A Still, Small Voice

He is well known to all of us at the hospital, but today he looks different. It has only been a few weeks since we saw him last. His face is fallen, his usual smile stifled by the pain and breathlessness resulting from the massive amount of fluid pushing up against his diaphragm. His eyes are a pale yellow, the sign of an overworked and failing liver unable to clear the icteric substance from his body. His lungs are tired, prompting frequent rests to catch his breath as he walks supporting his body with one hand against the wall. His stomach protrudes, the tension of the fluid against his skin notable from his shirt which is no longer large enough to cover his entire abdomen. His legs are swollen and heavy, each step forward a pace backward for his heart which struggles to keep up with the unyielding demands of his body. His blood pressure is lower than usual, a sign that his kidneys, too, are losing control in a whirlwind of irreversible hormone imbalances. A violent bodily storm signals this man’s earthly life is coming to its end.

“Then a violent wind came that ripped through the mountain, 

shattering everything in its wake. After that came an earthquake. Then a fire.”

The past year brought with it a windstorm of outpatient visits for weight checks, changes in medication dosing, extensive counseling, and regular blood tests. It was accompanied by innumerable emergency room visits to remove about five liters of fluid from his abdomen when the fluid built up too much to breathe or walk. There were also the frequent hospitalizations for the occasional aftershocks- delicate blood pressures after removing fluid, the need for careful adjustments of his diuretics, and suspected abdominal infections. With the severity of his illness and the lack of available treatment options, each visit was a reminder that we were one step closer to this inevitable moment, the extinguishing of a slowly burning fire.

“The Lord was not in the windstorm. Or the earthquake. 

And he was not in the fire.”

It is a calm Sunday and I am walking back from the hospital kitchen after eating lunch. Though I usually walk up to the house after lunch, I hear a still, small Voice tell me to go check on him. We recently decided to pursue palliative care measures after quickly realizing his body would not rebound from this final insult. We hope to alleviate his suffering as he nears death. As I slowly and quietly approach his hospital bed I am taken aback by the emptiness of his surroundings. It was habitual to see him walk, fight, recover, and rest alone along this journey of suffering, never a family member or friend at his bedside. It never occurred to me, however, that he would die alone as well. I wonder if he ever felt abandoned by the One who was never apparently present in the windstorm, in the earthquake, or in the fire.

“But after the fire…there came a still, small Voice, a tiny whispering sound.”

As he breathes his last breaths his eyes lock with mine and his arm reaches out to grab my shoulder. In his silent, wordless gestures I hear a still, small Voice say, “thank you.” And in an instant that seems to last much longer, I realize that all of this time he was never truly alone. His “thank you” brings to light all of the people who accompanied him and sustained him through this arduous journey: the nursing technicians who administered his medicines and helped him to the restroom, the cooks who prepared and served his three daily meals, the custodial staff who routinely changed his sheets and swept the floor near his bed, the lab technicians who regularly drew and analyzed his blood, the maintenance staff who handled and disposed of the large amounts of fluid we drained from his abdomen, and the priest and sisters who ensured his receipt of the Sacraments as spiritual nourishment. We all knew him by name though One larger than himself lay hidden behind the skin and bones of his tangible human body. And while accompanying him in the final moments of his life I saw the gentle face and heard the still, small voice of the One who had always been truly present within him.

“Out of these fires, we need to listen for that still small Voice. God is calling to us now, even if it sounds like only a whisper. In times like this we realize life is precious, but life is also fragile. What we have, we could lose in an instant. So, we should live for God, enjoy every moment, and never take anyone or anything in our lives for granted.”

~ Quoted inserts from: Archbishop José Gomez

Hold Your Eyes on God

The phone rings at 1 o’clock in the morning. The voice on the phone is that of a school teacher from a community seven hours away by fast boat or two days by peque-peque, a canoe with a motor on the back. We are informed that a pregnant woman with significant bleeding and her concerned husband are traveling down-river in their canoe to seek care. Their current location and estimated time of arrival to the nearest health post are critical pieces of information that are unavailable due to the remoteness of their village and the lack of reliable methods of communication. The midwife and I set out in the hospital’s ambulance boat to the nearest health post, the unknown looming over us like the unpredictable gray clouds in the distance, unsure whether it will pour rain or gently sprinkle.

