthy from the inside, by there are several boards that are broken or displaced. The motorcycles are dirty like they've been on the road for days. They aren't your typical Harley's they are like the little Honda trail bikes that are so common in small countries with bad roads like Haiti.

Waiting for the sake of waiting.

I am a very impatient person. In fact, I think I might be the most impatient person I've ever met. I don't want to wait for anything. I want to eat the second I'm hungry, I want to pay off my loans and debt now, not in a few years (when in actuality, I realize that it is pretty amazing that this is even possible). I want to be good at my job my first day of work. I want my injured back to heal and be 100% by the end of this weekend. When I have to wait on a lab result for one of my patients, even though the lab at the hospital I work in is really efficient, I still get frustrated. When we are understaffed, I try and do everything myself and juggle multiple patients, even though this just leads to chasing my own tail and sends my entire work-flow into a near tailspin. I want to know God's plan for our lives and I want it to be shown to me in vivid detail before I head out in the morning. I want what I want NOW!

I'm learning though, that the heart of my impatience though, is a sin issue. There is a lack of trust there. What I want is to take over for God and do things the way I think they should be done. I say things like "it's not just the destination but also how you get there" about travelling, but I don't feel that way about life. I think that as long as everything goes according to my plan and nothing ever takes longer than my timeline allows, then my life will feel whole.

You won't find it here.

Last week, my mind was just racing after I finished a very busy day in the ER. I lay in bed as my dear patient wife slept soundly wondering why my mind would not just shut off so I could sleep. I opened up my iPad and went online. I don't even know what I was looking for. I browsed my normal websites, Yahoo!News, Relevant Magazine, Facebook, and could not find anything that could help me shift my attention so that I can fall asleep (where I will probably just dream about work).

As I grew more and more dissatisfied with pretty much the entire internet and began searching frantically for something of some significance to read I heard, in my own voice of course, "You won't find what you're looking for here." But how could I know that? I didn't even know what it was that I was looking for. I have begun to understand this voice a little more over the years. It sounds like mine, but has a lot more wisdom than me. I read a lot, so sometimes this voice quotes something that I've read by some theologian, a piece of scripture I've read or heard quoted, some pastor I'v heard speak on a podcast or at church or even on rare occasions, a philosopher's insightful conclusion I once studied. Sometimes it's just an overriding theme in a sermon I once heard or a book I once read. Usually, though, it's worth listening to because it seems so profoundly apropos that I can't help but to admit that it must have been profoundly inspired. This was one of those times.

"We Work by Grace."

So I closed the web browser and saw this devotional app I downloaded a couple years ago hat I read only sporadically. The title of the day's devotion was "We Work by Grace" which was based upon one of Dr. John Piper's indomitably spiritually driven and logically fed books "Future Grace." At first glance, the title and even the first Bible verse of the devotion didn't seem even very applicable to my state of mind, but I read on. It was from 1 Corinthians 15:10:

By the grace of God I am what I am, and his grace toward me was not in vain. On the contrary, I worked harder than any of them, though it was not I, but the grace of God that is with me.

Don't worry, I didn't understand it either, at first. As Dr. Piper so eloquently unpacked this verse he extrapolated this bit of insightful wisdom: "I take this to mean that, as Paul faced each day's ministry burden, he bowed his head and confessed that unless future grace was given for that day's work, he would not be able to do it."

That WAS what I was looking for. As Piper expounds further he ties in the words of Christ fonud in John 15:5 "apart from me you can do nothing." Paul believed these words, we see in Philippians 4:19 and applied them: "My God will supply every need of yours according to his riches in glory in Christ Jesus."

and Piper concludes, "Then he acted with all his might."



My Portrait

My adventure longings have been maturing a bit over the last couple of years. I've gone from having an insatiable wanderlust to a desire for something much bigger, but the canvas is blank. I'm waiting and hoping for The Painter to dip His mighty brush into the colors of life and create this personalized masterpiece from the lives of my family and me to His glory. I have something to learn first, though. My frustration with not knowing what that "thing" I had to learn was turns out to be the very "thing" that I need to learn.

The journey and the destination are intrinsically linked. One cannot exist without the other. The value of a masterpiece, as any art aficionado will tell you, is as much about the masterful technique used to arrive at the final product as the beauty of that final product.

Donald Miller wrote in his book "A Million Miles In A Thousand Years" a conclusion I quote frequently:

“If you watched a movie about a guy who wanted a Volvo and worked for years to get it, you wouldn’t cry at the end when he drove off the lot, testing the windshield wipers. You wouldn’t tell your friends you saw a beautiful movie or go home and put a record on to think about the story you’d seen. The truth is, you wouldn't remember that movie a week later, except you’d feel robbed and want your money back. Nobody cries at the end of a movie about a guy who wants a Volvo.
But we spend years actually living those stories, and expect our lives to be meaningful. The truth is, if what we choose to do with our lives won't make a story meaningful, it won’t make a life meaningful either”

No one just wants a Volvo, although we often don' realize it. What we are designed to want is a meaningful life that unashamedly screams the glory of God's future grace.

