I began my medical residency with a cross around my neck and a Bible in the pocket of my white coat. The three or four years of residency are when a new doctor truly learns her craft. It is a grueling test of stamina and courage — like war — when much of what we see and even do is horrible and hard to explain to anyone not living it, too. We work on catnaps and irregular food and follow a strict hierarchy that leaves little room to question orders and decisions. The stakes are high, and mistakes are harshly punished. I had been warned by those before me to hold onto my faith with two hands, and I pondered this advice as often as my sleeplessness would let me.
What did it mean to bring God’s presence with me into a hospital room? What did radical discipleship look like in a white coat? How could I live each moment as Jesus’ hands and feet, even as I cared for people who didn’t know him? The week I started residency, an essay I had written on the intersection of my faith and medicine was published in JAMA. My attendings circulated it among the residency class, immediately identifying me as an outlier. A follower of Jesus. A target.
My supervisors told me to take off the cross I wore, or at least wear a smaller one. I carried a palm-sized Bible in hopes that some of my patients would ask me to read Scripture to them. No one did, and the weight of it in my pocket gave me headaches. I wore a shirt from my church on the OB floor and was told that I could wear only scrubs from then on. Each censure felt like a slap in the face; complying with them felt like a denial. Each morning as I finished another twenty-four hour shift, I felt the cock crowing out my inability to show my love for Jesus.
After a long string of sleepless nights, I came in for a twenty-four hour shift on the OB floor. Our team huddled in the morning, and the attending assigned me the induction of the preterm anencephalic baby in room twenty. The mom was fourteen; the baby, essentially brainless, had no chance of survival. The plan was to deliver the baby on Thursday, so the mother would be back to school on Monday with no one the wiser. I anticipated this delivery to be similar to a recent stillbirth I had attended: place the medicine in the vagina, check in periodically to make sure her pain and emotional trauma were being managed adequately, and — if the patient desired — call the chaplain when the baby delivered. Business as usual.
Sara sat Indian-style on the hospital bed chewing bubble gum. Her mother, perched on the edge of the chair next to her, looked strained. Determinedly cheerful. Several times during my explanation of the procedure, I had to draw Sara’s eyes back from the cartoons on the TV. “Okay, okay,” she said when I asked if she understood. Yes, she knew that the baby was missing most of its brain. Yes, she understood that she could ask for pain medication at any time. She didn’t have any questions.
I placed the medication and went on to my other duties. I delivered two healthy term babies. I sent four mother-baby pairs home, and I helped a mother whose baby was having trouble latching on to nurse. I checked back in on Sara, whose nurse had just done a tracing of her uterine contractions. The line of ink on the paper showed that the contractions were coming regularly, and above them was the baby’s heartbeat, one hundred and fifty beats per minute.
Wait. The baby had a heartbeat? I hadn’t even thought to ask about that. The baby didn’t have a brain. How could she have a heartbeat? I went to look for Angela, my senior resident, but there was an emergency — a woman bleeding heavily after her delivery — and I went back to Sara. She didn’t need pain medication yet. Her boyfriend Trevor had arrived and was lying in the bed with her watching Tom and Jerry. I began to work my way through the women arriving steadily in early labor. I placed another dose of medication to keep Sara’s contractions going.
The day crew left, and Angela and I snatched a bite of dinner. More women came in with abdominal pain and headaches and swollen feet. After ten I peeked in on Sara. She and her boyfriend were curled side by side like spoons in a drawer between the rails of the hospital bed. Her mother snored in the recliner. Sara’s vitals signs, last recorded an hour ago, were stable. The most recent tracing showed uterine contractions every six minutes. There was no line for the baby’s heartbeat. Did the nurse choose not to measure it, or had the heart stopped? Silently I backed out of the room.
Anencephaly is not an uncommon congenital malformation, affecting slightly more than one in five thousand babies. Many are affected by other malformations as well, and of those carried to term, up to one-quarter die before or during birth. Occurring in the first month of development, often before a woman even knows she has conceived, anencephaly is uniformly fatal. In one study, only three-quarters of the babies survived delivery. Of those, half lived less than twenty-four hours. Five percent survived six or more days. Sara’s baby was twenty weeks old — only halfway through her pregnancy. The baby would likely be about six-and-a-half inches long and weigh ten-and-a half ounces. This is length of my hand, and slightly less than the weight of a tall coffee at Starbucks.
Was the life of a baby who couldn’t live worth Sara’s sacrifice of half a year of school — to which she might or might not go back? Without the pregnancy, she could continue eighth grade as if none of this had ever happened. I saw her mother’s perspective, but I knew that my faith community would clearly see that I had ended a life.
At three-thirty in the morning, Sara cried for pain medication. The nurse stood by her bed and held her hand. Sara’s boyfriend, white-faced and biting his lip, sat on the little couch. Fat tears made tracks down Sara’s cheeks. “Of course you can have something for pain,” I said. “Let me just see where you are.”