As we approach our destination the steering mechanism of the boat comes loose. Unable to find a solution, the driver operates the steer manually from behind and the midwife takes control of the throttle. We move just quickly enough to overcome the current of the river, carefully inching forward at a speed similar to that of the peque-peque traveling somewhere out there in the distant jungle. We arrive at the health post in San Rafael, a community about three hours away from Santa Clotilde and wait nervously for the arrival of the hemorrhaging woman carrying her unborn (or newly-born) child. Various images cross my mind. I see a pale, lethargic woman holding her crying newborn child in her arms, umbilical cord still attached, his cries drowned out by the whirring motor at the rear of the canoe. I see a woman suffering from grueling labor pains, reclining and bracing herself on the shallow walls of the wooden canoe, unsure if the water in the canoe is coming up from the river, down from the rain, or out from the fluid surrounding her baby within her womb- her profuse bleeding makes the distinction indiscernible.

An hour passes and a peque-peque is heard approaching in the distance. A quick mental calculation tells us they have been en route for just over ten hours, ten hours in a hard, narrow wooden canoe amidst the starlit night’s barely-navigable darkness and the jungle’s threatening, mercurial weather. As it gets closer we see a barely-conscious woman lying under a wet blanket and her exhausted husband sitting at the rear steering the canoe. There is no sight nor sound of a baby- she is still pregnant. Reality quickly erases from my mind the previously-held images of a crying baby and laboring mother. A group of young men run down to the shore to hoist the woman on a backboard and carry her into the health post where we wait expectantly.

Information about the patient quickly unfolds before us…
Twenty-something-old woman.
Name? A person, not just a patient.
Alert and oriented.
Spontaneous breaths.
Palpable pulse.
Fast heart rate.
Low blood pressure.
Low oxygen saturation.

Now it’s time to act…
Quickly.
Intravenous access.
Oxygen.
Intravenous fluids.

We need more information…
Second pregnancy.
Eight months carrying her child.
Lower body garments soaked in blood.
Cervix four centimeters dilated.
Abdomen without any palpable contractions.
Not in active labor.

And the baby? Two patients, not one.
No name? Also a person.
Doppler ultrasound to confirm baby’s heartbeat.
Long, apprehensive silence.
Alive? Uncertain.
Last time baby moved? No answer.
Connect portable ultrasound.
Baby’s head pointed down.
Baby’s heart still.
Continued silence, now mournful.
Trace amount of doubt- just one more look.
Continued stillness, now certain.
Deafening silence.

Silence broken- voices.
“Hemoglobin level five!”
“Blood pressure dropping!”
She needs a transfusion.
Reminder- hours away from the hospital.
No blood.
Wait anxiously.

It’s time to act again…
Quickly and regretfully explain to the couple their unborn child has died in the womb.
Redirect focus to concern for saving the mother’s life.
More intravenous fluids.
Another point of intravenous access.
Tranexamic acid, a medication to counteract severe bleeding.
Continuous epinephrine (adrenaline) drip to maintain blood pressure.
Ready!
Update- boat still out of commission. Another boat is on the way.
Wait some more.
Hopefully the other hospital boat arrives soon to take us back to Santa Clotilde.

***

It’s a two-hour boat ride back to Santa Clotilde. IV fluids, medications, and tubing, secured with stretchy disposable gloves, hang from the metal poles that sustain the vinyl ceiling of the boat that protects us from the rain. Blood pressure, pulse, and oxygen monitors rest on my lap, occasionally disconnecting with the sudden jerks and accelerations of the boat as I check her vital signs every fifteen to twenty minutes. I welcome the cool breeze as sweat drips down my face and neck while the patient’s husband gently covers her cold, shivering body with the blankets they have brought along for the journey. Though we sit only a matter of inches from each other, I sense an invisible and insurmountable distance between us- how can I possibly understand his pain, his sorrow, and his fear. Just as near to him as I lie his dead child and dying wife.