Jesus, Spurgeon, Bunyan and me.

I watched a documentary last night on Charles Spurgeon after getting into bed, thinking that I would would probably fall asleep before it was over. It was just over an hour long and I couldn't stop watching. I think there was something about his life that was comforting to me.

One of my biggest issues right now is how lonely I've found myself while away from my family at school. So much of what I'm familiar with has stripped away. My sense of security has been left behind, several months ago. It's like removing an old venear to find the scratched and stained surface that I was able to forget about. Being around my family and the business of work and school and spending time with my kids and wife, working around the house, spending time with my friends, all those things were like patches permitting me to ignore the glaring insufficiencies that lay underneath.

I've found that I spend much my time believing in my own sufficiency, which has stunted my spiritual growth. I know that I am a man in need of a savior, more than ever and sometimes cry out to God for comfort and to make me feel a little less empty. The holes are normally filled by my wife and kids, I think. Now I'm forced to face these things, this emptiness, because its unbearable. I remember this feeling when I was on my cutter as a young Seaman Apprentice. I had believed at the time that I could be filled with my own accomplishment and respect for being a member of the armed forces. I looked to that uniform as a sort of veneer, but realized that I felt empty there too. I went in search of things to fill that void, things I regret now, but even more, I regret that those things did fill the void, to a very small meaningless extent anyway. They were temporary patches that concealed the root of the problem from me.

When I gave up that uniform, I felt like a part of me had died. The Coast Guard had been a major part of my personal identity, and still is in some ways. There are so many other things that I fill the void with too. So many meaningless things, and some lovely beautiful things too have I used to make me feel whole. But these things were misplaced. All the time, I've been chasing after so many nominally important accomplishments and material items to make me feel complete, but none of them did. And when they didn't, I got angry at them for letting me down, but I had assigned them to positions in my life that they were never meant to be in.

My wife, my children, they are some of God's greatest gifts to me. I cannot imagine how horrible I would feel if they were lost to me. I have always heard that one's family or possessions, or career or hobbies or extracurricular activities could become gods to them, and I was cautious. I didn't want them to be gods to me, I knew that there was only one God and that he should be my “all in all” and always thought that I had done well to do that. I read books about this, and heeded the warnings in the Bible about men who had put people and things before God just to have them stripped away, and feared this would happen so I tried to be more and more careful. What I didn't realize is that my fear of having these things taken from me made me cling to them like I should have clung to Christ. We were not made to be alone, we were made to enjoy God and experience his presence in our lives, but that need for companionship I unwittingly extended to my family in a way that put them before God in my life, and I never even realized it.

Actually, I'm still in the process of realizing it. I am very lonely here, away from my support system. It is a terrible feeling, being alone, but a necessary experience. Here, my family cannot fill the void and I am always looking for ways to fill it, ways that are not God's ways. I've tried walking downtown and ministering to homeless. I've tried building relationships with classmates. I've tried totally absorbing myself with school work, but I've only grown more weary in the process. I realize the hole is there, and I realize the things I'm doing to fill it and I realize that its an emptiness that only God can fill but I have two problems, at least, that I keep running head-long into:

1. Out of pride, I try to fill it myself. I read my Bible to try and cram God into me through my eyes and brain and when that doesn't work, I do one of the other things that I've mentioned
2. I ask God to fill me, but I don't feel Him doing it, so I get depressed or angry at Him.

I understand number one and I know how this is has created a problem for me. Number two, though, I don't know what else to do, or what not to do. I have the notion that I am not to do anything but that God will fill me upon asking Him, and might feel better for a moment or two, but its a fleeting sensation that leads me to believe that I'm still trying to do something, but don't know what.

I think Spurgeon encountered the same sort of paradoxical problem. He spoke of his loneliness and how he hated London when he had first gone by the request of the church to preach there. He knew he had been called there, and hated being there, but stayed all the same. I can relate to that. I do not like the Bay Area at all. There are too many people, it is too impersonal and everything moves far too quickly. I feel as if no matter how quickly I move or how hard I strive, I am always going to fall behind the rest of the pack. I have really never felt more out of place except for perhaps boot camp.

I can still remember the brokeness I felt when I first came to the realization over 12 years ago, while getting yelled at by my company commander that I was in a place where nobody loved me. I hurt, but I was determined to be tougher than that because, even saying that now, I feel like the worst kind of momma's-boy whiner. “Life is tough. Get used to it. Suck it up!” is what I would tell myself. And it worked much of the time. I learned to kill emotions before they had outward manifestations, and that served me well both in the Coast Guard and on the streets as a paramedic.

