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.

The World Turned Upside Down

While the world subjugates the goodness of Creation to pain and suffering,
…the cross converts despair into hope.

While the world spins on an axis of pride, retribution, and self-reliance,
…the cross stands on a firm foundation of humility, acceptant peace, and trustful surrender.

While the world continues to be ravaged by violence and storm,
…the cross withstands all bloodshed and torment.

While the world views dying to self as sorrowful self-deprivation and failure,
…the cross reveals its true joyful fulfillment and victory.

While the world lives on false pretense, crowning itself with an unmerited band of gold,
…the cross is sustained by true integrity, undeservedly crowned with a ring of painful wounds.

While the world consumes without ceasing,
…the cross imparts its everlasting blood of redemption and water of life.

While the world continues to breed division,
…the cross invites all to unity.

While the world teaches us to fend for ourselves,
…the cross reminds us we do not suffer alone.

While the world puts wayward man and woman on a pedestal,
…the cross elevates our constant, one true King.

While the world tells us, “you only live once,”
…the cross tells us, “you will live forever.”

While the world exists for the “self,”
…the cross exists for the “other.”

In a world of sterile, senseless hostility,
…the cross is fruitful, transformative love.

It has been said that the cross is symbolic of the world turned upside down. During this season of Lent we are invited to contemplate, accept, and enter into the significance and the power of the cross. Though encountering the cross is difficult and uncomfortable, trust in its fruitful reality brings us the paradoxical ease and comfort that can only be found in bearing the heavy burden of its evident desolation and cruelty.

Another hot and muggy afternoon puts me in my reclining rocking chair. I am kept cool by a series of well-aerated gaps between the chair’s thin, interlocking plastic bands and the fan on full blast. All of a sudden I hear a call from the security guard standing outside my window, winded from his run up the stairs leading to our house. “Doctor, emergency,” he says. Though I hear this phrase many times throughout any given week, his tone is marked by an uncommon sense of concern and urgency. The sense of urgency grows with each word and facial expression I encounter on my way down to the hospital. As I enter the emergency room, a teenage boy lies lifeless on the hospital bed. His stiff extremities and bluish skin are surrogate markers of the absent pulse soon discovered by palpation of his wrist. In the battle against time my hands soon find themselves on top of his chest, each compression into his chest a hopeful attempt to give him another chance at life. Five minutes, multiple pairs of hands, and a vial of epinephrine later, a life-sustaining pulse returns, his eyes are opened, and death seems a more distant reality.

One of the observers of the accident begins to tell us the story. The boy and his friend were riding their bicycles down a very steep hill which ends in a sharp curve. Upon turning the corner on his bicycle with no brakes, the boy violently collided with a set of ion bars. In an instant an unexpected tragedy became the halting reality in front of me amidst an already stifling afternoon.

Shortly after his resuscitation a late afternoon referral to the city of Iquitos is declined by the flight operator as dusk ominously approaches, the water plane’s pilot unable to safely fly in the dark. The boy still has not regained full consciousness and cannot breathe on his own. The remainder of the afternoon and evening finds a group of volunteers and hospital workers taking turns breathing for the boy as we pump oxygen-rich air into his lungs with a bag mask. Over twenty pairs of hands functioning as a human ventilator come together to save one life. Then, the morning’s hopeful sunlight is quickly displaced by a torrential rainfall- the flight evacuation is further delayed by the storm and each passing minute is filled with increasing doubt. The water plane finally departs on its fixed trajectory to Iquitos, all the while containing a life whose worldly fate is all too uncertain. Shortly after his arrival to Iquitos we learn the boy has passed away.

***

The brokenness and despair is palpable that day, a subversive sense of defeat lurking in the shadows with no possible worldly explanation to understand how this child’s life was so quickly and unjustly uprooted. And as the now broken and barren soil is disturbed by the uprooting of this once living and growing tree, the seeds around it are now stirred up. Once dormant, now awakened. Once stifled in packed soil, now set loose with the freedom to flourish. Once trapped in darkness, now invited to bathe in the sunlight. Once content to be contained within themselves, now anxious to sacrifice themselves- to be stripped of the comfort and protection of their shells and to blossom into the flowers they had been destined to be from the very beginning.

