moved

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from JAMA

Read a simple and beautiful article in JAMA:

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"Matthew, I'm going to take your temperature now.  Matthew, I'm going to listen to your breathing."  Whenever they touch him, they talk to him first, calling him by name.  I am moved by their respect, though the whole point of today is that he cannot hear them.  I don't notice if there is a time when they stop doing this.

The transplant nurse, Lindsay, gives us ceramic hearts.  She takes matching hearts and efficiently - reverently - ties them around Matthew's wrist.  He will wear them into the surgery; then, if we do not reclaim them, into his grave.

Lindsay amazes me.  She worked with us yesterday afternoon, explaining the medical facts of Matthew's condition, then started making telephone calls.  She was still at the hospital when we left last night.  She was there before us the next morning - we wonder if she ever left.  She divides her attention among two phones and a computer.  She occasionally focuses on Matthew - and, when we need her, on us - but he is still primarily the job of the ICU nurses.  When we got to the hospital this morning, Lindsay told us she had found a recipient for his liver.  Our joy at this news was almost pathetic.  There is no longer anything to worry about on Matthew's behalf, but anxiety requires a focus.  We allow ourselves to worry about which organs will be viable.

We say goodbye,one by one, taking turns.  Matthew's sister washes his face.  We reassemble - parents, siblings, in-laws like me, Matthew's fiancee, her parents, her siblings.  Some of us have never met before tonight - the wedding was still 2 months away.  We touch his hands, arms, face.  I marvel at how hot his skin feels.  We surround his bed.  We bow our heads.  We pray.  My prayer is silent, my hand on his shoulder.  I want to keep my hand on his skin, to feel the warmth of life for as long as possible.

Lindsay comes back, and others drift in behind her.  Jen, the nurse who took care of Matthew when he was first admitted four nights ago, arrives.  She is not scheduled to work tonight, but she has requested permission to go to the operating room with him.

They prepare Matthew for his last trip, down the hall, down in the elevator, into the operating room, into his final death.  I think of Matthew's utterly morbid sense of humor, and how he might be amused by the complexity of his death.  Friends ask, "When did he die?" and I will never have a simple answer.  It was partly Monday night when the sudden, tragic event took place; partly Wednesday night, when he was declared brain dead; and finally tonight, when his death gives life to three strangers.

Matthew's oxygen levels drop.  Lindsay pages an anesthesiologist.  She will not leave the room until he gets there.  Too soon, he arrives.  We fall in line behind Matthew, physicians, nurses, technicians, family bringing up the rear.  His entourage.  Instead of a wedding procession, Matthew has this awful walk, which lasts forever but is too brief.

It is the longest walk, and the saddest.  I wonder if we are terrifying the other families we pass, who must realize what we are doing.  We get to the elevators and Lindsay tells us we need to say goodbye.  One by one we touch him, tell him we love him, mumble good-bye, say nothing at all.  I pull my hand from his shoulder and the family embraces as the elevators swallow him up.  I marvel at Jen and Lindsay and their colleagues, starting a long surgery late at night after 2 days of intense work.

We walk back to his empty, empty room.  We mill around, aimlessly, trying to look busy, not wanting to leave this last place we shared with him.  We gather our coats, and collect the balloons that exhorted him to "Get Well Soon."

Finally we walk to the surgery waiting area.  We sit, staring at each other, making aimless conversation.  Jen calls us from the OR to tell us Matthew's liver is viable.  This news gives us the energy to stand up, leave the hospital, move forward into the new reality of life without him.

Matthew's death - sudden, shocking, far too early - will never make sense.  There is some solace in knowing that his organ donation helped others.  And I am forever grateful to those who called him by his name when it might not have seemed to matter.

The Clinical Years..

I haven't updated this in a while.  In fact, I just wrote a whole spiel on "gifts" which I just deleted.

In the end, I turn to this blog mostly to remind myself of the strength and faithfulness of God in my times of great weakness and doubt.  In the midst of my struggles, I write and receive His sweet mercies - mercies that altogether at once tell me He understands, He forgives, He consoles and He refines.

