Requiscat In Pace

Isaiah 58:10 "and if you spend yourselves in behalf of the hungry and satisfy the needs of the oppressed, then your light will rise in the darkness, and your night will become like the noonday"

There are a very small number of people whose spirit so resonates with your own that they become the dearest of friends, even if time and distance keeps you apart. Jerry Umanos was one of those few for me. I dare say there are many dozens of people who would say the same thing about him, his spirit was so compelling. He loved life, he loved people, he loved Jesus. His shocking murder on April 24^th while working at CURE Hospital in Kabul will create such a void in so many lives. And yet, the memories each of us has of Jerry will continue to shape us for however many years we have left on this earth.

I first ‘met’ Jerry over the phone; it was probably 1986 or 87. He called the University Pediatric ER where I was the senior resident that night. He found himself working in a small inner-city hospital and had a teenager with lupus who was critically ill. One often got such calls from ‘LMDs’ (local medical doctors – a derisive term), and as youthful and arrogant residents tended to doubt the story and the medical abilities of the caller. Our hospital was out of Medicaid days – which meant we were instructed to try and not take any more patients with Medicaid that month. I still don’t understand, but it seems that in order to remain financially solvent each hospital had a predetermined number of patient-days each month allocated to Medicaid patients. Our pediatric intensive care unit was full as well, so even if we had Medicaid days, we had no room. Jerry explained the clinical situation and that he had not been able to convince any other Pediatric hospital to take the young girl. It was clear to me that Jerry was both a brilliant pediatrician as well as a compassionate person. I told him to send the patient over and we would keep her in our ER until I could find an intensive care unit bed for her.

A few years later, in 1992, when Amy and I were about to start working at Lawndale Christian Health Center (LCHC) in Chicago, we met Jerry and Jan at a welcome picnic. Jerry immediately recalled our interaction over the young girl with lupus from a few years prior.  In his usual fashion, he said with a laugh, “I remember when you saved my butt…”  Of course all I had done was accept the patient in transfer; as I recalled it, Jerry had guided me on what to do once she was in my care.

As it turned out, Jerry, Jan, Amy, and I had been almost crossing paths for several years. Jan worked at LaRabida Children’s Hospital as a social worker where both Amy and I had rotated during residency. We met and cared for two of their to-be-adopted children. Whereas Amy and I were intimidated by the prospect of adopting children with known health needs, Jan and Jerry had opened their hearts and home.  Typical of both Jan and Jerry’s sense of humor, we were reprimanded for not having potty trained their son during his long stay at LaRabida (Jan was right, it never crossed our minds, we were so focused on his medical needs). Then Jerry reminded me of a note I had written in the medical chart of his now adopted daughter, in which I had written under neurologic exam “WNL”, which is medical jargon for within-normal-limits. Problem was, she had cerebral palsy and used a wheel chair. I attributed the note to sleep deprivation, but told Jerry that I was not sure what had happened because obviously when I took care of her she had a normal neurologic exam! Thus began our years of friendship. To this day I cannot imagine how he remembered one single note from what must have been thousands of pages.

My mind is a flood with wonderful memories of the years I have known Jerry.  Early in our practice together at Lawndale he shared with me his dream that we could make it a place of such excellence in health care that people would want to come there, even if they could afford to go anywhere they wished.  He certainly did his part to make LCHC such a place. There was no better general pediatrician that I am aware of in Chicago. The perfect combination of a sharp mind and a compassionate heart. He took care of our children – the highest professional compliment I can pay.

We worshipped together at Lawndale Community Church for several years. One Sunday as we approached the front door Jerry held it open for us, and my then 3 year old son John exclaimed in horror, “Dad, there’s a doctor here!” Worried perhaps that I might not realize the danger! Jerry laughed, of course, and told John it was even worse – he lived with doctors! Always a great sense of humor.