In the cross, the world is turned on its head. From the uprooting of a tree emerges a wooden cross, carved away by the brokenness of human hands. I am reminded that in our cross- in our individual and collective pains and sufferings- we find the only possible response to the world’s indiscriminate cruelty. Where the world means evil, only He means good. Only He is capable of bringing about a greater good from the adversity that surrounds us. Only in trustfully surrendering to His permissive will do we have the freedom to truly love. Only in our redemptive suffering do we gaze upon his face with His Mother at the foot of the cross. Only through the cross is found eternal life.

“A seed’s life is inside, yes, but it’s a life that grows by being given away and mixing with the soil around it. It has to crack open, to be destroyed.”

~ Bishop Robert Barron

Carried to Shore

 “Do not let the flood waters overwhelm me, nor the deep swallow me, nor the pit close its mouth over me.” 

~ Psalm 69:16 

The Amazon rainforest is an incredible, ever-changing, and living phenomenon. In it I stand within the warm embrace of its evergreen foliage and under the protection of its towering canopy. I inhale and exhale its sometimes stifling, but always life-giving, hot and humid breath. I observe its waking amidst its fog-dispersing sunrise and its falling asleep amidst its spellbinding sunset. I assess its nourishment in the rise and fall of its rivers’ waters. I listen to its voice in its natural chorus of harmonious birds, steady rain drops, and guttural toads. I sense the reality of its brokenness as I carefully dodge its multitude of disease-carrying and venomous creatures. And I am reminded of its hope when its colorful rainbow peaks out above the transient dark, gray storm clouds. In its dynamic, complex existence I see vessels of a broken world colliding with the current of God’s magnificent Creation. This current of infinite truth, beauty, and goodness always brings us back to shore where we encounter the fruits of faith, hope, and love. 

It can be tempting to let the brokenness of the world swallow us up by giving in to its untamed waters or by attempting to navigate the storm as the captain of our own ship. But in each of these approaches lies a degree of uncertainty that we will make it through the torrent. Reflecting on this past year I see an ocean of uncontrollable waves violently crashing against a calm, unwavering shore. Thankfully, I’ve discovered, we have been gifted another way to navigate these turbid and tumultuous waters that are far beyond our control- the way of faithful, trustful surrender. And though it might be unnerving to let go of the ship’s helm and countercultural to allow oneself to be guided by an invisible sonar, it is often the only way to make it safely back to shore. 

In the waves I see a new mother lose her life to a venomous snake bite. Distant access to care and corrupt government policies that neglect the country’s most vulnerable communities attempt to drag me under. Shortly after on the shore I see the priest come to give her earthly body a final blessing and I am reminded of the peaceful, everlasting life yet to come. 

The next wave carries a young boy who fell from a tree; he is now paralyzed from the waist down. A deep wave of depression pulls him under, and from the depths of these dismal waters, he doesn’t see the sun for months. While acceptance brings him to the surface, hope and courage carry him to shore. I see the sun illuminate the smile on his face as he takes his wheelchair outside for the first time. 

A mother watches her ten month-old daughter with Trisomy 18 take her last breath; in the same tumultuous wave I see thousands of other unborn children with her same condition who were never given the chance to take even one breath at all. Her mother stands brightly on the shore, a light of love and truth to all of those who never thought life was possible. 

I see a man sustaining his sister above the waters; she suffers from terminal cancer, each passing moment that much harder to stay afloat. As cancer consumes her body I see faith nourishing her soul. When the last of the stormy waves envelops her body, she is already on the shore looking out over tranquil waters- not a single wave in sight. 

Unable to stay afloat, a young child loses his sense of balance from a growing brain tumor. He is spotted from afar by an astute observer who brings him to shore where he now walks without fear. 

An elderly woman sits abandoned in the middle of a sea of loneliness. Tethered by an oppressive anchor of pain and suffering, she is unable to move. A humble friar brings a doctor and her family out to meet her; a ray of hope calms the stormy sea around her as the others help carry even the smallest portion of her heavy burden. 