I regret the circumstances. I worry about the outcome. I feel defeated by helplessness. What can I possibly do? Where can I look for answers? Easiest thing to do- rely on my own capabilities. Hardest thing to see- I am only capable of so much. Hardest thing to do- trust in Him and His plan. Easiest thing to see- He is capable of so much more.

What can I possibly do? To where can I look? Impossible rings loudly and incessantly in the depths of my ears, its hope-consuming doubt working its way into my mind and faith-destroying self-reliance piercing my heart. But then, I am reminded of the simple act of faith and hope: to hold my eyes on God and leave the doing to Him.

She survives to the next morning and we are able to evacuate her to Iquitos by seaplane where she undergoes emergent cesarean section with hysterectomy. She returns one month later to Santa Clotilde en route to her village. It is by no coincidence that as I go for my afternoon stroll, I see them waving to me in the distance. Only this time, their faces are full of light and life. And though much has been lost, we are grateful that He has made the impossible possible.

“Hold your eyes on God and leave the doing to Him. That is all the doing you have to worry about.”

~ St. Jane Frances de Chantal

Christmas Season JOY

How Can We Keep from Singing?

There is a word that describes a situation in which two seemingly unrelated or impossible events cooccur without a plausible cause or explanation. Our world calls this a coincidence. Indeed, in a world of disconnected, autonomous, and independently operating realities coincidence is an adequate description of such a remarkable phenomenon. However, the world in which we live is connected. Our being is not self-sufficient but dependent on others for survival and progress. We do not operate independently but with others, in others, for others, because of others. This reality begs the question, “How do we describe this remarkable phenomenon in a world that is unequivocally interconnected and interdependent?” I am compelled to accept that only an entity larger, more powerful, and more knowing than myself can produce such an occurrence. This occurrence reveals causation, possesses meaning, and portends purpose.

The stars scatter haphazardly across the night sky while the moon hides during its cyclical retreat from all earthly vantage points. The active sounds of the jungle let me know that, though darkness has descended, the earth does not sleep. We are walking some of the kids home from the youth retreat we are holding in Tacsha, one of the river communities a couple of hours away from Santa Clotilde. My feet find themselves traversing a rickety wooden bridge that connects one community to the next. With flashlight in hand I move cautiously, avoiding the unexpected gaps and unstable planks that threaten me with a plunge into the water-filled ravine below. My attention quickly shifts when the young girl walking next to me utters words that invite me into an invisible abyss deeper than any terrestrial ravine. “This is where I found my father when he hanged himself and tried to take his life,” she tells me. “Remember? You took care of him when he was in the hospital. You helped him recover.” As we approach her house I recognize her mother who runs out to greet me. The mutual surprised expression on our faces makes it known that neither of us expected this encounter. And the tears streaming down her face and the descent of my heart into my stomach communicate the mixed pain and joy of our shared experience. He continues to suffer from severe depression- their daily struggle apparent in their words and faces. As I walk back, the stifling silence of the night descends, drowning out the jungle’s lively song.

He walks into the clinic, his breathing loud and heavy with each stride. His voice is hoarse, frequently interrupted by a persistent cough- I wonder if he finds it more painful to breathe or to speak. Upon further questioning we learn he has suffered from these symptoms for almost a year. Though tuberculosis first comes to mind, a quick look into his mouth reveals a large ulceration on his palate which extends into the back of his throat and upward toward the back of his nose. Further testing confirms the diagnosis- leishmaniasis. This parasite, initially transmitted by a sand fly, first entered his nose and later invaded the back of his throat. Untreated, or with unsupervised treatment, this disease could cause obstruction of his airway and result in death. Given this concern we admit him to the hospital to begin the necessary anti-parasite treatment along with steroids to reduce the inflammatory response and hope he will recover without complications. This parasite, which holds his host’s voice captive, makes known its cruel advantage.

***

As I walk by the chapel that morning I hear a beautiful voice singing a familiar tune. The voice is so delightful I am compelled to stop in my tracks and peak through the small space between the chapel doors, careful not to interrupt or disturb the unrestrained melody reverberating from the chapel’s walls. To my surprise I see the same girl with whom I was walking the previous day singing at the top of her lungs a song of praise and thanksgiving to God. In an instant, the once-perceived bondage of despondent silence is replaced with the now-evident freedom of joyous praise and gratitude. Despite the darkness that surrounds her she clearly sees His truth, beauty, and goodness- “How can she keep from singing?”