Several of us men who worked at Lawndale met on Saturday mornings for about 10 years for fellowship, prayer and Bible study. We laughed as Jerry told us his plans to make a batting cage in his basement; winced in empathetic pain when he told us about his mountain biking escapades; cringed at his ideas for anniversary gifts for Jan; and generally marveled at his always joyful spirit.  During these times I got to know Jerry on an even deeper level.  What I saw was a beautiful reflection of Christ.

Jerry and I both left Lawndale for other callings, but we remained in touch.  Not infrequently, Jerry would email me a medical consult, complete with pictures and x-rays. I would do my best to answer his questions. But I admit I opened those emails with a sense of dread. If Jerry did not know the answer to a particularly tough question, odds were I would struggle. I wonder if those patients in Kabul realized how seriously Jerry took their health care. He could not settle for not knowing – he would reach out thousands of miles for a consult. I would occasionally return the favor.

As it happened, this past December we were both back in Chicago. We tried to arrange a gathering of the old (literally I am afraid) Bible study group, but our various visits to family did not allow the time, so we promised to try again this summer.

Now it is not to be. I know we will meet again in a better place, but for now, I am weeping. May your light continue to rise in the darkness.

YOLO

Coca Cola’s recent marketing scheme has tempted many of us to buy a drink, not because we’re thirsty, but just to see the word printed on the can. Today I splurged and purchased a Coke Zero (I was thirsty). There it was, my special word, “YOLO.” I pondered and puzzled. Was it English or Nyanja? Could it be a new video game? I wasn’t sure. I consulted my culture expert when he arrived home from school “Chris, what does YOLO mean?”

For those of you, over 50 who are not adolescent medicine specialists (I’ll bet Michelle Barratt knows this word), YOLO stands for You Only Live Once. I learned It has negative connotations in pop culture. Chris explicated at length. It is apparently an encouragement to excessive and often harmful behavior, similar to the idea of drink till you’re drunk.

When I say YOLO, however, I mean something entirely different. I use it to dare myself, and others to live life well. I say it to challenge my fearful anxious self to dream God-sized dreams and not to shy away from possible failure. Perfectionists and procrastinators desperately need this word.

 I once encouraged a physician co-worker to consider making some major changes in her life by telling her, “You only live once,” Shortly after our discussion she gave notice and quit a month before the yearly bonus. She was unmarried and hadn’t been on a vacation for years. She usually stayed at the office until late in the evening and on the weekends crashed behind closed shutters until Monday. At her goodbye party she announced, “It was Dr McAuley who told me to resign.” All eyes turned to glare at me. “She told me you know you only get to do this life once.” (YOLO) “I don’t have a job but I’m going on a cruise, then I’m going to spend time with my nieces and I’m going to dance. I’m not sure what I’m going to do after that but I am trusting God to lead the way.” YOLO is one of the reasons we are in Africa right now.

So, I am going to keep my can. It’s a phrase I want to be confronted with on a regular basis. I want to live more passionately, to live abundantly. Life is incredibly short and health is transient. I don’t want to waste a minute or as the song says, “I don’t want to go through the motions I don’t want to go one more day without your all consuming passion inside of me. I don’t want to spend my whole life asking what if I had given everything, instead of going through the motions.” This idea of no regrets, has recently taken on a more urgent beat. A dear friend’s college aged daughter just had a shunt placed and will have a brain biopsy in a week. It looks like a tumor. A sister in Christ begins chemotherapy for metastatic ovarian cancer next Tuesday. No one wants this to be part of the journey. We pray deliver us from evil and this is exactly the kind of evil we mean. We are never ready to spend time in the desert, to be tested and refined in the fire of suffering.

Can we praise God in the storm no matter where that storm takes us?  Even if we feel shipwrecked? I have been crying out to Jesus, asking God to do something amazing, creative, brilliant, transformative and restorative in the lives of these friends. I feel sadness and I tearfully lament at the brokenness of our human condition. I don’t ask why, I just ask to know with assurance He is in charge and His grip will not waiver, even until the end.  

