Lately I’ve been wondering why I’m in medicine. Rather, I’ve been wondering how to get out of medicine. I have two young boys who need me home so much, and the challenge of juggling their needs, my husband’s needs, and my needs with my patients’ need to have a physician available to them twenty-four-hours-a-day, seven-days-a-week, is truly impossible. At any given time, I am letting somebody — often several people — down. But more than that, I find medicine exhausting. I’m not talking about the fights with the HMOs, or the hours, or the fear of being sued. I’m talking about the suffering.
I am a doctor in a Community Health Center, and most of my patients are immigrants. Many speak little or no English. Their jobs — if they are lucky enough still to have them in the current economic slump — provide no health insurance or benefits. The pay is dismal. Those who have jobs work six or seven days a week, twelve-hour days, doing things that I would find mind-numbingly boring if I were doing them even an hour a day. Most of my patients suffer from poverty. A large proportion of them suffer from depression, anxiety, alcoholism, or domestic violence . . . on top of their diabetes, hypertension, chronic pain, and heart disease.
I believe that much of the healing in any doctor-patient relationship comes from naming the pain. I believe in talking about suffering, about the real issues: is it John’s blurry vision that makes it hard for him to inject his insulin for his diabetes, or the fear of going blind after watching his mother lose her vision, feet, and kidneys? Is it Guadalupe’s sciatica making this pregnancy so difficult, or the fact that her two children are still in Mexico and she has not seen them for three years? Is Carol suffering because of her back pain, or because her fourteen-year-old son ran away with a gang in November? Is George’s pain from his old gunshot wound or from the hole left in his heart by his wife’s unfaithfulness?
When my patients come to see me, I want to give them more than a pill. I want them to know the healing that comes from Christ’s presence and the wholeness he can give despite diabetes, despite sciatica, despite back pain. To offer this healing, I must enter into the garden of their suffering with them.
My work is exhausting. When I am working full-time, I go months without the creative energy to write, to make music, to quilt . . . yet these are the very activities that renew me. Countless medical resources list strategies to address my “burnout.” These suggestions include taking time for me and engaging in creative activities. But when I am worn out from sorrow on behalf of my patients, I can hardly eat my dinner, let alone write in my journal.
For a time, I thought that I was exhausted by the demands of having an active two-year-old son, a husband working eighty hours a week, and a full-time job. When my second son was born, however, I took a four-month maternity leave. I was sleeping very little, nursing all the time, and caring for my family; yet I had a surge of creative energy. I cooked fancy meals, sewed new curtains, and wrote poetry. All the energy I had been pouring into my patients’ lives, into sharing their suffering, I could use to quilt, write, dance, and sing, despite my physical fatigue. And I was finally able to identify the source of my exhaustion: sin. All day at work, I am surrounded by — steeped in — the effect of sin on God’s creatures, and it is exhausting.
This Lenten season, our family is preparing to move across the country. We will be changing homes, communities, churches, and jobs. I have been looking for work — hopefully still with the poor, and hopefully still in a community of immigrants — but part-time. I am finding it difficult to find a part-time job. Why should a practice hire a part-time doctor, when it could have a workaholic? We workaholic doctors are a dime a dozen — why settle for less? As a job that would fit with my family’s needs seems to be hard to find, I have given God fifty good reasons why now is the time for me to take a break. It’s time to leave medicine . . . probably not forever, but for a season. I have been asking him to give me a season of creative energy at home with my sons, with my husband, and with my church.
It is Monday night, and I am at work. Though my sons are asleep, I am thinking about getting home early so I can see my husband. Mondays are my long day, though this one — so far — has been lighter than most. I have seen most of the patients and might be able to finish my charts quickly. At eight o'clock, I have one patient left. But her visit changes the night completely.
Maria is an easy-going mother of three sons. She is now four months pregnant. This pregnancy is harder than her last, mostly because her youngest is eleven months old and still nursing. In that way, we are alike. I, too, am pregnant and nursed my youngest through the first half of this pregnancy, until he turned one last month. I like seeing Maria. But tonight we cannot find the baby’s heartbeat with my hand-held Doppler.
Sometimes at this stage, I reassure her, the heartbeat is hard to hear because the baby is less stationary than at 12 weeks, when we first heard it just above her pubic bone; yet the baby is still small, so we have to listen at just the right spot. Praying silently for God to save this baby, I lead her to another room so we could check with the ultrasound. There he is, an apparently perfect little boy, about the right size for sixteen weeks . . . perfect except that his heart is not beating.
My first thought: so much for an early night. My second thought: you selfish woman. My third thought: what now? Maria and I tread lightly through what has to be said: this is very hard. We have a few options. No, we don’t know why this happened. It is nothing you did. Maria chooses to wait overnight, since going through the emergency department late at night in our busy inner-city hospital could only make the nightmare worse. We plan that I will meet her in the hospital early in the morning. Shaken, she — and eventually I — go home.