Thirty days have passed. His treatment of daily intravenous infusions and weekly blood tests and heart monitoring is now complete. Daily physical exams corroborate the medication’s success in eliminating the parasite from his body. As the ulcerations of his nose and throat slowly shrink, his distorted palate takes form, his voice returns, and his breathing improves. Behind this man’s story of success, however, lies a dark and disappointing past. I recall the death of two patients previously diagnosed with his same condition who did not survive through treatment. I remember the frustrating delay and constant struggle with the government health system to make this necessary medication available as his condition worsened. The last time I hear his recovered voice as he walks out of the hospital, words of gratitude are spoken- “How can he keep from singing?”

In the end, coincidence is an inadequate, unfulfilling explanation for the extraordinary circumstances and co-occurrences we encounter in life. As I reflect on these two seemingly disconnected and isolated encounters this past month, I recognize the One direction in which they point me, the One reason to keep moving forward when all hope seems lost, the One being who unites all things in a common, meaningful purpose and toward a common, joyous end. As we prepare for the coming of Jesus this Advent season, we are reminded to open ourselves to the hope, peace, joy, and love that only He can provide. We are reminded to ask ourselves, “How can we keep from singing?”

“No storm can shake my inmost calm, while to that rock I’m clinging. Since love is Lord of heaven and earth, how can I keep from singing?”

~ Robert Lowry

Top and Middle Left: youth from my Catechism class preparing and receiving the Sacrament of Confirmation; Top Right: traveling in our ambulance boat to pick up a patient in respiratory distress; Middle Right: a unique symbiotic mammalian relationship found in the jungle. Bottom: fixing a poorly healed below-the-knee amputation site.

To Draw Breath

“We must remember God more often than we draw breath.”

~ St. Gregory of Nazianzus

She slowly walks into the emergency room, her chest marked with visible respiratory distress as her lungs quickly draw air in and out to meet her body’s increased demand for oxygen. The rapid oscillations of her chest wall make more apparent the unwavering, protruding abdomen which safeguards her unborn child lying just below her diaphragm. A stethoscope placed in the lower right portion of her upper back reveals the cyclic sound of crackles as if someone were gently crumpling a bag with his or her fingers. There is nothing gentle about her disease process, however, as we quickly realize she lacks oxygen, a serious pneumonia threatening the life of her and her child. Thankfully after a few days of oxygen, antibiotics, and rehydration, she recovers from her acute illness and is able to carry out her normal daily activities. All the while her baby lets us know she is well with a steady reassuring heartbeat and intermittent kicks and turns within her mother’s womb. And though we cannot see them, the unborn child’s breaths continue.

He arrives after a three hour boat ride from one of the rural health posts down-river. The imagined patient in my mind after the verbal sign-out given to me over the phone soon takes physical form. A child with swollen eyelids and a puffy face looks at me with a tired gaze, too tired to return the animated high-five and fist-pump routinely presented to my pediatric patients to distract them from the often unsettling hospital environment. He, too, is breathing more quickly than normal to provide enough oxygen to his body. With the stethoscope I am able to hear what will soon be visualized on the grayscale images of the ultrasound machine, a large and complex pleural effusion or collection of fluid inside the space normally occupied by his right lung. Further tests reveal his kidneys are also not functioning normally as they dump an excessive amount of protein from his body. Soon, we refer him to the hospital in the city of Iquitos for urgent drainage of the fluid with a chest tube and further necessary testing including a CT scan and laboratory analysis of the fluid in his chest. We are hopeful he will recover.