Another friend, who may have missed her calling as a stand up comedian, reported a recent encounter with her physician. She’d gone with a newly discovered lump in the neck and fearfully asked if she was going to die. Her doctor took off his glasses, looked her directly in the eyes and said, “We are all going to die.” 100% mortality-No one gets out of this life alive. What will we do with the time that is left?

Father God, I AM, the great physician, the healer of the broken, the savior and redeemer, the beginning and the end, hold us in your grip. Remind us daily to make the most of the time we are given, for your glory. YOLO.

Sustained and restored after cholecystitis

Psalm 41 says "Blessed is the one who has regard for the weak; the Lord delivers him in times of trouble." Indeed, "The Lord has protected me and preserved my life. The Lord has sustained me on my sickbed and restored me from my bed of illness. I said, O Lord have mercy on me; heal me..... "

It began abruptly just after 9pm on a Wednesday evening. Shortly thereafter I was unable to remain in bed due to the severity of pain. I paced and tried various positions; on my hands and knees, leaning over the table, sitting upright, to no avail. As doctors we are trained to ask, "Is there any position that makes it better or worse. Is there anything you do (eating, going to the bathroom etc) that brings it on or makes it better or worse." The answer to all of those questions was "no." The pain remained constant and severe, a band reaching from the middle just below the sternum to the far right side of my upper abdomen boring through into the back. After three hours I woke Jim up to examine me, not because he could do anything except perhaps be impressed.  I had Murphy's sign: as the patient takes a deep breath the liver is palpated and when the gallbladder is irritated there is an immediate cessation of breathing due to pain. I had been teaching this maneuver to 4th year medical students at the medical school just a few weeks earlier.  Jim agreed that it was most probably my gallbladder.  As I huffed and puffed, I prayed God would help me bear the pain and give relief. An hour later after vomiting several times the pain resolved within minutes (most likely after the stone passed into the intestines) and I was able to sleep. In the morning I proceeded to the get an ultrasound (+gallstones) and blood tests (my liver tests were 100 times the normal level). The clinical picture looked like a stone had been blocking the common bile duct. By the afternoon I developed a fever and started antibiotics. At that point I felt really exhausted and crummy. Friday morning Jim and I set out on a flight to South Africa. The ANTS taxi service took us directly to hospital where I was admitted and had repeat testing. Surgery was performed Saturday.  Less than 24 hours later I was discharged and we headed to the same B&B, The Crane's Nest, where Jim had recovered after colostomy two years previously.

Jim left Monday night to return to Zambia where Chris had fallen by the wayside with gastroenteritis. Then on Friday with my suitcase and backpack in hand ready to go directly to the airport I arrived at the surgeon's office only to be told the repeat blood tests were not all improving and some were worse. Jim felt the elevated tests were easily explained; the surgery, intraoperative dye study and the physiology of one test (alkaline phosphatase); delayed manufacture and release had all led to the increase. The surgeon insisted I remain. I returned to the Villas next to the US Embassy for easy access to the Internet and medical unit. Over the weekend I watched some of the winter Olympics (we don't have TV in Zambia so this was a treat).  Amazing what the human body can do.

On Monday the labs had all improved and it was agreed I would repeat them in Zambia in a month to be sure they were normal. I had the opportunity to share scripture with my surgeon who was troubled by a decision he needed to make. One of his patient's had end stage cancer and bowel obstruction. There was no further treatment or hope of prolonging her life. He was unsure as to whether to recommend a line be placed into a large central vein to give nutrition because this can sometimes result in discomfort and even infection and death. I asked him what the patient wanted and he said, "That's a good question." He didn't know. Doctors in South Africa do not always talk with their patients in the same way we do in the US. I went on to suggest that most people at the end of their life just want a little more time to be with family. We can always give hope and assure them we will be there for them. I told him that Psalm 139 has always been a comfort to me when it says, "Everyone of our days is already written in His book before there is even one." I cannot shorten or lengthen anyone's life. I am not God. I am grateful He is in control. Many times I can do very little for my patients except to be present at the end and that is enough." I sensed a deep loneliness in this man. He mentioned in a pained way that he did not have the same intimate relationship with many of his patients that an internist or a general practitioner might. People often did not even remember his name. As I left I thanked him and called him by name.

