Breaths of Faith

“For the truly patient man does not consider from whom the suffering comes…but no matter how great an adversity befalls him, no matter how often it comes or from whom it comes, he accepts it gratefully from the hand of God, and counts it a great gain.

~ The Imitation of Christ by Thomas A. Kempis

For him each day is a gift, its uncertain arrival like the unexpected, torrential rainstorms that pass through the jungle in the afternoon, providing instant relief from the stifling, unquenchable heat. He knows each day is not forever, but instead forever transient. However, unlike the rain that relieves one from the suffocating heat, the dawn of a new day cannot relieve him from the asphyxiating disease that wreaks havoc on his lungs. Like a boat with a leak in its hull waiting to sink, his lungs and airways continuously fill with mucus, patiently waiting to succumb to this relentless, external force.

He first presented to our hospital a little over two years ago, and his diagnosis has always been uncertain. Due to socioeconomic constraints and a broken, corrupt healthcare system, he has not been able to receive appropriate evaluation and management of his disease. Using the tools and resources available in our hospital, he has undergone treatment for tuberculosis, fungal infection, emphysema and chronic bronchitis, pulmonary fibrosis, and chronic bronchiectasis. Despite our best efforts his disease continues to progress.

***

For the outside observer it may appear obvious the reason for his continued survival. His body is maintained with medicines that reduce the inflammation in his lungs and help break up the mucus in his airways. The thrice-daily firm and rhythmic percussion of his chest and back by human hands aids in the mucus’ expulsion. Periodic antibiotics reduce the bacterial burden in his lungs, preventing severe infection. A steady flow of oxygen makes up for the irreversibly damaged parts of his lung that can no longer transport this invisible, yet vital, gas from the air to his blood. Five meals per day keep him nourished- the extra calories seem to be just barely enough to replenish the increased energy consumed by the muscles in his neck and between his ribs that help him breathe.

For those who have been by his side for the past two years, however, another cause for his survival is evident- a source just as invisible, just as constant, and just as vital as the oxygen flowing through the transparent tube and entering his lungs. Faith.

Invisible but not imperceptible, his unwavering faith is a testament to all. Where one goes through life unarmed, he is found always with a rosary around his neck and the Bible at his bedside. Where one takes each day for granted, he takes each day as an opportunity to be grateful for life. Where one breathes in and out without thinking, he takes in each breath with willful intention, knowing it may be his last. Where one sinks due to the oppressive weight of the world’s pain and suffering, he stays afloat with hope as his lifeboat. Where one lets the waves take him every which way, he propels himself forward, never losing sight of the Light on the horizon. Where one suffers with anger and resentment, he suffers with firm purpose and tremendous gratitude. Where one, insecure in what the future holds, sheds tears of despair and fear, he cries tears of joy and peace, secure in his Creator’s plan.

His care team has often found itself relying on the same faith, hope, and charity to which he serves as witness each and every day. At his side stand his wife, his nurses, and his doctors. And within each of them grows a trustful faith that the various medications will not cause harm, a patient hope that his condition will improve with each adjustment to his treatment, and a selfless, empathetic love that transcends and defies the financial limits, social norms, and structural violence that attempt to undermine his human dignity.

And in due time the fruits of this steadfast faith are soon breathed into life. Immense joy and peace fill the air when he takes his first steps after months of being bed-bound. Unprecedented gratitude flows freely when he finally gains the energy to play alongside his granddaughter. And the blinding light of God’s grace glistens from his tear-filled eyes when he recognizes that not once on this arduous journey has he ever been abandoned.

Top Left: My family visits Peru and the wonder of Machu Picchu; Top Right: Annual procession for Señor de los Milagros, a Peruvian devotion to the miracles of our Lord; Middle Left: Traditional medicine technique using a candle and a glass to remove mal aire or “bad air” in a woman’s body; Middle Right: Youth at our annual retreat send off their eco-friendly canoes, a symbol of their call to “go out” and witness to Christ in their everyday lives; Bottom Left: Our team of nurses and nursing technicians who work in the inpatient ward; Bottom Right: Nursing students and one of the Daughters of St. Camillus joyfully accompany a girl who suffers from quadriplegia.

Seized by Beauty

“The beautiful stops the viewer in his tracks and then plants within him a desire to speak to others of what he has seen.”