It is his second week of hospitalization with pulmonary tuberculosis and, although he had been improving, the physical state of his body quickly takes a downturn. The oxygen flowing through the small tubes leading into his nose is no longer sufficient to keep the most distant parts of his body saturated with this invisible yet life-sustaining gas. We place a face mask over his head to provide higher levels of oxygen. Despite our efforts he continues to breathe at a rate more than twice that of normal. His inspiration and expiration seem to blend together as the time between the two cycles steadily decreases. A stethoscope on his chest reveals a distant, muffled heartbeat almost inaudible to my focused and attentive ears. Again, the ultrasound helps us with our diagnosis. The invisible, reverberating ultrasound waves instantaneously converge- a distressed heart is seen bobbing side to side in a large pool of fluid. Its strong but vulnerable walls struggle to pump enough blood to the rest of his body. Shortly after as I stabilize a needle in his chest, his once-distant and hardly audible heartbeat makes itself known as I hear and feel the wall of his heart rhythmically stroke the tip of the needle draining the fluid around his heart. Despite our efforts to quickly reverse his accelerating disease, his bodily functions continue to deteriorate. And with every subsequent draw of his breath time draws us closer to his death. Thirty-two years of drawing breath are suddenly and tragically cut short.

***

To draw breath is to live. To draw breath is to purify that which harms us from the outside. To draw breath is to sustain the life of another who depends on us. To draw breath is to compensate for that which is suffocating. To draw breath is to fight for survival. To draw breath is to keep going when everything within and around is failing.

But to remember God more often than we draw breath is to allow Him to enter our whole being. It is to purify that which harms us from within. It is to depend on Him to sustain the lives of all. It is to help the other who is suffocating to breathe again. It is to emerge victorious rather than merely fight to survive. It is to transform failure into renewal. It is to truly unite ourselves with Him. To remember God more often than we draw breath is to live truthfully, joyfully, eternally.

Top Left: Procession of Señor de Los Milagros, a Peruvian devotion to the miracles worked by Jesus Christ; Top Right: Altar at a day retreat among the missionaries represented by the flags of our 5 different countries, Amazonian plants, textile, and canoe; Bottom Left: Youth group singing and delivering “get well” cards to hospitalized patients; Bottom Right: Beautiful and exotic, but venomous, caterpillar- DON’T TOUCH!

Taking a Step Back

“…the experience of beauty, beauty that is authentic, not merely transient or artificial, is by no means a supplementary or secondary factor in our search for meaning and happiness; the experience of beauty does not remove us from reality, on the contrary, it leads to a direct encounter with the daily reality of our lives, liberating it from darkness, transfiguring it, making it radiant and beautiful.” 

~ Pope Benedict XVI 

Though not initially obvious this painting is only a portion of a larger, more colorful, and more beautiful work of art. Zoomed in, it may be difficult to appreciate the painting for what it is. Shades of green and black mix with white dots to create an unknown form indiscernible and hardly attractive to the naked eye. Of course, zooming in to a work of art may reveal one’s complex artistic technique, individual brush strokes, hidden details, intricate use of layering and texture, and seamless blending or distinct separation of colors. However, the beauty of the details, the elaborate intricacies, may only catch the eye of an experienced virtuoso or nascent artist. 

More often, however, it is in taking a step back from a work of art that one is able to see the collective details take form and witness the artistic masterpiece’s unparalleled beauty. It is in this “bigger picture” view that one can visualize and understand the interplay between all its various parts. It is in the painting’s wholeness that its simplicity is made most evident. And it is in its overall impression that one is invited to take a closer look at its inner workings. 

*** 

Though I am not a painter, I imagine it is sometimes easy to get lost or hung up on the fine details and minor imperfections: the misdirected brush strokes, the failure to achieve a specific color blend, the crooked lines and shapes, the unintended smudges. Similarly, in life, it is often easy to focus on the daily mishaps and imperfections, the seemingly disconnected realities, unexpected occurrences, and undesired outcomes that appear to paint an unflattering picture of life. But in taking a step back and seeing life’s painting through the lens of Our Creator, ultimately what remains in the eyes of its beholder is an experience of authentic, radiant beauty. 

Prior to my return to the United States for vacation, I was blessed with the opportunity to go on a spiritual retreat about an hour outside of Lima. During this week of reflection I was able to “take a step back” from my daily life and routine in Santa Clotilde and see God’s beautiful masterpiece of the last eighteen months unfold before me… 

In the black I see darkness. I am reminded of the darkness experienced by those with whom I have shared the past year and a half. Material poverty grips tightly to its victims, subjecting them to preventable illness and a constant struggle to survive. Advanced disease consumes its vulnerable hosts, sometimes to the point of premature death. Violence and abuse lock their subjects into a traumatic cycle of indifference. Injustice and corruption reap the fruits of desperation and resentment. And selfishness inflicts on its prey the deep-seated feelings of fear, abandonment and loneliness. By itself the black is dark, austere, uninviting, lifeless, without purpose.

