Sunday, November 22, 2015


She was a young woman who delivered her baby and then died from complications of rheumatic heart disease. Her heart stopped beating early one morning and she could not be resuscitated.

She is fifteen years old and was brought in to Casualty after being raped by her HIV positive uncle. There is a commonly believed tale in some communities that intercourse with a virgin will cure HIV.

She is a young mother who has a placental abruption. Surgery saves the mother’s life but the child does not survive.

And many women deliver well and babies cry, filling their lungs with air and life as fathers laugh for joy. 

And this all happens within the confines of one small maternity ward in a rural African hospital over a short space in time: the sounds of weeping and sounds of healthy babies crying; our group of doctors standing next to the empty bed, or outside of a room where a little girl is trying to heal from a violent assault; long rows of healthy moms and babies waiting to be discharged and chatting happily as they nurse their little ones; a dad running up to a room to take his wife and new baby home. All at once. All together. All the sounds and sights and emotions blasting your senses.

And all I could think about at two the next morning as I stumbled along the busted dirt and rock road between our house and the hospital was how much our life can feel like tripping up broken roads in the dark. And it is not an original analogy, but one that I keep encountering because I keep having to climb this road over and over again, just as I continue to encounter both the joys and the sorrows contained within the walls of our maternity building. 

A visiting pediatric resident asked me a while back, just after losing a child to meningitis, if you ever get used to this kind of life and death, and how did I handle it? It was a hard question, because the resident had just lost a young life he had desperately tried to save, and his eyes were full of tears and pain and longing to make sense of a senseless death. The old answers I had been given as a resident-about becoming tough and strong and resilient-about being able to walk through pain and suffering and endure it with empathy, all the while maintaining professional objectivity-flew into my brain. But then I realized I had a different answer now-a different answer for me and for him: no you never get used to it, and you stay broken, because out of our brokenness, our soul wounds, our heart bruises, there is a new place out of which to love others better and more deeply and fully, and to care about the lost and wounded in ways only broken people can know.

Someone once said I needed to write more about the happy stories in my life and work. I do laugh with my interns, sing in the operating room, and celebrate loudly when we pull a baby out that cries or when a mom we thought might not make it later smiles at us as she gathers her child up in her arms and heads out the door to go home. But the truth is that many of my days and nights are filled up with the not so happy stories. We have stayed here because God has asked us to stay here. And it is hard and discouraging at times-yes, and also punctuated with great beauty and the miraculous-but often, it is just that broken road in the middle of the night, the devastated resident, the team of doctors standing in a sea of raw emotion, and then you get to get up the next morning and do it all over again.

Happy story: we are all together-interns, visiting daktaris and me-and we are teaching the interns how to tie knots with donated expired suture. We had a free hour-and it was the day that had started off with so much death-and we were all tired and sad and just wanted to do something simple, something that did not involve hard questions. I started to hum, and one of our interns, who is a musician, pulled out the lyrics from the old hymn “It Is Well with My Soul.” Suddenly we all began to sing-

When peace like a river attendeth my way
When sorrows like sea billows roll
Whatever my lot, Thou has taught me to say
“It is well, it is well with my soul.”

We left the suture room and walked over to our little hospital library. Sitting there was one of our visiting doctors who was struggling with all of the pain he had witnessed the night before. We surrounded him and sang that hymn in harmony-and our voices were strong and mostly on key-and we sang it for him, and for ourselves-but most of all, we sang it for the family of the woman who had died, and for the little girl who had been so hurt, and for the babies who did not make it and for their grieving mothers-and we sang it for the moms and dads and babies who had great joy and peace like a river. 

Monday night on call was another night of broken roads-but that night as I was traveling up and down, I was thinking of that hymn, and I looked up and away from my feet on the road. And as my eyes lifted above the dirt and rock, I saw a sky full of the brightest stars and constellations I have ever seen: and there amongst the blaze was the Southern Cross. And it was a gift-like that old hymn being sung after such a day, like the broken heart that works better for its brokenness, like the young resident who weeps for his patient one night, and then commits his life to returning to Africa as a missionary doctor, and like all of the beautiful mothers who survive and all of the babies who cry out in health and life.

And I am discovering out here that the gift is in the broken road too- and the broken heart, and the beauty that our Father brings out of this brokenness. No easy answers. Jesus did not offer us easy answers. He said to take up our cross and follow Him. Via dolorosa means “way of sorrows.” But at the end of that road, just beyond that cross, lies an empty tomb, and bright hope and joy unspeakable. And so we walk this road, and we sing and we weep. We stay the course, and sometimes look up into incredible beauty, and sometimes stare down into the mud. But through it all and in it all we cling to our hope in the One who was broken for us, and look up into His face-and there we see the way, the truth, and the life, and know: “It is well-it is well- with my soul.”