I've spent the last 5 weeks in my inpatient medicine service.  Many days have been long - waking up at 4:30am and coming home occasionally at 9pm, barely enough time to eat before sleeping to begin the day anew.  Insidiously over those 5 weeks, I adopted a spirit of dissatisfaction, deep discontentment that has fed increasing irritation and exhaustion.  A combination of physical & mental exhaustion, perpetual hunger from skipping meals, and constant anxiety over my future has threatened to twist me into a cynical student simply awaiting the end of my current rotation.

Tonight, I took just a few minutes...only a few minutes to sit in silence and pray.  And those few minutes have made all the difference.  Strength enough for this one step - and a continual heart of prayer for every step afterwards.  Thank you Father - you remind me of why I am here.  There is a great harvest.

Shout to the Lord

This past Sunday, I was blessed to be praising at church with my dear friend leading worship - the last opportunity I would have to see her leading before she's to move out of state.  Though New Community is a multi-ethnic church in love with a very gospel-influenced musical style, the set that Sunday included what was to me a quintessential "Asian-church" song - Shout to the Lord.

I first sang this song in 3rd grade when I was just 8 years old.  Once a week, our school would have our entire 3rd grade meet in the music and art department's lobby - a place affectionately known as "The Pod."  There, we would spend the next thirty minutes of the morning learning and singing praise songs - our school was after all, founded by missionaries.  Back then, in 1994, it wasn't quite the outrage for a non-Christian family to know their children were required to attend these praise gatherings once a week in return for some quality education.  In any regards, the song's catchy melody stayed in my head until I was re-exposed to it again in church, and then again and again throughout high school.  In fact, 10 years later in 2004, as part of my praise choir's last concert, our director asked the seniors to learn the motions, motions I still remember to this day.  But never did the words of that song resound with me as much as they did today, following the news I received that my grandmother was in a coma in Korea breathing what is sure to be some of her last breaths on this earth.

I had always envisioned this song to be a song of joyful declaration - Shout to the Lord all the earth, let us sing.  But today, I re-imagined the song as more of the fervent prayer of the desperate, lost, and suffering.  I imagine the original Psalmist in his darkest days, crying out in faith the praises of a Father who is ever faithful, believing beyond belief that even while surrounded in suffering, and especially so, He is ever worthy of the sweetest of praise.

My Jesus, my Savior...Lord there is none like you.  All of my days I want to praise the wonders of your mighty love.
My comfort, my shelter, tower of refuge and strength...let every breath, all that I have, never cease to worship you...
....nothing compares to the promise I have in you.  Shout all the earth - He is worthy.

one three nine

Lately, I haven't been able to frame my thoughts into words.  This psalm states them perfectly:

O Lord, you have searched me and you know me.

You know when I sit and when I rise; you perceive my thoughts from afar.

You discern my going out and my lying down;

you are familiar with all my ways.

Before a word is on my tongue you know it completely, O Lord.

You hem me in - behind and before; you have laid your hand upon me.

Such knowledge is too wonderful for me, too lofty for me to attain.

Where can I go from your Spirit?  

Where can I flee from your presence?

If I go up to the heavens, you are there;

if I make my bed in the depths, you are there.

If I rise on the wings of the dawn, if I settle on the far side of the sea,

even there your hand will guide me,

your right hand will hold me fast.

If I say, "Surely the darkness will hide me and the light become night around me,"

even the darkness will not be dark to you;

the night will shine like the day, for darkness is as light to you.

For you created my inmost being; you knit me together in my mother's womb.

I praise you because I am fearfully and wonderfully made;

your works are wonderful, I know that full well.

My frame was not hidden from you when I was made in the secret place.

When I was woven together in the depths of the earth, your eyes saw my unformed body.

All the days ordained for me were written in your book before one of them came to be.

How precious to me are your thoughts, O God!  How vast is the sum of them!

Were I to count them, they would outnumber the grains of sand.

When I awake, I am still with you.

calling

I won't lie - every time I've been asked what kind of doctor I want to be, the foremost considerations that enter my mind are things like work-environment, excitement, pay, hours...most medical students I know would go through the same thought process.  Yet ask those same medical students why they chose to become a doctor in the first place, and invariably the answer is, "I wanted to help people."  Heck, ask a middle or high schooler why they want to be a doctor and the answer would be the same.  Where does this motivation disappear to through medical school?