Yet even these dark spaces are illuminated with bright white dots. Transformed, the darkness in the painting takes on a new light- its purpose to accentuate the brightness that surrounds it. I am reminded of the bright light I have encountered during my time in Santa Clotilde. The mother who cares selflessly for her daughter living with permanent disability, a living example of ultimate self-giving. The Franciscan friars and religious sisters who visit the neglected and abandoned home-bound, providing for them a sense of belonging to a more beautiful reality larger than any earthly companion. The man with Down Syndrome who, given the chance to live out his inherent dignity, brings joy and humility to all those who cross his path. The courageous boat driver and nurse who navigate a dangerous river in the darkness of the night, risking their own lives to save that of another. The darkness, penetrated by the light, is now transformed into that which is purposeful and life-giving.

In the blue and green I see tranquility, a life of beautiful simplicity and symbiotic relationship between human persons and nature. I am reminded of the indigenous communities with whom we live who understand their dependence on nature’s gifts and are responsible stewards of Creation. I am reminded of the protective network of vast, winding rivers, the lush, green landscape scattered with a soothing blanket of trees and flowers, and the captivating diversity of birds and animals that grace us with their presence in the depths of the Amazon rainforest. Time passes at an unhurried pace with minimal distraction that fosters connection, wonder, and reflection. One’s will to live instead of one’s will to control leads to the acceptance and realization of our human limits and our reliance on the divine. True peace, I’ve learned, is a product of gratitude and acceptance.

In the yellow I see joy. The joy of a mother whose child once suffering from a brain tumor now is cancer-free and living out his childhood. The joy of a new doctor who, in learning a few procedures for the first time, feels prepared and confident to work alone in an extremely isolated and under-resourced area. The joy of an elderly couple in their eighties, who after a lifetime of spousal union decides to fully welcome God into their marriage in the Sacrament of Holy Matrimony. And the joy of a group of children and adolescents who, often suffering from feelings of low self-esteem and abandonment in their family, find a sense of belonging and self-worth in a humble, supportive Church community. This true joy, I now understand, is found within reality itself and not outside of it.

***

In gazing upon the painting of life- in searching for meaning and joy in this artistic encounter with reality- I see eternal, radiant beauty unfold before my eyes. In taking a step back, the confusion, the darkness, the blemishes and the imperfections are overcome with clarity, light, and magnificence. The challenge in life is two-fold: to relinquish control of the paintbrush and avoid the temptation to paint one’s own story and to take a step back to see the painting through His eyes and not one’s own. In an authentic experience of beauty that can only be designed, created, and made manifest by the Master Artist himself, truth and joy are found.

The Simple Secret

“I know you before you are born. I know you after you die. My plans for you are not defined by this world. Beginnings and endings are earthly ideas. I go on. And because I go on, you go on with me. Feeling loss is part of why you are on Earth. Through it, you appreciate the brief gift of human existence, and you learn to cherish the world I created for you. But the human form is not permanent. It was never meant to be. That gift belongs to the soul.”

~ The Stranger in the Lifeboat, Mitch Albom

He seizes violently in his bed- neck stiff, wrists clenched, arms and legs rhythmically oscillating as if desperately trying to unleash themselves from the chains attached to his static torso. Two doses of anti-seizure medicine are pushed through his veins- two failed attempts to halt the uncontrollable movements sparked by an unknown culprit hidden in the complex labyrinth of his brain. A different anti-seizure medicine finally abates the seizure and a sudden calm descends after the passing of the precarious storm. Though the convulsions have certainly stopped for the moment, his future remains uncertain. I think to myself, “this could be the end.”