Now, though, this stuff feels magnified, and I'm allowed enough time to actually think about it and for things to occur to me during my commute on the train or while laying in bed at night. And it confuses me. I think of Christian in Pilgrim's progress, how he left his family behind to voyage to the celestial city, and how, early in his journey, he was slowed by the Mire of Despondency, or something like that, and the burden he was carrying on his back was too heavy for him to move beyond it. By this point, he was definitely a Christian, and he definitely was saved by grace through faith in Christ's sufficiency, but that burden! Oh the burden! It was too heavy for him. At this stage of my life, having been a Christian for so many years, knowing my scripture so well, and working so hard to be a disciple, I find myself in the same place as this newly minted Christ follower!

That is where my problem lies, though, I am sure. I know that striving and working will not get me any closer to God because I've already been forgiven, but my prideful heart still hungers to do part of the work itself. My prideful heart wants to show Christ that His bloodshed wasn't wasted on me because I'm a talented and hard working guy who can do it himself. I have ideas and strategies and big plans for His kingdom! To what end! To glorify myself in His eyes? Its a farse! His righteousness and glory were somehow imparted to me on the cross, yet I think I can add to that? Do I think I can raise the level of the oceans by carrying 5 gallon buckets of water a hundred miles from my home to the coast too?!

I want to rest in Him! I want real rest! I need rest! In Him only can I find it, and in Him only can I be assured of salvation and worthiness. He doesn't need me for his glory! He is already glorified! How I love him! If only I could love Him more! I thirst to experience him in tangible ways and to invite him into the deepest most hidden parts of my soul, but I fear that when he sees what is there I will be ashamed! I know that darkness that lingers there and I don't even want to see it, let alone allow my heavenly father peer into these secret places where pride and anger and pain and sorrow sit stagnant and rotting.

But I see what's happening here. I can see that the veneer is being stripped away through this experience, that God is sanding me down, exposing the raw wood, where every flaw can be seen and worked out through His loving, knowing touch. I keep resisting, like a child refusing to let his dad remove a splinter from his finger because he's afraid it will hurt. I keep brushing Him off and telling Him that I want to carry my own baggage for a while, that its not his responsibility. He holds out his enormous mighty arms and offers but I can't, I just can't let Him. Oh that God would just take it from me, with force!

And I pray that I can abide by these words tonight:

Cast your burden on the LORD,

and he will sustain you;

he will never permit

the righteous to be moved.

(Psalm 55:22 ESV)

Amen.

Count It All Joy, My Brothers

I have been completely silent on my blogs since starting my training as a Physician Assistant at Stanford on July 2nd. Part of the reason for the lack of writing has to do with the business of the demanding academic schedule, but more so, I haven't known what I should write about, or lacked the inspiration.

Sometimes inspiration comes from desperation, as would have been the case had I written this blog last week during finals. I was a man of weak faith last week, which is disturbing. I have been teaching Bible study for years to college students, much of the time while I too was a college student (I got a late start). Late in the ministry I was teaching on believing God on His word, and that you can trust his promises. Before starting this program, I wondered if God's promises extended to my completing this program, to preventing my family from accruing a mountain of debt as I left my job and embarked on this challenging faith-testing journey.

In a previous blog, I remarked on my anxiety over leaving my safety net and pursuing this dream I had. This dream, I supposed (and still do) was of God's making and the Spirit's urging me to follow through on this "calling" to missions that I hadn't been able to put aside for years, even after having been told by people who I respect greatly on spiritual matters that I might be making a mistake. The thought never left me, and I assumed wrongly that I'd stand up strong to the test of faith; that I was already full enough with faith and mature enough in my relationship with Christ that no matter what happened, I'd remain strong in that faith.

I really let myself down over the last couple of weeks. I was completely overwhelmed by the prospect of 8 finals in one week, any of which, had I scored less than 70% could have been the end of my education at Stanford School of Medicine, leaving my jobless, in serious debt and with nothing to show for it but a head hung low. I was consumed with anxiety. In my mind, I had already failed, and in this ridiculously depraved mindset was already blaming God for failing me. I had come up with a hundred reasons of how He had turned His back on me when I had gone all in for Him. I was really worried about about what would become of me had I failed. Would I blame God? Would I ultimately blame myself? Would I become bitter? Would I become suicidal? Would I turn to drugs? Would my wife hate me and my kids be ashamed?

I know this all sounds idiotic and probably quite shocking to anyone who knows me, but it is true. God put someone in my life to encourage me every step of the way. I got emails, facebook messages, text messages, phone calls and all sorts of inspirational quotes and verses to help me through. These things came from the most unimaginable and surprising places.

In fact, I had friends whom I hadn't spoken with in years just give my family a large some of money with no strings attached at one point to just help us get through. That was during a different anxiety attack, though; one in which I didn't think I'd be able to continue school because the money was looking like it was going to run out. Don't get me wrong, things have been very tough, and we have never been forced to depend on God's provision so much ever in our lives (my wife and I). My problems kept mounting from about 3 weeks into the program.