I observe hundreds of people lost at sea, unable to see beyond the blinding mist kicked up by the crashing waves. A group of eye doctors volunteer their time and talent to open their eyes, the shore now clearly visible and not too far out of reach. 

The violent waters carry a multitude of disempowered women unable to seek care because of fear and oppression. A team of doctors from thousands of miles away delivers shelter from the storm- their compassionate care provides women with preventative screening for cervical cancer. These women are now empowered to take their first step on secure land. 

A young man is held under water by the stigma surrounding his medical diagnosis. He is only able to come up for air when doctors and nurses care for him in the hospital. Though the waves toss him around relentlessly, they cannot strip him of his dignity. When he finally washes up on the shore, he sees himself for who he truly is, all manmade labels and constructs dried up by the sun’s gentle, all-consuming warmth. 

A tumultuous wave presents a family with the difficult decision to pursue palliative care for their loved one. Just as the waters rise so too does our friendship grow despite our differences. On the surface of the shore I am nourished and sustained by their gift of a pineapple, a symbol of their joy and gratitude. 

A sudden wave crashes down on a mother who gives birth to her child with an unexpected defect. She is heartbroken as she realizes her infant is unable to feed at the breast due to a cleft lip and cleft palate. When, after a team of strangers rallies together to ensure she receives support and her child receives enough nutrition, the wave of despair subsides. In the end, I see a newborn just like any other lying on the calm shore of her mother’s embrace. And as the child learns to drink her mother’s milk from a bottle, a smile of hope returns to her mother’s face.

I witness a slow and steady wave of cancer suddenly separate the physical bond of husband and wife. As he floats away, the lives of all of those he has touched draw near. And though the despair of death is evident in the dark waters, the hope of resurrection is even more visible from the sunlit shore. 

And in the midst of this dark and stormy sea often filled with hopelessness, fear, anxiety, disappointment, injustice, apathy, and suffering, I remember the group of carefree children who invited me to join them for a swim in the murky waters of the Napo River. In their humility, fearlessness, and sincerity, they remind me of the joy of a simple leap of faith. 

“My hope is that when next New Year’s Eve approaches, the “tick” and “tock” of the clock rings less with the sounds of doubt and control and more with the sounds of faith and trust.” 

More than one year has passed since these thoughts left my heart and mind only to land as words on a blank page in front of me. And reflecting on my first year in mission in Santa Clotilde, Peru, I realize these thoughts-become-words are now permanent, colorful realities blended together on the canvas with which I first embarked on this journey. Each pass over the canvas a singular and permanent mark, together all the brushstrokes comprise a complex and evolving picture. Despite this work in progress-the uncharted periphery of the canvas’ borders, the myriad mistakes clearly visible with careful attention, and the multiple attempts to reconcile its blemishes with new paint-its Author has already revealed to us the final product. All that remains is to acknowledge the imperfections, persevere in their restoration, willingly relinquish control of the brush, and patiently wait for His finishing touches. For it is faith that protects us from being swallowed up by stormy waters and trust that brings us back to the shore where we were meant to be all along. 

Seeking Refuge

A blanket of dark, heavy clouds quickly passes through in the afternoon, the muddy ground, damp air, and majestic rainbow byproducts of its relentless deluge. Miniature “Mary” and “Joseph” prepare their makeshift costumes and the local ensemble of children’s voices, the acoustic guitar, the charango (typical Andean stringed instrument), and the guiro (typical Latin American percussion instrument) begin to play familiar Christmas tunes. Yesterday this symbolic group of pilgrims climbed a series of steep hills to seek refuge in the school where they were greeted with hot chocolate and panetón (sweet bread). The day before yesterday they departed from Santa Elisa, one of Santa Clotilde’s most distant communities. Today’s destination is a different neighborhood where, again, weary pilgrims will graciously be offered refuge after traveling by foot. Along the way the group prays the Rosary while reflecting on the mysteries of the soon-to-be born Messiah. Our prayers interspersed with traditional Christmas songs are heard among the town, and as we pass each house en route to our next landing place, more parents and their children begin to follow behind the group of wandering pilgrims. The crowd grows larger and the voices louder with each passing step and sounding note.