A few weeks ago he was admitted to the hospital with the feared and unwelcome cohabitation of HIV and tuberculosis progressively and silently consuming his body. Daily conversations and routine examinations dimly point us to an inconclusive cause for his symptoms: warming fever, bubbling depression, simmering confusion, and slow-brewing neurological signs finally culminating in the boiling point of his sudden, uncontrollable seizures. Finally, the addition of more antibiotics, steroids, and nutritional rehabilitation steadily cool things down. And as the temperature drops I notice the feelings of fear, abandonment, failure, and despair dissipate into the seemingly empty air. I think to myself, “this is a new beginning.”

The days following his recovery, his face is marked with a generous smile. His depression turned to joy, he tells me, “I want to continue getting better.” And as I contemplate the fragility of the human body and his near death experience, I realize we are both grateful for the gift of his continued existence. I realize, ultimately, that he goes on because He goes on.

***

I am called to the labor and delivery room to help with a delivery that is taking longer than expected. She is laboring with her first child, each contraction a new and painful experience, each coordinated push through trial and error an attempt to bring her child into the world. Her legs are drawn back and she is coached through the final remaining pushes that will give rise to the long-anticipated end to her pregnancy and the beginning of the child’s earthly life. A few moments later, the child slowly emerges from her mother’s birth canal. With her arrival we see a new beginning.

It does not take long to realize the child’s transition into the world is not progressing as expected. The cord is cut with urgency in response to her notable lack of movement, gray skin, and absent cry. After vigorously drying and stimulating the baby there is still no response, and suctioning the mouth and nose proves equally futile. The baby is carried to the warmer and a mask is placed over her small, fragile face. My body’s adrenaline immediately jumpstarts the rarely used and long-forgotten protocol for newborn resuscitation buried deep in my mind. “Breathe, two, three…breathe, two, three…” plays over and over in my head, intertwined with prayers and pleas for divine intervention to grant this apparently lifeless baby an opportunity to grow. A trembling hand places a stethoscope on her chest and finds no heartbeat. I instinctively begin chest compressions on the newborn, a practice I’ve only employed in theoretical simulations on plastic mannequins. The difference between make-believe and reality is palpable as I sense the pounding vessels in my neck and chest hovering over a pulseless child. My prayers and pleas increase as we exhaust the number of available treatment options available to human hands. Then, the increasing levels of adrenaline in my body remind me to give her some as well. I insert a breathing tube down her throat followed by a dose of adrenaline- this is our final effort. The natural passing of time and the artificial passing of each breath bring with them the passing of my hope. And as we remove the breathing tube from her body a short time later, I realize it is the end.

There are no words or gestures that can soothe a grieving mother suffering the loss of a child. We remind the mother she did everything she needed to do for her child to give and sustain her life. Together we look at her daughter’s motionless handprints and footprints pressed in dark ink on the paper in front of us, her daughter’s name written heavily across the page. And I am reminded that all is not still, lifeless. I am reminded that “beginnings and endings are earthly ideas.” Instead, bathed in His everlasting light and with her name written on our hearts, her daughter goes on because He goes on.

“No matter how great or how small my sufferings are, I have a choice. I can either let them make me bitter, or I can meet them with the confidence that God will not abandon me. That’s the choice…that’s the simple secret.”

~ Fr. Walter Ciszek, SJ

Vessels of Resilience

 

"Where the Lord finds the vessel empty He pours down His blessing.”

~ Thomas à Kempis

The hot sun casts its warmth on us as we prepare for our journey down-river; I am quickly blinded by its bright reflection off the water’s glistening surface. Our driver engages the engine on the back of the wooden canoe, sparking a monotonous mechanical rhythm that will accompany us throughout our fluvial journey. One by one we take our first step off of firm land into an unsteady, floating vessel carved from a once-living tree. In this simple exchange I am reminded of the indissoluble connection between the earth’s fruits and its life-sustaining water.