My senior year in college I would tell my friends, "Our careers are not an end.  They are simply a means to an end.  Our callings in life do not so explicitly revolve around a profession, but I believe them to revolve around the unique role God has called us to play in serving a specific people, to be a unique instrument in restoring something that was broken in His kingdom.  If our calling is to care for the sick in SE Asia, we can achieve that end by many different means - by providing medicinal care, by developing financial opportunities for people to afford that care, by devising and implementing infrastructure to improve sanitation and provide clean water; the means are endless."  Now here I am having near completely lost that perspective - my specialty, my career is threatening to become the end.  It's as if I've thrown away the secure shield of faith I've had that I am a part of God's great work and His will be done, and I've traded it for the flimsy, tattered tarp of ephemeral comfort I find in the shaky status of my immediate world; I've given up PEACE for CONTENTMENT.

No, what I really desire is still there within me - to find my role in seeking His justice and righteousness, a role into which I can pour all my passion, gifts, and prayers, through which I can say when the race is completed, I've given all in obedience and humility to the path that He has laid for me.  And only in seeking Him and His kingdom with all my heart until the very last day I draw breath can I hope to hear those important words, Well done, my good and faithful servant.

I don't know where that path will lead me, but for now I walk the part of that path that is school and I've got to be much more than just a student, though the world may tell me that is my greatest priority.  Tomorrow is not given to me, and if my life were to end before I graduate, I'd hate to realize I've wasted the last 4 years of my life in preparation for a purpose I never began to fulfill when clearly every morning we rise is a day for God's glory to be revealed through us - what Grace for Him to have chosen such a wretched person for that unimaginable purpose?  Father, draw up my eyes to your throne and make my paths straight.

The more I seek you, the more I find you,

The more I find you, the more I love you.

I want to sit at your feet, drink from the cup in your hand,

Lay back against you and breathe, hear your heart beat.

This love is so deep, it's more than I can stand.

I melt in your peace...it's overwhelming.

Sing. Shout. Dance.

Shout for joy to the Lord, all the earth, burst into jubilant song with music;

make music to the Lord with the harp, with the harp and the sound of singing,

with trumpets and the blast of the ram's horn -

shout for joy before the Lord, the King.

Let the sea resound, and everything in it,

the world, and all who live in it.

Let the rivers clap their hands,

let the mountains sing together for joy;

let them sing before the Lord,

for he comes to judge the earth.

He will judge the world in righteousness and the peoples with equity.

I stood outside today and watched the sun go down, casting the sky in vibrant shades I couldn't quite describe.  A few wisps of cloud dotted the scene above, swaying ever so slightly in the evening breeze to the soft music of a day gone to rest.  I thought of the beauty of the Lord, and the beauty of His creations and I felt an extraordinary sensation of longing.  As indescribable and unfathomable as nature can be, how beyond comprehension must it be to stand before Him in His full glory, fully swaddled in the unbridled warmth of His peace?  I thought of King David, who was raised from a poor shepherd's life to lead the people of the Lord, who proclaimed his desire to trade everything, everything, for just a day in His courts.

This Psalm calls upon us to join with the anthem of the Lord that is sung daily by His creation - there IS music in the rivers, in the mountains, and He calls US to be a beautiful harmony to that ongoing chorus.  I find most powerful, however, the last few lines of this Psalm.  We must sing not for the glory of a stagnant God, but in joy for the righteousness He brings to this incomplete world.  We think often of judgment only as hellfire and brimstone, of the frightening day when we either rise as redeemed Sheep or condemned and cast aside as Goats.  Yet His judgment is perfect and is deserving of praise - there is no fear for His grace has redeemed ALL people.  In effect, the song of the rivers and mountains is a song of grand anticipation for the ultimate redemption He will bring, when all things are finally and completely reconciled to Him, the fulfillment of God's greatest covenant with His children.

Bogged down in the drudges of work, in the mind-numbing toil of studying, we can take but a moment to step outside and quiet our minds just enough to hear the song of creation.  When stressed, discouraged, exhausted and alone, simply sing.