First, I ended up having to leave the situation I had been living in as some very generous friends in a city nearby had allowed me to sleep on an air mattress on their living room floor so that I wouldn't be homeless. It was not an ideal situation for either of us, and it became clear that I was really imposing on them, although they'd probably swear to this day that I wasn't. I evicted myself, confident that God had a really cool crash pad lined up for me. Well, I ended up sleeping in my car and in a tent for midterm week (except for the night before my first set of midterms when my dad put me up in a B&B in Half Moon Bay). There was one night I crashed on the couch of a classmate's friend's house while they were out of town but the next two weeks I slept in my tiny little car.

Then, out of the blue, a spare room opened up at my great aunt's house that was only about 35 minutes from Stanford. That where I'm staying now. Its a nice little detached furnished room that adjoins the back wall of her garage. I have a bathroom just a short walk across her patio, and a spa right outside my room. Things were really looking up. Then my car broke down. Not just broke down but BROKE down. Cracked heads, water pump, possibly radiator and a whole host of other smaller problems were the final diagnoses... prognosis: meh, not looking good pal. 

My dad and I towed the car back to Oakdale with a rented trailer. A friend did some of the more minor work on it for me, but the heads, that's gonna cost me. Well, not me personally, because a generous donor has volunteered to pay for the repairs. Not sure how much that's going to be yet, I'll have to come back to that later. In the interim, a friend from school loaned me her car for a week ebcause she lived close enough to ride her bike to school. Now I'm driving the old Jeep wrangler with a break neck top speed of 60 MPH, not that I could ever get up to that speed on bay area freeways anyway. But it is NOT an ideal commuter and was costing me $15-$20 per day to commute. That's not sustainable when you have no income, so I found some friends who carpooled to Stanford from the San Jose area, but that only worked out for about a week. The car pool was already crowded and these tiny little fuel efficient cars are not meant to have 5 people for 45 minutes in stop and go traffic 2-ways. I could tell that this wasn't a viable solution and let them have their comfortable drive back.

Then I discovered the Caltrain. Commuter trains, in case you are wondering, are WONDERFUL! They are relaxing, fun and give me an opportunity to study to and from school each day.

But, back to the academics. Many students in the calss have compared this to program to "drinking water from a fire hose." In a Facebook post, the week before finals I wrote:

Feel like I'm holding onto a tree in the middle of an information river while it all just washes over me. Every once in a while I can catch a gulp of the information and swallow it but about half the time I just choke on it. How am I ever going to get through these finals?

Just so you know that I am not exaggerating, I spoke with some med students about our finals and the volume of material we covered and they were blown away... and I quote: "I don't think they're allowed to make you guys do that." We have several people in this program who have Master's degrees in various fields from Public Health to Physiology who have said that never in their academic career have they been so challenged and overwhelmed. There are foreign doctors in the class who admit that this is challenging even for them after having been through medical programs and working in the medical field for several years.

Almost everyone in the class was a basket case for a week leading up to the final and finals week. I didn't start out that way. I had kept my cool for most of the week, had been extremely conscientious about studying and was pretty confident that I'd make it through when I was suddenly struck by the thought that I, being a simple paramedic in an urban scoop-n-run city in the valley and myself, coming from a po-dunk town and all my science classes having been from a po-dunk school, was more confident than the doctors, nurses with BSN's and people with Master's degrees in Human Physiology. WAS I CRAZY?!

And the anxiety took over. I absolutely studied my butt off for the next 3 days (and had been for the last 3 months as well) but I turned on the after burners, living off of coffee and whatever carbohydrate-rich food source I could stuff in my mouth. I think from Friday until the first final on Monday, I accumulated over 40 hours of study time. By the time I sat down for my first 5 finals, I was fried. It was like a dream where you think you might be dreaming but are not quite sure, then something bad happens and you realize its time to wake up, but can't and keep trying to tell yourself "This isn't real! This isn't real!" But it was.

After the finals I was mentally spent, emotionally drained, and more or less resigned to a fate that I had made up in my head that involved bouncing from one low-paying entry-level job to another for the rest of my life.
I didn't think I'd crumble like that. I had spent three months in preparation for this, staying up until all hours of the morning, studying drugs while brushing my teeth, drinking coffee by the gallon and running to the bathroom to splash water on my face when I'd start drifting off in lectures. I considered faking ADHD to get an Adderall prescription from the VA Hospital. I was depending on anything BUT God to get me through this.