Careful attention is directed toward our respective positions in the peque-peque in order to evenly balance the weight. Thoughts begin to spin in my head…We won’t capsize. A wide-mouthed plastic bottle lies on the floor of the canoe, its function initially a curious secret. An umbrella in hand serves as a shade from the sun and a pair of sunglasses protects my eyes from the reflective waters…We won’t burn. Dodging the direct sunlight, I am reminded that many that traverse these waters lack even basic protection from the sun’s relentless beams. As we float down the river I feel a wet sensation invading my sandals and brushing up against the skin of my feet. The plastic bottle soon makes its purpose known as I see the friar methodically scooping up the water inside the canoe and tossing it over the boat’s edge. We take turns emptying the canoe of a steadily rising layer of river water…We won’t sink. I am now grateful for the sunshine as I contemplate the ominous threat of a torrential downpour to the meager confines of our canoe. A spare liter of gasoline lies in the rear of the boat…We won’t become stranded. I remember all of the patients who have told me they don’t have enough money for gas to return to their community. Our trip is short to the small community of San Pedro, just under an hour. But it’s enough time to appreciate the welcome relief when we find ourselves standing and stretching on solid land…We have made it safely to our destination. I am reminded of those patients who have traveled for multiple days in more extreme conditions.

***

My limited knowledge of her arduous journey begins when her daughter fell from a tree a little over one year ago. After an emergency referral to Iquitos and multiple months hospitalized in the pediatric intensive care unit, her daughter was left paralyzed from the neck down. They returned to their home in the middle of the rainforest, two hours away from Santa Clotilde. I first visited their home a few months after her hospital discharge- tucked away in the jungle foliage, a wooden home on stilts greets a visiting group of doctors. Her daughter lies on the hard, wooden floor with non-healing bed sores. Her husband suffers from HIV- his wasting body tells me his health is deteriorating. The mother brings her daughter to the hospital a few months later- her daughter’s wounds have progressed and we are concerned for infection. After a month in the hospital as her physical wounds are healing, a new wound opens in her and her mother’s lives. Her husband arrives to the emergency room, his body flesh on bone, his mind altered and confused, his spirit reaching out for help as he grips my hand tightly with his remaining strength. The words, “doctor, help me,” are uttered from his dry, cracked lips. The next day he breathes his last, and all of a sudden the wounds seem too deep to heal, the water within the vessel rising too high too fast. A vessel on the verge of sinking inflicted with wounds of her own, the mother continues emptying herself for the sake of her daughter, a sacrificial love that keeps her afloat. 

He arrives with bruise marks on his neck, swollen from the rope once tied around his neck. His teenage daughter cut the rope and his neighbors carried him out of the muddy ditch. He is brought to the hospital for further evaluation and management. After a thorough investigation he is found to suffer from major depression, his suicide attempt a last-resort effort to end the pain and suffering only he understands. A year ago he suffered a stroke which left one side of his body minimally functional and he has been unable to work to support his family. A mix of chemical imbalances and a misunderstanding of his dignity as defined by “what he can do” instead of “who he is” wreaks havoc on his mind. More than a month has passed, a month of antidepressant treatment, mental health counseling, physical therapy, music therapy, and sacramental anointing of the sick. As we celebrate Mass for our patients outside the hospital one Saturday, his hand rests gently on his forehead while tears roll uncontrollably down his face. I sense the gifts of reconciliation and forgiveness at work, the restoration of a wounded, fragile vessel preparing for the remainder of the journey ahead. 

***

In a unique way my experience traveling in peque-peque reminds me of the intriguing yet precarious journey that is life. When I reflect on the various patients I have encountered recently and the challenging circumstances they have faced, I recognize that the peque-peque is more than a simple mode of transportation. Rather it is a dynamic symbol of their unparalleled resilience amidst an often violent, overpowering current.

Carved in His everlasting image and breathed into existence from His life-giving love, vessels of body and soul are propelled forward amidst the oppressive current of the world. Each vessel’s journey a unique trajectory with a common origin and shared destination. In the end, vessels of resilience fortified by faith, hope, and love, will say, “we did not capsize…we did not burn…we did not sink…we did not become stranded.” In the end, He will bring His beaten and battered vessels safely home. 

Top Left, Bottom Right: visit to community of San Pedro to discuss the importance of “living a healthy life;” Top Right: memorial Mass with his family in the community of Tacsha for the death of my friend who passed away on Good Friday last year; Middle: wound care during a home visit and a muscle abscess drainage with our team of volunteers; Bottom Left: quarterly birthday celebration with the youth group.