I thank God for all of you; my friends and family around the world who supported me in prayer, praying for my healing and for all the emails which were a daily encouragement and blessing!

Today I delivered food to the children in the prison. Last Friday I discovered a malnourished 9 month old with brittle reddish tinged hair, no family to bring food and a 3 year old from Congo, again no one to bring food. I was again reminded of Psalm 41 “Blessed is the one who has regard for the weak…”as well as the passage in my daily reading in Luke 14, ”When you give a luncheon, or a dinner …or a banquet invite the poor.” I don’t think God wants us to just read the words and study them. I think He’s serious about us doing them. So, today I delivered peanut butter, mango, potatoes, rice, Cheerios, avocado, biscuits and bananas.

This is my Life

The week I decide to blog about a typical week, ends up being the week I end up being medavaced to South Africa. If you asked Molly Crane who stayed with us a month last summer she would laugh and agree that yes that would be a typical week. Just when you thought you knew what you would be doing everything changes  (both car batteries die in one day and you aren't going anywhere). It reminds me of Jesus words about not worrying about tomorrow ,in fact don't even plan tomorrow but instead just be faithful with what God puts in front of you today. (Matthew 6:34, James 4:24)

Monday I drive to Mercy Ministries to drop off the $500 that Molly and her mother raised. I had called Dorothy, the Zambian woman in charge of the school for orphaned and vulnerable children and agreed with Edna her daughter on the date and time. When I arrive no one is there to accept the money. Edna has been admitted to the University Teaching Hospital, has had a c-section and delivered a healthy baby boy. Dorothy has taken a group of children to the ophthalmologist for eye exams. I depart taking the envelope with me.  I will text and make plans for a drop off next week.

Tuesday I lecture to 4th year medical students on Five Common Diseases in Children in Zambia; acute respiratory infection (pneumonia), malaria, diarrhea, HIV/AIDS, and malnutrition. I try an interactive style picking out a name on the list of over 100 students and calling on students to answer questions. Although not intended to be a humorous presentation one slide gets a laugh. It's a picture of a severely malnourished child. What I failed to notice before is the filthy ragged grey shirt worn by the mother with "Survivor" printed on it.

Most Tuesday mornings I attend an International Women's Bible study with a wonderfully prayerful group of ladies from all over the world; Zambia, Zimbabwe, South Africa, Ireland, Holland, New Zealand, Australia, Guatemala, Philippians, US, Ethiopia and England. A recent Beth Moore study on Daniel was a great encouragement to me as I under went three mammograms, an ultrasound and a breast aspiration during our month home in the US. I kept recalling the fiery furnaces of life where there are 3 possible endings. God either delivers us from the fire (we don't have to endure it, the spot on the CXR disappears, our faith is built up), or he delivers us through the fire (we have to have the radiation and chemo but we are cured and our faith is refined) or he delivers us by the fire and takes us into the arms of Jesus (the trial or suffering ends in death with no miraculous healing and our faith is perfected) As Jim and I often joke "What's the worst thing that could happen? and then what? and then what? "and eventually we end up in the arms of Jesus and remember that that is actually the best place to be.

Wednesday morning I paint with a multi-generational, multicultural art group at a local cafe. The owner of an art supply shop offers lessons and artists come for fellowship, encouragement and inspiration. In the  afternoon I experiment with a sack of guavas from a friend with a guava tree in her yard; the guava sorbet is refreshing, the guava and apple curry is inedible and the guava jelly well to be honest no one has actually tried it yet.