We meet at eight o'clock the next morning on the OB floor. It takes an hour to arrange for her official ultrasound, which we watch together in silence. Still a baby boy. Still dead. Then while she waits silently with her mother in the waiting room, I try to arrange a bed for her. Our hospital is big and does not run smoothly — it is a good place to be if you have been shot, but for many other ailments, it is far from ideal. I try being reasonable and explaining the reasons why I want her on the obstetrical floor while I induce her labor. I beg the charge nurse on her behalf and appeal to the nurses’ sympathy. At one o’clock, the house supervisor tells me there is no way they will accept her on the OB floor because her pregnancy has not made it to halfway. This is the policy. There can be no exceptions. They promise me a bed for her on the medical floor as soon as possible. Assuring Maria that I will come back at the end of the afternoon, I go to the clinic to see patients.
At 5:30 I go back to the hospital. Maria has just moved into her room. A nurse has placed her IV, but the medicines I ordered eight hours ago have not been given. She gives me a brave smile and tries to console me in my obvious frustration, as if she is the physician and I am the patient.
Perhaps I should have sent her through the emergency department last night — at least her physical ordeal would have been over by now. Instead, she has waited twenty-one hours without eating, and we still don’t know when her baby will be born. I spend half an hour with Maria then; we talk about how the medicine will affect her body, what the cramping will be like, and what her baby might look like when he is eventually born. Then she tells me to go home for dinner.
I return to the hospital for a different delivery around one in the morning and drop into Maria’s room on my way upstairs. She is sleeping. I ask her mother to have me paged when she awakes. Upstairs, a healthy baby girl with curly black hair arrives. Around 3:30, the nurse calls me, and I go down to see Maria. We cry again about this little life within her which had so quickly ended; we talk about how the labor pains are often worse with a stillbirth, because there is nothing to look forward to — no baby to cuddle, to nurse, to celebrate.
At 4:10, her baby, who she has named Jesús, slips out of her body and into the world. I am still with Maria, and we cradle his little body in our hands. His skull has a small fracture above his left eyebrow from the delivery. Otherwise, he is perfect. We weep, and we baptize him with the chaplain.
Maria’s delivery so easily could have gone differently. Jesús could have come without warning. Maria might have been alone. His birth could have been not only sad, but frightening. Often a stillbirth is dangerous for the mother because of the bleeding that can ensue. Yet Maria’s delivery — despite being in our impossible hospital, despite giving birth on the medical floor with one nurse to ten patients — is the best it could have been. And I know that by God’s grace, he used me to make it better.
This is the answer to my prayer. No, you may not leave the garden. Stay here and keep watch with me. Pray that you will not fall into temptation.
Friday night, my husband and I go to a Lenten Taizé service with some friends. On the way, I tell our friend Scott that maybe I am asking God the wrong question. He says I am asking the right question but I don’t like the answer. I don’t like Scott’s answer either.
The candles we light and place at the altar reflect their light back to us from shining marble. The cross, draped in purple, balances on its side like Jesus, fallen on the Via Dolorosa and caught by one hand. The Scripture, from Matthew 26, reads, “My Father, if it is not possible for this cup to be taken away unless I drink it, may your will be done.” I weep.
Sunday morning, we celebrate Palm Sunday, the Triumphant Entry. Our whole church waits at the top of the drive for the procession to come, singing, up the hill. We wave our palms. We sing. The wine and the bread are carried up the hill behind the cross, today adorned by a small bouquet of yellow tulips. My son squeals with delight when his three-year-old friend dances by us in the procession. We shout “Hosanna!” At the end of the service, girls dance with banners at the front of the church, and my son and I watch them from the front row. He claps and laughs with joy; I weep more. We sing:
Hail to the King
in all your splendor and majesty!
Finally, my spirit is willing, though my flesh is still weak. While Christ labors here in the garden, while he suffers the effects of evil in our world, in our city, in our lives; while Christ is sorrowful and troubled, until we are all free to worship him in his splendor and majesty — I will keep watch with him in the garden. I will drink this cup of suffering with his creatures. Not as I will, but as you will.
I wrote this piece in 2004. Ten years — ten Lenten seasons later — I am still in medicine, still in community health. The release from medicine I prayed for never happened. In the meantime, I have had two more children, faced the malpractice suit I so dreaded, and walked through the Valley of the Shadow of Death with many patients. I practice medicine 1-2 days per week now, still in a Community Health Center, and work in international health as well.
I have never found the illusive “balance” between work and home that we are told exists. I work in constant tension between the two worlds. When I am at home, I am aware of my patients’ unmet needs and the stress on my colleagues who are asked to “cover” my patients in my absence. Often at work, I feel the stress of that day’s pieced-together child care. But I still hear Christ’s call to wait with him in the garden, and I am still willing.