Oh, but the horrible scam of it all is that I thought I was trusting God. I really did. How could I, the guy who'd grown jaded to all sorts of danger on the violent streets of Stockton, who'd been to Haiti on medical missions, who'd sailed on a cutter into a typhoon, who'd voluntarily jumped into rapids to pull frantic near drownings to safety, who'd been the medical person in charge of the most traumatic multiple person shooting in Stockton in 20 years, and, most surprisingly, who'd been teaching people just like myself that they could bet it all on God's promises, not be trusting God?

Well, that paragraph should say it all. Pride. By God's grace, I survived those finals, all of them, without so much as a scratch. I was about to learn a really important lesson though. On Sunday, I had been discussing with some friends at church about the fact that we rarely hear pastors preach on the book of James. If you read the book for yourself, you can see why. It would be a really good way to lose about half your congregation. For some reason, or for that reason, I was drawn to it. So, yesterday, while on the empty train heading to school, I planned to read it. The first half of the first chapter stopped me in my tracks. I'd probably only read the book of James for myself (and not to teach a Bible study) once or twice in my life. Here's the first 8 verses of the first chapter:

James, a servant of God and of the Lord Jesus Christ, To the twelve tribes in the Dispersion: Greetings. Count it all joy, my brothers, when you meet trials of various kinds, for you know that the testing of your faith produces steadfastness. And let steadfastness have its full effect, that you may be perfect and complete, lacking in nothing. If any of you lacks wisdom, let him ask God, who gives generously to all without reproach, and it will be given him. But let him ask in faith, with no doubting, for the one who doubts is like a wave of the sea that is driven and tossed by the wind. For that person must not suppose that he will receive anything from the Lord; he is a double-minded man, unstable in all his ways.

 Obviously, the emphasis is mine. The point is clear: I am weak, but He is strong. Even my little kids could have told me that... in rhyme... with melody.

New Chapter but the Same Direction

I've bee somewhat absent from my regular blog ZachThinksDeep and have been seriously contemplating kind of ending that blog and picking up on this one. You see, this blog was entirely set up to inform and inspire missionaries and detail my journey to the missions. I am standing on the welcome mat of the door to the first leg of training for my role as a missionary. From here on, this conversation isn't ethereal, it's real. I am about to jump off the preverbal cliff into a realm of what I hesitate to call uncertainty. It makes no sense to many, that I can just leave my job and pursue an extremely expensive education with no plan to pay for it or how to support my family. I've hammered out as much of the details as I can such as how we are going to pay our mortgage and other bills but tuition and other living expenses (like groceries) that's kinda up in the air right now. One thing I know, that has been affirmed, is that this IS God's plan. I do not know how He plans to get us through, but I KNOW He will. I know, now that God permits us and even encourages us to take risks, promising to abound in mercy an grace (2 Corinthian 9:6-15). Of course, it seems to be agreed upon that I need not consider this a risk. Letting money slip through my fingers, trading financial security for a life ruled by faith, these things must seem like foolishness to the faithless reader, and I must admit, I struggle with these things too. I cannot live a life of secure monotony because I'm too afraid to take a chance and do what seems to be what I have been designed to do. My missionary story started half a decade ago, but is really the first time I've made that leap. I refuse to live like a coward or settle too easily for the mediocrity of a dream unfulfilled. I like Kevin DeYoung's words in his book "Just Do Something" in which he writes:

We don't take risks for God because we are obsessed with safety, security, and most of, with the future. That's why most of our prayers fall into one of two categories. Either we ask that everything would be fine or we ask to know that everything will be fine. We pray for health, travel, jobs -- and we should pray for those things. But a lot of prayers boil down to, "God, don't let anything unpleasant happen to anyone. Make everything in the world nice for everyone." And when we aren't praying this kind of prayer, we are praying for God to tell us that everything will turn out fine. That's often what we are asking for when we pray to know the will of God. We aren't asking for holiness, or righteousness, or an awareness of sin. We want God to tell us what to do so everything will turn out pleasant for us. "Tell me who to marry, where to live, what school to go to, what job to take. Show me the future so i won't have to take any risks." ... Obsessing over the future is not how God wants us to live, because showing us the future is not God's way. His way is to speak to us in the Scriptures and transform us by the renewing of our minds. His way is not a crystal ball. His way is wisdom. We should stop looking for God to reveal the future to us and remove all risk from our lives. We should start looking to God--His character and His promises--and thereby have confidence to take risks for His name's sake. God is all-knowing and all-powerful. He has planned out and works out every detail of our lives--the joyous days and the difficult--all for our good (Ecclesiastes 7:14). Because we have confidence in God's will of decree, we can radically commit ourselves to His will of desire, without fretting over a hidden will of direction.

Now pay close attention to this final paragraph.

In other words, God doesnt take risks, so we can. For some this means trusting God enough to let your money slip through your fingers. For others it means holding fast to the Word of God in some difficult circumstances or an unpopular situation. For others it means cross-cultural missions, or more evangelism, or a new dream, or confession of sin, or confrontation of sin, or new vulnerability in a relationship. And for some it means getting off your duff an getting a job, or overcoming your fear of rejection and pursuing a lovely Christian woman. For all of us it means putting aside our insatiable desire to have every aspect of our lives, or even the most important aspects of our lives, nailed down before our eyes before we get there.