~ Hans Urs von Balthasar

Her infant child’s head appears larger than the rest of her body, her torso and extremities overshadowed by her abnormally fluid-filled brain. She suffers from hydrocephalus, a disease in which excess fluid builds up in the brain, eventually leading to long-term brain damage or death if left untreated. She fights for air as her weakened windpipe collapses with every breath, a result of a condition known as tracheomalacia. The medical terms and physiologic mechanisms of her illness run through our minds as we move back and forth to examine her, write orders, and coordinate her care. Passers-by look at her child with curiosity and confusion as they go on with their lives. Around the patient is a flood of commotion, movement in all directions. Meanwhile her mother, fixed on her precious daughter, never leaves her child’s bedside. Her child’s physical affliction is palpable in her mother’s emotional suffering and all-encompassing sacrifice. Her first-time mother is young, her age and limited life experience made almost unrecognizable by the immense love and compassion for her dying child. Her child lies in a clean, carefully-selected pink dress. Her skin shines clear without any wounds or uncleaned grime. Her plump cheeks and chubby arms and thighs reflect her more-than-adequate nutrition. Her outstretched arms and pleading cry which can only be soothed with her mother’s embrace are a testament to their secure, intimate bond.

***

She sits patiently in her wheelchair by her dying mother’s bedside. Wheelchair-bound her entire life, she suffers from a form of muscular dystrophy, a disease in which the muscles break down and become nonfunctional over time. She recounts the many years her mother cared for her in her disability- feeding, bathing, dressing, listening. Her mother’s sacrifice in caring for her daughter is reflected in her daughter’s current unwavering devotion to her mother. Her mother has suffered a severe stroke and lies in our hospital in a semi-comatose state known as unresponsive wakefulness syndrome. She receives physical nourishment in the form of essential food and water through a feeding tube. Though her daughter is unable to feed, bathe, or dress her mother, she gifts her mother her untiring presence, emotional sustenance for a difficult journey. Her friends and family from her neighborhood respond with fervent prayer, remembering her as their spiritual matriarch. All of them recount how she instructed them in faith and taught them how to pray. Her memory and presence is carried from house to house for an entire month as the neighborhood gathers to pray the Rosary and provide her and her family the spiritual nourishment they need to get through this difficult time.

***

A couple of months have passed since the baby with untreated hydrocephalus was discharged from the hospital. I learn she recently passed away. We lament her death, especially from a disease that is often manageable in more developed nations with survival into adulthood. And as I think back to that special encounter, I am transformed by her mother’s witness. Though her child suffered from a severe, life-limiting disability, she was one of the most treasured and cared-for children I have had the privilege to meet during my time here in Santa Clotilde. This mother reminded everyone who crossed her path of her child’s inherent dignity, defined by who she was and not what she was able to do.

***

Three months have gone by and her mother remains in an unresponsive wakefulness state. None of us expected her to live this long, partly due to the severity of her illness and partly due to the lack of resources available to us at our hospital. She, too, is surrounded by unceasing movement day after day- nurses and physicians come in and out of her room for examinations and treatments, custodial staff maintain a clean, safe living environment, patients admitted and then discharged walk by her room not knowing who lies behind those doors. One thing, however, remains constant. Her daughter spends all of her days accompanying her mother, only taking breaks to bathe, eat lunch, visit the Virgin Mary outside the hospital, and attend Sunday Mass. Her devotion to her mother and her Creator once again causes me to pause amidst the daily motion. Despite her own suffering and self-limiting physical disability she finds the joy and strength to be present to her mother in her affliction. She, too, reminds everyone of her mother’s inherent dignity, defined by who she is and not what she is able to do.

With the beautiful witness of these courageous, compassionate, faithful, and selfless women we are compelled to see the Truth. And seized by its beauty, we are propelled forward to share this gift with a world so often stifled from its presence in our daily lives.

“Having been seized by the beauty of revelation, our only proper response is a change of life and a commitment to become a missionary on behalf of what we have seen.”

~ Bishop Robert Barron

Flower Photo: The flower “Queen of the Night” only blooms once per year and only for one evening; I had the rare opportunity to see it!; Top 3: Marian devotion every day during the month of May where each household receives the Virgin Mary and prays the Rosary; the last day we received the neighborhood in our home; Middle Left: Annual youth retreat in Santa Clotilde; Middle Right: Peru (national), Loreto (department), and Napo (district) flags are raised in the central plaza on Peru’s Independence Day, July 28th; Bottom: Traditional stilted houses that withstand the cyclical rise and fall of water here in the Amazon jungle.

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.