Thursday I head to the prison. I drop off the hot water kettle (thanks to Luke/Atticus Getz for his donation). The women are surprised. I assure them I have the commander's permission. I emphasize due to the filthy conditions and the recent outbreak of Shigella that all drinking water should be boiled. I say this as I stand by a pile of sacks reaching to the ceiling filled with dried foul smelling kapenta fish. I try not to stare at the flies creeping into the holes in the sacks. I pretend they are not there as if the situation is not that bad. I sit down and take out my bag and begin to listen to the stories in French, Swahili, Bemba, Nyanja and English. There are rashes, bug bites, headaches, back aches, watery eyes, stomach pain, heavy periods, vomiting, coughs, weight loss, racing hearts, anxiety, too much thinking, fear and depression. I pray with everyone. Many weep. I assure them there is a God who sees. The God who made them and formed them in their mother's womb has not forgotten them. If they were the only person in the world God would have still sent his Son Jesus to die for them. They are precious in His sight. They are not forgotten. Some women are refugees, some have been trafficked, some are drug addicts, thieves, even murderers. A few of the women guards stop by for medical advise and prayer. I am following His great commission in Mark 16:18 to place my hands on sick people so that they will get well." I am trying to do what Jesus did "preaching good news to the poor, proclaiming freedom for the prisoner, releasing the oppressed" Luke 4:18 and I am trying to be a sheep watching for the Son of Man,  the King who reminds us that when we serve others we are serving Him. "I was sick and you looked after me, I was in prison and you came to visit me." Matthew 25:31-46.

Friday I am back at the medical school pretending to be a patient waiting to receive "Bad News" from one of the 4th year medical students. My child has died. I am devastated. I weep tears.  I have a positive HIV test. They are nervous. I am in denial, I am angry and going to kill my husband, I refuse to get my result, I cry, I rage... you get the picture. Then we sit and discuss the interaction. Did they make sure they had the right patient, did they look me in the face, were they empathetic, did they make rash promises for a long life or a cure....or that surely God would give me another child.

Saturday I walk Terra with Jim at 6am. Nose to the ground she discovers an owl pellet and looking up we can see an owl roosting in a palm tree. Good dog! Back at home she jumps in the pool and lies down on the step submerging herself and gulping water. She shakes water all over us, leaps on the lounge chair and then onto the metal table. She towers above us standing upright.  Bad dog! "Down" I tell her. She lays down on the table and curls into a ball. I realize we need a new word, "Off."

Sunday we worship. The sermon focuses on the beatitudes; blessed are those who spiritually mourn over their lost and sinful condition, for they will be comforted by God's forgiveness and grace. I plant flower seeds in old plastic yogurt containers and harvest onions and avocados. Jim sleeps in the afternoon. Chris plays frisbee with friends and then attends the Baptist Fellowship where the topic of discussion is euthanasia. We talk about the lie of unmanageable pain over dinner.

Keeping Busy in Zambia

Amy's Class

Jim and I had the pleasure of teaching at Justo Mwale Theological College University from April to June. I had 12 students in the first year Pastoral Counseling course (one woman).  Jim taught a counseling course on AIDS to 4th year students. We both enjoyed discussing various Biblical passages regarding gender equality. Not surprisingly the Christianity brought to Africa by colonialist was a male dominant leadership model. Thinking about human beings made in the image of God and the feminine characteristics of God was challenging for many. I arranged for a tea just for female seminary students to meet and share their challenges and experiences and to encourage one another.

President and Mrs. Bush with Zambian
First Lady Dr. Christine Kaseba

At the end of June President and Mrs. Bush made another trip to Zambia to encourage cervical cancer prevention and treatment. During the week they were in Livingston Jim organized many local volunteers to paint a health center and I watercolor painted in the hotel room. President Bush has taken up painting (oil) as well and is doing a series on world leaders he has met. I thought I could do the same and have a series of one (him).