(emphasis mine) This or soemthign like it needs to be our battle cry. There is no more room for timidity.

Psaumes 124

"Cantique des degrés. De David. Sans l'Éternel qui nous protégea, Qu'Israël le dise!   
Sans l'Éternel qui nous protégea, Quand les hommes s'élevèrent contre nous, 
Ils nous auraient engloutis tout vivants, Quand leur colère s'enflamma contre nous;   
Alors les eaux nous auraient submergés, Les torrents auraient passé sur notre âme;   
Alors auraient passé sur notre âme Les flots impétueux. 
Béni soit l'Éternel, Qui ne nous a pas livrés en proie à leurs dents!   
Notre âme s'est échappée comme l'oiseau du filet des oiseleurs; Le filet s'est rompu, et nous nous sommes échappés. 
Notre secours est dans le nom de l'Éternel, Qui a fait les cieux et la terre"

"...Se Senye a k'ap pote nou sekou, se li menm ki fe syel la ak late a."

"... Our help is in the name of the Lord, the Maker of heaven and earth."

I saw this on the back of one of those colorfully painted taptaps (buses) on my way home from one of the clinics and I've been pondering the Psalm ever since.

I'm sure Haitians believe, by and large, that God is the creator of heaven and earth, but, since I don't speak the language and the only English speaking Haitians I know are devout Christians, I wonder if they actually believe that their help comes from the Lord.

I wonder if they ever wonder how God, the creator who clearly demonstrates His power over nature in the Bible, could shake the earth, kill hundreds of thousands and then send such feeble and clueless "helpers" to clean up the mess. I wonder how they reconcile this. I'm not sure how I reconcile it. I know Haitian men who are much younger than me who are spiritually much stronger in their faith and more spiritually mature than I am, but might be offended by this question.

I love God, I trust Jesus as my Lord and savour and believe that His sacrifice on the cross and resurrection brings me the promise of eternal life and I put my trust in that fact.

How someone who doesn't know the love and grace of God can actually believe that God is helping them is difficult for me to wrap my head around.

Chronic preventable illness, devastating communicable diseases, horrible water that is poisonous to you and rampant malnutrition can't be fixed by me or my team. We can't even put a noticeable dent in it. How is it that that appears to be God "helping" anyone to them?

God may be a God who allows some to suffer and others, probably like you and me, to flourish and thrive, but I understand Him to be a God who has suffered and still suffers with us all. Maybe I needed this trip to comprehend that.
Sent via BlackBerry by AT&T

Mist

This was our second trip to Boudon today. The drive seemed shorter this time. The village feels to rural and so isolated even though you can see the not-so-modern urban sprawl of Port-au-Prince just about 20 or so miles away, as the crow flies. Yet, this village is so remote and might as well be in the isolated interior of Africa.

Today, though, we couldn't see Port-au-Prince. We were high up in the clouds all day covered in a mist with only short periods of sunshine that showered my sun-burned skin with painful radiation to the point that I felt like hiding under one of the very few trees in this grassy step into the mountain side.

This was clearly an inclimate day for the villagers sine they were all bundled up until late in the afternoon, shivering and collectively complaining of the cold. To us, however, it was the most comfortable weather so far.

We weren't expecting to see too many people, or at least as many as we had in Boudon yesterday, but actually ended up see about twice as many. Some were very sick.

First was a young girl,maybe about 10 whose eyes were not just blood shot but the sclera was in fact completely red. I didn't treat or examine this girl, that was Darla, I just took her vitals. She had been trampled yesterday in a mass panic that really speaks to the terror that is just beneath the surface of every Haitian's psyche following the January 2010 earthquake.

I first caught word of this incident yesterday. I'm amazed by how fast rumours spread through such a remote area. While seeing patients yesterday, one woman I was getting medical history from became very distracted as I heard wales echoing throughout the vast mountain side. She didn't yet know what had happened but somehow knew something was bad.

I asked on of the interpreters and he told me that the villagers were frantic about a school that had collapsed an killed everyone inside. The hysteria was growing rapidly since this was a school that many parents in the area trucked their kids off to and I knew that the only thing we could do was get some reliable information instead of the unreliable mountain "corry" or an exaggerated rumour that is so common a phenomena that even Haitians have a creole name for it.

