Coming into Bloom

“What we all know is that great things take time...Gestation, growth. So we endure the harsh and the sweet processes that make growth possible.”

~ Bishop Robert Barron

I recognize him by the large conspicuous lesion protruding from his face. Only a few days ago did I receive his photo in a consultation from one of the Peruvian doctors working out in the rural health post. He was referred for untreated Human Immunodeficiency Virus (HIV) and cutaneous leishmaniasis, a skin disease caused by a parasite transmitted by the sandfly. If left untreated there is a risk of invasion and disfigurement of the nose, mouth, and throat by the parasite. He is promptly admitted for intravenous treatment of leishmaniasis and initiation of treatment for HIV.

He and his family are Kichwa, one of the many indigenous groups that live and maintain their traditional language and customs here in the Napo region of the Peruvian and Ecuadorian Amazon. He is marked with the characteristic cross-shaped tattoo on his forehead, his wife wears a colorful, pleated skirt with a typical floral design, and their child’s neck is adorned with an intricately-beaded necklace, all signs of their Kichwa identity. They walk barefoot, which often misunderstood as a sign of poverty, actually signifies their firm connection with the earth that lies beneath and around them. When we greet one another, it is a gentle meeting of two palms just barely touching rather than an exchange of firmly gripped hands. The latter has a more intimate implication in Kichwa culture.

Suddenly I am pulled away from my curious cultural encounter- my eyes are quickly drawn to his child. The boy’s unsteady gait stands out more than the attention-grabbing lesion on his father’s face. A quick examination of the child’s feet soon reveals the cause of his off-balance stride- his right foot is turned inward, a condition known as club foot. The two-year-old infant lives with a condition for which, in many developed nations, treatment is usually initiated a few weeks after birth. Nevertheless, the obvious deformity does not prevent him from going about life as any other two-year-old would. His step more intentional and cautious, he continues to run away in innocent disobedience, carefully scale any climbable object within his reach, and wander aimlessly in spontaneous curiosity. After discussing the need to travel to the city of Iquitos for an extended period of time for the treatment of their child’s club foot, the parents are anxiously hesitant and fearfully resistant. Disappointment sinks in; through the instinctive lens of a privileged upbringing one cannot see how they could refuse this opportunity for their child. Through a culturally sensitive lens, however, one is able to see the reasons for their uncertainty- they come from a small community two days away by boat and have never been to the city, they speak little Spanish, they have with them no family support, and they will have to leave behind their livelihood for months. We worry this child will continue through life unable to walk normally from an otherwise easily fixable deformity.

Weeks pass by and the father finishes his hospital treatment for leishmaniasis. The lesion on his face recedes, leaving a significant scar in its place. The family decides they will return home and come back in the future to address their child’s deformed foot. These discouraging words accompany a heavy doubt in our minds, and the father’s hopeful recovery is clouded by a resigned uncertainty in his child’s future. He is discharged and the family waits in the patient house until the departure of the next slow boat to their community. They will have to wait a few days.

A couple of days later I am surprised to see the father outside the emergency room. He complains of fever, abdominal discomfort, and chest pain. Again, it is his skin that points us to the suspected diagnosis. Rapidly growing purple bumps erupt on his neck, torso, legs and feet. A quick view in his mouth reveals similar spots on his palate. I think to myself, “I never thought I would see this in my medical career.” A week later, the diagnosis is confirmed with a skin biopsy- Kaposi sarcoma, a cancer that typically only occurs in those with a weakened immune system. We worry his life may be cut short by this AIDS (Acquired Immunodeficiency Syndrome)-defining illness. The situation continues to become more complex.

Multiple days go by, days filled with the routine greetings of “alli puncha,” “alli chishi,” and “alli tuta” (“good morning,” “good afternoon,” and “good evening” in Kichwa), long conversations and extensive counseling, and efforts to ease the father’s painful symptoms. Every day brings with it the anxiety of an invisible ticking time bomb and the same recurring questions. “Will he survive?” “Will his child ever receive the care he needs to walk normally?” As the days pass by, however, with each exchange of words, with each gentle “handshake,” and with each concerned gesture, I feel the walls of fear and doubt slowly break down- a relationship of trust and mutual understanding grows in their place. Until finally, one day, the child’s parents approach me saying they would like to go to Iquitos so he and his child can receive the care they need.

A couple months have come and gone, and I head to Iquitos for my quarterly visit to rest and stock up on supplies. I take a visit to the patient house where the family has been staying while they receive more advanced medical care. With joyful smiles they tell me the father’s skin lesions have disappeared with his HIV treatment and the child’s foot has slowly straightened out. I find him with his eighth cast (out of nine) on his leg, his expression communicating to me our shared desire for him to break free from the plaster restraint and run around on his new and improved foot. Instead, we continue to wait in patient anticipation. And seeing the physical restraint of his cast, I call to mind all of the invisible restraints from which this family broke free to receive the care they need: a difficult and stigmatized diagnosis, the clashing of distinct cultures and understandings of life, a corrupt and often unsupportive healthcare system, a stifling fear and anxiety of facing the unknown, and the prospect of leaving their family and trusting in strangers. Their story is an example of humble acceptance, arduous reconciliation, immense courage, and genuine sacrifice. And in the end we are grateful for the “harsh and sweet process that [made this] growth possible.”