I touched the bag sliding through the cervix like a peach squeezing through the neck of a jar. “Sara, you might be able to deliver right now and be done if you’d like.” Trembling, she nodded. I ordered a little pain medication for her, since Sara wasn’t going to have any of the afterglow-inducing euphoria of a normal birth. As it took effect, the wrinkles on her forehead relaxed, and she released her grip on the sheets. Trying not to stare at her Hello Kitty socks, I sat at the foot of the bed to wait.
Three more contractions, and she was able to talk again. There was a gush of hot fluid as the amniotic sac ruptured, and she felt an urge to push. Sara gave a few tentative efforts before figuring it out, but by that point, the baby was slipping from her vagina, and she shrieked in alarm.
We dried the baby girl, wrapped her in a blanket and put on a hat to cover the missing skull. With the hat, she looked like a miniature doll. Perfect. We finished with the mess of delivery and slipped the wet bedding away. Trevor hopped back to the bed to balance next to Sara and asked if he could hold the baby. They marveled at their daughter: her tiny fingernails, her perfect nose, her lashless eyelids. Her eyes would not have opened for another two weeks. The umbilical cord clamp dwarfed her belly, and her translucent skin shimmered. “Is she alive?” they asked.
“No. Would you like to give her a name?”
They already had given her a name, though they weren’t sure they would be allowed to bestow it on her. We called the chaplain, who came in at four-thirty and baptized their daughter Hope. They held her another two hours, until Trevor had to leave for school, and the nurse took Hope to the morgue. I went out to the desk to wait for rounds, where I would have to confess to the group that I ended Hope’s life. That my initiation into the medical world was so complete that I hadn’t even thought to question my actions until it was too late.
Angela met me there and gave me a hug. “You need to eat breakfast,” she said. “Take an hour — eat something, take a walk. I’ll do morning report with the team.”
I almost said no, thinking that the burden of what I’d done was too much for me to handle alone. She pushed me gently toward the elevator. I stumbled out of the hospital and walked for half an hour through the neighborhood under a canopy of trees with new leaves, falling blossoms, and humming bees. I longed to disappear, quit, hide — until a bit of the sun’s warmth crept back into my cold flesh and I realized I was hungry.
John 21 tells us how the distraught Simon Peter and other disciples went out to fish at night but caught nothing. The risen Jesus waited for them on the shore with a breakfast of fish and bread. He told them to cast their nets on the other side of the boat, which caused the nets to bulge with fish. One hundred and fifty-three of them. Recognizing Jesus — was it his voice? his sense of humor? the text doesn’t say — Peter leapt out of the boat to greet him. In verse 12, “Jesus said to them, ‘Come and have breakfast.’ None of the disciples dared ask him, ‘Who are you?’ They knew it was the Lord.”
Was Peter tempted, after his spectacular denial of Christ recorded in all four gospels, to hide under a rock? To say, “No, I can’t.” Can’t go back. Can’t face the Church, with its knowing eyes and long memory? He must have been. Yet his love for his fellow disciples was strong enough that when all was lost, he climbed back in the boat with them to do what they knew best. And his love for Jesus was strong enough that just a glimpse of the Lord across misty dawn waters and the shadow of a miserable night made him forget all that had gone before. All the failure, all the shame. This devastating love of Peter’s is the foundation of the Church.
I sat with my eggs and hash browns in the noisy hospital cafeteria and knew that the Lord was with me. Despite my inability to figure out how to be a Christian physician. Despite my denial. Despite Hope’s death at my hands. I longed to leap out of the boat and swim to the Lord.
John 21 goes on. “When they had finished eating, Jesus said to Simon Peter, ‘Simon son of John, do you love me more than these?’” Jesus asked him three times, after each Yes! Jesus commanded Peter to take care of his sheep. Three times, once for each of his denials, Jesus let Peter affirm his faithfulness.
For each of my own denials and failures, God has given me an opportunity to try again. To carry my cross or my faith — or my tiny Bible — into an exam room where someone is grieving, or suffering, or wondering. Through a middle-of-the night baptism or hymn sung with the family of a dying grandmother, I have been able to feed his sheep. And each time, Jesus has fed me breakfast on the beach.
I was so certain of the church’s condemnation, that it was years before I could share Hope’s birth and death with my faith community. This is where medicine and faith meet: in the hard places, where hope must be buried for a time and we don’t know how to proceed. Our nets are empty; we are empty and despairing. All that we know has failed us. But Jesus doesn’t offer us condemnation, no matter the magnitude of our denial. He offers us grace.
Were I to stay fishing on the same side of the boat, I would never get out of the water. Never splash through the lake to fall at his feet. Until I have breakfasted with Jesus after the hard night of catching no fish, I am not strong enough to answer Jesus’ question, “Do you love me?” I would never be able to answer him truly, “Lord, you know that I love you.” And I would never give him the opportunity to restore me to grace and build something new out of the ashes of my failure.