I asked Dr. Sorg to make a phone call to the mission to find out what really happened. Rob Baker, while driving back from dropping our team off in Boudon, had actually witnessed the event. He saw kids and parents scurrying out of a school carrying children who appeared injured. What had happened is two very big water trucks involved in the road construction had passed by the school and made the whole two-story brick and mortar building shake causing the kids to run for the exits with the bigger kids trampling the smaller ones in the stair way and in the bottle neck while going out the door. There was no real damage to the building, but, as a result, over 20 kids were treated and released from the Fermathe Mission Hospital with concussions and soft-tissue injuries. This girl with the bright red sclera was one of those who was trampled. She'll be ok according to our doctors, but she did take a beating.

Second was a young woman who had just recently had a c-section in which her baby had died. She was at home near Boudon and was too sick to go to the distant Fermathe hospital. She was number 75 in line to see the doctor and we were on number 39. Her husband walked her to the front of the line. We were short one interpreter today, so I was on my own doing crowd control with Abby taking vitals while the ever increasing crowd of people became a vocally perturbed by the apparent crowding in line.

I advised the husband that she'd have to wait in line, completely unaware of her medical issues as we had yet to even begin her intake. When he got upset with me I called an interpreter over who was doing another job to help me. He explained that this was a prior arrangement from yesterday and assured me that this had been cleared with Dr. Sorg, who was a couple hundred feet away in a tarp covered shack treating patients. I allowed the man to then take his wife to see the doctor and Abby kept her head down (wisely) while the crowd grew upset now with me. They were pointing their fingers at me and scowling at me. I got a very uneasy feeling and asked a couple interpreters to explain to the restless crown why she was permitted to skip ahead in line. The interpreters all shrugged at my predicament and made it clear that they didn't want to deal with the angry crowd either.

I appealed to Johnny, Darla's interpreter for the day, who seemed inpatient wit my silly request and ran up to the crown and asked them collectively if they were upset with me (the apparent equivalent to "you gotta problem? Good!") And every one smiled and said no. The second Johnny disappeared from view, the scowls began again and I again started to get that uneasy "oh crap" feeling paramedics who work in urban areas know well. I returned to the treatment shack and stressed to Dr. Sorg that I felt we were reaching a critical mass and someone needed to finally explain to everyone why this woman was allowed to go in front.

Dr. Sorg returned to the crowd and apparently realised the direction the mood was heading and implored one of the interpreters, I forget which, to explain the circumstances. The collective tempers cooled and everyone was left smiling. I was left scratching my head, but didn't have the time to process it before our next serious patient was thrust into the mix.

A tiny 28 year old girl sat down at our triage table out in the drizzle and rain. Her pulse was thready and fast. Her blood pressure was critically low. She was 5 months pregnant, hadn't eaten or had anything to drink for some time, possibly due to chronic nausea.

In a country where infant mortality rate is already higher than anywhere else in the Western Hemisphere, I considered my resources, which are few, we had to be slightly more aggressive in treating this patient. I had an interpreter explain to her that she was very sick (which she already knew) and that the abdominal cramps, dizziness and near syncope was indicative of need of some "special medicine". I carried her down the hill (she weighed MATBE 90 pounds) to our temporary pharmacy and started an IV. With 1 litre of Normal saline, almost all of her complaints were resolved except that she kept saying that she still wouldn't be able to eat because her throat was sore. We gave her some antibiotics, ranitidine and prenatal vitamins and I sought out so family to explain that she needed as much nourishment that they could muster to keep her and the baby alive.

After these, every other experience today seems mundane. The mist is lower in the valley now and I can actually feel it coming in my open window. I'll leave it open. I think its helping my dust-plaqued lungs.
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Boudon

Big Red 1 broke down. That was the first hang up. We thought we were going to get an early start this morning, but while waiting at the mission gate, the Honda 2 seater ATV, the one that Dr. Sorg, Abby, Johnny, Wilner and Hebron were in just decided to stop running.

We actually didn't find out until we were about a mile up the road following Rob Baker with Chelsea and Darla and he pulled over to let us know that he needed to turn back to sign a check for something. We waited up the road a little ways, but when Dr. Sorg never met us in Big Red AND we never saw Rob again, we grew concerned and turned back at the suggestion of Tee, my co-pilot.

Dr. Sorg was standing at the gate smiling with Abby and our translators when we arrived. They just resolved to pile into the pickup and leave Big Red 1 behind. We followed in Big Red 2 while wearing surgical masks and glasses to protect us from the increasingly unbearable exhaust fumes and dust.

I saw something on the way up that I've never seen in Haiti before. Road construction crews paving the single lane winding mountain highway.

Well, that's not exactly accurate, there are no official lanes in this part of Haiti and apparently only one speed limit sign (which said 50 km/hr, an impossibly dangerous speed on these roads). The road construction is a very good sign, it means that there might be an improvement in infrastructure coming to the heavily populated and developed areas of Haiti.

That's not where we were headed though. We were on our way to the previously unreached section of the Southwestern mountains called Boudon. What the area lacked in infrastructure, it made up in beauty. Beautiful scenery, beautiful weather and beautiful personalities.