“Mary” and “Joseph” arrive at the door of their anticipated shelter. Then begins the singsong exchange of Pidiendo Posada, a traditional song imagining the conversation between Joseph and the innkeeper in his search for a place for Mary to give birth to Jesus. The song begins with a desperate plea: “In the name of Heaven I ask of you shelter, for my beloved wife can go no further.” The innkeeper responds and Joseph’s heart is filled with little hope of respite: “I don't care who you are, let me sleep. I already told you we’re not going to open.” The song continues with a series of Joseph’s persistent supplications and the innkeeper’s unwavering refusals to provide them much-needed refuge. Finally, a sudden conversion in the last stanza fills the crowd with hope. “Enter, pilgrims; I did not recognize you” is sung, the host’s doors open, and “Mary” and “Joseph” followed by the crowd of carolers and passers-by eagerly enter the home. The smell of chocolate, cinnamon, and cloves fills the room while the priest celebrates the Liturgy of the Word. And after a short reflection on the day’s Gospel passage, the community partakes in a chocolatada, a sharing of hot chocolate and panetón prepared by the receiving home and neighborhood. This tradition continues every day until Christmas Eve after passing through each of the town’s principal neighborhoods and major institutions. By the end of the Christmas season, all of Santa Clotilde has heard, seen, and tasted both its spiritual and physical goodness.

After Christmas Day the joy of the Christmas season travels by boat to a small community about thirty minutes away. When we arrive with a handful of young carolers from our youth Christmas choir, a guitar, and various bags of goodies we are welcomed into a home decorated with red and green balloons and fluffy, plastic garlands hanging from the ceiling. A group of men, women, and children sit in a large circle and a white cloth hangs over the center table to welcome baby Jesus. A giant pot with a wooden spoon larger than most of the children in the room rests over a fire, everyone eagerly waiting to taste the sweet hot chocolate brewing inside.

Despite the evident joy and excitement in the room it doesn’t take long for my eyes to recognize the visible suffering of a young infant lying on the wooden floor. The combination of his emaciated body, somnolence, sunken eyes, and weak cry quickly communicate his illness. And a brief discussion with his mother and grandmother soon reveals the cause- two months of a diarrheal illness and poor nutrition after stopping breastfeeding. Though it is difficult to see him struggle while the other children in the room happily dance to cumbia music, drink hot chocolate, eat panetón, and line up to adore baby Jesus with a symbolic gesture, I am hopeful and relieved that his family has agreed for him to return with us to Santa Clotilde.

A few days later the numbers on the scale begin to rise, his diarrhea subsides, his sunken eyes begin to take form, and his weak cry becomes a feisty fight with each physical exam. I think to myself, “this infant has found refuge,” and I remember what a blessing it is to work in a hospital that is exactly that- a refuge for the infirm, the poor, the homeless, the maltreated, the forgotten. And although we only celebrate Christmas once per year, every time we receive one of the “least of these” under our roof, the Christmas spirit is re-kindled in our hearts: in each living soul we encounter the Savior Himself, God become flesh.

***

Later as I contemplate the significance of the posada, I am reminded of its mirroring of a lifelong process inherent to all mankind. In the posada we find His persistent and unremitting pursuit of our hardened hearts, our reluctance to accept His invitation in our brokenness, our perseverance in change of heart, the peace that comes with humbly opening our doors and welcoming Him into our home, and the true joy and true love of selfless giving. Just as He was once a peregrino pidiendo posada, a pilgrim begging for shelter, so too are we pilgrims searching wearily for our true home. A mysterious and beautiful paradox comes to light- in welcoming Him into our hearts, so too do we find our refuge in Him.

Wishing all of you, my family and friends, a happy and blessed Christmas and New Year! Thank you for all of your continued thoughts, prayers, and support!