In July Jim attended the African First Lady's Conference in Tanzania, to encourage other countries to bring women's health issues, specifically cervical cancer, forward in their countries. You may recall Jim was tasked with reducing maternal mortality by 50% in one year, a task many said was impossible. Results from the project are coming in and through the combined efforts of CDC, USAID, and many others it looks like we may actually hit our target. Now to expand country wide!

Terra

In July Terra, an almost 8 week old female German Shepherd joined our household. This was just days before Molly Crane's month long visit. Our socks, pants and skirts have small holes as do our legs from Terra teething.

I left in early August for a month in the US ostensibly to visit my parents and three of the kids. My dad has had several surgeries and hospitalizations and it looked like a good time to visit. It turned out I needed foot surgery and then a molar extraction for a large abscess I had failed to notice until Bob LoCascio took routine wing bite films. I wasn't even planning on getting my teeth cleaned until January but then there was a cancellation and I took it. As the oral surgeon said, "Someone is looking out for you." "Yes, you are right. God is" I responded.  

In August, Ruth began courses at Oakton including acting, creative writing, and a design art course. She seems to be thriving and has recently dyed her hair blonde for a role (check her out on facebook).

In September, Miriam adopted a lovely black cat, Magic, from Heartland shelter.  

Miriam continues to thrive living independently and participating in the PACE program. She put her guardian angel to the test recently, when she was struck by a car while crossing a busy road. Typical of Miriam, she flew and tumbled, broke her glasses, but told the police and paramedics, "I am fine, no need to go to the hospital..."  She is resilient!

Perhaps we won't drive this way...

John visited us for two weeks in September, following his summer as a camp counselor at Phantom Ranch and before he headed back to Seattle Pacific University. We took an adventuresome drive to the Lower Zambezi National Park. Typically one drives around the escarpment to remain on paved roads for as long as possible. Instead Jim suggested a short cut out Leopard's Hill Road 'through the bush' - only about 90 miles, but really off the beaten path. Jim spoke to others who had made the trip, and they said, "No worries, as long as you don't encounter another vehicle while in the mountains, and bring food, water, extra fuel, a satellite phone, and a winch ..." We did pretty well, using every bit of the 4-wheel capability of our Land Cruiser, until we encountered a truck coming at us in the mountain pass. Fortunately we got to climb the wall of the mountain while he got to inch along the edge - we exchanged looks of terror as we passed, and a big thumbs up when it became clear we would both live!

John and Chris fishing

The Park was awesome - amazing encounters with elephants, including a juvenile bull charging Jim as he scrambled to get into the tent - if only the elephant knew how flimsy that canvas was he might have kept coming. I helpfully pointed out to Jim that there was a large elephant charging at him as he struggled with the tent zipper. We tried our luck fishing for tiger fish on the Zambezi, always with an eye on the nearby crocodiles. No bites from either.

Thank you all for praying for the food situation in the prison. Just a few weeks ago, while I was in the US, the women and children incarcerated with them, were again allowed to have food brought in by their families. Prior to this they had only some dried fish and nshima provided by the prison.

Tumekutana 2014 Planning Committee

After returning to Zambia, I flew to Ghana to meet up with Caryl Weinberg and Rev Erica Rader and the Tumekutana team to begin working on the 2014 conference "Freedom in Christ: From Slavery to Empowerment." You can be in prayer as plans move forward.

Back in Lusaka Chris is busy with the school musical (Shakespeare's Pericles, Prince of Tyre, set to Fleetwood Mac!) and the IB program (large amounts of homework every day).  Chris worked this summer at the Embassy - in IT. Jim regularly meets people who comment on how great a worker Chris was and how they want him back next summer.

Tenacious

I  put five of my paintings into an exhibit and sold three (2 to Jim - he couldn't stand to see them go) to benefit wildlife conservation in Zambia.

Behemoth

We have home leave this December-January and so are looking forward to time with family and friends. We will try to look at a few colleges with Chris during the time, but mostly we hope to rest and enjoy running water, electricity, internet, and paved roads...