We saw 80 patients today, with many of the same complaints and lots of hypertension, even with one particularly sweet 19 year old mother. Darla, an NP with several years of experience in remote medicine from the North Pole to Eastern Europe and the 10-40 window, had a small dilemma at one point involving this 19 y/o mom and whether to give her captopril or HCTZ or both for her hypertension, which was extreme for her age.

Due to tridiculously high sodium intake of the rural Haitians, hypertension is an epidemic affecting nearly everyone, it seems. I dropped a message on Twitter and Facebook hoping for a quick answer as to the efficacy and possible adverse reactions of Captopril. I got a lot of responses (Thanks for those of you who cared so much that you took the time to ask people and do the research on that! I love you guys). The most surprising was an anonymous email from a physician from the American Academy of Paediatric Physicians who sent me a link to cited research findings (after the fact, but no less helpful). Captopril has not only been shown to not be harmful to breast fed babies, but intact showed that we probably UNDER-dosed the mom while trying to error on the side of caution. If we see her tomorrow we might remedy that.

If you are interested, I would be happy to send you the research on it.

So Darla and I discussed it for a minute and decided that we were primarily concerned with long term renal function and that captopril would fit the be in our risk v. benefit analysis. Luckily. As it turns out we were correct, if not overly cautious.

That little village with no road, no electricity, no plumbing, running water, sewage or any other modern convenience was filled with the 150 most wonderful people I've ever met. They were primarily agragarian growing onions and cabbage on the steep mountain sides over-looking the cloudy bay of Haiti and Port-au-Prince.

The homes were little more than corrugated metal nailed to shaved tree trunks embedded in the ground. On the roofs, like a patch work quilt, clothes were laid out to dry and doors remained opened, if there was a door at all, while chickens roamed freely. Giant pigs basked in the equatorial sun and mother cats nursed their kittens in the middle of busy walkways, entirely un-intimidated by all the people walking around them.

I took pictures of everyone, because everyone wanted to know what they looked like on a digital camera. The video camera was a big hit too, if not too overwhelming for some of the other older folks who knew no more of technology that the single battery operated transistor radio situated like a shrine next to a woman who appeared to be the gentle and revered matriarch of the village.
They were so blissfully impoverished. They seemed to really want for nothing, except for the two things we came to offer them. Medicine and the good news about what Christ did for us on the cross.

Not long after we arrived, we were sort of ambushed by a loud, carismatic and sweaty group of a couple men with anachronistic bullhorns and a single file line of women in all white chanting and singing at the top of their lungs. They marched all over the tiny village stopping each time they saw a "blanc" person congregating with a Haitian and would scream/sing something in Creole as if we were 100 yards away. After they finished they'd shout "Hallelujah" about 4 or 5 times then break up and shake our hands the return to formation and go accost someone else.

We were stopped dead in our tracks as Benjamin and I were sitting with this very old woman who didn't know what year she was born, trying to discern her medical history. When conversation became impossible, I pulled out my video camera and recorded the spectacle laughing at the silliness of it all. To be honest. I just thought that they were voodoo practitioners but Rob Baker told me that they were Catholics (probably Catholic mystics, a common combination of Catholicism and voodoo) that had come from another village and that they were probably visiting because they had heard that we were here. I'm not sure what their intention was but throughout the day, we saw at least 3 other similar groups traverse the switch backs of the mountains coming toward us (probably from other remote villages in the area), but we had no more visits.

A Haitian Baptist Pastor came to hang out with us while we moved the patients through the clinic and seeing their medical needs, grinning from ear to ear. Recently this village and a few surrounding villages have been getting visits from the native Haitian Pastors who walk for miles up the steep muddy mountain sides with nothing but a Bible to tell them about Jesus. Today 11 people chose to follow Christ and several more showed an intense interest in hearing the gospel. What a moving experience to see so many break from the years of tradition of voodoo-catholicism and seek a relationship with Christ!

The clinic day ended unlike any other. With the expert talents of Chelsea, a young full-time missionary new to BHM, a rousing game of Canar, Canar, Swa (Duck, duck, goose) was intiated and played for the very first time by some 20+ kids followed by sing-a-longs, Simon Says (which is really hard to play if you don't speak the language) and some soccer.

One of the most impressive things I saw was kids playing soccer in a dirt field with golf ball chunks of rock through BAREFOOT! Haitian kids are way tough!

The drive down through the mud and rock was a blast until about 15 minutes from Fermathe when we hit pavement again and, again, sucked exhaust fumes from a large taptap (taxi/bus/pick-up truck).

All was well after we got back and hung out with Patty Baker, Rob's wife, who walked around the campus with us for a bit and informed us of much of the history of this marvellous mission.

Our night ended like any other with dinner, fellowship and prayer and... Of course, counting pills and preparing the formulary for another day in the field.
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