“Growth is the only evidence of life.”

~ St. John Henry Newman

Top Left: A colorful toucan joins us by surprise for lunch in the hospital cafeteria one day; Top Middle: The child’s club foot with a noticeable callus now appears straight after several months of serial casting; Top Right: The parasite, leishmania, is spotted under the microscope by our wonderful, experienced lab technicians; Bottom Left: Solidarity- after almost one month without electricity, hundreds of townspeople come together to tug the new generator, resting on a group of logs, uphill to its resting spot where it will supply electricity to the whole town; Bottom Right: A beautifully-crafted bag-shaped nest created by the paucar (yellow-rumped cacique) once hung from the canopy of a tree- the hanging mechanism allows for better protection of their offspring from predators and withstands the forceful winds that often accompany jungle rainstorms.

Anchor of Hope

“May we who have taken refuge in him be strongly encouraged to seize the hope set before us. We have this hope, a sure and steadfast anchor of the soul, a hope that enters the inner shrine behind the curtain, where Jesus, a forerunner on our behalf, has entered.”

~ Hebrews 6:18-20

I am walking back from Sunday Mass- it is a peaceful and uneventful morning. As I climb the stairs up to the hospital I receive notice that there is an obstetric emergency in a community about one hour away by boat. A first-time pregnant mother, seizing, and her unborn child arrived at the rural health post a few hours after she first fell ill. We receive no other information as we hop on the ambulance boat, unsure of the seemingly precarious situation we will encounter down-river.

We slowly, but resolutely, enter the health post where silence unexpectedly occupies the space around us. Reassuringly, the silence is broken by the healthy cry of her newborn child whose high-pitched plea for milk quickly directs our attention to his mother. She lies unconscious on the bed, oxygen flowing through her nose and magnesium flowing through her veins to suppress the body’s return to violent convulsions. The blood and fluid on the bed and floor around her are enough to frighten anyone who has not previously attended a delivery. We proceed to carefully remove the placenta which provokes a reassuring pain response from the mother. And as she begins to wake up and react to her surroundings we are hopeful she will continue to improve. We are grateful mother and child have survived eclampsia, a disease of pregnancy that accounts for almost one quarter of maternal deaths in Peru. We agree to bring her and her child back to Santa Clotilde for close observation.

Just as everything seems to be calming down I hear a group of men run into the health post followed by the word, “emergencia.” A young woman lies unconscious on the bright orange backboard, foaming at the mouth, her skin pale and cool to touch. We learn she has been ill with fever for several days. It is unclear when she began to lose consciousness, now unable to walk or communicate her needs. Her husband, a community health worker from a nearby pueblo, only recently arrived to find her in such a delicate state. All of a sudden our history gathering is cut short by her diminishing oxygen saturation and a sudden loss of her pulse. Immediately we start chest compressions. Seconds later a dose of epinephrine flows through her body, each external compression an attempt to awake her dormant heart. A quick look at her husband’s downcast, yet acceptant, face tells me he already knows how it will end. Shortly after beginning CPR each push into her chest results in an exodus of massive amounts of old blood from her mouth and nose. An image of her six-month old child appears in my mind as we continue desperately to revive her using the only tools and methods available to our powerless hands and minds. I turn to God, pleading Him to do what I cannot. As they wrap and prepare her body for burial we pray for her soul and for her family who will now live only with the memory of their loved one.

We pull up to the shore of her community an hour later, a large crowd of people waiting at the cliff’s jagged edge. The sight of a body gently wrapped in white sheets produces from the crowd a distinct wail whose underlying emotions can only be understood by a mother who has just lost her child. Later we find she presented to the hospital days before her death with the diagnosis of leptospirosis, a bacterial infection transmitted by rats which rarely can cause hemorrhage in the lungs. We suspect this is the cause of her earthly passing. And as her body is carried from the boat, I feel a tug of immense despair pull at my heart, mirroring the same powerful tug the unanchored boat experiences by the river’s chaotic and relentless current.

We slowly work our way back to Santa Clotilde. The current of hopelessness is strong. A whirlpool of doubt and sadness erases any clarity that remains in the water’s dark, murky depths. Dead, fallen trees along the path intend to lead the weary vessel astray, or even worse, cause it to capsize and succumb to nature’s physics, sinking to the dark and suffocating river floor. Amidst the mental and emotional chaos, however, my eyes catch a glimpse of the once-fearful mother holding the warm and moving hand of her daughter who almost lost her life. Next to her sits the accompanying nurse who, suffering from the loss of a recent miscarriage, joyfully embraces the recovering mother’s newborn child.

And as we pull up to the dock in Santa Clotilde after what seems to be a perfect storm, the driver secures the boat to a steady, durable wooden post. The vessel, now anchored, allows us to freely disembark and move onward. I am reminded of the gift of the anchor of Hope which keeps us grounded when the troubled waters around us seek to pull us under.

“The image of the anchor…helps us to recognize the stability and security that is ours amid the troubled waters of this life, provided we entrust ourselves to the Lord Jesus. The storms that buffet us will never prevail, for we are firmly anchored in…this hope, which transcends life’s fleeting pleasures and the achievement of our immediate goals, makes us rise above our trials and difficulties, and inspires us to keep pressing forward, never losing sight of the grandeur of the heavenly goal to which we have been called.”

~ Pope Francis

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.